Sonography of malignant pleural effusion

Two hundred and ten patients with exudative pleural effusion were studied by ultrasound for sonographic signs of pleural carcinomatosis. Images were evaluated for echoes within the fluid, septations, sheet-like or nodular pleural masses, and associated lesions of the lung. Our results showed that sonographic findings of echogenic or septated fluid were unspecific for malignancy. Only the evidence of pleural masses was characteristic of malignant effusion. Ultrasound of the chest should therefore be carried out before invasive diagnostic procedures are planned. Received 31 May 1995; Revision received 12 September 1996; Accepted 14 January 1997     

Superimposition of computed tomography and single photon emission tomography immunoscintigraphic images in the pelvis: validation in patients with colorectal or ovarian carcinoma recurrence

A method of superimposing computed tomography (CT) and immunoscintigraphic (IS) single photon emission tomography (SPET) slices is presented and has been applied to 10 patients with suspected cancer recurrence. IS was performed with carcinoembryonic antigen (CEA)-specific indium-111 monoclonal antibodies (MoAbs) in 5 patients with colorectal cancer, and with OC125 ¹¹¹In-MoAbs in 5 patients with ovarian cancer. All patients had an abnormal CT image result in the pelvis, which was interpreted 5 times as recurrence, once as doubtful and four times as scar fibrosis. Recurrence was subsequently proven in all patients. Bone scintigraphy (BS) SPET was recorded at the same time as IS. No special technique was used during BS, IS or CT acquisition. CT images were fed into a computer using a CCD camera. Using the internal anatomical landmarks provided by the pelvic bone structures seen on CT and BS, an operator had to select corresponding fiducial points, which were used by the software to register the images. The final results were CT-BS and CT-IS superimposed images. CT-BS images were used for quality control. In all patients, the inspection of CT-BS and CT-IS showed that the registration process is accurate and assists in the co-interpretation of CT and IS images.This work was presented at the EANM congress, Vienna, September 1991 Offprint requests to: J.-C. Liehn     

良恶性胸腔积液的CT特征

目的 分析良恶性胸腔积液及胸膜增厚的cT表现，探讨两者间的不同特点。方法 分析145例经临床及病理证实的良恶性胸腔积液（良性68例，恶性77例）的CT征象。结果 145例胸腔积液中有115例伴有不同程度的胸膜增厚，根据其形态的不同可分为6种类型（恶性4型，良性2型）。结论 仅凭胸腔积液的密度不能区别其良恶性，胸膜的增厚有鉴别诊断意义，恶性胸腔积液的特点为胸膜明显增厚，一般大于10mm，且厚薄不均匀。良性胸膜增厚较轻，多小于10mm，且均匀一致。     

腺苷脱氨酶与癌胚抗原检测在胸腔积液诊断中的价值

目的分析腺苷脱氨酶（ADA）与癌胚抗原fCEA）检测在胸腔积液诊断和鉴别诊断中的应用价值。方法对46例自2008年9月-2009年6月我院经治有胸腔积液症状的患者检测胸腔积液和血清ADA、CEA水平。对不同疾病组结果分析比较。结果结核性胸腔积液组ADA为（43．00±13．82）U／L,CEA的含量为（1.25±1．22）μg／L;恶性胸腔积液组A-DA为（17．57±6．20）U／L,CEA为（293．74±197．50）±g／L。结核性胸腔积液组ADA含量较恶性胸腔积液组明显增高（P〈0．01）,恶性胸腔积液组CEA含量较结核性胸腔积液组明显增高愀0．01）。胸腔积液ADA（pADA）／BR清ADA（sADA）及胸腔积液CEA（pCEA）／血清CEA（sCEA）比值,结核性胸腔积液组（2．69±0．83、1．05±0．89）与恶性胸腔积液组（0．87±0．22、9．47±5．91）相比有显著性差异（P〈0．01）,pADA及pCEA判断结核性胸腔积液的临界值分别为：39U／L、pCEA〈51μg／L,恶性胸腔积液的敏感性为95％、特异性为99．8％。结论胸腔积液腺苷脱氨酶与癌胚抗原测定对结核性胸腔积液和恶性胸腔积液的诊断具有重要价值。     

腺苷脱氨酶与癌胚抗原检测在胸腔积液诊断中的价值

目的分析腺苷脱氨酶（ADA）与癌胚抗原（CEA）检测在胸腔积液诊断和鉴别诊断中的应用价值。方法对46例自2008年9月～2009年6月我院经治有胸腔积液症状的患者检测胸腔积液和血清ADA、CEA水平,对不同疾病组结果分析比较。结果结核性胸腔积液组ADA为（43.00±13.82）U/L,CEA的含量为（1.25±1.22）μg/L;恶性胸腔积液组A-DA为（17.57±6.20）U/L,CEA为（293.74±197.50）μg/L。结核性胸腔积液组ADA含量较恶性胸腔积液组明显增高（P〈0.01）,恶性胸腔积液组CEA含量较结核性胸腔积液组明显增高（P〈0.01）。胸腔积液ADA（pADA）/血清ADA（sADA）及胸腔积液CEA（pCEA）/血清CEA（sCEA）比值,结核性胸腔积液组（2.69±0.83、1.05±0.89）与恶性胸腔积液组（0.87±0.22、9.47±5.91）相比有显著性差异（P〈0.01）,pADA及pCEA判断结核性胸腔积液的临界值分别为：39U/L、pCEA〈5μg/L,恶性胸腔积液的敏感性为95%、特异性为99.8%。结论胸腔积液腺苷脱氨酶与癌胚抗原测定对结核性胸腔积液和恶性胸腔积液的诊断具有重要价值。     

多项肿瘤标志物联合检测对恶性胸腔积液诊断价值的探讨

目的：探讨胸腔积液糖链抗原50（CA50），糖链抗原125（CA125）及癌胚抗原（CEA）3项指标联合检测对恶性胸腔积液的诊断价值。方法：CA50采用免疫放射技术测定，CA125与CEA应用全自动化学发光免疫分析技术检测。结果：恶性胸腔积液中CA50、CA125与CEA水平明显高于良性胸腔积液组，差异均有显著性（P〈0．01）。3项指标联合检测诊断恶性胸腔积液的敏感性71．8％，特异性90．0％，准确性80．6％。结论：胸腔积液CA50、CA125及CEA单项检测在恶性胸腔积液诊断中特异性较高，而敏感性均偏低，且三者联合检测可提高恶性胸腔积液的敏感性及特异性，临床诊断价值更大。     

Accuracy of the diagnosis of pleural effusion on supine chest X-ray

Diagnosis of pleural effusion (PE) on supine chest X-ray (SCXR) is considered difficult. This study aimed at evaluating the accuracy of the diagnosis of PE on SCXR and was performed in two phases. At phase 1, a formula for the sonographic estimation of the volume of PE was established by correlating 24 measurements (in 7 patients in whom complete drainage was achieved) with the drained volumes. At phase two, 112 consecutive SCXRs were supplemented by sonography of the chest. The films were evaluated for the presence of PE and for the presence of different radiologic signs of PE. Sonography showed PE in 41 right and 30 left hemithoraces. The overall accuracy of the diagnosis of PE on SCXR was 82 %. Only one of the undiagnosed PEs had a volume of > 300 ml. The most accurate signs were increased density of the hemithorax, blunted costophrenic angle, and loss of the hemidiaphragm silhouette. Received 31 May 1995; Revision received 9 January 1996; Accepted 12 January 1996     

CT在术前评估卵巢恶性肿瘤淋巴结转移中的价值

目的 探讨全腹CT在卵巢恶性肿瘤淋巴结转移术前评估中的价值.方法 对136例原发性卵巢恶性肿瘤患者术前行全腹CT检查,并对淋巴结进行评估,根据部位将淋巴结转移分为腹腔及盆腔淋巴结转移.术后淋巴结组织病理学结果作为诊断淋巴结转移的金标准.结果 术前CT诊断卵巢恶性肿瘤患者盆腹腔淋巴结转移的敏感度为47.2％,特异性为67...     

Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: a meta-analysis

Objectives

To compare the diagnostic performances of computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET or PET/CT) for detection of metastatic lymph nodes in patients with ovarian cancer.

Methods

Relevant studies were identified with MEDLINE and EMBASE from January 1990 to July 2010. We estimated the weighted summary sensitivities, specificities, OR (odds ratio), and summary receiver operating characteristic (sROC) curves of each imaging technique and conducted pair-wise comparisons using the two-sample Z-test. Meta-regression, subgroup analysis, and funnel plots were also performed to explain the between-study heterogeneity.

Results

Eighteen eligible studies were included, with a total of 882 patients. PET or PET/CT was a more accurate modality (sensitivity, 73.2%; specificity, 96.7%; OR [odds ratio], 90.32). No significant difference was detected between CT (sensitivity, 42.6%; specificity, 95.0%; OR, 19.87) and MR imaging (sensitivity, 54.7%; specificity, 88.3%; OR, 12.38). Meta-regression analyses and subgroup analyses revealed no statistical difference. Funnel plots with marked asymmetry suggested a publication bias.

Conclusion

FDG-PET or FDG-PET/CT is more accurate than CT and MR imaging in the detection of lymph node metastasis in patients with ovarian cancer.     

Gadolinium-enhanced computed tomography angiography in multi-detector row computed tomography: initial observations

Rationale and Objectives. The feasibility of using gadolinium contrast medium for computed tomography angiography (CTA) in multi-detector row computed tomography and the effect of contrast medium dilution was investigated.Materials and Methods. Three pigs were each scanned in multiple sessions with injections of non-dilute and dilute contrast medium at a dose of 0.3 mmol/kg body weight. Non-spiral dynamic scanning at a fixed mid-abdominal aortic level and thoracoabdominal CTA were performed.Results. The magnitude of peak aortic enhancement was not significantly different between dilute and non-dilute contrast medium injections (P = .88), but the former showed earlier enhancement (mean of 2.3 seconds sooner, P < .01) than the latter. CT angiography with gadolinium contrast medium showed much lower enhancement than iodine contrast medium, but small vessels were readily identifiable.Conclusion. Gadolinium contrast medium combined with multi-detector row computed tomography may provide clinically useful CTA. Dilution of contrast medium shortens the enhancement time but has little effect on the magnitude.     

Use of computed tomography in the management of colorectal cancer

Computed tomography (CT) plays an important role in the management of colorectal cancer (CRC). The use of CT (colonography) as a screening tool for CRC has been validated and is expected to rise over time. The results of prior studies suggest that CT is suboptimal for assessment of local T stage and moderate for N stage disease. Recent advances in CT technology are expected to lead to some improvement in staging accuracy. At present, the main role of CT in pre-treatment imaging assessment lies in its use for the detection of distant metastases, especially in the liver. In a select group of patients, routine post-treatment surveillance with CT confers survival benefits. The role of CT for post-treatment assessment has been radically altered and improved with the advent of fusion positron emission tomography/CT. Perfusion CT shows promise as another functional imaging modality but further experience with this technique is necessary before it can be applied to routine clinical practice.     

Comparison of coronal and axial computed tomography measurements of mediastinal nodes before primary surgery for non-small cell lung cancer

Objective

To assess computed tomography (CT) evaluation of mediastinal nodes in non-small cell lung cancer to predict metastatic involvement by measurement of their axis and surface area in the coronal plane, as compared to standard short-axis measures in the axial plane.

Methods

Evaluation of mediastinal nodes was retrospectively performed on CT scans of 100 patients before thoracotomy. In all patients, mediastinal dissection was performed in the appropriate stations (n = 264) according to the side (59 right, 41 left) of the tumor. Measurements of short axis and surface area of the largest node in each dissected station were performed on axial and coronal planes.

Results

By using the standard threshold of axial short axis ≥10 mm, sensitivity and specificity were 25% and 98%, respectively. Areas under receiver operating characteristic curves were 0.828 and 0.821 for axial short axis and axial surface area data. For comparison, areas under receiver operating characteristic curves were 0.843 and 0.845 for coronal short axis and coronal surface area data, respectively. So, for a specificity of 98%, sensitivity was 29% for coronal short axis ≥11 mm and 33% for coronal surface area ≥123 mm². When using axial short axis ≥10 mm or coronal surface area ≥120 mm², sensitivity was 45%, whereas specificity remained at 96%.

Conclusion

Coronal measurements of mediastinal nodes give a slightly albeit non-significant improvement of diagnostic accuracy over axial ones. If both axial short axis and coronal surface area are taken into account, accuracy is improved.     

CT diagnosis of intrasplenic metastasis from ovarian carcinoma

Intrasplenic metastases from ovarian carcinoma cannot be always demonstrated intraoperatively. CT is the most important imaging modality of choice for staging and follow-up ovarian cancer; in this study we searched CT appearances of intrasplenic metastases from ovarian carcinoma. We retrospectively reviewed imaging histories of the patients with ovarian cancer from the radiology information system, and found 12 patients with intrasplenic metastasis. All patients underwent abdominal CT with 16-MDCT. We searched number, density and maximum diameters of splenic metastasis. The growing rate of three lesions, which were followed up by CT, was calculated. Serum cancer antigen (CA) 125 levels were noted. We also evaluated clinical history and pathology reports of all patients. Splenic metastases, solitary or multiple, were detected most frequently during the follow-up (1-14 years after initial diagnosis) and most were associated with other sites of recurrence. The diameters of lesions ranged from 4 to 85mm. All lesions appeared hypodense except for one lesion with dense calcification. Densities of lesions ranged from 12 to 208 Hounsfield units (mean, 49±51HU). Most lesions appeared as solid well-defined nodules; however some lesions had lobulated and irregular contours with an infiltrative pattern. The growing rates of three lesions were 0.72mm/month, 1.75mm/month and 2.70mm/month. Eight patients had elevated serum CA 125 levels (40-1256U/mL). We concluded that CT can demonstrate intraparenchymal and infiltrative splenic metastasis in patients with ovarian cancer even in the absence of increased CA 125 levels.     

联合检测胸水ADA、CEA、CA125、CA153在结核性与恶性胸水中的鉴别诊断价值

目的探讨联合检测胸水ADA、CEA、CA125、CA153对结核性与恶性胸水的鉴别诊断价值。方法收集114例已确诊胸腔积液患者的胸水,其中恶性组胸水64例,结核性胸水50例,检测两组患者胸水ADA、CEA、CA125、CA153水平。结果恶性组ADA明显低于结核组,而CEA、CA125、CA153水平明显高于结核组,两者差异显著。具有统计学意义。CEA、CA125、CA153对恶性胸水诊断的敏感性分别为73-4％、81．2％、43．8％,特异性分别为84．0％、46．0％、88．0％．准确性分别为79．8％、63．2％、66．7％,三项联合检测可显著提高诊断敏感性（93．4％）。ADA对结核性胸水的敏感性、特异性、准确性分别为83．4％、91．5％、87．6％。结论联合检测胸水ADA、CEA、CA125、CA153有助于结核性与恶性胸水的鉴别诊断。     

HRCT在检出恶性胸腔积液中胸膜病变的价值

目的 探讨HRCT检出恶性胸腔积液中胸膜病变的价值.方法 回顾分析恶性胸腔积液合并胸膜病变患者40例,复习恶性胸腔积液中胸膜病变的HRCT影像学表现.结果 本组40例患者CT平扫显示胸腔大量积液者12例,中等量或少量积液者28例.CT增强扫描,胸膜病变明显强化,主要表现为结节状强化.结论 HRCT主要用于肺部弥漫性病变的检出,通过本组病例发现HRCT对于检出恶性胸腔积液中的胸膜病变亦有较高价值.     

Renal artery mycotic pseudoaneurysm: diagnosis with multi-detector computed tomographic angiography

Renal artery mycotic pseudoaneurysms are uncommon complications of bacterial endocarditis and bacteremia. Complications include hemorrhage and refractory bacteremia, and prompt diagnosis can lead to appropriate treatment. Reported is a case where multi-detector computed tomography angiography led to the correct diagnosis.     

1.5T磁共振1H-MRS鉴别良恶性胸腔积液的初步研究

目的：探讨磁共振波谱对良、恶性胸腔积液的鉴别诊断价值。方法收集行胸腔穿刺抽液的胸腔积液标本46例,其中原发病确诊为良性者20例（包括肺结核14例、肺炎6例）,原发病确诊为恶性者26例（包括原发性肺癌18例、乳腺癌5例、肝癌2例、胃癌1例）。对胸腔积液标本进行离心处理,然后利用1.5T磁共振对胸腔积液标本进行波谱采集,分析良恶性胸腔积液的波谱特征。结果胸腔积液的波谱图中主要的代谢峰有乳酸、胆碱、肌酸、肌醇及脂质等。主要代谢物波峰下面积比较：乳酸：结核性（5.19±1.31）、炎性（6.08±1.56）和恶性胸腔积液（2.40±0.43）的乳酸峰下面积差异有统计学意义（F=8.45,P<0.01）;胆碱：结核性（2.75±0.91）、炎性（3.27±1.21）和恶性胸腔积液（6.76±1.73）的胆碱峰下面积差异有统计学意义（F=2.98,P<0.01）;肌醇：结核性（2.71±1.19）、炎性（2.25±0.81）和恶性胸腔积液（5.83±2.08）的肌醇峰下面积差异有统计学意义（F=38.49,P<0.01）。结核性和炎性胸腔积液中乳酸（t=-1.04,P＞0.05）、胆碱（t=-0.58,P＞0.05）和肌醇（t=1.19,P＞0.05）波峰下面积差异无统计学意义。结论良、恶性胸腔积液具有不同的波谱特征,利用磁共振波谱对良、恶性胸腔积液进行鉴别具有一定的临床应用价值。     

贝伐单抗联合顺铂治疗非小细胞肺癌恶性胸腔积液临床研究

目的探讨贝伐单抗联合顺铂胸膜腔内灌注对非小细胞肺癌恶性胸腔积液的临床疗效及毒副反应。方法将2011年1月至2015年1月解放军180医院收治的94例伴有恶性胸腔积液的非小细胞肺癌患者随机分为对照组和观察组,每组各47例。观察组患者给予贝伐单抗联合顺铂胸膜腔内灌注,对照组给予顺铂胸膜腔内灌注。观察并比较两组患者临床疗效及毒副反应发生情况。结果观察组治疗有效率(70.2%)高于对照组(44.7%),两组比较,差异有统计学意义(P<0.05)。毒副反应中,观察组的恶心呕吐及皮疹的发生率低于对照组,差异有统计学意义(P<0.05)。结论贝伐单抗联合顺铂胸膜腔内灌注治疗非小细胞肺癌恶性胸腔积液能取得较好疗效,且毒副反应发生率较低,值得临床推广。     

The utility of urgent abdominal computed tomography in the elderly patient

The purpose of this study was to assess the utility of urgent abdominal computed tomography (CT) performed in a nontrauma setting on a predominantly elderly population. We retrospectively reviewed abdominal CT images of 170 patients (average age, 64 years); CT was performed on a “stat” basis to evaluate suspected acute abdominal pathology at a typical urban Veterans’ Affairs hospital. Imaging results were correlated with subsequent clinical intervention. Abdominal CT was most commonly ordered to assess abdominal pain (119 cases, 71%), suspected abdominal abscess (11 cases, 6.5%), suspected leaking abdominal aortic aneurysm (11 cases, 6.5%), and suspected acute pancreatitis (8 cases, 5%). Clinically relevant findings were recorded in 96 abdominal CT cases (56%), only 23 (13.5%) of which depicted acute pathology. This included nine patients with abscesses, four with diverticulitis, two with nonspecific enteric inflammation, and two with cholecystitis. Only 16 patients (9%) required urgent therapy. The most common clinically relevant findings not requiring prompt intervention were cholelithiasis (11 cases), chronic pancreatitis (9 cases), and liver metastases (6 cases). Of 13 patients with abdominal aortic aneurysm diagnosed on abdominal CT, 11 presented with abdominal pain, but none showed signs of rupture. Although, in a predominantly elderly population, urgent abdominal CT often reveals significant chronic disease, it seldom depicts pathology requiring prompt therapy. Therefore, a more focused use of this examination is warranted.     

可弯曲内科胸腔镜对不明原因胸腔积液的诊断价值

目的探讨可弯曲内科胸腔镜技术对不明原因胸腔积液的诊断价值。方法对所有经过相关影像学、血生化检查以及胸腔穿刺进行胸水常规、生化、微生物学、细胞学、胸膜病理学等检查,仍不能明确其积液原因的113例患者进行可弯曲内科胸腔镜检查。结果恶性肿瘤48例（42．5％）,结核42例（37．2％）,普通炎症20例（17．7％）,不明原因3例（2．7％）。常见的并发症主要是疼痛,这些并发症均可控制,手术无一例出现严重并发症。结论可弯曲内科胸腔镜检查对不明原因胸腔积液的诊断是一项安全、敏感性和特异性均极高的检查方法,但不应作为首选。