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.     

Pancreatitis presenting as pleural effusions: computed tomography demonstration of pleural space extension of pancreatitis exudate

Reported are two cases of acute pancreatitis that presented as large pleural effusions in which the route of communication of the pancreatic fossa with the chest was demonstrated on computed tomography. The bloody effusions were right-sided in one case and bilateral in the other. Pleuropulmonary complications of pancreatitis and possible mechanisms for pulmonary involvement are presented.     

Cranial computed tomography of patients with malignant melanoma

Summary Sixty-eight patients with malignant melanoma were examined by CCT and the findings analyzed. Cerebral metastases were detected in 19 patients. Meningiomas were found in three patients, one with neurological symptoms and two without. Typical metastases less than 10 mm in diameter were located superficially in the grey matter, regular, homogenous, hyperdense, with no edema. Extensive peripheral edema was often associated with metastases measuring more than 10 mm. CCT revealed cerebral metastases in 6 (13%) of 46 asymptomatic patients. The metastases measured less than 10 mm in four and less than 20 mm in two of these patients. Scintigraphy was falsly negative in six patients with metastases smaller than 10 mm. Therefore, CCT is the method of choice for screening asymptomatic patients. Angiography may be of value in the differentiation between meningioma and melanoma metastases.     

Computed tomography of free pleural effusions

Forty-three CT examinations of the thorax of patients referred for pleural effusion were reviewed. Both normal and thin irregularly thickened pleurae were associated with either neoplastic or non neoplastic disease. In these cases surgery, fine needle biopsy or pleuroscopy may be recommended, their performance being facilitated by the knowledge of the CT findings. Focal pleural masses or thick irregular pleura were consistently associated with malignancies; however, it was not possible to differentiate between primary and secondary forms. The simultaneous imaging of pleura, lungs and mediastinum by CT is very useful for the diagnosis, prognosis, staging and therapeutic approach of neoplasms.     

The utility of multi-detector computed tomography in the diagnosis of malignant pleural effusion in the patients with ovarian cancer

Purpose

The purpose of this study was to retrospectively assess possible clinical predictors of malignant pleural effusion in patients with ovarian cancer.

Materials and methods

This review was performed on 38 ovarian cancer patients that showed pleural effusion in a CT scan and who underwent thoracocentesis before treatment. CT scans were obtained using a 4-channel multi-detector CT scanner. Fisher's exact test was used to determine the probability of malignant pleural effusion as a function of; amount of ascites, lymph node enlargement, amount of pleural effusion, pleural nodules, and pleural thickening.

Results

Sixteen (42.1%) of the 38 patients had malignant pleural effusion and malignant pleural effusion amounts were greater than those with nonmalignant effusion.Pleural nodules were more frequently found in the malignant pleural effusion group (eight [50%] patients) than in the nonmalignant group (zero [0%] patient) (p < 0.001). Supradiaphragmatic lymph node enlargement (with short axis diameter 1 cm or more) was more frequent in malignant group (12 [75%] patients) than in the nonmalignant group (two [9.1%] patients) (p < 0.001).

Conclusion

The probability of malignant pleural effusion in patients with ovarian cancer was found to be correlated with the amount of pleural effusion, the presence of pleural nodules, and supradiaphragmatic lymph node enlargement.     

Management of malignant pleural effusions and pneumothorax

Pneumothorax may occur spontaneously or result from underlying lung disease or as a complication of interventional thoracic procedures. Percutaneous catheter placement enables safe and effective drainage of pneumothoraces with rapid relief of symptoms and restoration of vital capacity and oxygenation.     

Treatment of malignant pleural effusions with tunneled long-term drainage catheters

PURPOSE: To assess the effectiveness of tunneled pleural catheters (TPCs) in the treatment of malignant pleural effusions (MPEs). MATERIALS AND METHODS: Twenty-eight patients with symptomatic MPEs had 31 hemithoraces treated with TPCs placed under image guidance. Chemical sclerotherapy had failed in two patients and two had symptomatic locules. Drainage was accomplished by intermittent connection to vacuum bottles. Pleurodesis was considered achieved when three consecutive outputs were scant and imaging showed no residual fluid. RESULTS: All catheters were successfully placed. Dyspnea improved in 94% (29 of 31 hemithoraces) at 48 hours and 91% (20 of 22 patients) at 30 days. Control of the MPE was achieved in 90% of hemithoraces (28/31), although five required ancillary procedures. Pleurodesis occurred in 42% (13 of 31) of hemithoraces, including both that underwent an earlier attempt at chemical sclerotherapy and one treated locule. Continued drainage without pleurodesis controlled the effusion in 48% (15 of 31). In only 7% was hospital time necessary for care related to the TPC. Early, transient catheter-related pain was common, but only three complications (in two patients) occurred. Neither of these altered patient care. CONCLUSIONS: Regardless of whether pleurodesis is achieved, TPCs provide effective long-term outpatient palliation of MPEs.     

Triage of patients with suspected coronary artery disease using multislice computed tomography

RATIONALE AND OBJECTIVES: Several studies have shown that multislice computed tomography (MSCT) has a high sensitivity and specificity for detecting coronary artery stenoses. The aim of the present study was to investigate whether MSCT can reliably triage patients with suspected coronary artery disease (CAD) to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or no revascularization. MATERIALS AND METHODS: A total of 123 patients with suspected CAD who were referred for conventional coronary angiography (CATH) additionally underwent MSCT (16*0.5 mm detector collimation). Therapeutic decisions made on the basis of CATH and MSCT strictly following current guidelines for treatment of CAD were compared with decisions made by a cardiac surgeon and an interventional cardiologist. Only MSCTs with at least adequate image quality in all coronary segments were included in the analysis (94/123). RESULTS: Decisions made on the basis of MSCT and CATH according to guidelines did not differ significantly (agreement of 88%, 82 of 94, P = .319). The therapeutic decisions made by the interventional cardiologist and the cardiac surgeon based on CATH differed significantly (overall agreement of 79%, 74 of 94 cases, P < .001; cardiologist: 78% PCI and 22% CABG versus surgeon: 38% PCI and 62% CABG), whereas there was 100% agreement regarding decisions for or against invasive treatment. CONCLUSIONS: MSCT shows good agreement with CATH in triaging patients with suspected CAD to CABG, PCI, or no revascularization. The choice of revascularization procedure is significantly more strongly influenced by whether an interventional cardiologist or a cardiac surgeon makes the decision than by the diagnostic test on which the decision is based.     

胸腔穿刺置管引流联合顺铂腔内注射治疗恶性胸腔积液

目的:探讨胸腔穿刺置管引流联合顺铂腔内注射治疗恶性胸腔积液的疗效及机制。方法:50例恶性胸腔积液患者分为观察组(27例)和对照组1(18例)对照组2(5例),观察组患者放尽胸水后经胸腔内注入顺铂进行治疗;对照组1患者单纯胸腔置管引流治疗,对照组2未行胸腔置管引流。结果:观察组有效率(85.19%)高于对照组1(55.55%)及对照组2(20.00%),差异具有统记学意义(P<0.01)。结论:胸腔置管引流联合顺铂腔内注射治疗恶性胸腔积液疗效显著。     

Impact of computed tomography on the care of patients with suspected hydrocephalus.

To assess the impact of computed tomography (CT) on patient care, a cohort of patients with suspected hydrocephalus admitted before installation of CT was compared to a similar cohort admitted after installation of CT. The after CT cohort used significantly fewer pneumoencephalograms and radionuclide brain scans. The average cost of neurodiagnostic evaluation was 22% less after CT. However, speed of workup, therapy, institution of therapy, discharge plans, and discharge diagnoses were not different for the two cohorts. We conclude that CT has made the diagnostic evaluation of patients who otherwise would have required pneumoencephalography for suspected hydrocephalus less expensive and less hazardous.     

Diagnostic limitations of 10 mm thickness single-slice computed tomography for patients with suspected appendicitis

Purpose The aim of this retrospective analysis was to evaluate the accuracy of 10 mm thickness single helical computed tomography (CT) examination for confirming the diagnosis of appendicitis or providing a diagnosis other than appendicitis, including underlying periappendical neoplasms. Materials and methods From April 1, 2001 to March 30, 2005, a total of 272 patients with suspected appendicitis underwent CT examinations. Of the 272 patients, 106 (39%) underwent surgery. Seven CT examinations for seven patients were excluded because of inconsistency of the CT protocol. We therefore reviewed 99 CT images (99 patients) with correlation to surgical-pathological findings to clarify the diagnostic accuracy of CT examinations. We compared the postoperative diagnosis with the preoperative CT report. The final diagnoses were confirmed by macroscopic findings at surgery and pathological evaluations if necessary. Results Of the 99 patients, 87 had acute appendicitis at surgery. The sensitivity, specificity, and accuracy of CT were 98.9%, 75.0%, and 96.0%, respectively. The positive predictive value and negative predictive value were 96.6% and 90.0%, respectively. Among nine patients in the true-negative category, five had colon cancers; and among three patients in the false-positive category, two had cancer of the cecal-appendiceal region as the underlying disease. Conclusion CT examination is useful for patients with suspected appendicitis, but radiologists should be aware of the limitation of thick-sliced single helical CT. They should also be aware of the possibility of other diseases, including coincident abdominal neoplasms and underlying cecal-appendiceal cancer.     

Septal lines in pleural inflammation: multidetector computed tomography findings in 30 patients

OBJECTIVE: The aim of the study was to evaluate the interstitial changes adjacent to pleural inflammation on multidetector computed tomography. METHODS: The multidetector computed tomography scans of 30 patients with pleural inflammation were retrospectively and blindly evaluated by 2 observers. A control group of 7 patients with documented fibrothorax was also included. The number, appearance, thickness, and extent of septal lines were analyzed. RESULTS: More than 10 septal lines immediately adjacent to the abnormal pleura were seen in 22 of the 30 patients with pleural inflammation and 2 of the 7 patients with fibrothorax (P<0.01). Septal lines that are more than 1 mm thick were seen in 13 of the 30 patients with acute inflammation and none of the patients with fibrothorax (P<0.01). Differences between focal and diffuse pleural inflammation included 10 cm or greater craniocaudal extent and more smooth septal lines with diffuse pleural inflammation. CONCLUSIONS: Pleural inflammation is associated with increased number and thickening of septal lines in the immediately adjacent lung parenchyma.     

Malignant pleural mesothelioma: computed tomography and correlation with histology

Objective

To review the computed tomography (CT) imaging findings of pleural mesothelioma at presentation and to correlate the CT with the histological subtype.

Materials and methods

Pathology reports from 1997 to 2006 were reviewed at two academic institutions to identify patients with proven pleural mesothelioma. Diagnosis was based on histologic findings in specimens obtained by transthoracic needle biopsy, surgical biopsy or resection. All histology slides were reviewed by a lung pathologist. CT scans, available in 92 patients, were reviewed blindly and in random order by two independent radiologists. Kappa analysis was completed to assess inter-observer agreement. Eighty patients in whom there was no significant delay between CT imaging and histological diagnosis were assessed by logistic regression analysis to correlate CT and histologic findings.

Results

Seventy-two of the 92 mesotheliomas were epithelial, 15 sarcomatous, and 5 of mixed histology. All patients (77 male, 15 female, mean age 68 years) had pleural thickening on CT; the thickening was nodular in 79 patients (86%) and mediastinal in 87 (95%). Ipsilateral volume loss was seen in 42 patients (46%). Pleural effusions were present in 80 patients (87%), being large (>2/3 hemithorax) in 19 patients (21%). Atypical features at presentation included bilateral disease in three patients (3%), and spontaneous pneumothoraces in nine patients (10%). Internal mammary lymphadenopathy was observed in 48 patients (52%) and cardiophrenic lymphadenopathy in 42 (46%). Inter-observer agreement was excellent (average kappa = 0.89). Ipsilateral volume loss was associated with sarcomatous or mixed mesothelioma (p = 0.004). Using logistic regression analysis, other CT findings did not correlate with histological subtype.

Conclusions

Ipsilateral volume loss is most frequently associated with sarcomatous or mixed mesothelioma. The remaining imaging findings are not helpful in predicting the histological subtype of malignant mesothelioma.     

Role of cardiac computed tomography in patients with suspected coronary artery disease: interaction with nuclear cardiology

Coronary computed tomography (CT) angiography (CTA) and myocardial perfusion single photon emission CT (SPECT, or MPS) provide complementary information on vascular structure and myocardial perfusion. In patients with coronary artery disease (CAD), the combination of both methods is helpful for disease detection and therapeutic strategy planning. This article addresses the utility of coronary CTA with current 64-row multidetector CT instruments, MPS, and the combination of these methods in the evaluation of CAD.