Primary pulmonary artery chondrosarcoma: the use of different imaging modalities

Fewer than 300 patients with primary pulmonary artery sarcoma have been reported since 1923,when it was first described by Mandelstamm.1 The diagnosis of pulmonary artery sarcoma is difficult,and misdiagnosis as chronic pulmonary embolism often occurs.Herein,we reported a case of primary pulmonary artery chondrosarcoma.So far as we know,this patient served as the first case ever reported to receive computed tomography pulmonary angiography （CTPA）,gadolinium enhanced magnetic resonance imaging （MRI）,and positron emission tomography/computed tomography （PET/CT） before surgery.By these means,the utility of different imaging modalities for pulmonary artery sarcoma was well demonstrated.Keywords：primary pulmonary artery chondrosarcoma; computed tomography pulmonary angiography;magnetic resonance imaging; positron emission tomography     

Giant cell interstitial pneumonia: unusual lung disorder and an update

Background Giant cell interstitial pneumonia （GIP） was a rare form of pneumoconiosis,associated with exposure to hard metals,which had been reported mostly as isolated case reports.We described eight cases of GIP diagnosed in our hospital during the past seven years,with particular reference to new findings.Methods Eight patients with GIP confirmed by biopsy in the Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University from 2005 to 2011 were retrospectively analyzed.For each patient,the occupy histories and medical records were thoroughly reviewed and clinic data were extracted.Two radiologists,without knowledge of any of the clinical and functional findings,independently reviewed the HRCT scans of all patients.Follow-up data were collected.Results Among the eight patients,seven had a history of exposure to hard metal dusts,one denied an exposure history.The most common manifestations were cough and dyspnea.One patient initiated with pneumothorax and another pleural effusion,both of which were uncommon to GIP.The main pathologic appearances were the presence of macrophages and multinucleated giant cells in the alveolar space.The clinical symptoms and radiographic abnormalities were obviously improved after cessation of exposure and receiving corticosteroid treatments,recurrences were observed in two patients when they resumed work.In spite of exposure cessation and corticosteroid treatment,one patient developed pulmonary fibrosis at seven years follow-up.Conclusions Awareness of the patients＇ occupational history often provided clues to the diagnosis of GIP.Histopathologic examinations were necessary to establish the right diagnosis.Exposure cessation was of benefit to most patients; however,pulmonary fibrosis was possible in spite of exposure cessation and corticosteroid treatment.Better ways should be found out to improve the outcome and quality of life.     

Combination of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging is an optimal way to evaluate rheumatoid arthritis in rats dynamically

Background Rheumatoid arthritis （RA） is a chronic,systemic autoimmune inflammatory disorder.Many methods have been used to observe the progress of RA.The purpose of this study was to observe the progress of RA in rats with 18F-fluorodeoxyglucose （FDG） positron emission tomography/computed tomography （PET/CT）,magnetic resonance （MR） imaging and arthritis score,and analyze the relationships among different methods in evaluation of RA.Methods Sixteen healthy Sprague Dawley （SD） rats about 8-week old were randomly assigned to a RA group and a control group.Bovine type Ⅱ emulsified incomplete Freud＇s adjuvant was used to induce arthritis in the RA group.Arthritis score of the rats in two groups were recorded,and 18F-FDG PET/CT,MR imaging were performed both on the corresponding rats every 3 days.All the rats were sacrificed at week 5,and histopathological examination was performed on rat knees stained with haematoxylin and eosin.Results The arthritis score and the standard uptake value （SUV） of knee joints in RA rats increased with the progression of arthritis gradually.Both peaks of arthritis score and SUV appeared at 21 days after the first immune injection,then the arthritis score and SUV of knee joints decreased slowly.The arthritis scores of knee joints in RA rats were positively correlated with their SUV changes.The MR images were confirmed by the histopathological studies.Conclusion PET/CT can detect the earliest molecular metabolism changes of RA,and MR imaging can follow up the dynamical anatomical changes of RA,all of which indicated that PET/CT and MR imaging may be applied as useful tools to monitor the progress of RA.     

Coronary artery anomalies: the left main coronary artery or left anterior descending coronary artery originating from the proximal of right coronary artery

Coronary artery anomalies （CAAs） are present at birth, but are usually asymptomatic and are found during coronary angiography or multi-slice computed tomography （MSCT） examinations. Their prevalence is less than 1.3% based published series.1＇2 The most common coronary anomaly is separate origin of the left anterior descending coronary artery （LAD） and left circumflex coronary artery （LCX） from the left sinus of the Valsalva. The second most common anomaly is the origin of the LCX artery from the right coronary artery （RCA） or right sinus of the Valsalva. We present two cases of coronary artery anomalies： one is the left main coronary artery （LMCA） arising from the proximal RCA, the other is the LAD originating from the proximal RCA.     

Neovascularization in the carotid atherosclerotic plaque is not associated with inflammatory cell aggregation

Background Monocytes and macrophages in atherosclerotic plaque lead to plaque instability.The aim of the study was to determine if plaque neovascularization led to inflammation.Methods Patients were consecutively enrolled if their carotid intimal media thickness was ＞2 mm,as revealed by duplex ultrasound.The patients then underwent dynamic contrast enhanced magnetic resonance imaging （DCE MRI） and fluorine-18 fluorodeoxyglucose （18F-FDG） positron emission tomography combined with computed tomography （PET CT）.A target to background ratio （TBR） of ＞1.25 or ＜1.25 served as the cutoff point for the presence and absence of inflammation,respectively.Results Twenty-six patients underwent bilateral carotid DCE MRI and 24 patients also underwent PET CT.One hundred and fifty-five plaques were evaluated by both DCE MRI and PET CT.There was no significant difference in plaque morphology between the TBR ＞1.25 （n=61） and TBR ＜1.25 （n=94） groups.No significant differences were found in plasma volume and transfer constant between the TBR ＞1.25 and TBR ＜1.25 groups.Conclusion Our study did not find a significant correlation between plaque neovascularization and the aggregation of inflammatory cells.     

Clinical and CT imaging features of mucinous tubular and spindle cell carcinoma

Background There are relatively few reports focusing on clinical and multi-slice CT （MSCT） imaging findings of mucinous tubular and spindle cell carcinoma （MTSCC）.Our study aimed to characterize the clinical and MSCT imaging features of MTSCC.Methods The imaging findings in 17 patients with MTSCC by MSCT were retrospectively studied.MSCT was undertaken to investigate tumor location,size,density,cystic or solid appearance,calcification,capsule sign,enhancement pattern,and retroperitoneal lymph node metastasis.Results Tumors （mean diameter,（3.9±1.7） cm） were solitary （17/17）,solid （16/17） with cystic components （5/17）,had no calcifications （14/17）,had a poorly defined margin （14/17）,were centered in the medulla （15/17）,compressed the renal pelvis （7/17）,and neither lymph node nor distant metastasis was found.The attenuation of MTSCC tumors was equal to that of the renal cortex or medulla on unenhanced CT （32.3±2.6,36.3±4.6,33.2±3.9,respectively,P ＞0.05）,while tumor enhancement after administration of a contrast agent was lower than that of normal renal cortex and medulla during all phases （P ＜0.05）.Conclusion MTSCC tends to be a solitary,isodense mass with poorly defined margin arising from the renal medulla with enhancement less than the cortex and medulla during all phases.     

Evaluation of CT findings for the differentiation of benign from malignant primary retroperitoneal tumors

Background Benign and malignant primary retroperitoneal tumors （RT） have different pathological manifestations,and overlapping imaging characteristics.This study aimed to evaluate the value of computed tomography （CT） for differentiating benign from malignant RT.Methods One hundred and ninety-four patients with clinical and radiographic data were evaluated retrospectively following surgical resection of primary RT.There were 38.1％ （n=74） benign lesions and 61.9％ （n=120） malignant lesions.Categorical variables were tested with a chi-square test or Fisher＇s exact test for the diagnostic indexes and sensitivity and specificity of CT characteristics.Results In univariate analysis,the differences in ill-defined margins,irregular surfaces,long diameter ＞6.75 cm,short diameter ＞6.25 cm,and solid or mixed texture had statistical significance; the sensitivity and specificity were 44.2％ and 91.9％,70.0％ and 62.2％,68.8％ and 60.7％,59.7％ and 74.2％,87.5％ and 35.1％,respectively.In multivariate analysis,a combination of all the above indexes was the best model for differentiating malignant tumors,resulting in the most accurate diagnosis of malignancies with a sensitivity of 77.2％ and a specificity of 81.1％ （P＜0.0001） when the score was 4.The differences in other findings including CT attenuation,number,and calcification had no statistical significance.The unique characteristics included the spotted enhancement （mottled high density）in schwannoma （P＜0.0001）,adipose tissue in liposarcoma （P＜0.0001）and paravertebral location in neurogenic tumors （P＜0.0001）.Conclusions More accurate differential diagnosis of primary RT can be made through comprehensive analysis of the combined diagnostic indexes of CT.Some specific characteristics of CT can assist in preoperative planning.     

Assessment of Coronary Stents by 64-slice Computed Tomography： In-stent Lumen Visibility and Patency

Objective To assess lumen visibility of coronary stents by 64-slice computed tomography （CT） coronary angiography, and determine the value of 64-slice CT in non-invasive detecting of in-stent restenosis after coronary artery stent implantation. Methods Totally, 60 patients （54 males, aged 57.0±12.7 years） and /05 stents were investigated by 64-slice CT at a mean interval of 20.0±16.6 months after coronary stents implantation. Axial multi-planar reconstruction images of the stents and curved-planar reconstruction images through the median of the stents were reconstructed for evaluating stent image quality on a 5-point scale （1=excellent, 5=nonassessable）, and stent lumen diameter was detected. Conventional coronary angiography was performed in 18 patients, and 32 stents were evaluated. Results Image quality was good to excellent on average （score 1.71±0.76）. Stent image quality score was correlated to heart rate （r=0. 281, P〈0.01） and stent diameter （r=-0.480, P〈0.001）. All the stents were assessable in lumen visibility with an average visible lumen diameter percentage of 60.7%±13.6%. Visible lumen diameter percentage was correlated to heart rate （r=-0.193, P〈0.05）, stent diameter （r=0.403, P〈0.001）, and stent image quality score （r=-0.500, P〈0.001）. Visible lumen diameter percentage also varied depending on the stent type. In comparison with the conventional coronary angiography, 4 of 6 in-stent stenoses were correctly detected. The sensitivity and specificity for the detection of in-stent stenosis were 66.7% and 84.6%, respectively. Conclusions Using a 64-slice CT, the stent lumen is partly visible in most of the stents. And 64-slice CT may be useful in the assessment of stent patency.     

Sezary syndrome： a rare form of cutaneous T-cell lymphoma

Sezary syndrome （SS） is an erythrodermic, aggressive, cutaneous T-cell lymphoma （CTCL） characterized by a malignant T-cell clone that localizes in the blood and skin, and its diagnosis is based on clinical, histological and biological features. Here we describe a typical case of SS.     

玻璃体黄斑牵拉综合征

Objective This study aimed to review the available literature on vitreomacular traction （VMT） syndrome and propose the future study prospect in this field. Data sources The data used in this review were mainly obtained from articles listed in Medline and Pubmed （1970- 2013）. The search terms were ＂vitreomacular traction,＂ ＂optical coherence tomography,＂ ＂vitrectomy,＂ and ＂ocriplasmin.＂ Study selection Articles regarding the pathophysiology, diagnosis, and treatments of VMT were selected and reviewed. Results VMT syndrome is a persistent attachment of vitreous to the macula in eyes with an incomplete posterior vitreous detachment and considered to be an uncommon status which correlated with some other macular disorders. Optical coherence tomography （OCT） can support a new way to examine and classify VMT. Nonoperative and operative intervenes on this disease have been developed recently, especially the intravitreal medical therapy. Conclusions VMT syndrome may be associated with various disorders in the macular region, depending in part on the size and strength of the residual vitreomacular adhesion. Regular OCT monitoring is recommended to detect it. Patients with asymptomatic VMT should be observed for at least 2-3 months; nonoperative treatment with ocriplasmin should be considered when disorders persist; surgery is recommended if VMT-related disease is significant.     

Progress of radiation oncology: known and unknown

Objective To elaborate known and unknown aspects of radiation oncology.Data sources Data cited in this review were obtained mainly from PubMed and Medline in English from 1999 to 2013,with keywords ＂individualized medicine＂,＂personalized medicine＂,＂radiation dose＂,＂radiation target＂,＂molecular targeted therapy＂,＂molecular imaging＂ and ＂functional imaging＂.Study selection Articles regarding radiation target delineation,radiation doses,new technology and equipment,combination of radiotherapy and molecular targeted therapy as well as other aspects were identified,retrieved and reviewed.Results A larger radiation field and a higher radiation dose are not always better.New equipment and technology are also not always better than conventional equipment and technologies.Effectiveness of radiotherapy combined with molecular targeted therapy needs more data to verify.Conclusion Personalized radiotherapy is the direction for the future.     

Isolated Pancreatic Tuberculosis in Non-immunocompromised Patient Treated by Whipple＇s Procedure： a Case Report

PANCREATIC tuberculosis （TB） is a rare disease and its diagnosis is difficult because of the lack of specific clinical manifestations. Computed tomography （CT） and magnetic resonance imaging （MRI）have some diagnostic values in this disease, but it is easy to misdiagnose pancreatic TB as a pancreatic tumor.1 In this article, we present a case of non-immunocompromised patient developing an isolated pancreatic TB, report the CT and MRI findings, and the surgical procedure for it,     

Three-dimensional localization of impacted canines and root resorption assessment using cone beam computed tomography

Summary： The purpose of this study was to develop a new way to localize the impacted canines from three dimensions and to investigate the root resorption of the adjacent teeth by using cone beam computed tomography （CBCT）. Forty-six patients undergoing orthodontic treatments and having impacted canines in Tongii Hospital were examined. The images of CBCT scans were obtained from KaVo 3D exam vision. Angular and linear measurements of the cusp tip and root apex according to the three planes （mid-sagittal, occlusal and frontal） have been taken using the cephalometric tool of the InVivo Dental Anatomage Version 5.1.10. The measurements of the angular and linear coordinates of the maxillary and mandibular canines were obtained. Using this technique the operators could envision the location of the impacted canine according to the three clinical planes. Adjacent teeth root resorption.of 28.26 % was in the upper lateral incisors while 17.39% in upper central incisors, but no lower root resorption was found in our samples. Accurate and reliable localization of the impacted canines could be obtained from the novel analysis system, which offers a better surgical and orthodontic treatment for the patients with impacted canines.     

Diffusion-weighted magnetic resonance imaging with short T1 inversion recovery-echo planar imaging combined with dual-head coincidence single photon emission computed tomography for diagnosing solitary pulmonary nodule

Positron emission tomography （PET） using 18F-fluorodeoxyglucose （FDG） has not been widely used in China for expensive cost （$1200）. Dual-head coincidence single photon emission computed tomography （DHC-SPECT） can depict many of the lesions depicted with a PET scanner in the lungs, which is used in place of PET-CT for discriminating malignant from benign pulmonary nodules in many studies. However, DHC-SPECT has inevitable false-negative results because the sensitivity for small lesions less than 2.0 cm is limited, and has high false-positive rate for active inflammatory nodules. Furthermore,DHC-SPECT also has a considerably higher cost （$300 in China） than other imaging examination.     

Evaluation with low-dose dual-phase helical computed tomography of patients with thyroid lesions

Background The incidence of thyroid cancer has been increasing.Our aim was to evaluate the efficacy of low-dose dualphase helical computed tomography （CT） in the characterization of thyroid lesions,and to discuss the relationship between image characteristics and their pathology.Methods One hundred and six patients with thyroid lesions underwent low-dose dual-phase helical CT after the injection of contrast material.CT scans were obtained at arterial and venous phase with delays of 25 and 65 seconds,and tube current of 60 and 120 mA,respectively.The attenuation change in the lesion between the arterial and venous phase was analyzed and categorized as ＂increased,＂ ＂decreased,＂ ＂mixed＂ or ＂no change.＂ Results Histopathologic diagnosis was obtained by surgery in 106 patients （115 lesions）.Of the 106 patients,45 had nodular goiter,5 thyroid adenoma,6 thyroiditis,and 50 papillary thyroid carcinoma （PTC） （59 lesions）.The attenuation value showed a significant difference （P ＜0.05） between the arterial and venous phase for the high attenuation area.There was statistical significant difference in terms of attenuation value in high attenuation areas at both phases and in low attenuation areas on arterial phase between nodular goiter and PTC （P ＜0.05）.However,there was no significant difference in attenuation value between adenoma and PTC.Twenty-nine cases （76.3％） of goiter manifested mixed type,3 cases （3/5） of adenoma showed decreased type,6 cases （6/6） of thyroiditis showed increased type,and 55 cases （93.2％） of PTC showed decreased type attenuation.The sensitivity,specificity for thyroid carcinoma by dual-phase CT were 94.9％ and 80.4％ respectively.The overall diagnostic accuracy for thyroid lesions by dual-phase CT was 87.8％.Conclusions The performance of dual-phase helical CT is related to the pathological structure of the lesions.The analysis of enhancement patterns by using dual-phase helical CT will be helpful in the differential diagnosis of thyr     

Morphometric measurement of the patella on 3D model reconstructed from CT scan images for the southern Chinese population

Background Due to racial differences in the morphology of the knee joint and due to most prostheses available in the market being designed using measurements from Caucasians,the objective of this study was to provide the morphometric data of the patella for the southern Chinese population for total knee arthroplasty （TKA）,patellar resurfacing,and prostheses design.Methods The CT slices of the knee joint were obtained from both knees of 40 Chinese volunteers （20 females,20 males,and age from 20-25 years） by performing a computer tomographic scan.A 3D model was reconstructed by Mimics software based on the computed tomography images.Six metrical characteristics were measured by digital ruler.Statistical analysis was performed with the SPSS statistical program.Results The mean,standard deviation and P values of measurements and ratios were calculated using SPSS.All dimensions showed a significant gender difference with P＜0.05,but the six variables of the left and right knees had no statistical significance with P＞0.05.In addition,we studied the relationship between six couples （H-W,H-T,H-HAF,W-T,W-HAF,T-HAF） of the four variables （H：height,W：width,T：thickness and HAF：height of articulating facet） that were measured,which showed a significant correlation.Conclusions Examination of the southern Chinese population revealed that males have larger patellae than women.In both genders,comparing data between left and right knees shows no statistically significant difference.Compared with Westerners in previous studies,the patella in our study was thin and small.There was a good linear regression correlation between measurements of the patella.The indirect measurement method on 3D models makes it easy to obtain anatomical data,and the results can provide a region and gender specific database for morphometric measurements of the oatella,and can be helpful for designing implants suited for southern Chinese patients.     

Computed tomography in predicting smear-negative pulmonary tuberculosis in AIDS patients

Background The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy.We aimed to assess the value of the computed tomography (CT) and cli...     

Reducing the radiation dose with the adaptive statistical iterative reconstruction technique for chest CT in adults: a parameter study

Background Currently there is a trend towards reducing radiation dose while maintaining image quality during computer tomography （CT） examination.This results from the concerns about radiation exposure from CT and the potential increase in the incidence of radiation induced carcinogenesis.This study aimed to investigate the lowest radiation dose for maintaining good image quality in adult chest scanning using GE CT equipment.Methods Seventy-two adult patients were examined by Gemstone Spectral CT.They were randomly divided into six groups.We set up a different value of noise index （NI） when evaluating each group every other number from 13.0 to 23.0.The original images were acquired with a slice of 5 mm thickness.For each group,several image series were reconstructed using different levels of adaptive statistical iterative reconstruction （ASIR） （30％,50％,and 70％）.We got a total of 18 image sequences of different combinations of NI and ASIR percentage.On one hand,quantitative indicators,such as CT value and standard deviation （SD）,were assessed at the region of interest.The signal-to-noise ratio （SNR） and contrast-to-noise ratio （CNR） were calculated.The volume CT dose index （CTDI） and dose length product （DLP） were recorded.On the other hand,two radiologists with ＞5 years of experience blindly reviewed the subjective image quality using the standards we had previously set.Results The different combinations of noise index and ASIR were assessed.There was no significant difference in CT values among the 18 image sequences.The SD value was reduced with the noise index＇s reduction or ASIR＇s increase.There was a trend towards gradually lower SNR and CNR with an NI increase.The CTDI and DLP were diminishing as the NI increased.The scores from subjective image quality evaluation were reduced in all groups as the ASIR increased.Conclusions Increasing NI can reduce radiation dose.With the premise of maintaining the same image quality,using a suitable percentage of ASIR can increase the value of NI.To assure image quality,we concluded that when the NI was set at 17.0 and ASlR was 50％,the image quality could be optimal for not only satisfying the requirements of clinical diagnosis,but also achieving the purpose of low-dose scanning.     

Association of chronic obstructive pulmonary disease with coronary artery disease

Background The relationship between chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) remains largely unknown.This study aimed to explore the association of COPD with CAD,e...     

Correlation between low tube voltage in dual source CT coronary artery imaging with image quality and radiation dose

The influence of low tube voltage in dual source CT（DSCT） coronary artery imaging on image quality and radiation dose and its application value in clinical practice were investigated. Totally, 300 cases of chest pain with low body mass index（BMI 〈18.5 kg/m2） subjected to DSCT coronary artery imaging were prospectively enrolled. The heart rate in all patients were greater than 65/min. The retrospective ECG gated scanning mode and simple random sampling method were used to assign the patients into groups A, B and C（n=100 each）. The patients in groups A, B and C experienced 120-, 100-, and 80-kV tube voltage imaging respectively, and the image quality was evaluated. The CT volume dose index（CTDIvol） and dose length product（DLP） were recorded, and the effective dose（ED） was calculated in each group. The image quality scores and radiation doses in groups were compared, and the influence of tube voltage on image quality and radiation dose was analyzed. The results showed that the excellent rate of image quality in groups A, B and C was 95.69%, 94.72% and 96.33% respectively with the difference being not statistically significant among the three groups（P〉0.05）. The CTDIvol values in groups A, B and C were 51.35±12.21, 21.28±7.13 and 6.34±3.34 mGy, respectively, with the difference being statistically significant（P〈0.05）. The ED values in groups A, B and C were 9.27±1.63, 4.56±2.29 and 2.29±1.69 mSv, respectively, with the difference being statistically significant（P〈0.05）. It was suggested that for the patients with low BMI, the application of DSCT coronary artery imaging with low tube voltage can obtain satisfactory image quality, and simultaneously, significantly reduce the radiation dose.