Transthoracic Ultrasound Elastography in Pulmonary Lesions and Diseases

Ultrasound elastography has shown promising result in the diagnosis of various diseases; however, its application for pulmonary diseases has yet to be clarified. This study aimed to assess the application and feasibility of ultrasound elastography in various pulmonary lesions and diseases. We enrolled 45 patients with radiographic evidence of pneumonia, tumors or obstructive pneumonitis, and 70 ultrasonic lesions were identified (eight necrosis, 17 atelectasis, seven consolidation and 38 tumors). Ultrasound elastography was performed and the strain ratio, which is the ratio of strain of the reference tissue to an equally measuring region of interest of a lesion, was measured. The strain ratio was significantly different among lesions with different ultrasound morphologies (1.03 ± 0.71 [necrosis] vs. 2.51 ± 1.14 [atelectasis] vs. 19.98 ± 15.59 [consolidation] vs. 36.19 ± 20.18 [tumor]; p < 0.05). The strain ratio of primary lung cancer was also significantly different from pneumonia (p = 0.023) and metastatic lung cancer (p = 0.015). In conclusion, transthoracic ultrasound elastography can differentiate pulmonary lesions with different ultrasound morphologies. ClinicalTrials.gov Identifier: NCT02636985.     

Ultrasonic signs of pneumothorax: Preliminary work

Ultrasonography is considered to have limited application in respiratory diseases because air reflects sound waves. Twenty-four patients with radiologically confirmed pneumothorax and 100 healthy subjects underwent sonography. In all normal subjects, the hyperechoic pulmonary interface showed respiratory motions termed the “gliding sign” with some comet-tail artifacts. Sonographic signs were shown in all pneumothoraces: disappearance of the gliding sign and no comet tails. The extent of collapse cannot be evaluated, but it is possible to determine its area in partial pneumothorax (N = 5). The follow-up (N = 8) showed the reappearance of the gliding sign. Ultrasonography may be helpful in diagnosing pneumothorax in certain cases. © 1993 John Wiley & Sons, Inc.     

三维增强磁共振胸腹部大血管成像的技术探讨

目的　探讨三维动态MRA(3DDCEMRA)成像技术在胸部、腹部大血管应用的价值。方法　使用 1.5T超导磁共振全身成像仪对 3 5例疑有胸部、腹部大血管病变的患者进行静脉手推团注磁共振造影剂法的 3DDCEMRA检查。一次屏气 2 2s可采集 14～ 2 4层图像。结果　所有 3 5例 3DDCEMRA均一次检查成功 ,清楚地显示了胸部、腹部大血管解剖结构 ,包括血流信号 ,血管壁及其壁周组织 ,对病变的定位及与周围血管和组织相关性均可以作出明确的判断。结论　 3DDCEMRA成像在采用了快速的梯度回波成像技术 ,合理的静脉团注造影剂 ,以及正确的图像分析和后处理后可以实现无创性的准确的胸部 ,腹部大血管的诊断 ,有可能替代常规DSA检查。     

创伤性胸外伤的临床诊治体会

目的:总结分析胸部外伤的诊治特点。方法:回顾分析760例胸部外伤程度及治疗情况,其中肋骨骨折,肺挫伤,血气胸常见,伴有颅脑损伤和腹部闭合伤。结果:治愈741例。心脏破裂抢救成功1例,死亡3例;复合伤引起死亡16例。结论:创伤所致胸外伤病情危急,具体分析致伤原因及根据临床体征检查,迅速作出诊断和快速救治是关键,合并颅脑损伤、腹部脏器损伤、急性呼吸窘迫综合征(ARDS)是其主要死亡原因。     

217例急性胸部创伤的X线与CT表现分析

目的了解胸部X线及CT检查对急性胸部创伤的诊断意义。方法回顾性分析217例急性胸部创伤患者的胸部X线和CT表现,对其诊断阳性率进行比较。结果肋骨、锁骨骨折X线阳性检出率高;胸壁血肿、纵隔及皮下气肿、气胸、血气胸、肺实质损伤、创伤性肺不张等均以CT阳性检出率高。结论急性胸部创伤的影像学改变多种多样。多种诊断方法相结合对提高诊断准确率很有帮助。     

Neuroblastoma Originating from Extra-abdominal Sites: Association with Favorable Clinical and Biological Features

Neuroblastomas originating from different sites might have different clinical and biological characteristics. In the present study, the clinical (age, sex and stage) and biological (N-myc amplification, Shimada pathology and levels of lactate dehydrogenase, ferritin and neuron-specific enolase) characteristics of patients with newly diagnosed neuroblastoma were compared according to the site of tumor origin (extra-abdominal versus abdominal). The event-free survival rate (EFS) was also compared between the two groups. Among 143 neuroblastomas, 115 tumors originated from the abdomen, 26 from extra-abdominal sites and 2 from unknown primary sites. Frequencies of stage 4 tumor and N-myc amplified tumor were lower in the extra-abdominal group than in the abdominal group (34.6% vs. 60.0%, P=0.019 and 4.2% vs. 45.0%, P<0.001, respectively). Levels of lactate dehydrogenase, ferritin and neuron-specific enolase were significantly lower in the extra-abdominal group than in the abdominal group. The probability of 5-yr EFS (±95% confidence interval) was higher in the extra-abdominal group than in the abdominal group (94.4±10.6% vs. 69.4±9.4%, P=0.026). Taken together, neuroblastomas originating from extra-abdominal sites might be associated with more favorable clinical and biological characteristics and a better outcome than neuroblastomas originating from abdomen.     

Malformations of the anterior chest wall

INTRODUCTION: Pectus excavatum or funnel chest is the most common anterior chest wall deformity seen in children and adults. The sternal depression appears to be caused by overgrowth of the costal cartilages, also the cause of the less common deformities: pectus carinatum (pigeon breast) and pectus arcuatum. BACKGROUND: Usually the overgrowth involves the third to seventh costal cartilages but it can be more or less extensive. The cardiopulmonary functional consequences are insignificant in the protrusional deformities and inconsistent in pectus excavatum and the indications for surgery are mainly cosmetic. VIEWPOINT AND CONCLUSIONS: The procedural modalities are guided by morphological study of the CT scan. We describe a surgical technique that comprise subperichondrial excision of all deformed costal cartilages followed by transverse sternotomy to correct the sternal deformity, anteriorly in the case of pectus excavatum and posteriorly for pectus carinatum and arcuatum. As the perichondrial sheaths are totally preserved they are sutured in continuous layers to give a shortening effect. In the case of pectus excavatum the sternum is then secured anteriorly for about 6 months by a retrosternal metallic strut in an overcorrected position. The partially resected seventh cartilages are then sutured to the xiphoid. Other surgical techniques are described, including modified Ravitch's procedure, modelling osteochondroplasty, prosthetic reconstruction and Nuss's procedure. Results of the more important series are reported and discussed.     

Influence of liquid crystal display monitors on observer performance for detection of diffuse pulmonary disease on chest radiographs

Purpose The purpose of this study was to assess the influence of liquid crystal display (LCD) monitors on the detectability of diffuse pulmonary diseases depicted on chest radiographs by comparing them with a high-resolution cathode ray tube (CRT) monitor. Materials and methods A group of 17 radiologists interpreted 87 soft-copy images on LCD monitors with pixel arrays of 1024 × 1280, 1200 × 1600, 1536 × 2048, and 2048 × 2560 and on a CRT monitor with a pixel array of 2048 × 2560. They were asked to indicate their individual confidence levels regarding the presence of diffuse pulmonary diseases. The luminance distributions of all monitors were adjusted to the same distributions, and the ambient illumination was 200 lux. Observer performance was analyzed in terms of the receiver operating characteristics (ROC). Results The average ROC curves for the five monitor types were similar, and there were no statistically reliable effects of the five monitor types on the readers’ diagnostic performances (P = 0.7587). Conclusion The detectability of diffuse pulmonary disease on the LCD monitors with a spatial resolution equal to or higher than a matrix size of 1024 × 1280 was found to be equivalent to that on the high-resolution CRT monitor.     

Revisit image control for pediatric chest radiography

Purpose The aim of this study was to analyze the fraction defectiveness and efficacy of the patient immobilization device (PID) for pediatric chest radiography. Materials and methods We examined 840 plain chest radiographs in six hospitals, including four children's hospitals and two general hospitals. The mean age of the patients was 1.9 years (range 0–5 years). Two board-qualified pediatric radiologists rated (into three grades, by consensus) the degree of inspiration, rotation, lordosis, scoliosis, and cutoff or coning as well as the quality of the chest radiographs. Results The incidence of “poor” and “very poor” quality examinations was 2/140 and 3/140 in each of two children's hospitals using PID. The corresponding figures were 9/139 and 17/140 in the two children's hospitals that did not use PID. The general hospital using PID had 14/140 “poor” and “very poor” examinations. The general hospital that did not use PID had 28/140 “poor” and “very poor” examinations. Thus, statistically better quality chest radiography was obtained with the use of PID (P < 0.001). Likewise, rotation, lordosis, and scoliosis were less frequently diagnosed as present when PID was used (P < 0.001, 0.001, 0.05). Cutoff or coning had no relation to the use of PID (P = 0.13). No significant difference was found between the degree of inspiration and the use of PID (P = 0.56). Conclusion Fraction defectiveness in the general hospital that did not use PID was as much as 14 times higher than that of the children's hospitals that used PID. The patient immobilization device is recommended for hospitals with technologists not specifically trained for pediatric examination.     

肩胛骨骨折与其合并伤关系的探讨

目的 分析115例肩胛骨骨折病例的临床资料,探讨肩胛骨骨折粉碎程度和涉及部位与合并伤之间的关系.方法 回顾性分析2006年8月至2008年3月115例肩胛骨骨折患者的病史及其影像学资料,分为单部分骨折组(83例)和多部分骨折组(32例),比较两组合并伤的发生率及特点.将单部分肩胛骨骨折组按Nordqvist与Petersson方法分成3组:肌肉覆盖部分(64例)、骨突起部分(11例)及肩胛盂部分(8例),并比较3组合并伤的发生率及特点.结果 绝大部分肩胛骨骨折是严重多发伤的一部分,致伤原因与高能量损伤有关.最常见的致伤原因是车祸伤(70.4%).损伤严重程度评分值(injury severity Scale,ISS)平均14.0,42例(36.5%)患者ISS>16.98例(85.2%)患者伴有不同程度和类型的合并伤,其中又以胸部合并伤的发生率最高(85/115,73.9%).多部分肩胛骨骨折组胸部简明损伤定级法评分值(abbreviated injury score,AIS)和总体ISS值均高于单部分肩胛骨骨折组.在单部分肩胛骨骨折组中,肌肉覆盖部骨折组较骨突起部和肩胛盂部骨折组的胸部AIS值和总体ISS值更高.结论 肩胛骨骨折尤其是骨折涉及多部分或肌肉覆盖部时更容易并发严重的胸部损伤.多部分肩胛骨骨折致伤原因多为高能量损伤,常伴发严重的胸部合并伤,可作为胸部严重损伤存在的一项骨性指标.