Color Doppler Twinkling Artifact in Diagnosis of Tuberculous Pleuritis: A Comparison with Gray-Scale Ultrasonography and Computed Tomography

The aim of this study was to determine whether twinkling artifact (TA) detected on color Doppler ultrasonography can effectively determine the presence of pleural calcification compared with computed tomography (CT) and differentiate tuberculous pleuritis (TP) and cancerous pleuritis (CP). One hundred six cases of TP and 26 cases of CP were scanned using gray-scale ultrasonography (GSU) and TA to determine the presence of pleural calcification. With CT as the reference standard, 63.3% and 79.6% of patients with pleural calcification were identified with GSU and TA, respectively. The detection rate of TA was higher than that of GSU (p?=?0.039). For the whole study population, 37.1% were identified as having pleural calcification with CT, significantly higher than the proportion detected with GSU (25.8%, p?=?0.001), but not different from that detected with TA (41.7%, p?=?0.327). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TA were 79.6%, 80.7%, 80.3%, 70.9% and 87.0%, respectively. The detection rate of TA was significantly higher than that of GSU (p?<0.001). When GSU was combined with TA (GSUTA), the positive rate in the TP group was significantly higher than that in the CP group (χ²?<?0.001). In conclusion, TA is comparable to CT and more sensitive than GSU in the detection of pleural calcification. Evaluation for GSUTA on pleura may help to differentiate TP from CP.     

Age related changes in thyroid and cricoid cartilages: An autopsy based radiological analysis

Forensic age estimation is an invaluable aspect of human identification. Out of these many means of age estimation, few regions with untapped potential for assistance in forensic age estimation are the age-related changes in the laryngeal cartilages. As the age advances, the thyroid and cricoid cartilages undergo gradual calcification in an individual. These age-related changes can be visualized in both the living and the dead using conventional radiography and can be objectively assessed. The objective of the present study was to evaluate the age-related changes in the laryngeal cartilages and the results may be utilized for age estimation in forensic examinations. The laryngeal cartilages were carefully dissected using standard procedures from 75 cadavers of age ranging from 17 to 65 years, during the post-mortem examination. The laryngeal cartilages were radiographed and replaced in the body cavity before culminating the post-mortem examination. The calcification of both cartilages was studied by using the standard grading method. Calcification scores of individual regions of both the laryngeal cartilages show a statistically significant positive correlation with chronological age (P < 0.05). Regression models derived from the degree of calcification of thyroid and cricoid cartilages showed standard error of estimates that ranged between 9.90 and 11.07 years. Considering the standard error of estimates of the regression analysis, the present study concludes that these regression models can be used in adjunct with other methods of age estimation such as the skeletal and dental age or when such methods are not viable as in cases of charred or mutilated remains.     

Lipoprotein(a): Pathophysiology,measurement, indication and treatment in cardiovascular disease. A consensus statement from the Nouvelle Société Francophone d’Athérosclérose (NSFA)

Central Illustration. Pathophysiological pathways providing a causal link between high plasma concentrations of lipoprotein(a) (Lp(a)) and atherosclerotic vascular disease and aortic valve stenosis (AVS). Clinical outcomes are related to accelerated atherosclerosis complicated by atherothrombosis (myocardial infarction, stroke), peripheral artery disease (PAD) or aortic valve replacement (AVR) caused by valve calcification and aortic stenosis. Apo(a): apolipoprotein(a); LDL: low-density lipoprotein; OxPL: oxidized phospholipids; NSFA: Nouvelle Société Francophone d’Athérosclérose; SP: serine-protease domain; V: plasminogen kringle V (reproduced with permission).

     

应用CT分析大脑中动脉钙化与脑梗死的关系

目的分析大脑中动脉水平段（M1段）钙化与相应供血区脑梗死的关系.方法经CT确诊的大脑中动脉M1段钙化患者121例（151支）,分析钙化的形态学特点、部位以及与血管的关系;用Cascoring自动分析软件计算钙化积分.对大脑中动脉钙化组与无钙化组脑梗死发病率及大脑中动脉钙化组中有或无梗死灶与钙化积分诸指标的关系进行分析.结果小结节状钙化121支,大结节状钙化18支,条状钙化12支.76支钙化位于大脑中动脉M1近段,55支位于大脑中动脉M1中段;20支钙化位于M1远段.钙化斑块与血管的关系,向心性43支,偏心性108支.大脑中动脉钙化组脑梗死发病率（51.7%）高于无钙化组（27.5%）,差异有显著意义（P＜0.01）;有梗死灶组钙化体积、钙化质量及积分大于无梗死灶组,差异亦有显著意义（P＜0.01）.结论CT容积扫描能显示大脑中动脉细小钙化,并能对钙化分型,确定钙化的部位.大脑中动脉钙化与否及钙化积分诸指标的大小与脑梗死的发生与否密切相关,钙化组比无钙化组更易发生脑梗死;有梗死灶组的钙化程度比无梗死灶组更严重.     

Morphological Alterations in the Tympanic Membrane Affected by Tympanosclerosis: Ultrastructural Study

Abstract

The ultrastructure of tympanoslerotic tissue, surgically excised from patients, has been studied with particular reference to the morphological changes of the connective tissue components and mineralization. Detailed analysis revealed the combination of degenerative and fibroplastic alterations, especially in the circular fibrous layer of the thickened lamina propria. In the biological material in this study the authors recognized different stages of calcium plaque development with discrete, moderate, and severe degree of mineralization. Extracellular matrix vesicles, with or without calcareous deposits, released by degenerating fibroblasts were prominent. In these biopsies no distinct morphological features of an inflammatory reaction were seen.     

Mitral annular calcification in the elderly – Quantitative assessment

PurposeTo determine the reliability of subjective and objective quantification of mitral annular calcification (MAC) in elderly patients with severe aortic stenosis, to define quantitative sex- and age-related reference values of MAC, and to correlate quantitative MAC with mitral valve disease.MethodsIn this retrospective, IRB-approved study, we included 559 patients (268 females, median age 81 years, inter-quartile range 77–85 years) with severe aortic stenosis undergoing CT. Four independent readers performed subjective MAC categorization as follows: no, mild, moderate, and severe MAC. Two independent readers performed quantitative evaluation of MAC using the Agatston score method (Agatston_MAC). Mitral valve disease was determined by echocardiography.ResultsSubjective MAC categorization showed high inter-reader agreement for no (k ?= ?0.88) and severe MAC (k ?= ?0.75), whereas agreement for moderate (k ?= ?0.59) and mild (k ?= ?0.45) MAC was moderate. Intra-reader agreement for subjective MAC categorization was substantial (k ?= ?0.69 and 0.62). Inter- and intra-reader agreement for Agatston_MAC were excellent (ICC ?= ?0.998 and 0.999, respectively), with minor inconsistencies in MAC involving the left ventricular outflow tract/aortic valve. There were significantly more women than men with MAC (n ?= ?227, 85% versus n ?= ?209, 72%; p ?< ?0.001), with a significantly higher Agatston_MAC (median 597, range 81–2055 versus median 244; range 0–1565; p ?< ?0.001), particularly in patients ≥85 years of age. Agatston_MAC showed an area-under-the-curve of 0.84 to diagnose mitral stenosis, whereas there was no association of Agatston_MAC with mitral regurgitation (p ?> ?0.05).ConclusionsOur study in elderly patients with severe aortic stenosis shows that quantitative MAC scoring is more reliable than subjective MAC assessment. Women show higher Agatston_MAC scores than men, particularly in the elderly population. Agatston_MAC shows high accuracy to diagnose mitral stenosis.     

Calcifying fibrous tumor of the gastrointestinal tract: A clinicopathologic review and update

Calcifying fibrous tumor(CFT) is a rare mesenchymal lesion that has been documented throughout the gastrointestinal tract. Gastrointestinal CFTs may occur at virtually any age, with a predilection for adults and for females. They occur most commonly in the stomach and the small and large intestines. CFTs are most often found incidentally, cured by local resection, and have a low risk of recurrence. Histology shows three characteristic features: Spindle cell proliferations within a densely hyalinized stroma, scattered calcifications, and lymphoplasmacytic inflammation. CFTs are immunoreactive for CD34, vimentin and factor XIIIa, helping to distinguish them from other benign mesenchymal neoplasms. The differential diagnosis of CFTs includes sclerosing gastrointestinal stromal tumor, leiomyoma, schwannoma, solitary fibrous tumor, inflammatory myofibroblastic tumor, plexiform fibromyxoma, fibromatosis, sclerosing mesenteritis, and reactive nodular fibrous pseudotumor. The pathogenesis of CFTs remains unclear, but some have hypothesized that they may be linked to IgG4-related disease, inflammatory myofibroblastic lesions, hyaline vascular type Castleman disease, sclerosing angiomatoid nodular transformation of the spleen, or trauma.     

MRI动态增强扫描对乳腺钼靶摄影中含簇状钙化灶良恶性病变的诊断鉴别价值

目的探讨磁共振(MRI)动态增强扫描对乳腺钼靶摄影(MG)中含簇状钙化灶良恶性病变的诊断鉴别价值。方法回顾性分析我院2013年2月至2018年6月收治的80例含簇状钙化灶乳腺病变患者MRI及MG影像学资料,并与术后病理结果进行对比,计算MRI动态增强与MG联合诊断乳腺含簇状钙化灶良恶性病变效能。结果MG诊断共有恶性病灶35个,良性病灶51个,MG联合MRI共诊断出恶性病灶38个,良性病灶48个,两种检测方法恶性病灶检出比较差异无统计学意义(P>0.05);MG联合MRI对含簇状钙化灶良恶性病变诊断灵敏度94.59%,特异度93.88%,准确度94.19%,阳性预测值92.11%,阴性预测值95.83%高于单独MG检测灵敏度72.97%,特异度83.67%,准确度79.07%,阳性预测值77.14%,阴性预测值80.39%,差异有统计学意义(P<0.05)。结论MRI动态增强扫描对乳腺钼靶摄影中含簇状钙化灶良恶性病变的诊断价值高于单独的MG检测。     

维生素K2对老年去卵巢大鼠血管钙化的影响

目的在老年去卵巢大鼠模型上探讨维生素K2对血管钙化的影响。方法 36只10个月龄雌性SD大鼠,随机分为假手术组、去卵巢组、去卵巢+维生素K2组。去卵巢手术后3周,去卵巢+维生素K2组给予维生素K2灌胃30 mg/kg,每周5次,持续12周。各组大鼠在术前及药物干预后每3周留取血清及尿液,18周后处死大鼠,HE染色观察子宫、血管组织变化,酶联免疫吸附法检测血清和尿液基质Gla蛋白(MGP)含量及雌激素水平变化,荧光实时定量PCR检测胸主动脉MGP mRNA的表达,免疫组织化学法观察血管未羧化MGP(ucMGP)的表达,Von Kossa染色观察动脉钙化,原子分光光度计测定血管总钙含量。结果去卵巢后大鼠子宫和血管组织切片呈现明显不同,血中雌激素水平下降,表明去卵巢大鼠模型构建成功。去卵巢前各组大鼠血清及尿液中MGP含量无明显差异(P>0.05);去卵巢后,假手术组MGP含量无明显变化,去卵巢组MGP含量下降,去卵巢+维生素K2组MGP含量先下降后上升。去卵巢+维生素K2组血管中MGP mRNA表达量较假手术组高(P<0.01),较去卵巢组低(P<0.01)。血管ucMGP表达出现在血管钙化周围区域,去卵巢+维生素K2组未见明显ucMGP的表达。去卵巢+维生素K2组血管总钙含量明显低于去卵巢组(P<0.01),高于假手术组(P<0.05)。结论 MGP在绝经后血管钙化的发病中有重要作用,维生素K2可能通过调节MGP羧化及基因表达抑制血管钙化。     

High‐Grade Histologic Features of DCIS are Associated with R5 Rather than R3 Calcifications in Breast Screening Mammography

Mammographic calcification is an important radiologic feature of early breast carcinoma whose index of suspicion for malignancy may be reported by a five‐tier R‐category system. This study aims to describe the histologic diagnoses underlying screen‐detected mammographic calcifications using both digital and screen‐film mammography, and to correlate these findings with radiologic R‐categories. Patients attending the Merrion Breast Screening Unit in Dublin between 2000 and 2011 were identified, who underwent needle‐core biopsy for assessment of mammographic calcifications without associated mass or architectural distortion. Radiologic R‐category was correlated with biopsy and excision histology reports. A total of 776 cases of calcification were identified, involving 769 individual patients. The radiologic R‐categories were as follows: R3 513 (66.1%), R4 192 (24.7%), R5 71 (9.1%). The positive predictive values for malignancy were R3 32.6%, R4 69.8%, R5 95.8%. Several histologic features of DCIS were associated with R5 rather than R3 radiology: high nuclear grade, solid or cribriform architecture, necrosis, periductal inflammation or fibrosis, and associated microinvasive or invasive carcinoma. Mammographic lesions and histologic whole and invasive tumors increased in size from R3 to R5. Radiologic size of calcifications correlated with whole (but not invasive) tumor size, although it tended to underestimate it by several millimeters. Digital‐detected calcifications were more likely than screen‐film detected to be categorized as R3 and less likely R4 or R5, and there was no significant difference in positive predictive value between the two imaging techniques in any R‐category. In conclusion, histologic features of DCIS, in particular those associated with high grade, are associated with R5 radiology. There is no significant difference in positive predictive value for malignancy in any R‐category between digital and screen‐film mammography.