X-ray study in infants of the first year of life who had congenital heart diseases: traditions, specific features, new capacities

The paper analyzes the experience with ultrafast computed tomography (CT) used for 4 years to examine 178 babies with complicated congenital heart diseases (CHD), admitted to A.N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, for surgical treatment. It shows the comparative capacities of X-ray study, CT, and catheterized angiography in the diagnosis of CHD and concomitant lung diseases in patients of the first year of life in terms of the physiological and anatomic features of the course of disease. A complex of noninvasive radiation studies is shown to be of high informative value in evaluating the actual anatomy of complicated cardiac and pulmonary anomalies and in detecting the predictors of respiratory complications. The introduction of CT into the traditional algorithm of preoperative examination of patients with CHD has resulted in a considerable reduction in intracardiac diagnostic studies in neonates and infants of the first year of life.     

能谱CT鉴别肺癌成骨性转移瘤与骨岛

目的:探讨能谱CT成像在鉴别诊断肺癌成骨性转移瘤(Osteoblastic metastases,OBMs)与骨岛(Bone island,BIs)的临床应用价值。方法:回顾性分析经病理证实的16例肺癌患者诊断为成骨性转移瘤36个病灶及临床诊断21例骨岛患者21个病灶,所有患者均行能谱CT扫描,测量各病灶40-140 ke V区间单能量水平CT值及钙(水)基物质浓度,最后计算出能谱曲线斜率k。采用独立样本t检验对两组各参数进行差异性比较分析。结果:OBMs的各水平单能量CT值、k值、钙(水)浓度均低于BIs,两组差异均有统计学意义(P0.05)。结论:能谱CT有助于鉴别诊断肺癌成骨性转移瘤与骨岛。     

Apport du TDM en imagerie multimodalité : le point de vue du physicien médical

The recent introduction of hybrid systems SPECT/CT and PET/CT in nuclear medicine, greatly improved the diagnostic accuracy for particular clinical indications, due to the possible attenuation correction of functional images and the availability of helpful anatomic information. The introduction of CT in the nuclear diagnostic process results in a significant increase of the patient dose. This increase should be justified and optimized considering both the clinical question and the CT settings available on these systems. The choice of CT settings directly affects the effective dose. It varies basically as the square of the tube voltage, linearly with the length of the scan and the product of the current by the rotation time of the tube. It is also inversely proportional to the pitch. For attenuation correction, the literature shows that it is possible to use a low CT tube current without significant effect on tumor FDG uptake or lesion size. Conversely low CT voltage must be used with caution, depending on the algorithm implemented in the CT hybrid device to transform CT Hounsfield units to the attenuation map at the appropriate energy. The radiation dose for anatomic correlation can be substantially lower than for diagnostic-quality CT. It is possible to reduce the patient's radiation dose by a factor of 2 or 3 by acquiring a low-dose PET/CT scan for anatomic correlation of adequate image quality if compared with diagnostic ¹⁸FDG PET/CT. Using specific CT settings, the effective dose can range 7.3–11.3 mSv depending on the patient weight and age.     

肿瘤/肝脏比值在~(18)F-FDG符合线路SPECT/CT显像在肺癌诊断中的价值

目的:探讨18F-FDG符合线路SPECT/CT显像在肺癌病灶的检测能力以及肿瘤/肝脏比值对肺部良恶性病灶及胸部小病灶诊断的临床价值。方法:回顾性分析2011年6月至2013年4月期间于西安交通大学第一附属医院行18F-FDG符合线路SPECT/CT显像的肺癌疑诊患者41例CT测量肺部原发病灶最大直径4.16±2.81厘米(最小直径1.3厘米,最大直径16厘米),以病理结果作为判断标准,通过t检验及接受者操作特征曲线(receiver operating characteristic,ROC)研究18F-FDG符合线路SPECT/CT显像对肺部病灶、肺及纵膈小病灶的诊断价值。结果:18F-FDG符合线路SPECT/CT显像肺部良恶性病灶的肿瘤/肌肉(T/N)、肿瘤/肝脏(T/L)比值差异均具有显著统计学意义(P0.01),T/L比值在肺部良恶性病灶和肺及纵膈最大横径小于3 cm的病灶ROC曲线的曲线下面积分别为0.857、0.810,均大于T/N比值相应的ROC曲线下面积(分别为0.825、0.760)。T/N=3.5为界值时,诊断肺部病灶的灵敏度为90%,特异度为71.4%,准确度为0.614;诊断最大横径小于3 cm病灶的灵敏度为70%,特异度为80%,准确度为0.50。T/L=2.3时诊断肺部病灶的灵敏度为80%,特异度为85.7%,准确度为0.657。T/L=1.6时诊断最大横径小于3 cm病灶的灵敏度为90%,特异度为80%,准确度为0.70。结论:T/N=3.5为界值时,对于肺部病灶及肺及最大横径小于3 cm病灶良恶性的鉴别能力较好。T/L比值对于肺部良恶性病灶和肺及纵膈最大横径小于3 cm的病灶诊断价值均高于传统常用的T/N比值,具有较高的准确性,可以良好的应用于18F-FDG符合线路SPECT/CT显像对肺癌的诊断中。     

Radiodiagnosis of liver hemangiomas

A combined use of radiation methods in the diagnosis of liver hemangiomas is considered. Twenty-two hemangiomas were detected in 18 patients using ultrasound investigation (USI), computerized tomography (CT) and angiography. The most characteristic signs of hemangiomas were identified. USI and CT were shown quite reliable in the detection of hemangiomas. They can be used for solving diagnostic problems depending on a situation. A diagnostic algorithm envisaging the most optimum use of USI, CT and angiography in liver hemangiomas, was developed.     

Computed tomographic densitometry in the diagnosis of chronic obstructive lung diseases

The capacities of spiral computed tomography (CT) synchronized with a patient's respiration in the diagnosis of chronic obstructive lung diseases (COLD) were studied. Normal lung parenchymal density was clarified in different parts. The densitometric changes typical of bronchial asthma (BA) and COLD were studied in relation to the severity of an obstructive process. The differential diagnostic criteria of BA and COLD, including those at the early stage of the disease, are proposed. The optimized procedure of spiral CT synchronized with the patient's respiration is presented.     

Magnetic resonance tomography, computed tomography and ultrasonic diagnosis of hemangiomas of the liver

The paper is concerned with the potentialities of modern radiation methods in the diagnosis of liver hemangiomas. USI, CT, angiography and MR-tomography (MRT) were used for investigation of 64 patients with liver hemangiomas. The diagnostic potentialities and the role of each of the above methods in the diagnostic algorithm in liver hemangiomas were studied. The results of the investigation have shown that MRT possesses a higher informative value than USI and CT in the diagnosis of liver hemangiomas and can even replace angiography in the verification of diagnosis.     

Magnetic resonance imaging in the diagnosis of gastric cancer: X-ray versus MRI anatomic findings

The paper assesses the present-day role of MRI in the diagnosis of gastric cancer. The authors consider the major prerequisites for the main aim of their study to be: 1) a dramatic incidence of diffuse (endophytic) gastric carcinoma, which requires significant correction of today's approaches to its diagnosis and 2) a rather biased and, in the authors' opinion, present-day mainly negative attitude towards MRI of the stomach as a diagnostic method for its tumor lesions. By applying the X-ray-MRI anatomic principle to the comparative study of MRI findings in 50 patients with predominantly gastric intramural carcinoma and in 25 patients without gastric tumors (controls), the authors present their methods for gastric MRI, the MRI semiotics of gastric cancer by concurrently touching upon a variety of problems that characterize the potentialities of MRI of the stomach in the diagnosis of its tumor lesions, including their differential diagnosis. As a result, the authors highly appreciate gastric MRI and consider this method to be included into the diagnostic algorithm of radiation techniques used in the diagnosis of gastric cancer, which should occupy its definite diagnostic place.     

Radiologic diagnosis of focal liver lesions

The paper is concerned with analysis of the results of combined investigation of 54 patients with focal liver lesions. USI, CT, angiography and radionuclide scintigraphy were performed. The diagnostic efficacy of USI and CT was 94.4 and 90.7%, respectively, that of scintigraphy was 68.5%, that of angiography was 55.5%. A scheme of the effective use of radiation methods in the diagnosis of sizable formations of the liver was worked out.     

Complex radiation diagnosis of post-operative recurrent hepatic tumors

The postoperative course of the disease was studied in 63 patients operated on for malignant hepatic lesion in 1990-1998. The pattern of surgical intervention-caused hepatic changes, which is observed at ultrasonography, CT, MRI, angiography, and oil-injected CT is described. Recurrences took place at the site of resection (9.5%) and outside (34.9%). Their largest number (71%) occurred in the first postresectional year. Diagnostic difficulties arose in the differential diagnosis of postoperative inflammatory changes and tumor recurrences at the site of resection (17% false positive results). Contrast MRI and intraarterial iodized oil CT proved to be the most effective radiation diagnostic techniques.     

Computed tomography-guided fine needle aspiration of peripheral lung opacities. An initial diagnostic procedure?

OBJECTIVE: To evaluate the results of computed tomography (CT)-guided fine needle aspiration (FNA) cytology following negative fiberoptic bronchoscopy and sputum cytology. STUDY DESIGN: Retrospective study of 64 patients who underwent CT-guided needle aspiration of lung opacities over one year. Following a review of the CT studies, patients were selected according to image characteristics of a primary neoplasm and pleural effusion in cases with pleural lesions. The lesions were classified into three categories--intrapulmonary and peripheral pulmonary, pleuropulmonary and pleural--and were localized and aspirated under CT using a fine needle (22-23 gauge) for obtaining cellular material. Lesions diagnosed as benign on FNA cytology were followed by serial CT scans for a period of two years at six-month intervals. RESULTS: Thirty-nine of 64 (61%) lesions were diagnosed as malignant on FNA cytology and 25 of 64 (39%) as benign. There was one false negative case. There were no serious complications from the procedure. CONCLUSION: FNA under CT guidance may be applied as the initial procedure in the diagnosis of peripheral malignant pulmonary lesions, rendering a high diagnostic yield.     

Adrenal imaging

The differentiation of adrenal nodules is wide and varies from primary benign neoplasia, through hormone secreting lesions, to primary and secondary malignant masses. With the rapid development of cross-sectional imaging, incidental detection of adrenal nodules has become an everyday practice, leaving clinicians with the necessity of further investigation. In this article, we present the current possibilities of adrenal gland imaging and we propose a diagnostic schema for differential diagnosis of incidentaloma. Non-contrast enhanced computer tomography (CT) is a modality of choice used for the differential diagnosis of adrenal lesions. It allows the detection of 95% of adrenal masses, and the characterisation of most of them. Magnetic resonance imaging (MRI) is a good modality for cases in which CT examination cannot determine the character of an adrenal tumour. Nuclear medicine study with the use of Iodine-131 meta iodobenzylguanidine(MIBG) is helpful in the diagnosis of pheochromocytoma. Positron Emission Tomography-Computed Tomography (PET-CT) is considered a useful method in patients with a known malignancy history. Ultrasound has a low sensitivity for the detection of small lesions and is not capable of reliable characterisation of visualised masses. However, this technique plays an important role in the follow-up of non-hypersecreting adrenal lesions.     

Spindle cell neuroendocrine carcinoma of the lung: report of a case with fine needle aspiration cytology and differential diagnostic considerations

BACKGROUND: Spindle cell neuroendocrine carcinomas of the lung may be frequently observed on fine needle cytology (FNC) samples and often pose stimulating differential diagnostic problems. CASE: The cytopathologic findings from FNC performed on a long-standing coin lesion of the lung in a 54-year-old woman were analyzed in view of the data and long clinical history. CONCLUSION: A final diagnosis of low grade spindle cell neuroendocrine carcinoma was reached by combining cytopathologic and immunocytochemical information. The main lesions considered in the differential diagnosis were intrapulmonary inflammatory myofibroblastic tumor (fibrohistiocytic variant) and spindle cell thymoma.     

Role and accuracy of rapid on‐site evaluation of CT‐guided fine needle aspiration cytology of lung nodules

A. Fassina, M. Corradin, D. Zardo, R. Cappellesso, F. Corbetti and M. Fassan
Role and accuracy of rapid on‐site evaluation of CT‐guided fine needle aspiration cytology of lung nodules Objective: To prospectively investigate the role of trans‐thoracic fine needle aspiration cytology (FNA) and the value of rapid on‐site evaluation (ROSE) in the clinical management of patients with pulmonary nodules/masses. Computed tomography (CT)‐guided FNA is commonly employed for the diagnosis of lung lesions although its position in the diagnostic work‐up is still a matter of debate. Methods: We reviewed 311 patients (211 males and 100 females, mean age 69.5 years) admitted to the University of Padova from 2004 to 2008, correlating the results of cytology with the available histological findings obtained from biopsies, surgery or autopsy. Results: Smears were adequate in 305 cases (98%) and inadequate in six (2%); a diagnosis of malignancy was achieved in 263 cases (86.2%); 39 cases (12.8%) were classified as non‐malignant; and three cases (1%) were classified as suspect for malignancy. When correlated with histology, FNA with ROSE discriminated malignant versus non‐malignant lesions (Cohen’s kappa 0.78), with three false negatives (sensitivity 96.3%, specificity 100%). Moreover, a satisfactory overall agreement of 71.4% was achieved in differentiating the cancer histological types. Pneumothorax occurred in 13 cases, haemoptysis in four, and chest pain in three. A single aspiration was sufficient in 79.6% of patients; two aspirations were needed in 17.4% and three in 3%. The low complication rate was related to the limited number of aspirations needed due to ROSE. Conclusions: FNA with ROSE is a safe and useful tool in the diagnostic work‐up of lung cancer patients, with no contraindications to its use as the first diagnostic procedure for all patients with peripheral lung lesions. FNA with ROSE should be reconsidered in the guidelines for diagnosing and managing lung cancer.     

Gastric and intestinal scintigraphy in the complex diagnosis of small bowel obstruction

An algorithm has been developed for radiation diagnosis of small bowel obstruction, which involves abdominal X-ray and ultrasound studies at the first stage and radionuclide evaluation of gastrointestinal transit, by using 100-150 ml of aqueous 99mTc-technefite or 99mTc-bromeside solution in a dose of 50-100 MBq (radiation load 0.7-1.4 MeV) per os. The sensitivity, specificity, and diagnostic efficiency of the whole radiation diagnostic complex and each procedure separately were determined by the results of examination in 180 patients with suspected small bowel obstruction, of whom 104 patients were operated on, but obstruction ceased during medical treatment. Inclusion of the radionuclide technique into the diagnostic complex involving plain radiography and ultrasonography was shown to enhance diagnostic efficiency up to 97-98%.     

多层螺旋CT对肺结核合并肺癌患者的诊断价值

目的:研究多层螺旋CT对肺结核合并肺癌的鉴别诊断价值。方法:选择2013年3月至2015年9月在我院确诊的肺结核合并肺癌患者32例和单纯肺结核患者39例应用多层螺旋CT扫描患者肺部病变情况。结果:肺结核合并肺癌组:陈旧性肺结核28例、活动性肺结核4例;病灶位置经典部位29例、非经典部位3例,合并鳞癌11例、腺癌13例、小细胞癌5例、未分化癌3例;10例结核病灶与肺癌病灶不同侧、13例结核病灶与肺癌病灶同侧不同叶、9例结核病灶于肺癌病灶同侧同叶。单纯性肺结核组胨旧性肺结核36例、活动性肺结核3例;病灶位置经典部位34例(上叶尖段11例、后段9例、下叶背段14例)、非经典部位5例。肺结核合并肺癌组患者分叶征、毛刺征、胸膜凹陷征、阻塞性肺炎及肺不张以及棘状突起比例高于单纯肺结核组,而空泡影比例低于单纯肺结核组,差异具有统计学意义(P0.05);两组钙化、斑片条索影、结节影以及空洞或空腔比较,差异无统计学意义(P0.05)。结论:多层螺旋CT对肺结核合并肺癌具有较高的临床鉴别诊断价值。     

X-Ray Phase-Contrast CT of a Pancreatic Ductal Adenocarcinoma Mouse Model

To explore the potential of grating-based x-ray phase-contrast computed tomography (CT) for preclinical research, a genetically engineered mouse model of pancreatic ductal adenocarcinoma (PDAC) was investigated. One ex-vivo mouse specimen was scanned with different grating-based phase-contrast CT imaging setups covering two different settings: i) high-resolution synchrotron radiation (SR) imaging and ii) dose-reduced imaging using either synchrotron radiation or a conventional x-ray tube source. These experimental settings were chosen to assess the potential of phase-contrast imaging for two different types of application: i) high-performance imaging for virtual microscopy applications and ii) biomedical imaging with increased soft-tissue contrast for in-vivo applications. For validation and as a reference, histological slicing and magnetic resonance imaging (MRI) were performed on the same mouse specimen. For each x-ray imaging setup, attenuation and phase-contrast images were compared visually with regard to contrast in general, and specifically concerning the recognizability of lesions and cancerous tissue. To quantitatively assess contrast, the contrast-to-noise ratios (CNR) of selected regions of interest (ROI) in the attenuation images and the phase images were analyzed and compared. It was found that both for virtual microscopy and for in-vivo applications, there is great potential for phase-contrast imaging: in the SR-based benchmarking data, fine details about tissue composition are accessible in the phase images and the visibility of solid tumor tissue under dose-reduced conditions is markedly superior in the phase images. The present study hence demonstrates improved diagnostic value with phase-contrast CT in a mouse model of a complex endogenous cancer, promoting the use and further development of grating-based phase-contrast CT for biomedical imaging applications.     

肺癌患者肺动脉和支气管动脉CTA的临床研究

目的:对比分析肺癌患者和肺部非癌性病变肺动脉和主支气管动脉CTA特点。方法:回顾性统计分析82例行高度怀疑肺癌患者的肺部CTA,经病理证实肺癌54例,肺结核球28例,同时选择对照组22例。对比分析肺动脉(Pulmonary artery,PA)内径、主支气管动脉(Bronchial artery,BA)显影率和及其各级分支显影率。结果:肺癌组、肺结核球组和对照组左主支气管动脉显影率分别为83.3%、77.7%和72.7%。右主支气管动脉显影率87.0%、83.3%和68.1%。肺癌组左右主支气管动脉清晰显影率高于肺结核球组和对照组,差异有统计学意义(P0.05)。左右两侧肺癌组PA内径明显大于结核球和对照组,差异有统计学意义(P0.05)。左右侧肺癌组PA显影分级明显高于结核球和对照组,差异有统计学意义(P0.05)。左右双侧PA主干内径差异无统计学意义(P0.05)。结论:肺部癌性病灶动脉供血增加,肺动脉和支气管动脉CTA能够显示肺癌病灶供血情况,可用于临床辅助鉴别诊断影像学不能确诊的肺部病变。     

磁共振成像对非小细胞肺癌的诊断价值分析

目的:探讨磁共振成像(Magnetic resonance imaging,MRI)对非小细胞肺癌的诊断价值。方法:选择2016年9月-2019年4月南京医科大学附属脑科医院(胸科院区)放射科收治的肺部结节患者74例,包括病理证实为肺部良性病变54例(良性组)和非小细胞肺癌20例(肺癌组)。所有患者都给予常规MRI、增强MRI与磁共振扩散加权成像(Diffusion weighted imaging,DWI),记录影像学特征并评估其诊断价值。结果:肺癌组的病灶形态、边缘等MRI特征与良性组对比差异无统计学意义(P0.05)。在b值=0、600、800、1000 s/mm~2条件下,肺癌组的病灶表观扩散系数(Apparent diffusion coefficient,ADC)值都显著低于良性组(P0.05)。肺癌组的病灶MRI增强Ⅰ型+Ⅱ型比例显著高于良性组(P0.05)。MRI鉴别诊断非小细胞肺癌的敏感性与特异性为98.1%和94.4%。结论:MRI用于非小细胞肺癌的诊断能反映病灶组织的血流动力学与水分子活动状况,具有较高的诊断敏感性与特异性。     

CT联合DR对早期周围型肺癌的诊断价值

目的:分析数字X线摄片(DR)、CT及其联合应用对周围型肺癌的诊断价值。方法:选择该院2012年2月~2016年3月收治早期周围型肺癌患者90例为研究对象,分别进行数字化X线摄影和CT检查,以手术切除或病理结果为最终诊断的金标准,计算两种检查方法及其联合对早期诊断周围型肺癌的敏感度、特异度和准确率阳性预测值以及阴性预测值。结果:胸部DR检出空泡征者7例(7.8%),分叶征47例(52.2%),边缘有细小毛刺征36例(40%),胸膜凹陷征9例(10%);CT见病变边缘分叶征71例(78.8%),长短毛刺征57例(63.3%),空洞征27例(30%),胸膜凹陷征32例(35.6%)。DR诊断周围型肺癌的敏感性、特异性及准确性分别为85%、81%、85.6%,而CT则为90%,87.6%,90.5%,均高于DR。DR与CT两者联合诊断周围型肺癌的敏感性为98.4%,显著高于DR(85%)和CT(90%)。结论:在早期周围型肺癌的影像学诊断中,CT的临床价值显著优于DR,而两者联合诊断的临床价值明显优于单独检测。