Computed tomography radiomics study of invasion and instability of lung adenocarcinoma manifesting as ground glass nodule.

Background: Ground-glass nodule (GGN) is the most common manifestation of lung adenocarcinoma on computed tomography (CT). Clinically, the success rate of preoperative diagnosis of GGN by puncture biopsy and other means is still low. The aim of this study is to investigate the clinical and radiomics characteristics of lung adenocarcinoma presenting as GGN on CT images using radiomics analysis methods, establish a radiomics model, and predict the classification of pathological tissue and instability of GGN type lung adenocarcinoma. Methods: This study retrospectively collected 249 patients with 298 GGN lesions who were pathologically confirmed of having lung adenocarcinoma. The images were imported into the Siemens scientific research prototype software to outline the region of interest and extract the radiomics features. Logistic model A (a radiomics model to identify the infiltration of lung adenocarcinoma manifesting as GGNs) was established using features after the dimensionality reduction process. The receiver operating characteristic (ROC) curve of the model on training set and the verification set was drawn, and the area under the curve (AUC) was calculated. Second, a total of 112 lesions were selected from 298 lesions originating from CT images of at least two occasions, and the time between the first CT and the preoperative CT was defined as not less than 90 days. The mass doubling time (MDT) of all lesions was calculated. According to the different MDT diagnostic thresholds instability was predicted. Finally, their AUCs were calculated and compared. Results: There were statistically significant differences in age and lesion location distribution between the "noninvasive" lesion group and the invasive lesion group (P<0.05), but there were no statistically significant differences in sex (P>0.05). Model A had an AUC of 0.89, sensitivity of 0.75, and specificity of 0.86 in the training set and an AUC of 0.87, sensitivity of 0.63, and specificity of 0.90 in the validation set. There was no significant difference statistically in MDT between "noninvasive" lesions and invasive lesions (P>0.05). The AUCs of radiomics models B1, B2 and B3 were 0.89, 0.80, and 0.81, respectively; the sensitivities were 0.71, 0.54, and 0.76, respectively; the specificities were 0.83, 0.77, and 0.60, respectively; and the accuracies were 0.78, 0.65, and 0.69, respectively. Conclusions: There were statistically significant differences in age and location of lesions between the "noninvasive" lesion group and the invasive lesion group. The radiomics model can predict the invasiveness of lung adenocarcinoma manifesting as GGNs. There was no significant difference in MDT between "noninvasive" lesions and invasive lesions. The radiomics model can predict the instability of lung adenocarcinoma manifesting as GGN. When the threshold of MDT was set at 813 days, the model had higher specificity, accuracy, and diagnostic efficiency.

[CT imaging features and misdiagnosis analysis of occult anterior calcaneal process fracture].

OBJECTIVE: To explore CT imaging features and reason for missed diagnosis of clinical practice of occult anterior calcaneal process fracture. METHODS: From July 2013 to November 2018, the clinical data of 13 patients with occult an anterior calcaneal process fracture were retrospectively analyzed, including 2 males and 11 females, aged from 22 to 54 years old. Classification of fracture, displacement of fracture, direction of fracture line, size of fracture, with or without tarsal coalition, other fractures and misdiagnosis, the time from injury to diagnosis, condition of treatment and fracture healing were observed according to case history, data of X-ray and CT. RESULTS: Thirteen patients were diagnosed as occult anterior calcaneal process fracture after CT examination. According to Degan classification, 9 patients were type I, 4 patients were typeII; 4 patients were occurred displacement, and 9 patients did not occurred displacement. On the horizontally CT, fracture line of 12 patients showed transverse, 1 patient oblique, and the size of fracture ranged from 0.40 to 1.72 cm; while on the sagittal view, fracture line of 12 patients showed vertical, 1 patient oblique, and the size of fracture ranged from 0.10 to 0.59 cm. No patients combined with talocalcaneal and scaphoid bridge. Six patients were simple anterior calcaneal process fracture, 7 patients combined with other fractures. Eight patients were misdiagnosed. The time from injury to diagnose ranged from 0 to 21 days. Nine patients with type Iwere performed conservative treatment, 6 patients healed well and 3 patients with fracture line less than 1 cm on horizontally view occurred fracture nonunion. Four patients with type II did not perform operation, and fracture were not union, regardless of fracture size. CONCLUSIONS: Occult anterior calcaneal process fracture have high rate of missed diagnosis in clinical practice. CT imaging features of fracture showed that most fracture line were transverse on CT horizontal plane while vertical on CT sagittal plane, as well as small side of fragment on CT sagittal plane with differernt sizes of fragment on CT horizontal plane; type Ifracture with fragment less than 1 cm on CT horizontal plane and type II both have high rate of nonunion while treated with conservative treatment.

[Clinical study on the relationship between the displaced fracture of the inferior ramus of pubis and the posterior pelvic ring injury].

OBJECTIVE: To investigate relation between displaced inferior ramus fractures and posterior pelvic ring injury. METHODS: From August 2012 to August 2015, 51 patients of pubic ramus fractures with complete record were retrospective reviewed including 27 males and 24 females with an average age of(49.1±19.0) years old ranging from 9 to 90 years old. The time from injury to treatment ranged from 0.3 to 48 hours with an average of 10.1 hours. According to Tile classification of pelvic fractures, 28 cases were type A, 17 cases were type B, 6 cases were type C. Pelvic radiographs and computed tomography scans were detailed and evaluated for whether there were posterior pelvic ring injury, meanwhile pubic rami fractures were divided into 4 groups as follow: displaced inferior ramus fractures group, undisplaced inferior ramus fractures group, displaced superior ramus fractures group, undisplaced superior ramus fractures group;the incidence rate of association of posterior pelvic ring injury was determined and compared. RESULTS: Twenty-six patients had displaced inferior ramus fractures, all of them (100%) were combined with posterior pelvic ring injury. Twenty patients had undisplaced inferior ramus fractures, 6 of them(30%)were combined with posterior pelvic ring injury. Twenty-eight patients had displaced superior ramus fractures, 22 of them(78.5%) were combined with posterior pelvic ring injury. Twelve patients had displaced superior ramus fractures, 5 of them(41.6%) were combined with posterior pelvic ring injury. Compared with undisplaced inferior ramus fractures group, there was statistic difference(P=0.028 8<0.05) on the incidence rate of posterior pelvic ring injury, there were no statistic difference(P=0.055 8>0.05;P=0.168 3>0.05) while compared with other undisplaced superior ramus fractures group and displaced superior ramus fractures group, but the incidence rate of association with posterior pelvic ring injury much higher than both of two groups (100% vs 41.6%, 78.5%). CONCLUSIONS: Displaced inferior pubic ramus fractures have the highest incidence rate of association with posterior pelvic ring injury, frequently prompted injury to the posterior pelvis. Displaced inferior ramus fractures were an indirect evidence of posterior pelvic injury.

[An abnormal deeper lateral femoral notch is an indirect evidence for anterior cruciate ligament tear].

OBJECTIVE: To investigate the relationship between degree of abnormal deeper lateral femoral notch between anterior cruciate ligament tear. METHODS: The radiograph and MRI image material of 16 patients with anterior cruciate ligament injury from January 2013 to November 2013 were reviewed including 14 males and 2 females with an average age of 28.3 years old ranging from 18 to 52 years. Eleven cases was on right side and 5 on left. Survey tool of PASC imaging system was used to measure the depth of lateral femoral notch in patients with abnormal indicated by lateral X-ray view or sagittal view of MRI in knee joint,while clinical data,physical examination,image material in arthroscopy of these patients were retrospective researched. RESULTS: Four patients had an abnormal lateral femoral notch with the depth of 2 mm on lateral X-ray and sagittal MRI, while positive anterior drawer sign and Lachman test as well as anterior cruciate ligament tears on MRI, and completed tears were comfirmed on the operation of arthroscopy. Two patients without abnomal lateral femoral notch on lateral view of X-ray while with the depth of 1 mm on sagittal view of MRI were also coupled with positive anterior drawer sign and Lachman test as well as anterior cruciate ligament tears on MRI, and one of them were comfirmed completed anterior cruciate ligament tears on the arthroscopy operation and completed tear could not comfirmed on another one because of disagreed with arthroscopy operation. CONCLUSION: There appears to be an association between abnormal lateral femoral notch on lateral view of knee with anterior cruciate ligament tears. An abnormal deeper lateral femoral notch is an indirect evidence for anterior cruciate ligament tears.