Risk stratification for 1- to 2-cm gastric gastrointestinal stromal tumors: visual assessment of CT and EUS high-risk features versus CT radiomics analysis.

OBJECTIVES: To investigate the ability of CT and endoscopic sonography (EUS) in predicting the malignant risk of 1-2-cm gastric gastrointestinal stromal tumors (gGISTs) and to clarify whether radiomics could be applied for risk stratification. METHODS: A total of 151 pathologically confirmed 1-2-cm gGISTs from seven institutions were identified by contrast-enhanced CT scans between January 2010 and March 2021. A detailed description of EUS morphological features was available for 73 gGISTs. The association between EUS or CT high-risk features and pathological malignant potential was evaluated. gGISTs were randomly divided into three groups to build the radiomics model, including 74 in the training cohort, 37 in validation cohort, and 40 in testing cohort. The ROIs covering the whole tumor volume were delineated on the CT images of the portal venous phase. The Pearson test and least absolute shrinkage and selection operator (LASSO) algorithm were used for feature selection, and the ROC curves were used to evaluate the model performance. RESULTS: The presence of EUS- and CT-based morphological high-risk features, including calcification, necrosis, intratumoral heterogeneity, irregular border, or surface ulceration, did not differ between very-low and intermediate risk 1-2-cm gGISTs (p > 0.05). The radiomics model consisting of five radiomics features showed favorable performance in discrimination of malignant 1-2-cm gGISTs, with the AUC of the training, validation, and testing cohort as 0.866, 0.812, and 0.766, respectively. CONCLUSIONS: Instead of CT- and EUS-based morphological high-risk features, the CT radiomics model could potentially be applied for preoperative risk stratification of 1-2-cm gGISTs. KEY POINTS: • The presence of EUS- and CT-based morphological high-risk factors, including calcification, necrosis, intratumoral heterogeneity, irregular border, or surface ulceration, did not correlate with the pathological malignant potential of 1-2-cm gGISTs. • The CT radiomics model could potentially be applied for preoperative risk stratification of 1-2-cm gGISTs.

Application value of double-layer spectral detector CT in differentiating central lung cancer from atelectasis.

BACKGROUND: Central lung cancer with obstructive atelectasis is very common in clinical practice. Determination of the tumor borderline is important. Conventional computed tomography (CT) alone may not be sufficiently accurate to distinguish central lung cancer from obstructive atelectasis. Spectral CT can improve the soft-tissue resolution greatly. In this study, we evaluated the application value of double-layer spectral detector CT in differentiating central lung cancer from atelectasis. METHODS: A total of 51 patients (37 males) with pathologically confirmed central lung cancer accompanied by atelectasis were enrolled. The rates of differentiation between tumors and atelectasis were retrospectively analyzed using conventional CT and three types of spectral images (40 keV virtual monoenergetic imaging, iodine density map, and their fusion image) of unenhanced scans as well as arterial and venous phases. Cochran's Q test and Friedman test were used to compare the differentiation rates and the maximal diameters of the tumors in each image. RESULTS: Among the 51 cases, conventional CT, 40 keV monoenergetic, iodine density, and their fusion images of the venous phase were successful in differentiating tumors from atelectasis in 17 (33.33%), 35 (68.63%), 39 (76.47%), and 38 (74.51%) cases, respectively. The differentiation rates of the 40 keV monoenergetic, iodine density, and fusion images were significantly higher than those of conventional images (χ2=-0.35, -0.43, and -0.41, respectively, all P<0.001). There were no significant differences in the differentiation rates among the 40 keV monoenergetic, iodine density, and fusion images (χ2=-0.06, -0.08, 0.02, respectively, all P=1.00). The maximal tumor diameters in the four images did not significantly differ (χ2=3.61, P=0.31). Conventional and spectral images of unenhanced and arterial phases could not/barely identify the tumor borderlines. CONCLUSIONS: Venous-phase spectral images of double-layer spectral detector CT can differentiate most central lung cancers from atelectasis, and the maximal diameter measurement of the tumor is reliable. Double-layer spectral detector CT can accurately identify the borderlines of most central lung cancers through spectral images during routine CT examinations without requiring other imaging modalities. Therefore, this method has considerable clinical value for applications in tumor staging, efficacy evaluation, and radiotherapy.

Differential diagnosis of pulmonary nodular mucinous adenocarcinoma and tuberculoma with dynamic CT: a retrospective study.

Background: Pulmonary nodular mucinous adenocarcinoma (PNMA) tends to be easily misdiagnosed as tuberculoma in practice. In this study, we aimed to discriminate PNMA from tuberculoma with dynamic computed tomography (CT). Methods: In this study, 38 consecutive pathologically confirmed cases of PNMA and 23 cases of tuberculoma from January 2015 to December 2019 were retrospectively collected. The mean CT attenuations of each lesion were examined. The values on the plain scan, the venous scan, and the enhanced values (CT attenuation of lesion of venous scan minus that of the plain scan) were tested with an independent t-test pair-wisely. Receiver operating characteristic (ROC) curve analyses were performed to test the differential diagnosis values. The presence of satellite lesions was determined with the chi-square test. Results: The mean CT attenuation of tuberculoma shown on the plain scan was significantly higher than that of PNMA (35.15±16.00 vs. 24.00±12.67 HU; P<0.01). The enhanced value of tuberculoma on venous scan was significantly lower than that of PNMA (13.44±13.40 vs. 22.52±14.00 HU; P=0.02). The optimum CT attenuation of the plain scan and the enhanced value for differential diagnosis were 28.80 and 14.25 HU [area under the curve (AUC) =0.72, 95% confidence interval (CI): 0.58-0.86; and AUC =0.70, 95% CI: 0.59-0.84], with sensitivity (78.3% vs. 71.1%) and specificity (63.8% vs. 69.6%) respectively. The satellite lesions were more often observed in the tuberculoma group (P<0.01). Conclusions: The CT attenuation of the plain scan, the enhanced value after enhancement, and the presence of satellite lesions might be useful in differentiating PNMA from tuberculoma.

The assessment of the frequency and arrangement of the subsegmental branches of V3 using computed tomography angiography.

BACKGROUND: The frequency and arrangement of the subsegmental branches of the third portion of the vertebral artery (V3) have been assessed in small samples by autopsy, but they have not been assessed by computed tomography angiography (CTA). To determine the frequency and arrangement of subsegmental branches of V3 by CTA and to analyze the interrelationships among frequency, arrangement, sex, and side-to-side. METHODS: First, the radiology records of 668 consecutive patients who underwent cervical or craniocervical CTA scans from October 1, 2017 to October 31, 2019 were retrospectively retrieved. Second, the four demarcation points were ascertained to define the three subsegments by reviewing the resource images, namely, the vertical portion of V3(V3v), horizontal portion of V3(V3h), and extradural portion of V3(V3e). Then, the numerical value and the location of the bifurcating branch in each subsegment of V3 were recorded. Third, the frequency and arrangement of the branches was assessed, and the relationships between sex, laterality and frequency and arrangement were analyzed as well as the interobserver performance. RESULTS: On the left, 25%, 20.21%, and 6.59% were the frequencies of one branch in the V3v, V3h, and V3e, and 1.05%, 0.00%, and 0.45% were the frequencies of two branches, respectively. On the right, 25.04%, 17.07%, and 6.44% were the frequencies of one branch in the V3v, V3h, and V3e, and 1.04%, 0.3%, and 0.15% were the frequencies of two branches, respectively. There were no differences between the side-to-side and numerical values of the branches according to the t-test (P=0.4341, P=0.7968), and there were no differences between the side-to-side variable, sex variable and number of branches according to the t-test (P=0.4474, P=0.3593). There were no differences between the side-to-side and eight arrangements (permutation of 000; 100; 110; 111; 010; 011; 001; 101) by using the two-sample KS test (P=0.942), and there were no differences between sex and the eight arrangements according to the two-sample KS test (P=0.9973, P=0.8519). The interobserver reliability was excellent (Spearman's ranked correlation: 0.9927). CONCLUSIONS: The frequency and arrangement of V3 subsegmental branches could be displayed by source imaging with CTA, and there were no significant differences according to the sex or side of the individual. It was imperative to acquaint the subsegmental branches before the operation involving V3 in the craniocervical junction to determine the surgical approach and reduce bleeding during the surgical procedures.

Early Changes in Apparent Diffusion Coefficient for Salivary Glands during Radiotherapy for Nasopharyngeal Carcinoma Associated with Xerostomia.

Objective: To evaluate the early changes in the apparent diffusion coefficient (ADC) of the salivary glands during radiotherapy (RT) and their association with the degree of xerostomia at 6 months after RT in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: We enrolled 26 patients with NPC who underwent RT. Each patient underwent diffusion-weighted MRI of the salivary glands at rest and with gustatory stimulation within 1 week before RT and 2 weeks after the beginning of RT. The ADC at rest (ADCR) and increase and increase rate with stimulation (ADCI, ADCIR) of the submandibular and parotid glands were calculated. The differences in the variables' values between 2 weeks after the beginning of RT and baseline (ΔADCR, ΔADCI, and ΔADCIR) were compared to the degree of xerostomia at 6 months after RT. Results: The ADCR of the submandibular and parotid glands were both significantly higher at 2 weeks after the beginning of RT than found at baseline (both p < 0.01). The ADCI and ADCIR for the parotid glands were both significantly lower at 2 weeks after the beginning of RT than found at baseline (both p < 0.01). ΔADCI and ΔADCIR of the parotid glands were associated with the degree of xerostomia at 6 months after RT (r = -0.61 and -0.72, both p < 0.01). Conclusion: The ADCs of the salivary glands change early during RT. The differences in the ADC increase and increase rate of the parotid glands between 2 weeks after the beginning of RT and baseline were associated with the degree of xerostomia at 6 months after RT.

[Chaihu Longgu Muli decoction combined with acupuncture at back-shu points for chronic fatigue syndrome].

OBJECTIVE: To observe the effect difference between Chaihu Longgu Muli decoction combined with acupuncture at back-shu points and simple Chaihu Longgu Muli decoction for chronic fatigue syndrome. METHODS: Sixty patients were randomly assigned into an herbal group and a combination group, 30 cases in each one. Simple Chaihu Longgu Muli decoction was used in the herbal group for continuous one month, one decoction a day. Based on that in the herbal group, 30 min acupuncture was used in the combination group at bilateral Xinshu (BL 15), Feishu (BL 13), Pishu (BL 20), Ganshu (BL 18) and Shenshu (BL 23), with acupoints according to syndrome differentiation. Acupuncture was given for 3 courses, 10 times as a course with 3 days between two courses, once a day. Fatigue status was evaluated before and after treatment by fatigue scale 14 (FS-14) and self-rating anxiety scale (SAS). RESULTS: The FS-14 scores, including body fatigue scores, mental fatigue scores and total scores, and SAS scores after treatment were lower than those before treatment in the two groups (all P<0.01), with better improvements in the combination group (all P<0.01). CONCLUSION: Chaihu Longgu Muli decoction combined with acupuncture at back-shu points can improve chronic fatigue syndrome, which are better than simple Chaihu Longgu Muli decoction.

Analysis of computed tomography and pathological observations of non-Hodgkin lymphomas with peritoneal, omental and mesenteric involvement.

The aim of the present study was to evaluate the association between computed tomography (CT) images and the pathological observations of non-Hodgkin lymphoma (NHL) patients with peritoneal, omental and mesenteric involvement. In total, 26 patients suffering from an NHL with peritoneal, omental or mesenteric involvement were reviewed retrospectively, and the observed CT scan characteristics were analyzed. In addition, associations among the CT scan characteristics and the NHL subtypes, including diffuse large B-cell, mantle cell, follicular cell and T-cell lymphoma, were evaluated. The CT scan characteristics of the NHLs with peritoneal, omental and mesenteric involvement included peritoneal cord-like thickening, peritoneal omental nodular and swelling thickening, omental cake-like thickening and mesenteric mass. The probability of peritoneal linear, omental nodular and swelling thickening was found to be higher in diffuse large B-cell lymphoma cases compared with cases of other NHL subtypes (P<0.05). However, the probability of omental cake-like thickening and mesenteric mass was not found to be significantly different among the NHL subtypes (P>0.05). Signs of peritoneal, omental and mesenteric involvement were observed in the CT scans of all the NHL subtypes, particularly in diffuse large B-cell lymphoma cases. Therefore, linear, omental nodular and swelling thickening were characteristic of diffuse large B-cell lymphoma, while omental cake-like thickening and mesenteric mass were observed in all NHL subtypes.

Reference ranges for atlantodental interval in adults and its variation with age and gender in a large series of subjects on multidetector computed tomography.

BACKGROUND: The atlanto-dental interval measurement in the cervical spine in young adults has been reported on multidetector computed tomography (MDCT), but has not been systematically assessed in all ages. PURPOSE: To evaluate the reference ranges for the atlanto-dental interval (ADI) in a large sample of adult patients on MDCT and to analyze the relationships of these measurements with gender and age of the patients as well as inter-observer performance. MATERIAL AND METHODS: First, a consecutive series of 700 Chinese patients aged over 18 years undergoing an upper cervical MDCT scan were divided equally into seven age groups. Second, the mid-sagittal image of the atlanto-dental joint was chosen for measurement and ADI was defined as the distance intercepted from the segment line linking the center of anterior atlas tubercle with that of posterior tubercle. Third, the correlation of ADI with age and gender was analyzed using linear regression analysis. Finally, the inter-observer performance was assessed using Bland and Altman's limits of agreement. RESULTS: The ADI was 1.77 ± 0.39 mm, 1.61 ± 0.37 mm, 1.58 ± 0.36 mm, 1.41 ± 0.29 mm, 1.31 ± 0.29 mm, 1.34 ± 0.28 mm, and 1.06 ± 0.47 mm in the age groups 18-24 years, 25-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, and older than 70 years, respectively. The range of ADI was 0.85-3.12 mm in the age group 18-39 years, 0.71-2.55 mm in the age group 40-59 years, and 0.00-2.37 mm in the age group older than 60 years. There was no difference between gender and ADI (r = 0.00, P = 1.000). ADI decreased linearly with age (r = -0.511, P = 0.000). The inter-observer performance was reliable. CONCLUSION: ADI measurements on MDCT linearly decrease with increasing age, and these are not affected by gender in adult patients. Different reference values might be used at different ages when diagnosing atlantoaxial anterior dislocation or subluxation.

Manifestations and pathological features of solitary thin-walled cavity lung cancer observed by CT and PET/CT imaging.

The aim of the present study was to analyze and improve the understanding of computed tomography (CT) and positron emission tomography (PET)/CT imaging and the pathological features of solitary thin-walled cavity lung cancer. A total of 16 patients with pathologically confirmed solitary thin-walled cavity lung cancer were included in the present study. All of the patients received CT scans. Among these, two patients underwent an additional PET/CT examination. The CT and PET/CT images were analyzed and a cross-check analysis of the pathological results was conducted. In total, 16 cases of lesions demonstrated thin-walled cavities on the CT images. Among these cases, three presented with an uneven thickening of the cavity walls, 10 cases exhibited wall nodules and three cases presented with compartments in the cavity. The standard uptake value (SUV) of the cavity wall increased in two patients who underwent PET/CT examinations. The 16 cases of lesions were pathologically confirmed as adenocarcinomas. Light microscopy revealed that the tumor cells, which were observed in 12 cases of lesions, had diffused along the inner cavity wall and the tumor cells of four cases had invaded the bronchial wall. Images of the chest that demonstrated a single thin-walled cavity accompanied by uneven thickening of the cavity wall or wall nodules, in addition to an increase in the SUV and compartments in the cavity, indicated potential lung cancer. Valves formed as a result of bronchial wall damage may have led to the cavity.