Lymphatic plastic bronchitis and primary chylothorax: A study based on computed tomography lymphangiography.

BACKGROUND: This study presents an evaluation of the computed tomography lymphangiography (CTL) features of lymphatic plastic bronchitis (PB) and primary chylothorax to improve the diagnostic accuracy for these two diseases. AIM: To improve the diagnosis of lymphatic PB or primary chylothorax, a retrospective analysis of the clinical features and CTL characteristics of 71 patients diagnosed with lymphatic PB or primary chylothorax was performed. METHODS: The clinical and CTL data of 71 patients (20 with lymphatic PB, 41 with primary chylothorax, and 10 with lymphatic PB with primary chylothorax) were collected retrospectively. CTL was performed in all patients. The clinical manifestations, CTL findings, and conventional chest CT findings of the three groups of patients were compared. The chi-square test or Fisher's exact test was used to compare the differences among the three groups. A difference was considered to be statistically significant when P < 0.05. RESULTS: (1) The percentages of abnormal contrast medium deposits on CTL in the three groups were as follows: Thoracic duct outlet in 14 (70.0%), 33 (80.5%) and 8 (80.0%) patients; peritracheal region in 18 (90.0%), 15 (36.6%) and 8 (80.0%) patients; pleura in 6 (30.0%), 33 (80.5%) and 9 (90.0%) patients; pericardium in 6 (30.0%), 6 (14.6%) and 4 (40.0%) patients; and hilum in 16 (80.0%), 11 (26.8%) and 7 (70.0%) patients; and (2) the abnormalities on conventional chest CT in the three groups were as follows: Ground-glass opacity in 19 (95.0%), 18 (43.9%) and 8 (80.0%) patients; atelectasis in 4 (20.0%), 26 (63.4%) and 7 (70.0%) patients; interlobular septal thickening in 12 (60.0%), 11 (26.8%) and 3 (30.0%) patients; bronchovascular bundle thickening in 14 (70.0%), 6 (14.6%) and 4 (40.0%) patients; localized mediastinal changes in 14 (70.0%), 14 (34.1%), and 7 (70.0%) patients; diffuse mediastinal changes in 6 (30.0%), 5 (12.2%), and 3 (30.0%) patients; cystic lesions in the axilla in 2 (10.0%), 6 (14.6%), and 2 (20.0%) patients; and cystic lesions in the chest wall in 0 (0%), 2 (4.9%), and 2 (4.9%) patients. CONCLUSION: CTL is well suited to clarify the characteristics of lymphatic PB and primary chylothorax. This method is an excellent tool for diagnosing these two diseases.

Tuberous sclerosis complex combined with primary lymphedema: A case report.

BACKGROUND: Tuberous sclerosis complex (TSC) and primary lymphedema (PLE) are both rare diseases, and it is even rarer for both to occur in the same patient. In this work, we have provided a detailed description of a patient's clinical presentation, imaging findings, and treatment. And a retrospective analysis was conducted on 14 published relevant case reports. CASE SUMMARY: A 16-year-old male came to our hospital for treatment due to right lower limb swelling. This swelling is already present from birth. The patient's memory had been progressively declining. Seizures had occurred 1 year prior at an unknown frequency. The patient was diagnosed with TSC combined with PLE through multimodal imaging examination: Computed tomography, magnetic resonance imaging, and lymphoscintigraphy. The patient underwent liposuction. The swelling of the patient's right lower limb significantly improved after surgery. Epilepsy did not occur.after taking antiepileptic drugs and sirolimus. CONCLUSION: TSC with PLE is a rare and systemic disease. Imaging can detect lesions of this disease, which are important for diagnosis and treatment.

The value of the dermal rim sign on nonenhanced magnetic resonance imaging for predicting dermal backflow in patients with primary lower extremity lymphedema.

PURPOSE: The dermal rim sign (DRS) on nonenhanced magnetic resonance imaging has been shown to predict dermal backflow (DBF) in patients with secondary upper limb lymphedema. However, whether the DRS has the same effects on primary lower extremity lymphedema (PLEL) has not been clearly reported. Therefore, this study aimed to explore whether the DRS can be used to diagnose DBF on lymphoscintigraphy in patients with PLEL. METHODS: A total of 94 patients who were diagnosed with PLEL were recruited for this retrospective study from January 2022 to December 2023. All the patients were divided into two groups according to the lymphoscintigraphy findings: no DBF and DBF. The magnetic resonance imaging data of the two groups were recorded and statistically compared for the following indicators: range of lymphedema involvement (left, right, whole lower limbs, only thigh, only calf and ankle), signs of lymphedema (notable thickening of skin, parallel line sign, grid sign, honeycomb sign, band sign, lymph lake sign, crescent sign, DRS), and lymphedema measurement (skin thickness, band width). The DRS is characterized by notable thickening of the skin plus the grid sign and/or honeycomb sign, plus the band sign. RESULTS: The following statistically significant differences in the following indicators were found between the two groups (P < .05): notable skin thickening, parallel line sign, grid sign, honeycomb sign, band sign, DRS, skin thickness, and band width. The sensitivity, specificity, and accuracy for predicting for DBF with the DRS was 82%, 64%, and 77%, respectively. CONCLUSIONS: This study confirmed good consistency between the DRS and DBF from the perspective of imaging. This tool is suitable for children, adolescents, and patients with contraindications to lymphoscintigraphy. The DRS has important value in assessing the severity of PLEL. The DRS is suggested for the clinical use of combined surgical treatment of PLEL.

Value of the short time inversion recovery sequence of magnetic resonance imaging in the staging of Klippel-Trenaunay syndrome complicated with lymphedema.

OBJECTIVE: Currently, the focus on limb lymphedema (LE) is on classification and staging. However, few scholars have conducted staging for Klippel-Trenaunay syndrome complicated LE (KTS-LE). This study aimed to investigate the value of the short time inversion recovery sequence of magnetic resonance imaging (MRI) in the staging of KTS-LE. METHODS: Forty-six patients who were diagnosed with KTS-LE were recruited for this retrospective study from July 2011 to November 2022. Referring to the clinical staging standard of lower extremity LE of the International Society of Lymphology in 2020, all patients were divided into three groups: stages I, II, and III. The MRI indicators of the three groups were recorded and statistically compared: LE range (unilateral bilateral, lower limbs, only thighs, only calves and ankles), abnormal parts (skin thickening, abnormal subcutaneous fat signal, abnormal muscle signal, muscle hypertrophy or contraction, abnormal bone signal, hyperostosis), and subcutaneous soft tissue signs (parallel line sign, grid sign, band sign, honeycomb sign, lymph lake sign, crescent sign, and nebula sign). RESULTS: There was a significant difference in the honeycomb sign among the three periods (P = .028). There was a significant difference between stage II and stage I disease (P < .05). There was a significant difference between stage II and stage III disease (P < .05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the honeycomb sign in diagnosing KTS-LE of stage II were 87.5%, 63.2%, 33.3%, 96.0%, and 67.4%, respectively. In contrast, the other signs were not statistically significant among the three periods. CONCLUSIONS: The short time inversion recovery sequence of MRI is of great value in KTS-LE. The honeycomb sign is an important imaging indicator for the diagnosis of stage II disease. It is necessary to evaluate the severity of edema with MRI for KTS-LE, which is very important for therapeutic options.

Quantitative evaluation of primary lower extremity lymphedema staging using MRI: a preliminary study.

Background: The staging of primary lower extremity lymphedema (LEL) is difficult yet vital in clinical work, and magnetic resonance imaging (MRI) can be used for quantitative assessment of primary LEL due to its high resolution for soft tissues. In this study, we evaluated the value of MRI-based soft tissue area measurements for staging primary LEL. Methods: A total of 90 consecutive patients with clinically diagnosed primary lower limb lymphoedema from January 2017 to December 2019 in Beijing Shijitan Hospital were enrolled retrospectively. Short time inversion recovery (STIR) sequence was applied to measure the total, muscle, bone, and subcutaneous areas in the upper 1/3 level of the bilateral lower calf. The difference between the affected and unaffected calf regarding the subcutaneous area was obtained, and (subcutaneous area)/(bone area) and (subcutaneous area)/(muscle area) were calculated. According to the International Society of Lymphology (ISL) clinical staging standard established in 2020, all patients were divided into stages I, II, and III, accordingly. Statistical analysis was performed to determine the validity of MRI measurements in staging LEL. Results: There were 33 patients classified as stage I clinically, 44 patients as stage II, and 13 patients as stage III. There were significant differences in total, subcutaneous, the difference in subcutaneous area of limbs, subcutaneous/bone (S/B), and subcutaneous/muscle (S/M) between stage I and II as well as between stage I and III (P<0.001), but not between stage II and III (P=0.706, 0.329, and 0.229, respectively). A positive correlation was detected between the clinical stage and difference in subcutaneous area of limbs (rho =0.752, P<0.001), S/B (rho =0.747, P<0.001), S/M (rho =0.709, P<0.001), and subcutaneous (rho =0.723, P<0.001). For staging primary LEL, receiver operating characteristic (ROC) curves indicated that the difference in subcutaneous area of limbs had the best discrimination ability among parameters [area under the ROC curve (AUC) =0.950; 95% confidence interval (CI): 0.875-0.987; sensitivity: 95.45%; specificity: 84.85%], followed by S/B (AUC =0.930; 95% CI: 0.848-0.975; sensitivity: 77.27%; specificity: 93.94%) and S/M (AUC =0.895; 95% CI: 0.804-0.953; sensitivity: 77.27%; specificity: 90.91%). The ROC curves indicated that subcutaneous area (AUC =0.927; 95% CI: 0.844-0.974; sensitivity: 84.09%, specificity: 90.91%) and total (AUC =0.852; 95% CI: 0.753-0.923; sensitivity: 70.45%; specificity: 90.91%) also had discrimination ability between stage I and II. Conclusions: The measurement of the soft tissue area of the calf may be used as an auxiliary method for staging primary LEL. For patients with unilateral primary LEL, the difference in subcutaneous area of limbs could be a specific indicator to distinguish clinical stage I from II.

Systematic lymphatic abnormality-related osseous lesions: a study based on CT lymphangiography.

Background: Few studies have focused on the morphology of systematic lymphatic abnormality-related osseous lesions. In this study, we classified systematic lymphatic abnormality-related osseous lesions into four types based on their morphology and density. We also discussed the imaging features of computed tomography lymphangiography (CTL) in this disease. Methods: In this retrospective cohort study, the clinical and imaging data of 39 patients with systematic lymphatic abnormality-related osseous lesions were collected. All patients underwent computed tomography (CT) scans of the chest and abdomen after direct lymphangiography, and two experienced radiologists evaluated the CTL features of intraosseous and extraosseous lymphatic vessel abnormalities. Results: Intraosseous osteolytic changes were observed in all 39 patients. According to the morphological density of the lesions, systematic lymphatic abnormality-related osseous lesions were classified into four types: cyst-like (76.9%), canal-like or honeycomb-like (87.2%), osteoporosis-like (41.0%), and osteosclerosis-like (20.5%), with abnormal deposits of lipiodol seen in the first two types. Enhanced CT of the thorax and abdomen was performed in 11 cases, and enhancement was not seen in any intraosseous lesions. Conclusions: The CTL features of systematic lymphatic abnormality-related osseous lesions have specific characteristics and are often accompanied by extraosseous abnormalities, which can provide a vital imaging basis for the diagnosis and differentiation of this disease.

Endoscopic classification and pathological features of primary intestinal lymphangiectasia.

BACKGROUND: The appearance of the intestinal mucosa during endoscopy varies among patients with primary intestinal lymphangiectasia (PIL). AIM: To classify the endoscopic features of the intestinal mucosa in PIL under endoscopy, combine the patients' imaging and pathological characteristics of the patients, and explain their causes. METHODS: We retrospectively analyzed the endoscopic images of 123 patients with PIL who were treated at the hospital between January 1, 2007 and December 31, 2018. We compared and analyzed all endoscopic images, classified them into four types according to the endoscopic features of the intestinal mucosa, and analyzed the post-lymphographic computed tomography (PLCT) and pathological characteristics of each type. RESULTS: According to the endoscopic features of PIL in 123 patients observed during endoscopy, they were classified into four types: nodular-type, granular-type, vesicular-type, and edematous-type. PLCT showed diffuse thickening of the small intestinal wall, and no contrast agent was seen in the small intestinal wall and mesentery in the patients with nodular and granular types. Contrast agent was scattered in the small intestinal wall and mesentery in the patients with vesicular and edematous types. Analysis of the small intestinal mucosal pathology revealed that nodular-type and granular-type lymphangiectasia involved the small intestine mucosa in four layers, whereas ectasia of the vesicular- and edematous-type lymphatic vessels largely involved the lamina propria mucosae, submucosae, and muscular layers. CONCLUSION: Endoscopic classification, combined with the patients' clinical manifestations and pathological examination results, is significant and very useful to clinicians when scoping patients with suspected PIL.

Enhanced computed tomography imaging features predict tumor grade in pseudomyxoma peritonei.

Background: Because few studies have focused on the correlation between computed tomography (CT) signs and tumor grade in pseudomyxoma peritonei (PMP), we evaluated predictive value of abdominal enhanced CT in identifying high- vs. low-grade cases. Methods: In all, 75 patients diagnosed with PMP after surgery were consecutively recruited. The preoperative enhanced CT images were retrospectively analyzed for ascites, hepatic scalloping, omental and peritoneal lesion appearance, intralesional calcification and septa, and peripheral organ involvement. Logistic regression models were applied to analyze the relationship of CT signs with PMP grade. Receiver operating characteristic curves were generated to evaluate the potential utility of CT signs in detecting high-grade PMP. Results: Massive ascites (P=0.017) and peritoneal solid nodules (P<0.001) were more common in high-grade cases. Multivariate logistic regression identified massive ascites [odds ratio (OR) =4.389, 95% confidence interval (CI): 1.210-15.921; P=0.025] and peritoneal solid nodules (OR =19.932, 95% CI: 3.560-111.596; P<0.001) as independent predictors of high-grade PMP. For the 55 patients with hepatic scalloping, the maximum thickness of mucin deposition at the hepatic scalloping wave in high-grade PMP was thinner than that in low-grade PMP (P=0.021). Thickness of mucin deposition at the hepatic scalloping wave (OR =0.346, 95% CI: 0.148-0.809; P=0.014) was an independent predictor of high-grade PMP, with a cutoff value of 18.6 mm. Cancer antigen 125 (CA125) combined with CT signs was significantly better at diagnosing high-grade PMP than was CA125 alone in both the overall patients [area under the ROC curve (AUC): 0.812 vs. 0.656; P=0.020] and those with hepatic scalloping (AUC: 0.859 vs. 0.600; P=0.007). Conclusions: The CT signs of high-grade PMP significantly differ from those of low-grade PMP, and thus combining CT signs with CA125 may be highly valuable for classifying PMP.

A Risk Score System Based on the Methylation Levels of 15 RNAs in Breast Cancer.

Background: Breast cancer (BC) occurs in the epithelial tissues of the breast gland, which is the most common cancer in women. This study is implemented to construct a risk score system for BC. Materials and Methods: The methylation data of BC from The Cancer Genome Atlas database (the training set) and GSE37754 from Gene Expression Omnibus database (the validation set) were downloaded. The differentially methylated RNAs (DMRs) between BC and normal samples were screened by limma package, and the correlations between the expression levels and methylation levels of the DMRs were analyzed to calculate their Pearson correlation coefficients (PCCs) using the cor.test function. To build the risk score system, the optimal RNAs were identified by penalized package. Subsequently, the nomogram survival model was established using the rms package. The lncRNA-mRNA comethylation network was constructed by Cytoscape software, and then enrichment analysis was performed using DAVID tool. Results: From the 1170 DMRs between BC and normal samples, 800 DMRs with significant negative PCCs were screened. For building the risk score system, the 15 optimal RNAs were selected. Afterward, the nomogram survival model based on four independent clinical prognostic factors (including age, radiation therapy, tumor recurrence, and RS model status) was constructed. In the comethylation network, the long noncoding RNA (lncRNA) PRNT was comethylated with FAM19A5 and RBM24. For the mRNAs in the comethylation network, angiogenesis and pathways in cancer were enriched. Conclusion: The risk score system and the nomogram survival model might be of great importance for the prognosis prediction of BC patients.

Unicentric Castleman disease: multidetector computed tomography classification with surgical and pathologic correlation.

BACKGROUND: This study aimed to correlate multidetector computed tomography (MDCT) classification of unicentric Castleman disease with the surgical and pathologic features. METHODS: The imaging manifestations of 63 cases of unicentric Castleman disease confirmed by pathology were retrospectively analyzed. Every patient underwent an MDCT examination. Classification based on imaging manifestations, surgical, histopathological, and imaging features were simultaneously reviewed and analyzed by two radiologists, with any disagreements resolved by consensus. RESULTS: Sixty-three patients with unicentric Castleman disease were divided into I-IV types by imaging manifestations: type I, single mass with smooth margin (n=5); type II, single mass with irregular or lobulated margin (n=33); type III, single invasive mass with blurred margin (n=20); and type IV, multiple fused masses (n=5). Thirty-eight cases of type I and type II were diagnosed as hyaline-vascular type by pathology after complete surgical resection; 20 cases were type III, in which eight cases were partially resected, 17 cases were pathologically diagnosed as hyaline-vascular type, and the remaining three cases were a mixed type. In five cases of type IV that could not be completely resected, four cases were hyaline-vascular type, and one case was plasma cell type. CONCLUSIONS: MDCT is an excellent tool for the detection and diagnosis of unicentric Castleman disease. Classification by MDCT features is a reliable method for evaluating tumor infiltration and growth mode, which helps surgical optimization.

Metal artifact reduction using mono-energy images combined with metal artifact reduction software in spectral computed tomography: a study on phantoms.

BACKGROUND: This study aimed to evaluate the effectiveness of spectral computed tomography (CT) mono-energy imaging combined with metal artifact reduction software (MARs) for metal implant artifact reduction using a phantom. METHODS: A quantitative standard phantom with 9 cylinders was used to simulate the attenuation of the different tissues of the human body around the metal implant. Groups A and B were divided according to conventional CT scan mode and spectral CT scan mode. Three sets of reconstructed images, including 120 kVp-like + MARs images, mono-energy images (MonoE), and MonoE + MARs images, were generated after spectral CT scanning. High-attenuation artifacts and low-attenuation artifacts were observed around the coil in the images of groups A and B. The CT values (Hounsfield unit) and standard deviation (SD) values of the artifacts were measured, and the artifact index and hardening artifact removal rate were calculated. RESULTS: Compared to conventional poly-energy CT images, for high-attenuation and low-attenuation artifacts, the artifact indices of 120 kVp-like + MARs, MonoE, and MonoE + MARs images were all reduced significantly. The hardening artifact removal rates of the high-attenuation and low-attenuation artifacts of 120 kVp-like + MARs images were 82% and 92%, respectively. The hardening artifact removal rate of the high-attenuation and low-attenuation artifacts of MonoE and MonoE + MARs images increased with the mono-energy level. CONCLUSIONS: Spectral CT using the 120 kVp-like + MARs, 110-140 keV MonoE, and MonoE + MARs reconstruction methods can reduce metal implant artifacts in varying degrees. MonoE + MARs reconstruction was the best method for reducing metal artifacts.

Diagnosis of Lymphangiomatosis: A Study Based on CT Lymphangiography.

RATIONALE AND OBJECTIVES: Lymphangiomatosis is a rare disease characterized by the widespread presence of lymphangiomas in any part of the body. In previous studies, lymphatic vessel abnormalities in lymphangiomatosis have only rarely been mentioned. The objective of this paper is to discuss the imaging features of lymphangiomatosis, including cystic lesions and lymphatic abnormalities, on computed tomography lymphangiography (CTL). MATERIALS AND METHODS: All 34 patients who were diagnosed with lymphangiomatosis underwent direct lymphangiography followed by CTL. The CTL images were independently analyzed by two experienced radiologists. The CTL image analyses included assessment of the features of cystic lesions and lymphatic vessel abnormalities. RESULTS: (i) CTL revealed several cystic lesions ranging in size from 3 mm to 14 cm; the lesions were located in the neck and shoulders (61.8%), mediastinum (52.9%), retroperitoneum (70.6%), and pelvis and perineum (64.7%). (ii) Approximately 29.4% of patients showed abnormal contrast medium accumulation in cystic masses. (iii) Approximately 67.6% of patients showed lymphatic reflux. (iv) Dilated lymphatic vessels were distributed in the mediastinum (38.2%), retroperitoneum (50.0%), pelvis and lower limbs (47.1%). (v) Finally, 8.8% of patients had perineal lymphatic fistulae, and 2.9% of patients had chyluria. CONCLUSION: Lymphangiomatosis is a type of systemic lymphatic abnormality that is accompanied by multiple cystic lesions. The therapeutic measures for lymphangiomatosis are determined by the size of the cystic lesions. Furthermore, the prognosis of lymphangiomatosis is affected by lymphatic abnormalities.

CT Lymphangiography (CTL) in Primary Intestinal Lymphangiectasia (PIL): A Comparative Study with Intraoperative Enteroscopy (IOE).

RATIONALE AND OBJECTIVES: To investigate the clinical feasibility of CT lymphangiography (CTL) in primary intestinal lymphangiectasia (PIL) by comparison with intraoperative enteroscopy (IOE) during exploratory laparotomy. MATERIALS AND METHODS: Eleven PIL patients (F/M, two/nine, age range 10-37 years) were recruited in this study, and they were performed IOE during exploratory laparotomy for suspected serious lymphatic-intestinal leakages. All the patients were performed CTL before surgery, and the imaging data were reviewed by two radiologists separately. CTL assessments included intestinal lesions, edematous lesions, intestinal and mesenteric lymphangiectasia, lymphaticabdominal leakages, lymph fluid reflux, lymphangioma and abnormal lymphatics in other area. The intestinal lymphangiectasia and lymphaticintestinal leakages were confirmed by histology and IOE. RESULTS: For CTL, (1) nine intestinal wall thickening; (2) eight ascites, complicated with four pleural effusions, (3) eight intestinal and mesenteric lymphangiectasia, (4) six lymph fluid reflux (5) one lymphatic-abdominal leakage, (6) two lymphangioma. While for IOE, intestinal lymphangiectasia has been confirmed in all patients, including five segemental and six diffusive lesions in intestinal mucosa. Besides, one lymphatic-intestinal fistula, one lymphatic-abdominal leakage was confirmed. Compared to IOE and histology, the accuracy of CTL was 72.7% in detecting intestinal lymphangiectasia. CONCLUSION: Compared to IOE, CTL demonstrates feasibility in detection of intestinal lymphangiectasia and other abnormalities in whole lymphatic circulation for PIL. Combination of CTL with IOE accommodates guidance for preoperative evaluation and therapeutic management for PIL.

Unipedal Diagnostic Lymphangiography Followed by Sequential CT Examinations in Patients With Idiopathic Chyluria: A Retrospective Study.

OBJECTIVE: The objective of our study was to investigate the clinical value of diagnostic lymphangiography followed by sequential CT examinations in patients with idiopathic chyluria. MATERIALS AND METHODS: Thirty-six patients with idiopathic chyluria underwent unipedal diagnostic lymphangiography and then underwent sequential CT examinations. The examinations were reviewed separately by two radiologists. Abnormal distribution of contrast medium, lymphourinary leakages, and retrograde flow were noted, and the range and distribution of lymphatic vessel lesions were recorded. The stage of idiopathic chyluria based on CT findings and the stage based on clinical findings were compared. Therapeutic management and follow-up were recorded. Statistical analyses were performed. RESULTS: Compared with CT studies performed after lymphangiography, diagnostic lymphangiography showed a unique capability to depict lymphourinary leakages in three patients. Lymphourinary fistulas and abnormal dilated lymphatic vessels were found in and around kidney in all patients. CT depicted retrograde flow of lymph fluid in 47.2% of patients. The consistency in staging chyluria based on CT findings and clinical findings was fair (κ = 0.455). Twenty-nine patients underwent conservative therapy, and seven underwent surgery. Surgical therapy was superior to conservative management (no recurrence, 85.7% of patients who underwent surgery vs 62.1% of patients who underwent conservative therapy; p = 0.025). CONCLUSION: From assessing the drainage of contrast medium on unipedal diagnostic lymphangiography and the redistribution of contrast medium on sequential CT examinations, it is possible to detect the existence of lymphourinary fistulas, the precise location of lymphatic anomalies, the distribution of collateral lymphatic vessels, and hydrodynamic pressure abnormality in the lymph circulation in patients with idiopathic chyluria. CT staging of chyluria provides additional information that can be used to guide therapeutic management.

Primary intestinal lymphangiectasia: Multiple detector computed tomography findings after direct lymphangiography.

INTRODUCTION: To analyse the findings of multiple detector computed tomography (MDCT) after direct lymphangiography in primary intestinal lymphangiectasia (PIL). METHODS: Fifty-five patients with PIL were retrospectively reviewed. All patients underwent MDCT after direct lymphangiography. The pathologies of 16 patients were confirmed by surgery and the remaining 39 patients were confirmed by gastroendoscopy and/or capsule endoscopy. RESULTS: After direct lymphangiography, MDCT found intra- and extraintestinal as well as lymphatic vessel abnormalities. Among the intra- and extraintestinal disorders, 49 patients had varying degrees of intestinal dilatation, 46 had small bowel wall thickening, 9 had pleural and pericardial effusions, 21 had ascites, 41 had mesenteric oedema, 20 had mesenteric nodules and 9 had abdominal lymphatic cysts. Features of lymphatic vessel abnormalities included intestinal trunk reflux (43.6%, n = 24), lumbar trunk reflux (89.1%, n = 49), pleural and pulmonary lymph reflux (14.5%, n = 8), pericardial and mediastinal lymph reflux (16.4%, n = 9), mediastinal and pulmonary lymph reflux (18.2%, n = 10), and thoracic duct outlet obstruction (90.9%, n = 50). CONCLUSIONS: Multiple detector computed tomography after direct lymphangiography provides a safe and accurate examination method and is an excellent tool for the diagnosis of PIL.

Computed tomography lymphangiography findings in 27 cases of lymphangioleiomyomatosis.

Background Lymphangioleiomyomatosis (LAM) is a rare disease involving the bronchi, lymphatic vessels, and veins. However, there are few reports about lymphatic vessel abnormalities associated with LAM. Purpose To evaluate computed tomography (CT) lymphangiography findings in cases of LAM, especially lymphatic vessel abnormalities. Material and Methods Twenty-seven patients with LAM underwent direct lymphangiography (DLG), followed by a post-procedural thoracoabdominal CT examination. Results All 27 patients were diagnosed with LAM, including 25 (93%) with chylothorax, eight (30%) with chyloperitoneum, seven (26%) with chylous fluid in the chest and abdomen, and one (4%) with lower-limb lymphedema. The CT lymphangiography showed that 27/27 (100%) patients presented iliac or retroperitoneal lymphatic vessel dilation; 20/27 (74%) presented thoracic duct outlet obstruction; 9/27 (33%) presented pleural lymph leakage; and 13/27 (48%) presented an abnormal distribution of contrast agent in the contralateral lumbar trunk, 3/27 (11%) in the pulmonary field, 1/27 (4%) in the abdominal cavity, and 4/27 (15%) in the pelvic cavity. Five of the 27 patients (19%) had retroperitoneal lymphangioleiomyomas, with contrast agent accumulation in three cases during CT lymphangiography. Two of the 27 (7%) patients had enlarged lymph nodes in the retroperitoneum. All 27 patients (100%) diagnosed with LAM displayed various lung cysts on thoracic high-resolution CT scans. Conclusion CT lymphangiography findings can be used to diagnose most LAM cases accurately. Moreover, these findings also display the various lymphatic vessel abnormalities associated with LAM.

Diffuse Pulmonary Lymphangiomatosis: MDCT Findings After Direct Lymphangiography.

OBJECTIVE: The aim of this study was to analyze the findings of MDCT performed after direct lymphangiography in patients with diffuse pulmonary lymphangiomatosis. MATERIALS AND METHODS: Twenty-three patients (13 male and 10 female patients) diagnosed with diffuse pulmonary lymphangiomatosis on the basis of clinical features and findings from imaging, bronchoscopy, and pathologic analysis were retrospectively evaluated. All patients underwent pulmonary MDCT after direct lymphangiography, surgical operation or open lung biopsy, and histopathologic examination. MDCT images were analyzed by two experienced radiologists independently. RESULTS: MDCT after direct lymphangiography revealed numerous intrathoracic abnormalities, including abnormal distribution of contrast medium, dilatation of lymphatic channels, mediastinal soft-tissue infiltration, and peribronchovascular thickening. Nineteen patients had interlobular septal thickening, 18 had diffuse ground-glass opacities, 22 had pleural effusion, 14 had extrapleural soft-tissue thickening, 20 had pericardial effusion and thickened pericardium, 10 had multiple lymphadenopathy in mediastinum, and five had mediastinal, pericardial, and thoracic aeroceles. CONCLUSION: MDCT performed after direct lymphangiography is well suited to clarify the characteristics of intrathoracic disorders and is an excellent tool in the diagnosis of diffuse pulmonary lymphangiomatosis.

[Efficiency of (99)Tc(m)-sestamibi in diagnosis of parathyroid diseases with primary hyperparathyroidism].

OBJECTIVE: To evaluate the efficiency of (99)Tc(m)-sestamibi (MIBI) in the diagnosis of parathyroid diseases with primary hyperparathyroidism. METHODS: One hundred and four cases with primary hyperparathyroidism underwent MIBI and parathyroidectomy between May 2010 to November 2013 were reviewed. With MIBI, single adenoma was found in 91 cases, two adenomas in 5 cases, carcinoma and hyperplasia in 3 cases respectively. Primary hyperparathyroidism was diagnosed based on the associated symptoms and signs in 93 patients, while it was indicated in 11 asymptomatic patients due to the presence of hypercalcemia in health examination. Parathroid hormone levels ranged from 98 to 2 800 ng/L, and serum calcium levels were between 2.56-4.23 mmol/L. RESULTS: The sensitivity of MIBI for total diseased parntyroids was 84.0% (100/119), and that for parathyroid adenoma, parnthyroid carcinoma, atypical adenoma and primary parathyroid hyperplasia was 87.1% (88/101), 3/3, 2/2 and 7/13, respectively. CONCLUSIONS: MIBI is efficient in the diagnosis of parathyroid diseases with primary hyperparathyroidism. The size and cystic degeneration of parathroid disease are two common factors decreasing MIBI reliability, and thyroid nodule is additional source leading to false-positive results.

Dual source CT angiography in popliteal artery entrapment syndrome.

AIM: To evaluate the clinical value of dual source computed tomography (DSCT) angiography in the diagnosis and treatment for popliteal artery entrapment syndrome (PAES). MATERIALS AND METHODS: 8 patients with PAES were retrospectively reviewed. 64-slice dual source CT angiography was performed based on the following protocol: 100 mL of Iopamidol (370 mgI/mL) was injected at a rate of 3.5 mL/s and arterial phase images were obtained by using bolus tracking. Axial DSCT images and reconstructed images including multi-planar reconstruction (MPR), maximum intensity projection (MIP), volume rendering (VR) were collected and analysed. All patients underwent Doppler colour ultrasound examinations and surgeries. RESULTS: The popliteal artery and the neighbouring muscular structures were clearly shown on the axial images revealing the cause of the arterial entrapment. Furthermore, the site and length of the segmental occlusion and collateral developments were well demonstrated on reconstructed images. Characterisation and classification based on DSCT angiography were confirmed by surgeries. PAES was accurately diagnosed by DSCT angiography in all enrolled patients. In contrary, only 5 PAES cases were accurately diagnosed by ultrasound examination. CONCLUSION: DSCT angiography is a noninvasive and valuable tool in the diagnosis of PAES and plays an important role in the determination of treatment plans.

[Retrospective analysis of relationship between radiological features and prognoses of pneumocystis pneumonia in non-AIDS immunocompromised patients].

OBJECTIVE: To elucidate the relationship between the radiological features and prognoses of pneumocystis pneumonia (PCP) in non-acquired immunodeficiency syndrome (non-AIDS) immunocompromised patients. METHODS: Retrospective analyses were performed for the radiological features and prognoses of 36 non-AIDS immunocompromised PCP patients hospitalized at Peking University First Hospital from April 2006 to April 2010. There were 24 males and 12 females with an average age of (51.7 ± 18.9) years. RESULTS: All patients underwent chest photographic examinations and chest computed tomography (CT) was performed on 29 of them. The overall case fatality rate (CFR) of 36 patients was 33.3% (12/36). At the start of anti-PCP treatment, there were normal chest radiography (n = 7), bilateral diffuse infiltration (n = 21), bilateral diffuse consolidation (n = 8), aerothorax, mediastinal emphysema or pneumohypoderma (n = 6) and numbers of deceased patients (n = 0, 8, 5 and 5 respectively). The CFRs of the patients with normal chest radiography and aerothorax, mediastinal emphysema or pneumohypoderma were both statistically significant as compared with the overall rate (P < 0.05). At the start of anti-PCP treatment, there were bilateral diffuse ground glass opacities (GGO) (n = 29), "mosaic sign" (n = 19), air bronchogram (n = 19), pulmonary consolidation (n = 17), bilateral pleural effusion (n = 7), thickened lobular septa (n = 6), cystic lesions (n = 5), aerothorax, mediastinal emphysema or pneumohypoderma (n = 4) and numbers of deceased patients (n = 8, 5, 5, 5, 2, 2, 2 and 4 respectively). The CFRs of the patients with aerothorax, mediastinal emphysema or pneumohypoderma were statistically significant as compared with the overall rate (P < 0.05). CONCLUSIONS: The major radiological features of PCP in non-AIDS immunocompromised patients are bilateral diffuse infiltration. And bilateral diffuse GGO on chest CT scans are usually accompanied with "mosaic" sign, air bronchogram or pulmonary consolidation. The prognoses are excellent for the patients with normal chest radiograph and poor for those with aerothorax, mediastinal emphysema or pneumohypoderma.