The value of coronary CT angiography in diagnosing ischemic stenosis / 中华放射学杂志

Objective:To assess the value of coronary CT angiography(CCTA) based vessel characteristics and plaque features in diagnosing ischemic stenosis.Methods:From April 2014 to June 2021, 129 patients (including a total of 158 coronary arteries) who underwent CCTA, then completed invasive coronary angiography (ICA) as well as fractional flow reserve(FFR) within 30 days were retrospectively enrolled. All coronary arteries were divided into ischemic group (FFR≤0.80, n=77) and non-ischemic group (FFR>0.80, n=81). Vascular characteristics, high-risk plaque features, quantitative parameters and the morphology of plaque were obtained from CCTA images. Independent samples t-test, Wilcoxon rank sum test and χ 2 test were used to compare afore-mentioned variables between the ischemic group and the non-ischemic group. The logistic regression model was used to analyze the risk predictors for ischemic stenosis. Results:Compared with non-ischemic group, the stenosis degree of coronary arteries in ischemic group was more serious(72.09%±8.55% vs. 63.52%±13.49%; t=4.765, P<0.001). The proportion of left anterior descending artery(LAD) lesions in ischemic group was higher than that of non-ischemic group [88.31%(68/77)vs. 55.56%(45/81); χ 2=20.793, P<0.001]. In terms of CCTA plaque characteristics, the ischemic group demonstrated longer plaque length, smaller minimum lumen area, larger plaque burden, increased percent plaque diffuseness, and diffuse lesions were more common. As for morphological characteristics of plaque, the proportions of plaques with rectangle shape, proximal longitudinal eccentric shape and distal longitudinal eccentric shape were higher than those of non-ischemic group, whereas cosine eccentric plaques were more common in the non-ischemic group( P<0.001). Multivariate logistic regression analysis showed that the stenosis severity(OR =1.09, 95 %CI 1.04-1.14, P<0.001), LAD involvement(OR =4.23,95 %CI 1.01-17.72, P=0.049), diffuse lesion(OR =6.71,95 %CI 1.43-31.52, P=0.016), proximal longitudinal eccentric shape (OR =3.77,95 %CI 1.27-11.16, P=0.017), and distal longitudinal eccentric shape (OR =3.91,95 %CI 1.19-12.85, P=0.025) were the independent influence factors for ischemic stenosis. Conclusion:The CCTA-based stenosis degree of coronary artery, LAD involvement, diffuse lesion, proximal longitudinal eccentric shape, distal longitudinal eccentric shape were important influence factors for ischemic stenosis.

Placas pleurales por inhalación de fibras de asbesto: reporte de dos casos y revisión de literatura / Pleural plaques by inhalation of asbestos fibers: report of two cases and literature review

INTRODUCCIÓN: Las placas pleurales por fibras de asbesto se caracterizan por lesiones compuestas por tejido fibroso que se ubican en la pleura parietal. Suelen aparecer hasta en un 3% a 58% de los trabajadores que estuvieron expuestos a fibras de asbesto, y en un 0,5% a 8% en población general. El OBJETIVO de este artículo es presentar dos casos clínicos de pacientes a los que se les detectó en la radiografía de tórax alteraciones pleurales posiblemente asociadas a la exposición a fibras de asbesto. CASOS CLÍNICOS: Caso 1. Paciente de sexo masculino de 49 años, trabajador de la construcción con antecedentes de exposición a fibras de asbesto. Se le realizó una radiografía de tórax con técnica OIT (Organización Internacional del Trabajo), la que evidenció alteraciones pleurales focales. Una tomografía axial computarizada de tórax, confirmó la presencia de placas pleurales. Caso 2. Paciente de sexo femenino de 79 años, jefa de hogar, sin exposición laboral conocida a fibras de asbesto. En una radiografía de tórax anteroposterior, se observó la presencia de una placa pleural focal. Se solicitó una tomografía axial computarizada de tórax, la que confirmó la presencia de placas pleurales. CONCLUSIÓN: La radiografía de tórax con técnica OIT es el instrumento básico para la identificación de enfermedades relacionadas con la exposición a fibra de asbesto. El estudio debe ser completado con una tomografía axial computarizada de tórax cuya sensibilidad es mayor permitiendo detectar tempranamente las anomalías pleurales. Es fundamental la historia ocupacional detallada ya que constituye el método más fiable y práctico para medir la exposición a fibra de asbesto.

INTRODUCTION: Asbestos fiber pleural plaque is characterized by lesions composed of fibrous tissue that are located in the parietal pleura. They usually appear in up to 3 to 58% of workers who were exposed to asbestos fiber, and 0.5 to 8% in the general population. The OBJECTIVE of this article is to present two clinical cases of patients who were detected in the chest radiograph pleural alterations associated with exposure to asbestos fibers. CLINICAL CASES: First case: 49-year-old male patient, building worker with a history of exposure to asbestos fibers. Focal pleural alterations were detected by a chest x-ray performed according ILO (International Labour Organization) technique. The presence of pleural plaques was confirmed in a computed tomography of the chest. Second case: Holder, without occupational exposure to asbestos fibers. An anteroposterior chest radiography showed the presence of focal pleural plaque in a CT scan of the chest. CONCLUSION: Chest x-ray with ILO technique is the basic instrument for the identification of diseases related to asbestos fiber exposure. The study should be completed with a CT scan of the chest whose sensitivity is greater, allowing early detection of pleural abnormalities. Detailed occupational history is essential, as it is the most reliable and practical method to measure asbestos fiber exposure.

Patrón crazy paving en una mujer joven: hallazgo inesperado y tratamiento no tradicional en un caso de proteinosis alveolar pulmonar / Crazy paving computed tomography pattern in a young woman: unexpected findings and non-traditional treatment in a pulmonary alveolar proteinosis case

El patrón llamado 'crazy paving' en tomografia computada de tórax (TAC) puede deberse a diferentes condiciones siendo una de ellas la Proteinosis Alveolar Pulmonar (PAP), rara condición que puede llevar a insuficiencia respiratoria y a menudo, a la muerte. Presentamos el caso de una mujer joven con una historia de un año de evolución de disnea progresiva y tos seca que consultó por un cuadro de aparición brusca de fiebre, calofríos, malestar general y falla respiratoria hipoxémica severa (PaO2 = 51,9 mmHg con FiO2 = 0,50) en la cual la TAC de tórax mostraba un patrón de empedrado o 'crazy paving' que significó un desafío diagnóstico resuelto finalmente con una biopsia pulmonar quirúrgica que mostró una PAP. Ante el fracaso del tratamiento tradicional de Lavado Pulmonar Total (LPT) se usó una aproximación terapéutica novedosa consistente en una serie de 4 lavados lobares con un perfluorocarbono, Perflubron (PFC) bajo anestesia local seguido por 5 sesiones de Plasmaféresis. Casi inmediatamente después de este tratamiento la paciente evidenció mejoría radiológica y funcional. La PaO2 fue de 89,9 mmHg respirando aire ambiental y la CVF y el VEF1 aumentaron alcanzado respectivamente el 77 y el 75% de sus valores normales de referencia. Dadas las características químicas y físicas del PFC, pensamos que es una alternativa válida al LPT en estos casos.

Crazy paving computed tomography pattern may be due to a number of causes, one of them being Pulmonary Alveolar Proteinosis, a rare condition leading to respiratory failure and often to death. We present the case of a young woman with a one-year history of progressive dyspnea and dry cough, who consulted for an acute onset of fever, chills, malaise and severe hypoxemic respiratory failure (PaO2 = 51.9 mmHg; FiO2 = 0.50) with a 'crazy paving' pattern on chest CT. This diagnostic challenge was resolved by a surgical lung biopsy that showed a pulmonary alveolar proteinosis. Taking into account that the traditional treatment using whole lung lavage had already failed in this patient, a novel therapeutic approach was settled. A series of 4 lobar lavages with a perfluorocarbon (Perflubron) under local anesthesia followed by 5 plasmapheresis sessions were carried out. The patient showed radiographic and functional improvement almost immediately after this treatment. PaO2 was 89.9 mmHg breathing room air and FVC and FEV1 increased to reach 77 and 75% respectively of their normal reference values. Because of its chemical and physical properties we think this novel therapeutic approach should be a valuable alternative to saline solution for whole lung lavage in these cases.

Ruptura pieloureteral espontánea bilateral durante un urotac: caso clínico / Bilateral spontaneous renal pelvis rupture during a computed tomography: report of one case

Spontaneous rupture of the urinary excretory system is a rare condition. It is mainly associated with obstruction of the excretory system and is usually unilateral. We report a 58 years old male who, during the performance of a computed tomography of the urinary system, felt an intense lumbar pain. A bilateral rupture at the level of the fornix was found. The patient had an uneventful evolution thereafter. Fifteen days later a new computed tomography showed indemnity of the urinary excretory system.

Bladder anatomical changes and dose variation during the course of intensity-modulated radiation therapy of cervical cancer / 中华放射肿瘤学杂志

Objective To investigate bladder anatomical changes and dose variation in patients with cervical cancer.Methods We analyzed 20 patients,undergoing external beam radiotherapy scanning cone beam CT(CBCT)before each fraction.Bladder was contoured on each CBCT,was projected onto the planning CT and assesses anatomical changes and dose variation.Results A total 451 CBCT images,for 20 patients were collected for analysis,show more change in bladder volume and position.In 15 cases bladder volume and V45 had no significant correlation(r=0.225 -0.473,all P>0.05),4 cases shows negative correlation(r=-0.564,P<0.05;r=-0.597,P<0.01;r=-0.942,P<0.01;r=-0.816,P<0.01),1 case shows positive correlation(r=0.662,P<0.01).Have more than the criteria(V45≤50%)number is 64/451(14.2%)in whole treatment.Conclusions For most patients by filling adequacy bladder,bladder dose variation is acceptable:CTV lager for individual patients should be closely observed its regression,implementation of the offline or online calibration.

Comparison of different threshold ~(18)FDG PET with computer tomography for defining gross tumor volume in non-small cell lung carcinoma / 中华放射肿瘤学杂志

Objective Under different standard uptake value(SUV),to assess gross tumor volume (GTV) definition for non-small cell lung cancer(NSCLC) with 18-fluoro-deoxy-glucose positron emission tomography (~(18)FDG PET) both under definite threshold (42 percent threshold) and various relative threshold (threshold SUV/maximum SUV) derived from the linear regressive function,threshold SUV=0.307?(mean target SUV)+0.588,with computer tomography (CT).Methods Of 20 patients with non-small cell lung cancer,the CT GTV (GTV_(?)).PET GTV with 42 percents threshold (GTV_(42%)) and PET GTV with relative threshold (GTV_(?)) were obtained and compared.Results The mean GTV_(42%),,mean GTV_(?) and mean GTV_(CT) was (13 812.5?13 841.4),(24 325.3?22 454.7) and (28 350.9?26 079.8)mm~3,respectively,with the difference in mean GTV among these three methods significant (F =10,P＜0.01).The GTV_(42%) was smaller than the GTV_(?) and the GTV_(CT)(P＜0.01),with i(?)significant difference between GTV_(?) and GTV_(CT)(P=0.125).Conclusion The relative threshold is more suitable to define the gross tumor volume than the definite threshold.

Imaging diagnosis of skull epidermoid cyst:analysis of four cases / 中华放射学杂志

Objective To study the CT and MR imaging features of skull epidermoid cyst. Methods CT and MR findings of 4 cases of pathologically proved skull epidermoid cyst were analyzed and correlated with operative and pathologic reports.Results CT and MR appearances of skull epidermoid cyst were as follows:(1)crater-form or scalloping deossification with sclerotic border and fatty density focus was detected on CT.(2)The lesions were isointense to hypointense relative to normal white matter in T1-weighted image,prominent hyperintense in T_2-weighted image,mild to moderate hyperintense in diffusion-weighted imaging(DWI),and isointense to hypointense in apparent diffusion coefficient(ADC) map on MR.Proton MRS revealed lactate(Lac)peaks at 1.3 ppm and amino acids(AAs)at 0.9 ppm. (3)No enhancement was found in substance region of all tumors on both enhanced CT and enhanced MR examinations.Conclusion CT and MR appearances of skull epidermoid cyst have unique features which are very helpful in the diagnosis of skull epidermoid cyst.

Imaging Diagnosis of Bone Benign Fibrous Histiocytoma / 实用放射学杂志

Objective To explore the image features of benign fibrous histiocytoma of bone and its correlative differential diagnosis.Methods Nine cases of benign fibrous histiocytoma of bone were retrospectively analyzed by comparing the imaging findings with surgical and pathological results.Results In all 9 cases,the tumors were single,ranged from 10 mm?15 mm?20 mm to 50 mm?50 mm?60 mm in diameter,which appeared as round or oval destruction with clear border in the bone,neither calcification nor ossification.The border of tumors in 5 cases was accompanied by integrated sclerosis ring with homogeneous thickness.There were expanding changes in 6 cases,no expanding changes in 3 cases.4 cases underwent MRI,2 cases were homogeneous,low signal on both T1WI and T2WI,and 2 cases were low signal on T1WI and high signal on T2WI with low signal sclerosis ring in circumference.There were no periosteum reaction and soft-tissue tumor in 9 cases.Conclusion X-ray,CT and MRI are valuable in the diagnosis of benign fibrous histiocytoma of bone,for some typical cases,the correctly diagnosis of it can be made before operation.

Comparative Study of Focal Nodular Hyperplasia:Radiologic and Pathologic Features / 实用放射学杂志

Objective To explore the pathological and imaging characteristics of focal nodular hyperplasia(FNH) of liver.Methods 17 cases of FNH proven pathologically underwent triphase spiral CT scan,of them,10 cases underwent fast MR imaging.The pathological andimaging features were comparatively analysed.Results All lesions were a solitary globular or lobulated mass,the majority of cases wasapproximately 2~5 cm in diameter.On plain CT and MRI,FNH was classically seen as a solitary,homogeneous and slightly hypoattenuating or isoattenuating area in comparison with normal liver,slightly hyper-or isointense on T_2WI,intense homogeneous enhancement during the arterial phase of enhanced imaging,and hyperattenuating in 12 cases,hypoattenuating or isoattenuating in 6 cases in comparison with normal liver during venous and delayed phase.The central scar was showed in 11 cases during delayed phase and 8 cases showed delayed enhancement,4 cases had pseudocapsular like enhancement in delayed images.In histology,17 cases of FNH were well limited but nonencapsulated,the hyperplastic parenchyma of the liver was subdivided into small nodules surrounded by the fibrous septa,there was a central scar composedof fibrous connective tissue and malformed vessels of various caliber.Conclusion The typical FNH can be easily diagnosed,while theatypical cases should be differentiated from hepatocelluar adenoma,hepatocellular carcinoma and hemangiomas.