Effect of ultrasound and CT three-dimensional reconstruction in open reduction and internal fixation of fractured ribs / 国际外科学杂志

Objective:To evaluate the effect of ultrasound and CT three-dimensional reconstruction in open reduction and internal fixation of fractured ribs.Methods:A retrospective case-control study was conducted to analyze the clinical data of 112 patients with chest trauma and rib fractures admitted to Yan′an People′s Hospital from January 2021 to September 2023. According to the different preoperative positioning methods used, the reconstruction group was divided into a reconstruction group ( n=61) and a combined group ( n=51). The reconstruction group positioned the surgical incision position based on conventional CT three-dimensional reconstruction, while the combined group positioned the rib fracture end based on CT three-dimensional reconstruction combined with ultrasound. Record clinical data of two groups of patients and compare their preoperative positioning accuracy, average incision length, exposure time of fracture ends, fracture healing time, incision infection rate, surgical related indicators, visual analogue pain score (VAS) at one month after surgery, and surgical incision healing levels. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for inter group comparison; Comparison of count data between groups using chi-square test; The comparison of grade data were conducted using Mann-Whitney U test. Results:The preoperative localization accuracy, postoperative VAS at one month, and surgical incision healing grade A of the combined group patients were 94.4%, (2.26±0.48) points, 96.1%, respectively, the reconstruction group were 84.1%, (4.52±1.34) points, 72.1%, the combined group was better than the reconstructed group, the difference between the two groups was statistically significant ( P<0.05); The average incision length, fracture exposure time, fracture healing time, surgical time, and thoracic tube retention time of the combined group were (7.32±2.44) cm, (18.06±4.78) min, (48.16±4.58) d, (55.46±7.48) min, and (3.57±1.28) min, respectively. The reconstruction group were (10.16±2.86) cm, (29.45±5.65) min, (55.36±4.45) d, (64.36±7.52) min, and (7.49±1.52) min, respectively, the difference between the two groups was statistically significant ( P<0.05). Conclusion:Application of ultrasound combined with CT three-dimensional reconstruction in open reduction and internal fixation of fractured ribs can increase the preoperative positioning accuracy, which can guide the surgical incision, thus alleviating postoperative pain, facilitating postoperative healing, minimizing surgical trauma, and improving the patient′s prognosis.

Abdominal no Contrast and Contrast-Enhanced Multi-Slice CT After Orally Diluted Iodide in Diagnosis of Time Segment for Gastrointestinal Fistula Secondary to Acute Pancreatitis / 中国医学影像学杂志

Purpose To evaluate the diagnostic accuracy of abdominal plain scan and contrast-enhanced multi-slice CT after orally diluted iodide in time segment(Post-ODI ANCCE-MSCT)for gastrointestinal fistula(GIF)secondary to acute pancreatitis(AP).Materials and Methods A total of 108 patients with late AP in the prospective and continuously collected database of Hunan Provincial People's Hospital from January 2017 to December 2022 were retrospectively extracted.Their demographic information and clinical features were recorded and GIF were screened by Post-ODI ANCCE-MSCT.The comprehensive clinical diagnosis results within 5 days thereafter were used as reference standards.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Post-ODI ANCCE-MSCT for diagnosing GIF secondary to AP were calculated using a four-cell table,and the consistency of the two methods was evaluated by Kappa test and McNemar's test.Results Sensitivity was 91.5%(95%CI 78.7%-97.2%),specificity was 98.4%(95%CI 90.0%-99.9%),positive predictive value was 97.7%(95%CI 86.5%-99.9%),negative predictive value was 93.8%(95%CI 84.0%-98.0%),and the accuracy was 95.4%(95%CI 91.4%-99.3%),respectively.The Kappa value was 0.905,and P value was 0.375 via McNemar's test.Conclusion Post-ODI ANCCE-MSCT can diagnose GIF secondary to AP in a simple,non-invasive,rapid and accurate way,and provide earlier,more accurate and reliable image basis for clinical diagnosis and treatment.

The value of CT three-dimensional reconstruction combined with serum carbohydrate antigen 19-9 and carcinoembryonic antigen detection in the diagnosis and resectability evaluation of hilar cholangiocarcinoma / 中国基层医药

Objective:To investigate the value of three-dimensional reconstruction combined with serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) detection in the diagnosis and resectability evaluation of hilar cholangiocarcinoma (HCCA) before resectable lymph node metastasis.Methods:A total of 65 patients with suspected HCCA who were treated at Yiwu Central Hospital from June 2019 to June 2022 were included in the observation group. Thirty healthy people who concurrently underwent physical examinations in the same hospital were included in the control group. All participants underwent a CT three-dimensional reconstruction examination. Simultaneously, the automatic electrochemiluminescence immunoassay analyzer was used to measure serum levels of CA19-9 and CEA. The outcomes of percutaneous transhepatic cholangiography were used as the "gold standard". The consistency between CT three-dimensional reconstruction, CA19-9 detection, and CEA detection, either individually or combined, and the "gold standard" in the diagnosis of HCCA was evaluated.Results:Serum levels of CA19-9 and CEA in the observation group were (62.71 ± 10.63) U/mL and (62.71 ± 10.63) ng/mL, respectively, which were significantly higher than those in the control group [(12.37 ± 7.39) U/mL, (1.31 ± 0.97) ng/mL, t = 23.43, 11.59, both P < 0.05). The levels of CA19-9 [(71.69 ± 12.37) U/mL] and CEA [(8.89 ± 3.51) ng/mL] in patients with HCCA who had lymph node metastasis were significantly higher than those in patients with HCCA who had no lymph node metastasis [CA19-9 (56.78 ± 10.16) U/mL, CEA (6.45 ± 2.11) ng/mL, t = 4.14, 2.76, both P < 0.05].Compared with histopathological examination, the accuracy of CT three-dimensional reconstruction in typing was 85.00%. According to the "gold standard" diagnosis, CT three-dimensional reconstruction, CA19-9 detection, and CEA detection, alone and their combination, successfully detected HCCA in 22 cases (55.00%), 26 cases (65.00%), 31 cases (77.50%), and 38 cases (95.00%), respectively. The detection rate of HCCA was the highest when CT three-dimensional reconstruction, CA19-9 detection, and CEA detection were combined, and the difference was statistically significant ( χ2 = 18.15, P < 0.05). Compared with CT three-dimensional reconstruction (AUC: 0.808), CA19-9 detection (AUC: 0.721), and CEA detection (AUC: 0.703) individually, their combination (AUC: 0.913) had the highest value in the diagnosis of HCCA (all P < 0.05). Conclusion:CT three-dimensional reconstruction, CA19-9 detection, and CEA detection have a certain diagnostic value for HCCA, but the combination of CT three-dimensional reconstruction with the detection of serum levels of CA19-9 and CEA has a higher diagnostic value for HCCA, providing an effective reference for the preoperative evaluation of the resectability of HCCA in the clinic.

Clinical characteristics and CT findings of Pneumocystis Jirovecii pneumonia in 46 cases with hematological diseases / 中华血液学杂志

Objective: To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. Methods: A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. Results: In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients (χ(2)=11.039, P=0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all P>0.05) . Conclusion: The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.

CT study on safety target area of femoral neck model screw channel and establishment of a stable spatial coordinate system / 中华骨科杂志

Objective:To study the image features in direction and quantity on CT scans of the axial safety target area of Sawbone femoral neck screw tunnels and possibility of establishing a stable spatial cartesian coordinate system.Methods:After three-dimensional reconstruction of CT data of 40 Sawbone femoral necks, the real axial CT images (perpendicular to the surgical central axis) of each femoral neck were superimposed respectively to get the intersection, called axial safe target area(ASTA). With the anterior cortex of femoral neck basilar seen as a landmark, the spatial rectangular coordinate system ( x, y, z) was established to measure superior-inferior diameters (D-SI), anterior-posterior diameters (D-AP) and the oblique angles. Each intersection was overlapped to the original axial CT images to find coronal position of ASTA boundaries. In addition, coronal CT union (equivalent to anteroposterior X-ray) and sagittal CT union (equivalent to lateral X-ray) were obtained by images in situ superposition method, from which the coronal positions of the isthmus of the perspective boundary (D-SI and D-AP) were determined. The coincidence of the boundary positions of ASTA and those of the perspective isthmus was compared. Pearson correlation coefficients were calculated for the left and right sides respectively to analyze the correlation between D-SI and D-AP. Results:Every ASTA presented an oblique rounded quadrilateral, whose front base was flat and coincided with anterior cortex of femoral neck basilar (FNB). In this coordinate system, D-SI were 35.13±0.51 mm on the left and 30.98±0.82 mm on the right, while D-AP were 26.66±0.39 mm on the left and 27.53±0.72 mm on the right. There was no significant correlation between D-SI and D-AP (left: R=0.43, P=0.060, right: R=0.32, P=0.176, respectively). All the isthmus of X-ray boundary fell at the corresponding ASTA boundary. The oblique angles ranged from 8° to 29°, and all parameters were within the range of normal femoral neck (the anterior cortex of the femoral neck basilar is flat, with a D-SI range of 26-38 mm, a D-AP range of 17-29 mm, and an oblique angle range of 5°-53°). Conclusion:The intersection method can be used to conveniently acquire directional-quantitative-stable individualized ASTA of Sawbone femoral neck. Thus, a stable spatial cartesian coordinate system can be established based on the anterior cortex of femoral neck basilar.

Correlation analysis between muscle CT measurement parameters, energy expenditure and risk of acute exacerbation in patients with stable chronic obstructive pulmonary disease / 中国医师进修杂志

Objective:To explore the correlation between muscle CT measurement parameters, energy expenditure and acute exacerbation in patients with stable chronic obstructive pulmonary disease (COPD).Methods:The clinical data of 146 patients with stable COPD from March 2020 to November 2021 in Lu′an Hospital Affiliated to Anhui Medical University (Lu′an People′s Hospital) were retrospectively analyzed. The clinical data were recorded; the lung function was measured by bronchodilator test. The cross-sectional area and CT value of the pectoral muscle were measured by reconstructed CT images of the mediastinum; the total energy consumption was calculated by Weir formula. Acute exacerbations within 3 and 12 months were recorded. Multivariate Logistic regression was used to analyze the independent risk factors for acute exacerbation in patients with stable COPD. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of total energy expenditure, pectoral muscle cross-sectional area and pectoral muscle CT value for predicting acute exacerbation in patients with stable COPD.Results:Among 146 patients with stable COPD, 38 cases (26.03%) developed acute exacerbation within 3 months (acute exacerbation group), and 108 cases (73.97%) did not develop acute exacerbation (non-acute exacerbation group). The proportion of age<60 years old, rate of acute exacerbation within 12 months and rate of pulmonary function grading Ⅲ to Ⅳ in acute exacerbation group were significantly higher than those in non-acute exacerbation group: 71.05% (27/38) vs. 47.22% (51/108), 52.63% (20/38) vs. 30.56% (33/108) and 63.16% (24/38) vs. 37.96% (41/108), the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value were significantly lower than those in non-acute exacerbation group: (2 036.28 ± 163.13) J/d vs. (2 389.59 ± 204.71) J/d, (28.79 ± 3.45) cm 2 vs. (31.61 ± 4.56) cm 2 and (29.79 ± 3.06) HU vs. (34.52 ± 4.38) HU, and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that age ≥60 years old, lower total energy expenditure, smaller pectoral muscle cross-sectional area and lower pectoral muscle CT value were independent risk factors for acute exacerbation in patients with stable COPD ( OR = 26.493, 1.015, 1.245 and 1.437; 95% CI 3.745 to 187.405, 1.008 to 1.022, 1.002 to 1.546 and 1.109 to 1.861; P<0.01 or <0.05). The ROC curve analysis result showed that combined prediction of the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value for acute exacerbation in patients with stable COPD had the largest area under the curve (0.962), with a sensitivity of 86.1%, a specificity of 80.8%, and the optimal cutoff values of 2 206.12 J/d, 32.39 cm 2 and 31.63 HU, respectively. Conclusions:The elderly age, smaller pectoral muscle cross-sectional area, lower pectoral muscle CT value and lower total energy expenditure are independent risk factors for acute exacerbation in patients with stable COPD. The combination of pectoral muscle cross-sectional area, pectoral muscle CT value and total energy expenditure has a good predictive effect on the risk of acute exacerbation in patients with stable COPD, and relevant indexes can be paid attention to in clinical treatment.

Multi-slice spiral CT manifestations of perivascular epithelioid cell tumors / 中国基层医药

Objective:To investigate CT manifestations of perivascular epithelioid cell tumors.Methods:The multi-slice spiral CT manifestations in 11 patients with perivascular epithelioid cell tumors which were pathologically confirmed in the First Affiliated Hospital of Shantou University Medical College between October 2012 and August 2021 were retrospectively analyzed.Results:Perivascular epithelioid cell tumors were located in the kidney of eight patients, in the right lobe of the liver of two patients, and in the descending colon of one patient. The largest tumor, approximately 20.0 cm × 26.0 cm × 11.0 cm, was located in the kidney. The smallest tumor, 2.4 cm × 2.6 cm × 3.4 cm, was located in the colon. CT plain scans showed uniform density without bleeding, calcification, or fat in two patients, and non-uniform density with fatty change in two patients. Contrast-enhanced CT images showed non-uniform enhancement in the arterial phase in 10 patients and uniform enhancement in one patient. Contrast-enhanced CT images showed decreased degrees of enhancement of the lesions in 11 patients from the portal venous phase to the delayed phase and dilated and tortuous vascular shadows in 11 patients.Conclusion:The multi-slice spiral CT manifestations of perivascular epithelioid cell tumors are characteristic and the multi-slice spiral CT is of value for the diagnosis of perivascular epithelioid cell tumors.

Diagnostic value of thin-layer three-dimensional reconstruction technology combined with personalized scanning for benign and malignant solid solitary pulmonary nodules / 中国基层医药

Objective:To investigate the diagnostic value of thin-layer three-dimensional reconstruction technology combined with personalized scanning for benign and malignant solid solitary pulmonary nodules.Methods:The clinical data of 140 patients with solid solitary pulmonary nodules admitted to Jiangshan People's Hospital form January 2020 to July 2021 were retrospectively analyzed. These patients consisted of 40 patients with benign solid solitary pulmonary nodules (benign group) and 100 patients with malignant solid solitary pulmonary nodules (malignant group). All patients underwent thin-layer three-dimensional reconstruction combined with personalized scanning. The pulmonary nodule signs achieved by thin-layer three-dimensional reconstruction combined with personalized scanning and the diagnostic performance of the combined technology were compared between benign and malignant groups.Results:The proportions of patients with lung cavity sign, lobular sign, vascular convergence sign, vacuole sign, emphysema distribution sign, split pleura sign, and distal perforating vascular sign in the malignant group were 11.0%, 81.0%, 77.0%, 49.0%, 6.0%, 10.0% and 31.0%, respectively, and they were 42.5%, 62.5%, 55.0%, 27.5%, 20.0%, 32.5%, and 5.0%, respectively in the benign group ( χ2 = 15.80, 5.00, 5.66, 4.55, 4.76, 8.96, 9.33, all P < 0.05). The most sensitive sign was lobular sign, which had the highest efficiency, up to 82.0%, in differentiating benign and malignant pulmonary nodules. Conclusion:Lung cavity sign, lobular sign, vascular convergence sign, vacuole sign, emphysema distribution sign, split pleura sign, and distal perforating vascular sign differ greatly between patients with benign and malignant solid solitary pulmonary nodules. Lobular sign has the highest sensitivity in differentiating benign and malignant solid solitary pulmonary nodules. Thin-layer three-dimensional reconstruction combined with personalized scanning has a diagnostic value for benign and malignant solid solitary pulmonary nodules.

A new classification of atlas fracture based on CT reconstruction and its clinical significance / 中华骨科杂志

Objective:To investigate the clinical significance of a new classification system for atlas fractures based on pre- and post-treatment CT features, with a focus on diagnosis and treatment.Methods:A retrospective analysis was conducted on 75 cases of cervical vertebra fractures treated at the Sixth Hospital of Ningbo City between January 2015 and December 2020. The study included 44 males and 31 females, with an average age of 53.3±13.0 years (range: 27-81 years). The fractures were classified according to the Landells classification, resulting in 12 cases of type I, 13 cases of type II, 33 cases of type III, 9 cases that were difficult to classify due to fracture lines located at anatomical junctions, and 8 cases that could not be classified using the Landells classification due to diverse injury mechanisms. To establish a new preliminary classification for cervical vertebra fractures, the researchers considered whether the fracture line in the CT images involved the facet joint surface of the atlas, the impact on bilateral half-rings, and the displacement distance of the fracture ends. Five spinal surgeons were randomly selected to classify the CT images of the 75 patients using the new classification method. After one month, the imaging data of the 75 cases of cervical vertebra fractures were randomized and reclassified to assess the reliability and repeatability of the classification.Results:The new cervical vertebra fracture classification method comprised three types based on whether the fracture line involved the facet joint surface of the atlas: type A (no involvement of the facet joint surface of the atlas), type B (involvement of one side of the facet joint surface with intact contralateral half-ring), and type C (involvement of one side of the facet joint surface with fractured contralateral half-ring). Additionally, based on the maximum displacement distance between the fracture ends (>4 mm), six subtypes were identified: subtype 1 (≤4 mm displacement) and subtype 2 (>4 mm displacement). Consequently, the subtypes were classified as A1, A2, B1, B2, C1, and C2. According to the new classification method, the 75 patients included 17 cases of A1, 12 cases of A2, 7 cases of B1, 13 cases of B2, 12 cases of C1, and 14 cases of C2. The classification demonstrated excellent consistency, as assessed by the five doctors, with Kappa values of 0.85 and 0.91 for reliability and repeatability, respectively. At the final follow-up, all conservatively treated patients achieved bone healing, while four surgically treated patients experienced non-union of the fracture ends but exhibited good fusion between the atlas and axis. The remaining surgically treated patients achieved bony union without complications such as loosening or fracture of internal fixation.Conclusion:The new cervical vertebra fracture classification method, based on CT imaging features, comprehensively covers common clinical cases of cervical vertebra fractures and demonstrates excellent consistency. It provides valuable clinical guidance for the diagnosis and treatment of cervical vertebra fractures.

Construction of containing CT imaging features Nomograms model of postoperative intraluminal thromus formation in patients with aortic dissective aneurysm / 中国医师进修杂志

Objective:To investigate the construction of containing CT imaging features Nomograms model of postoperative intraluminal thromus (ILT) formation in patients with aortic dissective aneurysm (ADA).Methods:One hundred and twenty patients with Stanford type B ADA treated with overlapping stent endoluminal repair and multilayer spiral CT (MSCT) examination in Affiliated Hospital of Jining Medical College from May 2020 to February 2022 were selected. The patients were divided into the modeling population (84 patients) and the validation population (36 patients) according to a 7∶3 ratio. The factors influencing postoperative ILT formation in ADA patients were analyzed by univariate and Logistic multifactor regression models, and the prediction model of postoperative ILT formation was constructed based on the influencing factors.Results:In the modeled population, the rate of ILT formation within 1 month after luminal repair with overlapping stents was 27.38%(23/84), including 5 cases in the aortic arch and 18 cases in the abdominal aorta. In the modeled population, the results of univariate analysis showed that the sex, age, body mass index(BMI), smoking, drinking, hypertension, hyperlipidemia, rupture diameter, rupture distance from left subclavicular artery, involvement of important branches, uneven thickening of aneurysm wall, low density on plain scan and operation timing between the ILT formation group and non-ILT formation group had no statistically significant ( P>0.05). The diabetes mellitus, irregular inner wall, calcified plaque, postoperative anticoagulant therapy, B-type brain natriuretic peptide (BNP), fibrinogen (Fib), D-dimer (D-D) and C-reactive protein (CRP) between the two groups had statistical differences: 43.48%(10/23) vs. 11.48%(7/61), 86.96%(20/23) vs. 57.38%(35/61), 91.30%(21/23) vs. 62.30%(38/61), 21.74%(5/23) vs. 57.38%(35/61), (523.60 ± 128.74) ng/L vs.(271.83 ± 109.65) ng/L, (3.82 ± 0.96) g/L vs. (2.85 ± 0.83) g/L, (601.37 ± 75.62) μg/L vs. (389.20 ± 68.79)μg/L, (0.63 ± 0.19) mg/L vs. (0.48 ± 0.15) mg/L, P<0.05. The results of Logistic multifactor regression analysis showed that diabetes mellitus, irregular inner wall, calcified plaque, postoperative anticoagulant therapy and BNP, Fib, D-D CRP levels were influential factors for postoperative ILT formation in Stanford type B ADA patients ( P<0.05). The C-index of the model was 0.903 and 0.894 for the modeled and validated populations, respectively, which had good discrimination and was good at predicting ILT formation after operation in Stanford type B ADA patients. The model had good clinical utility in predicting postoperative ILT formation in Stanford B ADA patients. Conclusions:The Nomograms model can help to screen and identify patients with high risk of ILT formation at an early clinical stage.

Application of multi-slice spiral CT combined with three myocardial markers in the diagnosis of acute chest pain causes / 中国医师杂志

Objective:To investigate the value of multi-slice spiral CT (MSCT) combined with three myocardial markers in the diagnosis of acute chest pain etiology.Methods:A retrospective study was conducted on 120 patients with acute chest pain admitted to the Affiliated Hospital of Jining Medical University from January 2020 to December 2020. All patients underwent MSCT imaging examination upon admission, and serum creatine kinase isoenzyme MB (CK-MB), troponin I (cTnI), and myoglobin (MYO) levels were also tested. The final clinical diagnosis was used as the judgment standard to draw a 2×2 four-square table, and calculate the value of MSCT, CK-MB, cTnI, and MYO in the diagnosis of acute chest pain etiology.Resultsl:Among the 120 acute chest pain patients included, 75 were diagnosed with acute coronary syndrome (62.50%), 16 with aortic dissection (13.33%), and 29 with pulmonary embolism (24.17%). The coincidence rate of MSCT diagnosis of coronary heart disease was 86.67%(65/75), the diagnosis of aortic dissection coincidence rate was 12/16, and the diagnosis of pulmonary embolism coincidence rate was 75.86%(22/29). The serum CK-MB, cTnI, and MYO levels in the coronary heart disease group were significantly higher than those in the aortic dissection group and pulmonary embolism group, and the differences were statistically significant (all P<0.05). There was no significant difference in serum CK-MB, cTnI, and MYO levels between the aortic dissection group and pulmonary embolism group (all P>0.05). The sensitivity of CK-MB, cTnI, and MYO in the differential diagnosis of acute chest pain patients with coronary heart disease and non-coronary heart disease were 93.33%, 85.33%, and 89.33%, respectively, and the specificity were 73.33%, 80.00%, and 77.78%, respectively. The areas under the receiver operating characteristic (ROC) curve were 0.833, 0.826, and 0.836, respectively. Conclusions:MSCT can better identify coronary heart disease, aortic dissection, and pulmonary embolism in patients with acute chest pain, while the three myocardial markers can better distinguish patients with coronary heart disease and non-coronary heart disease. Therefore, MSCT combined with myocardial markers should be used for the diagnosis of acute chest pain patients in clinical practice to facilitate early clinical diagnosis.

Evaluación multimodal del hematoma subdural crónico

Introducción: El hematoma subdural crónico es la complicación tardía más frecuente del trauma craneoencefálico. Su diagnóstico precoz y el tratamiento oportuno permiten la evolución favorable y curación de los pacientes. Objetivo: Sistematizar los diferentes ejes de clasificación del hematoma subdural crónico, que permitan la evaluación multimodal con una orientación más precisa de la técnica quirúrgica. Métodos: Se realizó una revisión bibliográfica en las principales bases de datos disponibles, centrada en las diferentes clasificaciones clínicas y radiológicas del hematoma subdural crónico y se seleccionaron 26 artículos. Se escogieron las principales clasificaciones y escalas y se aplicaron en 22 pacientes, obteniéndose resultados preliminares. Resultados: Las escalas de evaluación clínica de Bender, Marckwalder y la clasificación de Gordon Firing son las más conocidas, sin embargo, existen clasificaciones tomográficas que tienen en cuenta la densidad, la homogeneidad del hematoma que son de gran importancia en la selección de la técnica quirúrgica. La presencia de membranas y tabiques aparecen solo incluidas dentro de la valoración de la densidad del hematoma. Existen otras con valor predictivo que identifican aquellos factores relacionados con las recurrencias, desde antes de la cirugía, las mismas se consideran un factor de mal pronóstico para la evolución final de los pacientes con este tipo de hematomas. Conclusiones: La evaluación preoperatoria exige de la aplicación de múltiples escalas, la identificación y caracterización de las membranas es importante para personalizar la técnica quirúrgica, en busca de disminuir la morbilidad y mortalidad posoperatoria.

Introduction: Chronic subdural hematoma is the most frequent late complication of cranioencephalic trauma. The early diagnosis and correct treatment allow the recovery of patients. Objective: To systematize the different criteria of classification of chronic subdural hematoma that leads the multimodal evaluation for more effective selection of surgical technique. Methods: A review of literature about chronic subdural hematoma was done in the main database focused on different clinical and radiological classifications and 26 articles were selected. The main classifications and scales were chosen and applied to 22 patients, obtaining preliminary results. Results : Benders, Marckwalder and Gordon Firing scales are the most common, nevertheless there are tomographic classifications that include density, homogeneity of hematoma that are of great importance in the selection of the surgical technique. The presence of membranes and septum are only included in the evaluation of hematoma density. There are some others with predictive value that identify those factors related to recurrences before surgery that are considered a bad prognosis to the final evolution of these patients with this type of hematoma. Conclusions: The previous evaluation to surgery requires the use of different scales, the identification and characterization of membranes are important to select the optimum surgical technique to decrease morbidity and mortality after surgery.

Long-term prognosis evaluation value of normal coronary computed tomography angiography in patients with suspected coronary heart disease / 中国医师进修杂志

Objective:To explore the long-term prognosis evaluation value and risk factors of normal coronary computed tomography angiography (CCTA) in patients with suspected coronary heart disease (CHD).Methods:The clinical data of 332 patients with suspected CAD from June 2006 to July 2017 in the First Affiliated Hospital of Dalian Medical University were retrospectively analyzed. All patients received more than 2 times of CCTA examination, and the baseline CCTA was normal. Patients were followed up for at least 4 years, and the endpoints were coronary neo-plaque on CCTA or cardiovascular events.Results:Among 332 patients, the interval time between baseline and follow-up CCTA and clinical follow-up time were (5.6 ± 0.5) and (9.8 ± 0.6) years, 304 patients had normal baseline and follow-up CCTA (group Ⅰ); 28 patients had normal baseline CCTA while abnormal follow-up (group Ⅱ), the patient found coronary neo-plaque, and the incidence of coronary neo-plaque was 8.4% (28/332). Two patients (0.6%, 2/332) suffered from cardiovascular events, all of whom were in group Ⅱ. In group Ⅱ, a total of 34 coronary neo-plaques were found on follow-up CCTA. Multivariate Logistic regression analysis results showed that smoking, hypertension and hyperlipidemia were the independent risk factors of normal baseline while follow-up CCTA with neo-plaque in patients with suspected CAD ( β = 0.84, 0.83 and 0.84; OR = 2.37, 2.32 and 2.33; P<0.01). Conclusions:The suspected CAD patients with normal baseline CCTA have a good long-term prognosis. However, the patients who have risk factors such as smoking, hypertension and hyperlipidemia should be taken seriously, especially the patients who have normal baseline while follow-up CCTA with neo-plaque.

Feasibility study of percutaneous placement of lumbar cortical bone trajectory screws based on CT data / 中华骨科杂志

Objective:To simulate the placement of percutaneous cortical bone trajectory (CBT) screws on reconstructed CT images and three-dimensional lumbar model and to measure the morphometric parameters for guiding the placement of percutaneous CBT screws.Methods:The CT images of 100 adult patients with lumbar spine diseases were studied. The CT images were reconstructed using Mimics software. Taking the projection point on the lamina at the junction of the inner and lower edge of the smallest coronal section of lumbar pedicle as the entry point, the cephalad angle, lateral angle, maximum screw length, maximum screw diameter, distance between trajectory and spinous process were measured. At the same time, the relationship between the trajectory and spinous process was observed by using the reconstructed three-dimensional image.Results:The lateral angle of the trajectory from L 1 to L 5 were 9.3° (8.9°, 9.8°), 9.6° (8.9°, 9.8°), 10.4° (9.5°, 11.3°), 11.81°±1.24° and 13.6° (12.5°, 14.5°), respectively. The cephalad angle from L 1 to L 5 were 26.6° (26.0°, 27.0°), 26.2° (25.7°, 26.5°), 26.9° (26.5°, 27.4°), 25.94°±0.92° and 24.3° (22.7°, 25.4°), respectively. Significant statistic differences were found among all levels in the cephalad angles and lateral angles. The mean diameters of the trajectory from L 1 to L 5 were 5.65±0.49 mm, 6.38±0.60 mm, 6.91±0.67 mm, 7.42±0.76 mm and 8.33 (7.59, 9.01) mm, respectively. Except L 1 and L 5, there were significant differences among all levels in the maximum screw diameters. The mean length of the trajectory from L 1 to L 5 were 36.4 (35.4, 37.0) mm, 36.7 (35.8, 37.3) mm, 37.6 (37.1, 38.1) mm, 37.8 (37.3, 38.1) mm and 36.2 (35.2, 36.9) mm, respectively, and there were also significant differences among all levels. The ration in superior endplate for each segment were 41.08% (34.36%, 45.60%), 37.94% (32.97%, 43.63%), 40.18% (34.56%, 44.49%), 38.61% (34.80%, 46.24%) and 40.9% (35.32%, 46.02%), respectively and statistical differences were significant between L 1 and L 2 and L 2 and L 5. The mean distance between the trajectory and the spinous process from L 1 to L 5 were 7.27±1.23 mm, 7.19 (5.97, 8.28) mm, 7.32 (6.01, 8.28) mm, 7.31±1.36 mm and 7.45 (6.32, 8.23) mm, respectively. In the sagittal CT image, the tip of the trajectory located near the posterior two-fifths of the superior end plate, and the extended line of the trajectory located at the inferior edge of spinous process. In the three-dimensional reconstruction model, no obstruction was found between the simulated screws and the spinous process. Conclusion:Lumbar CBT screw can be implanted percutaneously, and spinous process will not hinder the implantation process. Spinous process and upper endplate can be used as a sign to guide the percutaneous CBT screw implantation. Digital analog screw placement can offer a useful reference for the clinical application of percutaneous cortical bone trajectory screw.

Diagnostic value and clinical significance of MRI combined with MSCT in ischiofemroal impingement syndrome / 中国医师杂志

Objective:To explore the diagnostic value and clinical significance of total volume of quadratus femoris muscle (TQFMV), ischial angle, femoral neck angle (FNV) measured by magnetic resonance imaging (MRI) combined with eccentric distance and lesser trochanter height measured by multi-slice spiral CT (MSCT) in the diagnosis of ischiofemoral impingement (IFI) syndrome.Methods:A total of 82 patients with IFI in Beijing Huairou Hospital from October 2017 to July 2020 were selected as the observation group. In addition, 82 healthy patients who underwent MRI and MSCT were collected as the control group. The general data, MRI and MSCT parameters of the two groups were compared, and IFI influencing factors were analyzed by logistic regression. The correlation between MRI and MSCT parameters and clinical manifestations and the correlation between MRI and MSCT parameters were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of MRI and MSCT parameters for IFI.Results:There were statistically significant difference between the two groups of gender, age, MRI parameters (TQFMV, ischial angle, FNV), and MSCT parameters (eccentricity, lesser trochanter height) (all P<0.05). Logistic regression analysis showed that gender, age, MRI parameters (TQFMV, ischial angle, FNV), MSCT parameters (eccentricity, lesser trochanter height ) were all influencing factors of IFI (all P<0.05). MRI parameters (TQFMV, ischial angle, FNV), MSCT parameters (eccentricity, lesser trochanter height) were all related to quadratus femoris muscle (QFM) edema, fat infiltration and pain degree in IFI patients (all P<0.05). The MRI parameter TQFMV of IFI patients was positively correlated with the MSCT parameter eccentricity and lesser trochanter height, while the ischial angle and FNV were negatively correlated with the MSCT parameter eccentricity and lesser trochanter height (all P<0.05). The AUC of MRI parameters (TQFMV, ischial angle, FNV) and MSCT parameters (eccentricity, lesser trochanter height) in the diagnosis of IFI were high, especially the highest in combined diagnosis, reaching 0.859. Conclusions:MRI parameters TQFMV, ischial angle, FNV and MSCT parameters, eccentricity and lesser trochanter height are related to the clinical manifestations of IFI patients. Combined detection of them can improve the diagnostic value of IFI and avoid missed diagnosis and misdiagnosis.

Clinical study of venous phase CT value in predicting central group lymph node metastasis of papillary thyroid carcinoma / 国际肿瘤学杂志

Objective:To investigate the clinical value of imaging features of primary lesions combined with venous phase CT value in predicting central group lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC) .Methods:Clinical data of 170 PTC patients who underwent central group LN dissection in the First People's Hospital of Handan City of Hebei Province from January 2017 to June 2020 were retrospectively analyzed. All patients were divided into different groups according to whether central group LN metastasis or not, and there were 89 patients with central group LN metastasis and 81 patients without central group LN metastasis. The CT value and imaging features of primary lesions in different periods were analyzed, and the imaging features of primary lesions combined with venous phase CT values to predict the central group LN metastasis were evaluated by the receiver operating characteristic (ROC) curve.Results:There were no statistically significant differences in CT value in plain scan phase and CT value, net increased CT value, standardized CT value in arterial phase between patients with and without central group LN metastasis (all P>0.05) . The CT value, net increased CT value and standardized CT value in venous phase of patients with central group LN metastasis were (113.84±22.95) HU, (59.05±12.10) HU and 0.72±0.14 respectively, which were significantly higher than those of patients without central group LN metastasis [ (103.99±17.67) HU, (51.29±14.45) HU and 0.59±0.10] ( t=3.26, P<0.001; t=3.81, P<0.001; t=3.67, P<0.001) . ROC curve analysis showed that the area under the curve for diagnosing central group LN metastasis of PTC patients was 0.75, 0.70 and 0.76 when the cut-off values of CT value, net increased CT value and standardized CT value in venous phase were 115.78 HU, 62.37 HU and 0.75 respectively. There were statistically significant differences in the diameter of primary focus and the contact area of thyroid capsule between patients with and without central group LN metastasis ( Z=-2.34, P=0.019; Z=-2.08, P=0.037) . There were no statistically significant differences between calcification and primary lesion location (both P>0.05) . Lesion diameter >2 cm (87.73%) and capsule contact range ≥1/2 (92.17%) had the highest specificity in predicting central group LN metastasis. The imaging features of primary lesion combined with standardized CT value in venous phase was in good agreement with histopathological diagnosis results in predicting central group LN metastasis (Kappa=0.475) , and the sensitivity and specificity were 73.12% and 82.75% respectively. Conclusion:The imaging features of the primary lesion combined with CT value in venous phase have a good clinical value in predicting central group LN metastasis in PTC patients. Patients with primary lesion diameter >2 cm, capsule contact range ≥1/2 and the standardized CT value in venous phase >0.75 are more likely to have central group LN metastasis.

Comparison of diagnostic value of ultrasound and multi-slice spiral CT in wrist joint lesions of rheumatoid arthritis / 中国医师进修杂志

Objective:To investigate the diagnostic value and imaging characteristics of ultrasound and multi-slice spiral CT in rheumatoid arthritis (RA) wrist joint lesions.Methods:The clinical data of 54 cases of RA wrist arthropathy in Jianhu Hospital Affiliated to Nantong University from December 2018 to April 2020 were analyzed. All the patients were examined by ultrasound and multi-slice spiral CT. The imaging characteristics of ultrasound and multi-slice spiral CT were analyzed, and the detection rates of synovitis, joint effusion, tenosynovitis, bone erosion and wrist joint lesions were calculated.Results:A total of 1 188 joints were examined in 54 patients with RA, including 108 wrist joints, 540 metacarpophalangeal joints and 540 proximal interphalangeal joints. There was no significant difference in the detection rate of wrist joint synovitis, joint effusion and tenosynovitis between ultrasound and CT ( P>0.05). The wrist joint lesions detection rates of ultrasound and CT were 97.2%(105/108) and 46.3% (50/108), the difference was statistically significant ( χ2 = 36.52, P<0.05). Ultrasound image features: synovitis ultrasound image showed hypoechoic joint cavity, not by joint displacement or compression image, color Doppler flow imaging (CDFI) examination could see blood flow signal;joint effusion in ultrasound image of joint effusion was strip, strip-shaped, non-uniform distribution, image was affected by joint displacement or compression, CDFI examination had no blood flow signal; bone erosion ultrasound image showed bone cortical continuous interruption or "crater" "insect erosion" like defects. CT imaging features: wrist joint space narrow, osteoporosis, some patients with scaphoid, distal radius visible bone erosion. Conclusions:The detection rate of wrist synovitis, joint effusion and tenosynovitis by ultrasound and multi-row spiral CT are similar. The multi-row spiral CT examination have a slight advantage in evaluating the joint space and bone changes. The sensitivity of wrist bone erosion and wrist joint lesions are higher than those of multi-row spiral CT, which can guide the early clinical diagnosis and treatment of RA.

CT parameter changes and imaging analysis of each cerebral lobe in patients with monophasic depression / 中国基层医药

Objective:To analyze the imaging changes of patients with monophasic depression based on the changes in CT parameters of each cerebral lobe.Methods:A total of 100 patients with monophasic depression who received treatment in Department of Radiology, Shaoxing 7 th People's Hospital between June 2019 and June 2021 were included in the observation group. An additional 100 healthy individuals who concurrently received physical examination were included in the control group. CT scan of the brain was performed in all participants. CT value of each cerebral lobe was compared between the two groups. Results:CT values of the left frontal lobe and left temporal lobe in the observation group were (40.88 ± 2.01) HU and (40.21 ± 3.01) HU, respectively, which were significantly lower than those in the control group ( tleft frontal lobe = 2.94, P = 0.004; tleft temporal lobe = 3.29, P = 0.001). CT values of the right frontal lobe and right temporal lobe in the observation group were (40.09 ± 2.52) HU and (44.93 ± 3.03) HU, respectively. There were no significant differences in CT values of the right frontal lobe and right temporal lobe between the two groups ( tright frontal lobe = 1.89, P = 0.060; tright temporal lobe = 1.89, P = 0.060). There were no significant differences in CT values of the left and right occipital lobes and the left and right parietal lobes between the two groups (all P > 0.05). One-way analysis of variance revealed that the CT values of the left and right frontal lobes were negatively correlated with age (-0.441, -0.211) and course of disease (-0.445, -0.191) (both P < 0.05); the CT values of the left and right frontal lobes were not significantly correlated with 24-item Hamilton Depression Rating Scale score and the number of attacks (all P > 0.05). The CT values of the left and right temporal lobes (-0.207, -0.213), the left and right occipital lobes (-0.185, -0.195) and the left and right parietal lobes (-0.185, -0.180) were negatively correlated with age (all P < 0.05). The CT values of the left and right temporal lobes, the left and right occipital lobes, and the left and right parietal lobes were not significantly correlated with course of disease, 24-item Hamilton Depression Rating Scale score, and the number of attacks (all P > 0.05). Conclusion:The left and right frontal lobe and the left temporal lobe are atrophic in patients with monophasic depression. The degree of atrophy is closely related to the course of disease. Therefore, these findings can be used as a reference for imaging diagnosis of degenerative diseases of the central nervous system.

Caracterización tomográfica de las membranas en pacientes con hematoma subdural crónico

Introducción: El hematoma subdural crónico es un hematoma encapsulado por dos membranas interna y externa. Existen diferentes clasificaciones imagenológicas que incluyen las características de estas lesiones, pero la presencia de las membranas y sus características es un aspecto poco descrito. Objetivo: Describir las características tomográficas de las membranas de los hematomas subdurales crónicos. Métodos: Se realizó un estudio descriptivo en el Servicio de Neurocirugía en conjunto con el Servicio de Imagenología, del Hospital Universitario Manuel Ascunce Domenech durante el año 2021. Se incluyeron 20 pacientes adultos que fueron operados con el diagnóstico de hematoma subdural crónico. Las membranas se caracterizaron de acuerdo con su densidad, grosor, número de capas, morfología y extensión. Resultados: Predominaron los pacientes de más de 65 años del sexo masculino, con hematomas unilaterales más frecuentes del lado izquierdo. El volumen promedio fue de 150 ml y el diámetro fue de 3 cm. Fueron más frecuentes las membranas finas, hiperdensas, incompletas, de una sola capa y la morfología fue variable. Conclusiones: Las membranas que conforman el hematoma subdural crónico pueden observarse en la tomografía axial computarizada. Se han encontrado diferentes tipos de membranas de acuerdo con su densidad, grosor, morfología, extensión y presencia de tabiques. La presencia de una membrana gruesa o fina con tabiques, puede tener indicación de una craneotomía que permita la resección cuidadosa de la membrana parietal y la apertura suficiente de la visceral para facilitar la re expansión cerebral y disminuir la incidencia de recolecciones.

Introduction: Chronic subdural hematoma is a hematoma encapsulated by two internal and external membranes. There are different imaging classifications that include the characteristics of these lesions, but the presence of the membranes and their characteristics is a little described aspect. Objective: To describe the tomographic characteristics of the membranes of chronic subdural hematomas. Methods: A descriptive study was carried out in the Neurosurgery service in conjunction with the Imaging service of the Manuel Ascunce Domenech University Hospital during the year 2021. 20 adult patients who underwent surgery with the diagnosis of chronic subdural hematoma were included. The membranes were characterized according to their density, thickness, number of layers, morphology and extension. Results: Male patients over 65 years of age predominated, with more frequent unilateral hematomas on the left side. The average volume was 150 ml and the diameter was 3 cm. Thin, hyperdense, incomplete, single-layer membranes were more frequent, and the morphology was variable. Conclusions: The membranes that make up the chronic subdural hematoma can be seen on computerized axial tomography. Different types of membranes have been found according to their density, thickness, morphology, extension and presence of septa. The presence of a thick or thin membrane with septa may indicate a craniotomy that allows careful resection of the parietal membrane and sufficient opening of the visceral membrane to facilitate brain re-expansion and reduce the incidence of recollections.

Encondroma: a propósito de un caso / Enchondroma: a case report

RESUMEN Fundamento: los tumores óseos son lesiones frecuentes, cada tipo histológico tiene patrones típicos que los identifican. Sin embargo, en ocasiones se pueden presentar de forma atípica. Objetivo: conocer el caso de una paciente con encondroma en la región proximal de la tibia derecha. Presentación del caso: mujer de 74 años de edad, blanca con antecedentes de hipertensión arterial y asma bronquial, la cual acude a la consulta de Ortopedia y Traumatología por dolor a nivel de la rodilla derecha que aumenta con la actividad física y se acompaña de limitación funcional y crepitación articular. La tomografía axial computarizada mostró imagen osteoblástica a nivel de la meseta tibial derecha sin ruptura de la cortical. Además se evidenció múltiples quistes subcondrales de aspecto degenerativo, presencia de osteofitos tibiales, femorales ipsi y contralateral, espacio femoro-rotuliano muy disminuido asociado a esclerosis del cóndilo femoral. Con los elementos descritos se decidió llevar la paciente al quirófano, para tratamiento de tipo quirúrgico. Se realizó exéresis de la tumoración, la que fue enviada al departamento de anatomía patológica para estudio histológico que confirmó el diagnóstico. La zona de hueso extraída se llenó con cemento quirúrgico. Conclusiones: el encondroma es un tumor benigno de origen cartilaginoso, su presencia por encima de los 40 años de edad es ocasional y constituye el principal diagnóstico diferencial del condrosarcoma de bajo grado histológico. Debido a lo infrecuente de esta afección fuera de su rango de edades, es necesaria la biopsia para confirmar el diagnóstico.

ABSTRACT Background: bone tumors are common lesions, there are specific features related to each histological type, but unusual and atypical presentations do occur. Objetive: to show the case of a patient with an enchondroma in the proximal right tibial plateau. Case report: a 74 year old white woman, who had had previous personal history of hypertension and asthma is taken to the Orthopaedic and Traumatology outpatient department complaining of right knee pain which gets worse with physical activity associated to limited range of motion and articular crepitus. CT scan showed an osteoblastic lesion in the proximal upper right tibial plateau without cortical breaking. On the other hand, multiple subchondral degenerative cysts were found in the knee joint as well as osteophytes, sclerosis and joint space narrowing. Taken into account the entire previous patient' features, surgery was performed and consist of tumor resection with bone cement filled. The specimen was send to the pathology department showing enchondroma. Conclusions: enchondroma is a benign cartilaginous bone tumor unfrequently found over 40 years of age, the main differential diagnosis is low grade chondrosarcoma. Because of the infrequent presentation of this case in regards to age, surgery was warranted to confirm diagnosis.