CT perfusion combined with energy spectrum imaging to evaluate the short-term efficacy of bronchial arterial chemoembolization for lung cancer / 中华内科杂志

Objective: To evaluate the clinical value of dynamic volumetric CT perfusion combined with energy spectrum imaging in bronchial arterial chemoembolization (BACE) in patients with lung cancer. Methods: The data of 31 patients with lung cancer confirmed by pathology and treated with BACE in Lishui Central Hospital from January 2018 to February 2022 were retrospectively collected, including 23 men and 8 women, aged 31-84 (67) years. All patients received perfusion scans of lesion sites within 1 week before surgery and 1 month after surgery. We collected and compared the changes in preoperative and postoperative perfusion parameters such as blood flow (BF), blood volume (BV), mean through time (MTT), permeability surface (PS) and energy spectrum parameters including arterial phase CT value (CTA), venous phase CT value (CTV), arterial phase iodine concentration (ICA), venous phase of iodine concentration (ICV), arterial standardization iodine concentration (NICA), and intravenous standardized iodine concentration (NICV) to confirm the significance of these parameters in evaluating the short-term efficacy of BACE in the treatment of advanced lung cancer. Data normality was tested using the Kolmogorov-Smirnov test and normally distributed measurement data are expressed here as mean ± standard deviation; the independent-samples t-test was used for comparisons between two groups. The measurement data that were not normally distributed are expressed as median (interquartile interval) [M (Q1, Q3)], and the comparison between the two groups used the Kruskal-Wallis test. Count data are expressed as cases (%), and comparisons between groups used the χ2 test. Results: The objective response rate (ORR) and disease control rate (DCR) at 1 month after BACE were 54.8% (17/31) and 96.8% (30/31), respectively. CT perfusion parameters and energy spectrum parameters of patients before and after BACE treatment were compared. The results showed that BF, BV, MTT, ICA, ICV and NICV were significantly decreased after BACE treatment compared with before treatment, and the differences were statistically significant[58.06 (40.47,87.22) vs.23.57(10.92, 36.24) ml·min-1·100g-1,3.33(2.86,6.09) vs.2.12(1.96,3.61)ml/100g,2.70(2.19,3.88) vs.1.53 (1.12,2.25)s, 3.51 (3.11,4.14)vs.1.74 (1.26,2.50)mg/ml,2.00 (1.30,2.45) vs.1.32(0.92,1.76)mg/ml,0.51(0.42,0.57) vs.0.33(0.23,0.39)](all P<0.05). At the same time, compared with the non-remission group, the study results showed that the difference of parameters in remission group before and after BACE was more obvious, including ΔBF, ΔBV, ΔMTT, ΔPS, ΔCTA, ΔCTV, ΔICA, ΔICV, ΔNICA, ΔNICV were significantly increased, and the difference was statistically significant [36.82(32.38, 45.34) vs.9.50(-1.43, 12.34) ml·min-1·100g-1,4.46(2.52, 5.79) vs.0.22(-0.76, 4.09) ml/100g,4.22(2.25, 6.77) vs.0.43(-2.53, 1.88) s,10.07 (2.89, 13.13) vs.-2.01(-6.77, 4.28) ml·min-1·100g-1,14.22(11.88, 20.57) vs.4.18(-5.25, 6.37) HU, 34.6(14.88, 43.15) vs.11.60(0.26, 25.05) HU,0.95(0.54, 1.47) vs.0.11(0.20, 0.59) mg/ml,1.57(1.10, 2.38) vs. 0.26(-0.21, 0.63) mg/ml,0.05(0.03, 0.08) vs.-0.02(-0.04, 0.01),0.18(0.13, 0.21)vs. 0.11(-0.06, 0.16)](all P<0.05). Conclusions: CT perfusion combined with spectral imaging could effectively evaluate the changes in tumor vascular perfusion in patients with advanced lung cancer before and after BACE treatment, which has important value in judging the short-term efficacy after treatment.

Comparison and Correlation of Magnetic Resonance Imaging and Clinical Severity in Nonhuman Immunodeficiency Virus Patients with Cryptococcal Infection of Central Nervous System / 中华医学杂志(英文版)

Background@#The incidence of cryptococcal meningitis among immunocompetent patients increases, especially in China and imaging plays an important role. The current study was to find the correlation between magnetic resonance imaging (MRI) manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS).@*Methods@#A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study. All the patients had MRI data and clinical data. The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease. Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t- test, Chi-square test, Mann-Whitney test and Spearman rank correlation analysis.@*Results@#In all 65 patients, 41 cases (41/65, 63.1%; Group 1) had normal immunity and 24 cases (24/65, 36.9%; Group 2) had at least one identifiable underlying disease. Fever, higher percentage of neutrophil (NEUT) in white blood cell (WBC), and increased cell number of cerebral spinal fluid (CSF) were much common in patients with underlying disease (Group 1 vs. Group 2: Fever: 21/41 vs. 21/24, χ = 8.715, P = 0.003; NEUT in WBC: 73.15% vs. 79.60%, Z = -2.370, P = 0.018; cell number of CSF: 19 vs. 200, Z = -4.298, P < 0.001; respectively). Compared to the patients with normal immunity, the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs. Group 2: 20/41 vs. 20/24, χ = 7.636, P = 0.006). The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r = -0.472, P = 0.031; r = 0.779, P = 0.039; respectively).@*Conclusions@#With the increased number of the involved brain areas in patients with identifiable underlying disease, the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.

Value of spiral CT and its reconstruction technique in the diagnosis of gastrointestinal stromal tumors in the small intestine / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the spiral CT and its reconstruction techniques in diagnosis and localization of gastrointestinal stromal tumor originated in the small intestine.</p><p><b>METHODS</b>The data of spiral CT scan and MPR, STS-MIP of 24 patients with gastrointestinal stromal tumor in the small intestine confirmed pathologically were analyzed retrospectrvely.</p><p><b>RESULTS</b>Of 24 cases, 1 had multiple tumor, while the other 23 had single one. Seventeen of these tumors were benign and 7 malignant, with 2 in the duodenum, 12 in the jejunum and 10 in the ileum. The range of tumor diameters was from 2.5 to 12 cm. The main clinical characters of the tumors on the CT image: (1) The tumor of 15 cases located outside of the enteric cavity, 7 inside of the enteric cavity or presented as thicken bowel wall and 2 showed as niche sign. (2) The tumor shape of 19 cases were round-like, and 5 lobulated or irregular. (3) The tumor density of 12 cases was homegeneous, 7 heterogeneous and 5 map-like in the center. (4) The tumor enhancement style in 19 cases were homegeneous in dynamic enhanced scan, and 16 were slightly or mildly heterogeneous in the artery phase but apparently enhanced in the venous and equilibrium phase, with 5 showed as fast-in fast-out enhanced mode. Of those, one showed obvious enhancement in artery phase, while 2 did not. (5) The tumor of 2 cases had no clear margin and had invaded the surrounding tissue. (6) The arteries supplying tumors in 20 cases were demonstrated by multiple planar reconstruction (MPR), sliding thin slab-maximum intensity projection (STS-MIP). The accuracy of diagnosis and localization of gastrointestinal stromal tumor in the small intestine by spiral CT scan combined with MPR, STS-MIP were 91.7% (22/24) and 95.8% (23/24), respectively.</p><p><b>CONCLUSION</b>Spiral CT and its reconstruction techniques (MPR, STS-MIP) can play an important role in the differential diagnosis and localization of gastrointestinal stromal tumor originated in the small intestine.</p>

Diagnostic value of spiral computed tomography in adhesive ileus / 中国医学科学院学报

<p><b>OBJECTIVE</b>To discuss the diagnostic value of spiral computed tomography (CT) in adhesive ileus.</p><p><b>METHODS</b>We retrospectively analyzed 40 patients with adhesive ileus who were diagnosed by CT and confirmed by operations. The main reconstruction method included multi-planar reconstruction (MPR) and sliding thin slab-maximum intensity projection (STS-MIP).</p><p><b>RESULTS</b>Among all the 40 patients, localization diagnosis was correct in 32 patients (80%) and partially correct in 8 patients (20%). The main signs included: (1) dilated proximal intestinal canal and collapsed distal intestinal canal in 40 patients (100%); (2) smooth transitional zone in 39 patients (97.5%); (3) delayed enhancement of regional bowel in 33 patients (82.5%); (4) beak sign in 32 patients (80%); (5) adhesions balteum in 6 patients (15%); and (6) pseudotumor appearance in one patient (2.5%).</p><p><b>CONCLUSION</b>Spiral CT has an important value in detecting adhesive ileus.</p>