The 'double­track sign': A novel CT finding suggestive of the diagnosis of T1a gastric cancer.

Effective identification of T1a stage cancer is crucial for planning endoscopic resection for early gastric cancers. The present study aimed to determine the diagnostic value of the double-track sign in patients with T1a gastric cancer using computed tomography (CT) imaging. A total of 152 patients diagnosed with pathologically proven T1a gastric cancer at The First Affiliated Hospital of Zhengzhou University (Zhengzhou, China) between July 2011 and August 2021 were retrospectively reviewed. The control group consisted of 2,926 patients with gastritis. Clinical data, including patient characteristics and preoperative CT imaging findings with gastric morphological features, were reviewed and analyzed. Out of 51 patients with T1a gastric cancer finally included, 31 (60.8%) exhibited local double-track enhancement changes of the stomach, referred to as the 'double-track sign', on CT images. In addition, four patients (7.8%) had well-enhanced mucosal thickening of the gastric wall. Of the 2,926 control subjects, none had any double-track sign and six patients (0.2%) had local gastric wall thickening with abnormally strengthened enhancement. In conclusion, a double-track sign on CT images is beneficial in the diagnostic differentiation of T1a gastric cancer.

Analysis of influencing factors of nerve invasion in locally advanced gastric cancer.

OBJECTIVES: Accurate preoperative diagnosis of locally advanced gastric cancer (GC) with nerve invasion is very important for guiding the clinical formulation of a reasonable treatment plan, improving treatment efficacy, and improving prognosis. The present study sought to analyze and evaluate the clinicopathological features of locally advanced GC, and to explore the risk factors associated with the state of nerve invasion. METHODS: The clinicopathological data of 296 patients with locally advanced GC were retrospectively analyzed in our hospital from July 2011 to December 2020 who underwent radical gastrectomy. PNI is defined as a tumor close to the nerve and involving at least 33% of its circumference or tumor cells within any of the 3 layers of the nerve sheath. The patient's age, gender, tumor location, T stage, N stage, TNM stage, degree of differentiation, Lauren classification, microvascular invasion, as well as TAP, AFP, CEA, CA125, CA199, CA724, CA153, tumor thickness, longest diameter, and plain CT value, arterial phase CT value, venous phase CT value, arterial phase enhancement rate, venous phase enhancement rate were assessed. RESULTS: A total of 296 patients with locally advanced GC were included, and 226 (76.35%) were positive for nerve invasion. Univariate analysis showed that tumor T stage, N stage, TNM stage, Lauren classification, tumor thickness, and longest diameter were related to the state of nerve invasion (P < 0.05). Multivariate analysis showed that tumor TNM stage was an independent risk factor for nerve invasion (OR 0.393, 95%CI 0.165-0.939, P = 0.036). CONCLUSIONS: Tumor TNM stage is an independent risk factor for nerve invasion (+) in patients with locally advanced GC. Patients at high risk of nerve invasion should be followed closely and, if necessary, performed pathological examinations.

Gastric morphological type: A supplementary addition for the evaluation of gastric cancer.

Clinical and pathological features are important factors that affect the prognosis and treatment strategies of patients with gastric cancer (GC). An upper gastrointestinal barium X-ray examination is commonly used to show gastric mucosa and morphological changes. The aim of the present study was to evaluate the association between gastric morphological type and the clinicopathological features of patients with GC, based on double-contrast barium X-ray imaging. A total of 329 patients with GC who underwent upper gastrointestinal barium X-ray examination were analyzed. The gastric morphological type was divided into four types on barium X-ray images: Horn-type, hook-type, weak-type and waterfall-type stomach. The χ2 test or Fisher's exact test was used to assess the association between gastric morphological type and the clinicopathological features. There was a statistically significant difference in the location of GC between different types of gastric morphology. Hook-type and horn-type GC were commonly present in the lower region of the stomach, while waterfall-type GC was mainly located in the upper region of the stomach. The incidence of waterfall-type non-poorly differentiated GC was higher than that of other gastric types. The incidence of waterfall-type intestinal-type GC was higher than that of other gastric types, and horn-type GC was more common in mixed-type GC. There was a statistically significant difference in the T-staging of GC between different types of gastric morphology. In conclusion, gastric morphological type correlates with the location and T-stage distribution of GC.

Inflammatory myofibroblastic tumor of the bladder: Computed tomographic features.

Inflammatory myofibroblastic tumor (IMT) is a rare tumor with intermediate biologic potential, in which lack of understanding often poses difficulties in preoperative diagnosis and treatment. The aim of the present study was to characterize the computed tomography (CT) features of the bladder IMT. The CT images of nine pathologically confirmed bladder IMT were retrospectively reviewed. All patients underwent both unenhanced CT and contrast-enhanced CT. The diameter, location, contour, growth pattern, margin, boundary, density and enhancement pattern of the lesions were assessed. The mean Ki67 value of an irregular blood clot was 18% and that of no blood clot was 12%. A total of eight (89%) patients had one tumor and 1 (11%) patient had multiple tumors. An endophytic growth pattern was observed in 4 (44%) patients, an exophytic growth pattern in 2 (22%) patients, and a mixed growth pattern in 3 (33%) patients. The tumor manifests morphologically as either polypoid (n=5), or cauliflower-like (n=1) soft-tissue mass with a wide base in the cavity, or a limited thick-walled (n=3). The tumor margins were smooth (n=8) or lobulated (n=1), and the tumor boundaries were either clear (n=7) or ill-defined (n=2). The lesions showed either ring-shaped (n=3) or heterogeneous (n=6). The polypoid and cauliflower-like soft-tissue mass showed a symmetrical change in the center of the lesion after enhancement. The bladder IMT is mostly a single polypoid nodule in the superior wall, mostly endophytic growth, with ring-haped enhancement and symmetrical change after enhancement as its characteristic manifestations.

Imaging Findings and Clinical Features of Primary Spinal Epithelioid Hemangioendothelioma.

Rationale and Objectives: Primary spinal epithelioid hemangioendothelioma (SEHE) is an extremely rare angiocentric vascular neoplasm with inherent metastatic potential, which pursues a clinical course intermediate between hemangioma and angiosarcoma. The present study sought to present computed tomography (CT) and magnetic resonance imaging (MRI) findings and clinical features of primary SEHE and review the literature. Materials and Methods: Clinical data of four patients with primary SEHE confirmed by pathology from January 2011 to May 2020 were analyzed retrospectively. Two cases underwent CT scan, while 3 cases underwent MRI scan. Image observation included the tumor location, bone changes, morphology, density/signal characteristics, and enhanced features. Results: The four patients were all women who ranged in age from 25 to 74 years. Four cases of the lesions were in the vertebral body; among them, two cases involved the accessory of the vertebra. Soap bubble appearance was detected in 2 cases, honeycomb osteolytic appearance in 2 cases, a sclerotic margin in 3 cases, and accompanying vertebral compression fracture in 1 case. CT showed a slightly inhomogeneous low density with punctate high-density foci. MRI showed an inhomogeneous low signal on T1-weighted image (T1WI) and a high signal on T2WI. Contrast-enhanced CT/MRI demonstrated moderate to intensive inhomogeneous enhancement of the lesions. The discs were normal. In one case, lesions presented a dural tail sign. Conclusions: Primary SEHE is so rare in the clinic as an aggressive vascular tumor. The relatively typical clinical features and radiographic findings can help in preoperative diagnosis.

Disease state prediction for 2019 novel coronavirus (COVID-19) pneumonia using CT manifestations and body temperature dynamic analysis: A SQUIRE-compliant study.

ABSTRACT: 2019 Novel Coronavirus (COVID-19) is a new acute infectious disease of respiratory system, posed a great threat to human health because of its strong infectivity and rapid progress. This study aimed to assess the severity of COVID-19 Pneumonia by analyzing the change of CT manifestations and body temperature.This retrospective review included 22 patients with COVID-19 pneumonia. The imaging manifestations and clinical features were observed and evaluated.Most of the infected patients were men (13/22, 59%). Fever (>38°C) (17/22, 77%) and cough (6/22, 27%) were the main symptoms. Leukocytes count decreased in 23% of patients and lymphocyte decreased in 41%. Twenty-one patients with pneumonia had abnormal findings on chest CT. The special CT manifestations were observed at the first CT examination when the lesions progressed, including a single ground glass nodule with uneven density, multiple ground glass opacities distributed in subpleural, and the ground glass opacities confined in superior lobe. The special CT manifestations were observed at the first CT examination when the lesions resolved, including ground glass opacities with homogeneous density. The lesion involved in the bilateral lungs and the absorption of the lesions mainly occurred in bilateral inferior lobes. Three patients had normalized body temperature increased more than 1°C within 1 to 2 days after admission. Ten patients fluctuated more than 1°C within 1 to 7 days after admission and the second CT scans showed the disease was at the progressive stage.Dynamic analysis of CT manifestations and body temperature have the potential to predict the severity of COVID-19 pneumonia.

CT findings and clinical features of Epstein-Barr virus-associated lymphoepithelioma-like gastric carcinoma.

Epstein-Barr virus (EBV)-associated lymphoepithelioma-like gastric carcinoma (LELGC) is a rare primary stomach tumor, which has overlapping imaging features with mass forming gastric carcinoma (GC). The aim of our study was to present the computed tomography (CT) findings and clinical features of EBV-associated LELGC to increase awareness of this entity.The CT findings and clinical features of 4 patients with pathologically documented EBV-associated LELGC were retrospectively analyzed.Among the 4 patients, 3 were male, and 1 was female. The medium age was 51 years old. All cases were single lesions including 1 was in the gastric cardia, 1 was in the gastric body, and 2 were in the gastric antrum. A focal thickening of the gastric wall was conducted, with a large thickness-to-length ratio. The low-density stripe of the normal gastric wall abruptly terminated at the edge of the lesion. The CT images of 4 cases showed inhomogeneous density with the radiodensity values ranging from 25 to 48 HU. In addition, an ulcer was demonstrated with an irregular base and slightly raised borders in all cases. Enhancement after injection of contrast material was heterogeneous enhancement (n = 3) or homogeneous (n = 1). After enhancement, obvious enhancement was seen in 1 case, moderate enhancement was seen in 3 cases, with the peak value of the tumor in the portal phase. No evidence of lymph node involvement and distant invasion was observed.Although LELGC is quite rare, it should be considered in differential diagnosis of early GC, advanced GC, and lymphoma. The relatively typical CT appearance, combined the age and sex of patients, can suggest the diagnosis of LELGC.

Iodine Concentration in Spectral CT: Assessment of Prognostic Determinants in Patients With Gastric Adenocarcinoma.

OBJECTIVE: The purpose of this study was to use virtual monochromatic spectral CT to investigate the usefulness of iodine concentration (IC) and its correlation with clinicopathologically determined prognostic factors in gastric adenocarcinoma. SUBJECTS AND METHODS: From June 2012 to March 2015, 34 patients with gastric adenocarcinoma underwent arterial and portal venous phase spectral CT. The ICs in the arterial and portal venous phases were calculated and then normalized with the aorta as normalized IC (NIC). The surgical specimen was evaluated with CD34 staining to determine microvessel density (MVD). The correlation between imaging results and clinicopathologic findings was investigated for histologic grading, lymph node metastasis, serosal involvement, distant metastasis, pathologic TNM stage, and MVD. RESULTS: The mean arterial phase NIC value of tumors was 0.12 ± 0.03, portal venous phase NIC value was 0.39 ± 0.06, and MVD was 26.94 ± 7.87 vessels per high-power field (×400). Both arterial phase and portal venous phase NIC values were significantly higher in poorly differentiated gastric adenocarcinomas (p = 0.005) than in moderately differentiated tumors (p = 0.013). There was no significant correlation between NIC and serosal involvement or distant metastasis. There was significant correlation between the NIC and MVD in gastric adenocarcinoma (arterial phase NIC, p = 0.013; portal venous phase NIC, p = 0.001). However, neither the arterial nor the portal venous phase NIC of gastric adenocarcinoma had a significant relation to lymphatic metastasis or pathologic TNM stage. There was a significant difference between the high and low MVD groups with respect to portal venous phase NIC (p = 0.045). CONCLUSION: NIC can serve as a useful predictor of angiogenesis and degree of differentiation of moderately and poorly differentiated gastric adenocarcinomas.

Radiological and clinical features of primary NK/T-cell lymphoma involving the whole length of the esophagus: A case report.

Primary esophageal natural killer (NK)/T-cell lymphoma is a markedly rare tumor. There were only 6 cases of the disease identified prior to June 2015. In the present study, the aforementioned cases were validated, and relevant computed tomography (CT) results and clinical features of primary esophageal NK/T-cell lymphoma were determined, to increase awareness of this type of tumor. CT features and clinical presentations of a patient with pathologically confirmed esophageal NK/T-cell lymphoma was analyzed. The patient exhibited non-specific clinical symptoms and CT images revealed diffuse thickening of the entire length of the esophagus. The patient received cycles of systemic chemotherapy and subsequent chest CT images demonstrated prompt and marked shrinkage of the tumor. At the time of writing, the patient has survived for 24 months and experiences a good quality of life without postprandial fullness or difficulty swallowing solid food. In addition, the characteristics of 6 patients with complete clinical features of this type of tumor, on the basis of a review of published studies (online PubMed, Medline, Google Scholar, Chinese Biomedicine Database and China Journal Full Text Database search), were retrospectively analyzed. Although primary esophageal NK/T-cell lymphoma is a markedly rare tumor, it is considered to be included in differential diagnosis of patients presenting with a fungal or viral infection, therapy-related mucositis or reflux esophagitis. The final diagnosis of primary esophageal NK/T-cell lymphoma is on the basis of a combination of clinical, CT and histopathological results.

Neuroendocrine carcinoma of the stomach: clinical features and CT findings.

PURPOSE: The purpose of the study is to investigate the computed tomographic characteristic and clinical findings of gastric neuroendocrine carcinoma (G-NEC) to increase awareness of this disease. METHODS: Twenty-two patients with a diagnosis of G-NEC were identified through the PACS of our hospital from August 2010 to November 2014. The clinical data, computed tomography (CT) features, and pathology records were analyzed. RESULTS: Among the 22 patients, 21 were male (95.45%), and 1 was female (4.55%). The mean age was 63.5 years old. Positive rates of neuroendocrine markers were 77.28% for chromogranin A staining, 86.36% for synaptophysin staining. All cases were single lesions including 16 (72.73%) in the gastric fundus, 3 (13.64%) in the gastric body and 1 (4.55%) in the gastric angle. Additionally 2 (9.09%) were found in the gastric antrum. Gastric wall was local thickening in 15 cases, and mass formation in 7 cases, with the stenosis and deformation of the adjacent gastric cavity. The long-axis diameter of the lesions ranged from 1.2 to7.4 cm (mean diameter, 2.47 cm), and the long-axis diameter was <2 cm in 12 case, 2-7.4 cm in 10 cases. The radiodensity values of the lesions were homogeneous density in 15 cases ranging from 22 to 47 HU (mean 34 HU). An ulcer with an irregular base and slightly raised borders located in the stomach was seen in 19 cases. The CT images showed homogeneous enhancement in 15 cases and heterogeneous enhancement in 7 cases. Obvious enhancement was seen in two cases, moderate enhancement was seen in sixteen cases, and mildly enhancement was seen in four cases. The peak value occurred in the arterial phase in 5 cases and the peak value was seen in 17 cases in the portal phase. Eleven lesions invaded the gastric serosa, and lymphatic metastasis was observed in 21 cases, 8 of which were combined with liver metastasis. CT images revealed 2 cases of the liver metastasis had obvious enhancement. CONCLUSION: The CT features regarding location, incidence rates of ulcer and enhancement pattern described in our findings are common in all malignant gastric tumors. Therefore, the diagnosis of G-NEC must be confirmed with pathological test.