[Comparative study of identification of pulmonary perfusion with dual source computed tomography in diagnosing pulmonary embolism].

OBJECTIVE: To explore the diagnostic value of dual source computed tomography (CT) in the diagnosing acute pulmonary embolism (PE). METHODS: A total of 20 cases with suspected PE were scanned by dual source CT and the data were analyzed with the software packages of conventional 3D, pulmonary embolism detection (PED), lung vessels and lung PBV. The examination with the highest detection rate was used to screen for pulmonary segment of PE and verify the diagnostic consistency with dual-energy perfusion imaging (DEPI) on pulmonary segment of PE. RESULTS: The detection rates for PE in pulmonary artery branches were all 30% for CTPA, lung vessels and PED. There were no statistical difference. The detection rates for PE in pulmonary lobar arteries were 47.0%, 49% and 50% for CTPA, lung vessels and PED. There were no statistical difference. The detection rates for PE in pulmonary segment arteries were 14.2%, 19.7% and 26.1% for CTPA, lung vessels and PED. Statistical differences existed among CTPA, lung vessels and PED. The detection rates for PE in pulmonary subsegment arteries were 3.7%, 4.5% and 7.0% for CTPA, lung vessels and PED. Statistical differences existed between PED, CTPA and lung vessels. No statistical difference existed between CTPA and lung vessels. PED had the higher clinical value on the diagnosis of PE of pulmonary segmental artery and inferior segmental artery. The sensitivity of DEPI for PE was 85.7%, specificity 94.1% and kappa 0.789. The diagnosis on PE of DEPI and PED image had a higher consistency. CONCLUSION: The dual-energy scanning of dual source CT has higher practical values in the diagnosis of PE. And PED can visualize the pulmonary artery segment and a downstream segment of PE. Pulmonary perfusion imaging may show the perfusion abnormalities due to pulmonary blood flow changes. A combination of both increases the diagnostic rate of PE.

Imaging findings and clinical features of atypical retroperitoneal abscess caused by duodenal perforation: a case report and review of the literature.

INTRODUCTION: A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the head of the retroperitoneal pancreas. CASE PRESENTATION: A 28-year-old Chinese man presented with fever and abdominal pain after overeating and heavy drinking. On physical examination, he had mild tenderness in his upper abdomen. Laboratory examination results showed a white blood cell count of 24.06 109/L and a neutrophil absolute value of 18.81 109/L, and a computed tomography scan showed an irregular soft tissue mass with uneven enhancement of the cystic wall in the retroperitoneal space. Gastroscopy showed that there was a fistula in the anterior wall of the duodenal bulb. Endoscopic anastomosis clip system (over-the-scope clip) of the duodenal fistula was performed successfully. After the operation, nasal feeding was provided with a nutrition tube, and empiric anti-infection, acid-inhibiting, and stomach-protecting treatments were administered. Our patient's body temperature gradually returned to normal, and his abdominal pain decreased. CONCLUSIONS: A retroperitoneal abscess caused by duodenal perforation can be diagnosed by clinical symptoms and abdominal computed tomography imaging. The choice of treatment should be based on accurate and timely clinical and imaging data.

Imaging findings of inflammatory myofibroblastic tumor in breast: A case report.

RATIONALE: Inflammatory myofibroblastic tumors (IMTs), particularly breast IMTs, are rare neoplastic lesions typically associated with a favorable prognosis. Breast IMTs are easily misdiagnosed as other types of malignant lesions, and therefore there is a significant unmet need for a better preoperational differential diagnosis based on imaging manifestations. Here, we report the imaging findings of a breast IMT and compare our findings with previously published features of breast IMTs. PATIENT CONCERNS: The patient, a 43-year-old female, reported the presence of a palpable lump within her left breast. An ultrasound examination revealed an irregular hypoechoic mass with unclear boundaries. Mammography demonstrated a mass of heterogeneous and striped density with granular calcification. Magnetic resonance image (MRI) inspection displayed an irregular tissue lump with an undistinguishable boundary and a further dynamic contrast-enhanced MRI disclosed an associated efflux change. DIAGNOSES: Breast inflammatory myofibroblastic tumors. INTERVENTIONS: Breast needle biopsy and mammary resection were performed. Pathological staining of the bulk resected tumor after preoperative preparation revealed that the tumor-like tissue was enriched for spindle cells arranged in fascicular clusters. Histopathological diagnosis and immunohistochemistry confirmed the mass as being a breast IMT. OUTCOMES: No metastatic recurrence was found during 6-month or 1-year follow-ups. LESSONS: Breast IMTs commonly develop in elderly women with atypical imaging features. They are primarily composed of lobular soft tissues infiltrated with an abundant focal blood supply and granular calcification. Development of breast IMTs is closely related to trauma. A preliminary diagnosis of such masses can be made based on combined manifestations of both clinical and imaging features, while a final confirmation still requires pathological staining. Imaging examinations are of value for such tumors to define the lesion edges and their associations with adjacent tissues.

Quantitative evaluation of intravoxel incoherent motion diffusion-weighted imaging (IVIM) for differential diagnosis and grading prediction of benign and malignant breast lesions.

BACKGROUND: That breast carcinoma is the most common malignant lesion in women. This study aimed to differentiate benign from malignant breast lesions and to predict grading of the latter by comparing the diagnostic value of different parameters in intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). MATERIALS AND METHODS: Retrospective analysis was performed utilizing imaging and pathological data from 112 patients with 124 breast lesions that underwent IVIM-DWI examination with 3.0 T MRI. Out of 124, 47 benign and 77 malignant lesions were confirmed by pathological diagnosis. The diagnostic performance of f, D, and D* value to distinguish benign from malignant breast lesions, was evaluated using pathological results as the gold standard. Correlation between D value and Ki-67 index was evaluated to predict grading of malignant breast lesions. RESULTS: The D value (0.99 ±â€Š0.21) of patients with malignant lesions was significantly lower than that (1.34 ±â€Š0.18) of patients harboring benign lesions (P = .00). The D* value (7.60 ±â€Š2.10) in malignant lesion group was higher than that (6.83 ±â€Š2.13) of the benign lesion group (P = .113). The f value (8.50 ±â€Š2.13) in malignant lesion group was remarkably higher than that (7.68 ±â€Š1.98) of benign lesion group (P = .035). For differential diagnosis of benign from malignant breast lesions, optimal diagnostic threshold of D value and f value were 1.21 and 7.86, respectively. The areas of D and f values under the ROC curve were 0.883 and 0.601, respectively. The sensitivity, specificity, and accuracy of D value were 83.0%, 86.7%, and 85.5%, respectively. Accordingly, those indexes of f value were 64.9%, 57.4%, and 62.1%, respectively. Furthermore, the Ki-67 staining index of malignant lesions was robustly negatively correlated with D value (r = -0.395, P < .01). CONCLUSION: Concrete parameters of IVIM-DWI can help to improve the specificity and accuracy in differential diagnosis of breast benign and malignant lesions. D value is most relevant and valuable in predicting the grading of malignant breast lesions.

Inflammatory myofibroblastic tumor of the lumbar spinal canal: A Case Report With Literature Review.

RATIONALE: Inflammatory myofibroblastic tumor (IMT) is a rare type of mesenchymal tumor. IMT can arise in multiple anatomic locations. IMT of the lumbar spinal canal is exceptionally rare. PATIENT CONCERNS: Here, we report the case of a 56-year-old male patient with an IMT who was in good health until 1 year prior to admission, when he began experiencing pain in both lower extremities and the lower back. INTERVENTIONS: A space-occupying lesion in the lumbar canal was identified by magnetic resonance imaging and then surgically resected. DIAGNOSES: Histopathological analysis of the lesion revealed a composition of mucous edema, inflammatory cells, collagenous fibers, and spindle cells that were diffuse and positive for smooth muscle actin and CD68; focal positive for vimentin and desmin; and negative for CD34 (marker of vascular endothelial cells), CD21, CD23, CD35, S-100, Epstein-Barr virus infection, Ki-67, and anaplastic lymphoma kinase. Thus, the diagnosis was an IMT of the lumbar canal. OUTCOMES: In the spinal canal, IMT should be considered in the evaluation of tumors although it is a very rare diagnosis. It is a benign lesion, but it has potential for invasion and recurrence. LESSONS: There are no characteristic imaging features of these tumors, but they can be addressed by complete surgical excision. Patients with these lesions should undergo frequent long-term follow-up to detect and address recurrence.

Diagnostic Value of Dual-Source Computerized Tomography Combined with Perfusion Imaging for Peripheral Pulmonary Embolism.

BACKGROUND: Pulmonary embolism has become the third most common cardiovascular disease, which can seriously harm human health. OBJECTIVES: To investigate the diagnostic value of dual-source computerized tomography (CT) and perfusion imaging for peripheral pulmonary embolism. PATIENTS AND METHODS: Thirty-two patients with suspected pulmonary embolism underwent dual-source CT exams. To compare the ability of pulmonary embolism detection software (PED) with CT pulmonary angiography (CTPA) in determining the presence, numbers, and locations of pulmonary emboli, the subsequent images were reviewed by two radiologists using both imaging modalities. Also, the diagnostic consistency between PED and CTPA images and dual-energy pulmonary perfusion imaging (DEPI) for segmental pulmonary embolism was compared. RESULTS: CTPA images revealed 50 (7.81%) segmental and 56 (4.38%) sub-segmental pulmonary embolisms, while the PED images showed 68 (10.63%) segmental and 94 (7.34%) sub-segmental pulmonary embolisms. Thus, the detection rate on PED images for peripheral pulmonary embolism was significantly higher than that of the CTPA images (P < 0.05). There was good consistency for diagnosing segmental pulmonary embolism between PED and CTPA and DEPI (kappa = 0.85). The sensitivity and specificity of DEPI images for the diagnosis of pulmonary embolism were 91.7% and 97.5%, respectively. CONCLUSION: PED software of dual-source CT combined with perfusion imaging can significantly improve the detection rate of peripheral pulmonary embolism.

Comparative study of image quality between axial T2-weighted BLADE and turbo spin-echo MRI of the upper abdomen on 3.0 T.

OBJECTIVE: To compare image quality of turbo spin-echo (TSE) with BLADE [which is also named periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER)] on magnetic resonance imaging (MRI) for upper abdomen. MATERIALS AND METHODS: This study involved the retrospective evaluation of 103 patients (63 males, 40 females; age range 19-76 years; median age 53.8 years) who underwent 3.0 T MRI with both conventional TSE T2-weighted imaging (T2WI) and BLADE TSE T2WI. Two radiologists assessed respiratory motion, gastrointestinal peristalsis, and vascular pulsation artifacts, as well as the sharpness of the liver and pancreas edges. Scores for all magnetic resonance (MR) images were recorded. Wilcoxon's rank test was used to compare hierarchical data. Cohen's kappa coefficient was adopted to analyze interobserver consistency. RESULTS: Compared to TSE T2WI, BLADE TSE T2WI reduced all of the examined motion artifacts and increased the sharpness of the liver and pancreas edges (all P < 0.05). Medium to good interobserver consistency was obtained for evaluating these indicators. The scanning time of BLADE TSE T2WI was 4-16 s shorter than that of conventional TSE T2WI. CONCLUSION: Compared to TSE sequence, the BLADE technique can reduce the respiratory motion, gastrointestinal peristalsis, and vascular pulsation artifacts, while decreasing the scanning time and improving the anatomic detail and image quality.