Effect of 5-Line Signs in the Prediction of Staging, Progression, and Prognosis of Peripheral Lung Carcinoma: Preliminary Observation Report.

BACKGROUND: The single line of the normal interlobar fissure shown on a thin section image can be reconstructed as a 5-line sign on axial maximal intensity projection. The line between the lung nodule and the pleura is called the pleural tail sign on thin image. On the axial maximal intensity projection, it can also be reconstructed as the 5-line sign or fewer than 5 lines. OBJECTIVE: This study aimed to observe the effect of 5-line signs in staging, progression, and prognosis of peripheral lung carcinoma. MATERIALS AND METHODS: This study included 132 patients with peripheral lung carcinoma. Among these patients, 93 were men and 39 were women, with an age range of 27 to 82 years and a lung nodule range of 0.98 to 8.75 cm. Maximal intensity projection was reconstructed based on 1.0 or 1.25 mm of thin-slice images in multislice spiral computed tomography. Five-line signs on the margin of the nodule (mass) were observed and were classified into grades 1 to 4 according to the sharpness of the 5-line signs. RESULTS: Multivariate logistic regression analysis showed that the sharpness of the 5-line signs was correlated with N and TNM staging of peripheral lung carcinoma (P = 0.012, P = 0.016). The lower the sharpness of the 5-line signs, the greater the number of cases of progression of the tumor (P < 0.001), and thus the higher the mortality rate and the lower the survival rate (P = 0.001). The sensitivity and specificity of predicting tumor progression were 56.3% and 93.3%, and those of tumor prognosis were 61.1% and 82.4%, respectively. CONCLUSIONS: The sharpness of the 5-line signs has certain effects on the prediction of invasion, progression, and prognosis of lung carcinoma, particularly of small lung cancer (≤3.0 cm).

Neuromelioidosis: a series of seven cases in Hainan province, China.

Melioidosis, which is caused by Burkholderia pseudomallei, is predominately a disease of tropical climates and is especially widespread in south-east Asia and northern Australia. Melioidosis affecting the central nervous system has a low incidence but a high mortality. We present seven cases of neuromelioidosis and analyze the disease characteristics and imaging features. Typical clinical features of this disease included high fever and headache. Five patients had an irregular fever with a temperature ≥ 39℃. Peripheral blood leukocytes and the neutrophil ratio were raised in all patients. On computed tomography and magnetic resonance imaging the disease mainly manifested as intracerebral single or multiple nodules, as well as ring and flake-like enhancements with rapid lesion progression. This study demonstrated the importance of imaging examination in the clinical evaluation and diagnosis of neuromelioidosis.

Comparison of the rebuilding effects of different computed tomography scanners and reconstructive settings for the five-line sign in normal interlobular fissures.

BACKGROUND: Based on the images generated from two multi-slice computed tomography (CT) scanners, we intended to compare the five-line sign of normal interlobular fissures produced on axial or oblique maximum intensity projection (MIP) reconstructions using different algorithms. METHODS: Two groups of 50 subjects underwent either 16-slice or 256-slice spiral unenhanced chest CT. None of them in either group displayed any abnormality. For each case, maximum intensity projection (MIP) data were used to calculate the axial or oblique projection using four algorithms: standard axial, standard oblique, high-resolution axial, and high-resolution oblique algorithm. The results were then used to reconstruct images of six locations of the lung. The clarity of the five-line sign of the reconstructed MIPs for the interlobular fissures was determined and graded as 1 (unclear), 2 (barely clear), or 3 (clear). Comparisons of the rate and the degree of clarity were performed using non-parametric tests. RESULTS: Data from both the 16-slice and 256-slice CT revealed that the standard oblique algorithm was the best among the four methods for presenting clear images of the five-line sign (p < 0.001), whereas the high-resolution axial algorithm was the worst. In addition, the two CT units exhibited no significant differences in the clarity of the five-line sign (p = 0.273). CONCLUSIONS: The standard oblique algorithm was the best approach to reveal the five-line sign of normal lung fissures. Both 16-slice and 256-slice CT were effective for reconstructing the sign.

Conditions and mechanism for the appearance of interlobar fissures as 5-line signs in axial maximum intensity projection images.

PURPOSE: To assess the conditions and mechanism for the 5-line sign of normal interlobar fissures revealed on axial maximum intensity projection (MIP). SUBJECTS AND METHODS: Fifty subjects (32 males and 18 females aged 16 to 76 years) whose conditions were diagnosed as normal on computed tomography (CT) of the chest were presented. Images for the fissures with a slice thickness of 1.25 mm, a space thickness of 1.25 mm, and an MIP slab thickness of 6.25 mm were reconstructed. RESULTS: A 5-line shadow of normal interlobar fissures was shown on axial MIP imaging using a slab thickness of 6.25 mm. On axial MIP imaging, 93% of interlobar fissure parts were manifested as clear or barely clear. CONCLUSIONS: On axial MIP imaging using a slab thickness of 6.25 mm, normal interlobar fissures were displayed as 5-line signs, which, similar to the beaded small lung vessels shown on MIP imaging, might be a partial volume-averaging phenomenon.

Assessment of hepatic functional reserve by cirrhosis grading and liver volume measurement using CT.

AIM: To explore a method for quantitative assessment of hepatic functional reserve by combining computed tomography (CT) volumetry with CT grading of liver cirrhosis before liver resection in patients with hepatocellular carcinoma. METHODS: CT images of 55 patients undergoing liver resection were studied prospectively. The degree of liver cirrhosis was referred as "CT grade" and the percentage of remnant liver volume (PRLV) [PRLV = predicted RLV/predicted total liver volume (PTLV) multiply 100%; PTLV (mL) = 121.75 + 16.49 multiply body mass (kg)] were calculated by adding slice by slice of CT liver images. The postoperative RLV, pathologic stages of liver fibrosis in non-tumor area and survival time in these cases were analyzed. RESULTS: There was a significant difference in survival time between the group with PRLV <= 50% and the group with PRLV > 50% (c2 = 4.988, P = 0.026), and between the group with CT grade 0/1 and the group with CT grade 2/3 (c2 = 5.429, P = 0.026). With combination of the both parameters, an oblique line was identified according to the distribution of 32 survivors versus 23 deceased subjects. The mortality rate above the line was 7.1% (1/14), and that below the line was 53.7% (22/41), indicating a significant difference between the two rates (c2 = 9.281, P = 0.002, P < 0.05). CONCLUSION: PRLV and CT grades are significantly correlated with hepatic functional reserve. The predicted line using these two parameters is useful in candidates undergoing liver resection for judging hepatic functional reserve.