Ultrasound Radiomics Effective for Preoperative Identification of True and Pseudo Gallbladder Polyps Based on Spatial and Morphological Features.

Purpose: To explore the value of ultrasound radiomics in the preoperative identification of true and pseudo gallbladder polyps and to evaluate the associated diagnostic accuracy. Methods: Totally, 99 pathologically proven gallbladder polyps in 96 patients were enrolled, including 58 cholesterol polyps (55 patients) and 41 gallbladder tubular adenomas (41 patients). Features on preoperative ultrasound images, including spatial and morphological features, were acquired for each lesion. Following this, two-stage feature selection was adopted using Fisher's inter-intraclass variance ratios and Z-scores for the selection of intrinsic features important for differential diagnosis achievement with support vector machine use. Results: Eighty radiomic features were extracted from each polyp. Eight intrinsic features were identified after two-stage selection. The contrast 14 (Cont14) and entropy 6 (Entr6) values in the cholesterol polyp group were significantly higher than those in the gallbladder adenoma group (4.063 ± 1.682 vs. 2.715 ± 1.867, p < 0.001 for Cont14; 4.712 ± 0.427 vs. 4.380 ± 0.720, p = 0.003 for Entr6); however, the homogeneity 13 (Homo13) and energy 8 (Ener8) values in the cholesterol polyp group were significantly lower (0.500 ± 0.069 vs. 0.572 ± 0.057, p < 0.001 for Homo13; 0.050 ± 0.023 vs. 0.068 ± 0.038, p = 0.002 for Ener8). These results indicate that the pixel distribution of cholesterol polyps was more uneven than that of gallbladder tubular adenomas. The dispersion degree was also significantly lower in the cholesterol polyp group than the gallbladder adenoma group (0.579 ± 0.054 vs. 0.608 ± 0.041, p = 0.005), indicating a lower dispersion of high-intensity areas in the cholesterol polyps. The long axis length of the fitting ellipse (Maj.Len), diameter of a circle equal to the lesion area (Eq.Dia) and perimeter (Per) values in the cholesterol polyp group were significantly lower than those in the gallbladder adenoma group (0.971 ± 0.485 vs. 1.738 ± 0.912, p < 0.001 for Maj.Len; 0.818 ± 0.393 vs. 1.438 ± 0.650, p < 0.001 for Eq.Dia; 2.637 ± 1.281 vs. 5.033 ± 2.353, p < 0.001 for Per), demonstrating that the cholesterol polyps were smaller and more regular in terms of morphology. The classification accuracy, sensitivity, specificity, and area under the curve values were 0.875, 0.885, 0.857, and 0.898, respectively. Conclusions: Ultrasound radiomic analysis based on the spatial and morphological features extracted from ultrasound images effectively contributed to the preoperative diagnosis of true and pseudo gallbladder polyps and may be valuable in their clinical management.

Imaging and Contrast-enhanced Ultrasound features of duodenal neuroendocrine tumor: A case report.

Duodenal neuroendocrine tumors are rare neoplasms arising from endocrine cells. Here we present a case of 32-year-old woman with Duodenal neuroendocrine tumors, report the imaging and contrast-enhanced Ultrasound (CEUS) features and review previous literatures of neuroendocrine tumors, which may be valuable for the differential diagnosis of duodenal neoplasms.

The correlation of pulmonary arterial hypertension with late recurrence of paroxysmal atrial fibrillation after catheter ablation.

BACKGROUND: Paroxysmal atrial fibrillation (PAF) is one of the most common clinical arrhythmias. Although radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillation has continuously matured and developed in recent years, some patients treated with RFCA continued to have atrial fibrillation recurrence, and the recurrence rate was high. Determining indicators to predict the recurrence of PAF after RFCA is significantly important for improving the surgical success rate and guiding clinical work. This study aimed to investigate the influence of pulmonary arterial hypertension (PAH) on the late recurrence of PAF after RFCA. METHODS: A total of 300 patients with PAF, who underwent RFCA for the first time at the Department of Cardiology of Fujian Union Medical College Hospital from January 2013 to October 2016, were retrospectively studied. These patients were regularly followed-up from 3 months at least to 3 years and clinical data were collected. In order to observe the 100 PAF patients with PAH were assigned into the observation group, and 200 PAF patients without PAH were assigned as the control group. PAH and its related clinical characteristics were evaluated by univariate analysis of variance (ANOVA) and logistic regression analysis. RESULTS: The follow-up results revealed that 34 patients had early recurrence, and the early arrhythmia recurrence rate was 11.3%. Furthermore, 22 patients had late recurrence, including 19 patients with atrial fibrillation and three patients with atrial flutter; and the late recurrence rate was 7.3%. The univariate ANOVA revealed that PAH (P=0.001), early recurrence (P=0.014) and Left atrial diameter (LAD) (P=0.023) had significant effects on late recurrence after PAF ablation. Furthermore, logistic regression analysis revealed that PAH (P=0.049, OR =1.053, 95% CI: 1.000-1.109) was independently correlated to late recurrence of PAF. CONCLUSIONS: PAH is a predictive factor for late recurrence of PAF after RFCA.

Association of VEGFR-2 Gene Polymorphisms With Clopidogrel Resistance in Patients With Coronary Heart Disease.

Vascular endothelial growth factor receptor 2 (VEGFR-2) plays a central role in atherogenesis. We investigated the correlation between VEGFR-2 polymorphisms and the risk of clopidogrel resistance (CR) in patients with coronary heart disease (CHD). The study involved 275 patients with CHD undergoing percutaneous coronary intervention and on antiplatelet clopidogrel therapy. The participants were divided into CR group (n = 59) and non-CR group (NCR, n = 216) based on maximum platelet aggregation measurements. VEGFR-2 gene polymorphisms, +1192C>T (rs2305948), +1416T>A (rs1870377), and -271A>G (rs7667298), were genotyped using polymerase chain reaction-restriction fragment length polymorphism. Enzyme-linked immunosorbent assay was used to measure serum transforming growth factor, beta receptor 2 levels. CR was found in 59 patients (20.45%). A significantly higher proportion of patients in the CR group had a history of diabetes mellitus compared with the NCR group (P < 0.05). Genotype and allele frequency of VEGFR-2 +1192C>T (rs2305948) was significantly higher in the CR group than in the NCR group (all P < 0.01). In the VEGFR-2 +1192C>T (rs2305948), the angina pectoris, recurrent myocardial infarction, and combined end point events were significantly more prevalent in the TT carriers than in the CC + CT carriers. In VEGFR-2 -271A>G (rs7667298), the GG carriers had a lower proportion of target lesion revascularization and angina pectoris in contrast to the AA + AG carriers (all P < 0.05). Based on our results, VEGFR-2 +1192C>T (rs2305948) polymorphism is strongly associated with increased CR and main adverse cardiovascular event incidence in patients with CHD undergoing percutaneous coronary intervention. Additionally, patients with CHD with diabetes mellitus history were more likely to develop CR. The associations of +1416T>A (rs1870377) and -271A>G (rs7667298) polymorphisms with CR were inconclusive and will need to be examined further.

[Real-time CT of upper airway in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To explore the technology and clinical application of real-time CT scan in obstructive sleep apnea hypopnea syndrome during awake and drug induced sleep state. METHODS: Sixty-two patients with OSAHS diagnosed by polysomnography underwent 256 layer spiral CT scan during awake and drug-induced sleep apnea state, and multiplanar reconstruction and volume rendering of computed tomography images were performed. To observe the dynamic changes of upper airway and locate the sites of airway obstruction in patients with OSAHS, the minimum section area, diameter and volume of pharynx cavity were measured on reconstructed 3-dimensional computed tomography. RESULTS: Real-time CT scans were completed successfully in all of the patients. It was revealed that airway obstruction frequently occurred at retropalatal and retroglottal region. Real-time CT scans revealed 29 cases with airway obstruction at isolated retropalatal region, 19 cases with airway obstruction at retropalatal and retroglottal region simultaneously, 6 cases with airway obstruction at retropalatal and epiglottal region simultaneously, 7 cases with airway obstruction at retropalatal, retroglottal and retroglottal region simultaneously, 1 case without airway obstruction. There was no airway obstruction at retroglottal or retroglottal region isolatedly. Rate of single region airway obstruction was 46.8% (29/62), and rate of multiple regions airway obstruction 51.6% (32/62). The real-time CT results showed that starting from Friedman tongue position I to IV, the percentage of obstruction at retroglottal and (or) retroglottal region simultaneously were increasing, the percentage of obstruction were 0/6, 8/25, 13/20, 11/11, respectively (χ(2) = 22.00, P < 0.005). The minimum section area, volume, minimum anteroposterior diameter and left-right diameter of pharynx cavity between awake and drug-induced sleep apnea state had statistically significant difference in all region. CONCLUSIONS: Real-time CT scans in drug-induced sleep state could get more information about the anatomical and pathological changes of upper airway, providing relatively objective morphological basis for the diagnosis and treatment of patients with OSAHS. Therefore, real-time CT scans have important value in practical application.

Radiological diagnosis of duodenocaval fistula: a case report and literature review.

Duodenocaval fistula (DCF) is an uncommon but lethal clinical entity. The high mortality has been attributed to the difficulty of diagnosis before attempts at definitive therapy. In this case report, we describe a patient with a series of computed tomography (CT) examinations over a 2-mo period in hospital. A low-density air bubble appeared in the inferior vena cava (IVC) on the second day in hospital and became clear on day 19, and gradually enlarged. Magnetic resonance imaging (MRI) also clearly demonstrated a high-signal enteric contrast medium or thrombus and signal-void air bubbles in the IVC. However, cavography did not show the filling defect. We suggest that noninvasive CT and MRI should be chosen as a first-line investigation, and IVC, including the surrounding structures, should be carefully reviewed on images if DCF is clinically considered.

[Study on the overall anatomical features and clinical value of lumbar nerve root, plexus and branches in CT reconstruction].

OBJECTIVE: To identify the overall anatomical characteristics and the clinical value of the lumbar nerves under CT multiplanar reconstruction. METHODS: Fifty normal subjects and 30 patients with LN diseases (51 sides) were selected, including 10 patients with lumber intervertebral disk hernia, eight patients with spinal stenosis, 5 patients with spondylolisthesis, 1 patient with tethered cord syndrome, 1 patient with lumbar scoliosis, and 5 patients with spinal trauma The 16-slice helical CT (Light Speed, GE Company) was used for scanning the lumbar vertebra with multiplanar reconstruction in Workstation (ADW4.1) with UNIX System in DICOM format. The image was set on the same slice for the overall anatomy and manifestations of the lesions. RESULTS: The same-slice imaging showed the strip-like LN slightly lower than the surrounding muscle in density. Each LN went out of the dural sac at an acute angle. The course of the lumbar plexus and its major branches, including the obturator nerve, femoral nerve and reproductive nerve, and their relations to the adjacent structures were clearly revealed. The percentage of the segments displayed was well associated with the reconstruction angle, with the order being oblique coronal > outward-rotated oblique coronal > oblique sagittal > coronal > sagittal section. The major manifestations of abnormal LN included compression and displacement (50 sides, 98.0%), morphological changes (49 sides, 96.1%), adhesion (41 sides, 80.4%). CONCLUSIONS: The CT multiplanar reconstruction is ideal for the imaging of the overall size, shape, running and tension of the LN root; it is valuable in clinical diagnosis.

[Value of multiplanar reconstruction of lumbar nerve roots on the same level by high resolution computed tomography in diagnosis of lumbar disc herniation and/or bulge].

OBJECTIVE: To explore value of multiplanar reconstruction of lumbar nerve roots on the same level by high resolution computed tomography (HRCT) in diagnosis of lumbar disc herniation and/or bulge (LDHB). METHODS: Thirty-one patients with manifestations of typical nerve root compression, such as lumbago and tenderness of percussion pain at the corresponding sites were scanned with 16-slice spiral CT and multiplanar reconstruction of lumbar nerve roots on the same level with the workshop ADW4.150, and were diagnosed as with LDHB with 50 segments. The diagnoses were confirmed by operation later. RESULTS: This technique showed not only the existence of LDHB but also the signs of nerve root compression, including the touch of nerve roots with the LDHB (100%), translocation of nerve roots (96%), morphological change (94%), changes of diameter (92%), changes of direction (88%), changes of density (80%), increase of the angle between the dural sac and nerve root (76%), etc. Along with the prolonging of time, the nerve roots became thinner in all segments. CONCLUSION: Multiplanar reconstruction of lumbar nerve roots on the same level by high resolution computed tomography is valuable in the diagnosis of lumbar disc herniation and/or bulge.

[Percutaneous lung cancer cryotherapy guided by computer tomography].

OBJECTIVE: To document the feasibility, safety and efficacy of percutaneous lung cancer cryotherapy (PLC) guided by Computer Tomography (CT). METHODS: Two hundred and thirty seven patients with lung cancer underwent CT-guided PLC from August, 2001 to April, 2003. CT-visualized immediate ice formation beyond tumor margins was compared to tumor size and location. PLC feasibility and safety were evaluated. CT scan, lung tissue biopsy and survival rate were observed at different stages postcryoablation. RESULTS: All the patients underwent PLC using local anesthesia with minimal or no sedation. Iceball formation was well seen as negative Hounsfield units within soft tissue masses. Tumor size and location were independent determinants of ice coverage which was 97% (n = 124) for masses < 4 cm in diameter, and 80% (n = 183) for masses > 4 cm in diameter (P < 0.01). Only 59 patients had transient mild hypertension, and no death occurred during cryotherapy. Most of the slight side-effects were self-limited. No major bleeding or bronchial sequelae were identified. CT scan showed that necrotic cavitation larger than the original mass developed in 78% of the cases within one week, and mostly resolved by 6 months (4%). Partial resolution + complete resolution was noted by 1 - 6 months, which demonstrated reduced or stable tumor size. Necrotic coagulation could be found within 1 month and fibrin scarring 3 months postcryoablation. The survival rate in 18 months was 86% for patients at an early stage of lung cancer, and 21% for patients at stage III, while the one year survival rate for patients at stage IV was 9%. CONCLUSION: CT-guided PLC, with minimal procedure associated morbidity or sequelae, is a promising treatment for lung neoplasm of any stage in nearly any location.