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Objective:To investigate the feasibility of simultaneous arteriovenous enhancement of neck CT with two-stage injection of contrast agent and its effect on image quality and radiation dose.Methods:A total of 30 patients undergoing neck CT enhancement scan due to space-occupying lesions in Beijing Tongren Hospital, Capital Medical University from February to April 2022 were prospectively included as the experimental group. The neck CT enhancement scan was performed with two-stage injection of contrast agent and arteriovenous simultaneous enhancement. The dosage of contrast agent was calculated according to the patient′s body weight, and the method of two-stage injection was adopted. The dosage of contrast agent in the first stage was 0.7 ml/kg, with normal saline in the middle stage, and the second stage (began at 35 s) was 0.3 ml/kg. A total of 30 patients with gender and age matching with the experimental group from December 2021 to January 2022 were retrospectively collected as the control group. The control group was treated with the traditional arterial phase and venous phase scanning method with the dosage of 1.0 ml/kg contrast agent. The arterial phase was scanned at the 30 s and the venous phase was scanned at the 60 s. The CT values of bilateral carotid arteries and jugular veins in the experimental group were measured, the CT values of bilateral carotid arteries in the arterial phase were measured in the control group, and the CT values of bilateral carotid arteries and jugular veins in the venous phase were measured. Carotid artery enhancement score was performed for images of experimental group and control group in arterial and venous phase, and jugular vein and lesion enhancement score was performed for images of experimental group and control group in venous phase. The effective dose was calculated for both groups. The difference of carotid artery CT values between images was compared by one-way analysis of variance, and LSD method was used for pairwise comparison. The CT values of jugular vein were compared using independent sample t test. Kruskal-Wallis test was used to compare carotid artery enhancement scores, and Nemenyi method was used for pairwise comparison. Jugular vein and lesion enhancement scores and effective dose were compared by Mann-Whitney U test. Results:The CT value of carotid artery of experimental group [left (276±24) HU, right (273±25) HU] was lower than that of control group in arterial phase [left (329±33) HU, right (327±32) HU], and higher than that in the venous phase [left (147±15) HU, right (148±16) HU]. All the differences were statistically significant ( P<0.001). The CT value of jugular vein of experimental group [left (206±18) HU, right (203±19)] was higher than that of control group in the venous phase [left (154±15) HU, right (151±15)], the difference was statistically significant ( t=11.88, 11.76, both P<0.001). There was no significant difference in carotid artery enhancement score between experimental group and control group in arterial phase ( P=0.624), but the carotid artery enhancement score of the experimental group was higher than that of the control group in the venous phase, and the difference was statistically significant ( P<0.001). The scores of jugular vein and lesion enhancement in experimental group were higher than those of control group in venous phase, and the difference was statistically significant ( Z=5.01, P<0.001). The effective dose of the experimental group [2.41(2.04, 2.72) mSv] was decreased by 52.2% compared with the control group [5.04(4.18, 5.44) mSv], and the difference was statistically significant ( Z=-6.24, P<0.001). Conclusions:The neck CT enhanced scan with two-stage injection of contrast agent and arteriovenous simultaneous enhancement method can obtain comprehensive images of arterial and venous phases, and realize simultaneous enhancement of carotid artery, jugular vein and lesions, and reduce radiation dose.
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Objective:To assess the clinical and imaging features of SMARCB1-deficient sinonasal carcinoma.Methods:Form January 2016 to November 2021, the clinical data and pretreatment imaging findings of 16 cases with pathologically proven SMARCB1-de?cient sinonasal carcinomas were analyzed retrospectively in Beijing Tongren Hospital, Capital Medical University. Immunohistochemistry for SMARCB1 showed loss of the protein in the tumor nuclie. Clinical and imaging features, including tumor location, TNM stage, size, density of CT, bone change, MRI signal intensity, enhancement pattern, type of time-intensity curve (TIC) of dynamic contrast enhanced MRI (DCE-MRI), apparent diffusion coefficient (ADC) value and diffusion weighted imaging (DWI) were evaluated. For 14 cases, correlation of the ADC value and Ki-67 index was subsequently evaluated with Pearson correlation analysis.Results:For the 16 cases SMARCB1-deficient sinonasal carcinomas, clinical stage of T4 was 12 cases and T3 was 4 cases. The location included ethmoid sinus ( n=4), nasal cavity only ( n=1), both nasal cavity and ethmoid ( n=8), ethmoid and maxillary sinus ( n=1), ethmoid and frontal sinus ( n=1), ethmoid and sphenoid sinus ( n=1). The tumor size was (4.5±1.2) cm. Iso-attenuated of CT images was showed in 13 cases and heterogeneous with necrosis was showed in 3 cases. Focal bone erosion was found in 13 cases and extensive bone destruction was found in 3 cases. Compared with adjacent muscles, T 1WI of all 16 cases showed isointense, with focal hypointense in 3 cases. On T 2WI, the tumor was graded as isointense in 9 cases, hyperintense in 7 cases, with lower inner septal in 6 cases. Enhancement was graded as mild in 11 cases, moderate in 5 cases.MRI Enhancement images showed mild enhancement in 11 cases, moderate enhancement in 5 cases, heterogeneous enhancement in 6 cases, and homogeneous enhancement in 10 cases. For DCE-MRI of 14 cases, there were 10 cases of Ⅲ type and 4 cases of Ⅱ type of the TIC. The ADC value of 14 cases was (1.02±0.27)×10 -3 mm 2/s. The Ki-67 index was 48%±21%. No correlation was observed between Ki-67 index and ADC value ( r=-0.38, P=0.183). Conclusions:SMARCB1-deficient carcinomas are mostly centered in the nasal and ethmoid region of anatomic distribution. Tendency to be infiltrative the adjacent bone structure with invasive bone reaction, mild to moderate heterogeneous enhancement, T 2WI with lower inner septal, and Ⅲ types of TIC are certain suggestive imaging features of the entity.
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Objective:To investigate the value of the 8-channel eye surface phased array coil in improving image quality and demonstrating ocular masses on 3.0 T MR scanner.Methods:From July 2018 to January 2020, the data of orbital MRI in 692 patients with ocular masses on 6 medical centers were prospectively collected. The patients were simple randomly assigned into 8-channel eye surface phased array coil group (413 patients) or 8-channel head phased array coil group (279 patients), with the same MRI sequences. The signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated in orbital anatomy structures and masses (eyelid mass, intraocular mass, lacrimal mass and orbital mass). The image quality scores including motion artifact, mass margin, the relationship between the mass and adjacent structures, and overall image quality were recorded. The differences of image quality between the two groups were compared by two independent sample t-test or Wilcoxon rank test. Results:The SNR and CNR were higher in eye surface coil group than those in head coil group ( P<0.05). The scores of ocular movement artifacts were higher in head coil group than those in surface coil group ( P<0.05). The scores of intraocular mass margin, the relationship between the mass and adjacent structures, and overall image quality were higher in surface coil group than those in head coil group ( P<0.001). There were no significant differences in mass margin, the relationship between the mass and adjacent structures, and overall image quality scores of eyelid, lacrimal gland, and orbital mass between the two groups ( P>0.05). Conclusion:3.0 T MR scanner combined with the 8-channel eye surface phased array coil can improve the SNR and CNR of orbital MR images, the demonstration of the intraocular mass margin and the relationship between the mass and adjacent structures.
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Objective:To evaluate the feasibility of measurement and characteristics of intraocular lens (IOL) tilt using the swept-source optical coherence tomography (SS-OCT) biometer (IOLMaster 700) and to explore its potentially relevant parameters.Methods:A cross-sectional study was conducted.Two hundred and forty-two eyes (119 right eyes, 123 left eyes) of 185 patients after phacoemulsification and IOL implantation were included in Beijing Tongren Hospital from July to September 2018.The IOL position, angle κ, angle α, corneal curvature, anterior chamber depth (ACD), pupil diameter (PD), and axial length (AL) were obtained by IOLMaster 700, and the IOL tilt direction and magnitude were calculated.The within-subject standard deviation and intraclass correlation coefficient were used to evaluate the repeatability of three IOL tilt measurements.Binocular symmetry of IOL tilt and the correlation between IOL tilt and different influencing factors were evaluated by Pearson linear correlation analysis or Spearman rank correlation analysis.Influencing factors for IOL tilt were assessed by multiple linear regression analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2018-049). Patients were informed of the purpose and methods of this study and signed the written informed consent.Results:The repeatability of IOL tilt measurements was excellent with a within-subject standard deviation of 5.16° for IOL tilt direction and 0.13° for IOL tilt magnitude.IOL tilt was mirror symmetric in both eyes.The IOL tilt direction in right eyes ranged from -89.60° to 87.53° with a mean of (18.85±29.65)°, and the tilt magnitude ranged from 1.32° to 7.05° with a mean of (4.16±1.26)°.The IOL tilt direction in left eyes ranged from -84.30° to 89.44° with a mean of (21.17±32.38)°, and the tilt magnitude ranged from 0.58° to 7.40° with a mean of (3.80±1.31)°.There were moderate and weak positive correlations of IOL tilt direction and tilt magnitude between both eyes ( r=0.473, P<0.001; r=0.335, P=0.011). IOL tilt magnitude was weakly positively correlated with angle α and IOL diopter ( rs=0.272, P=0.003; r=0.285, P=0.002), and was weakly negatively correlated with ACD, PD and AL ( r=-0.303, P=0.001; r=-0.233, P=0.011; rs=-0.331, P<0.001). In backward stepwise regression analysis, the regression equation of IOL tilt magnitude, angle α, ACD, PD, AL and IOL diopter in multiple linear regression analysis was as follows: IOL tilt magnitude=10.503+ 1.456×angle α-0.532×ACD-0.196×AL ( R2=0.400; F=8.588, P<0.001). Conclusions:The SS-OCT biometer can be an effective method to assess IOL tilt.IOL tilt is mirror symmetric between the right eyes and left eyes.
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Objective:To compare the changes of morphology of pharynx in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and healthy individuals during oral or nasal breathing, and explore the relevant influencing factors. Methods:Twenty-nine adult patients with OSAHS and 20 non-snoring controls underwent MRI to obtain upper airway structural measurements while the subjects were awake and during mouth breathing with a nasal clip.The following were analyzed. ①The changes of upper airway structure of oral and nasal respiration in non-snoring control/OSAHS patients were observed; ②The differences and influencing factors of upper airway structure changes between OSAHS patients and controls were compared during breathing. Results:The control group consisted of 15 males and 5 females, with an apnea-hypopnea index （AHI）<5 events/h, while the OSAHS group comprised 26 males and 3 females with an AHI of 40.4±23.1 events/h and the mean lowest arterial oxygen saturation （LSaO2） was 79.5% ±10.0%. In the both groups, the vertical distance between the mandible and the posterior pharyngeal wall decreased （P<0.05）; The long axis of tongue body decreased （P<0.05）, and the contact area between tongue and palate decreased. There was no significant change in the total volume of the retropalatine（RP） and retroglossal（RG） airway in the control group （P>0.05）. However, the minimum cross-sectional area and volume of the RP airway in OSAHS decreased （P<0.001）. The lateral diameters of uvula plane in OSAHS decreased during mouth breathing, which was contrary to the trend in the control group （P=0.017）. The AHI of patients was positively correlated with the reduction of the volume of the RP airway during oral breathing （P=0.001）; The reduction of the distance between the mandible and the posterior pharyngeal wall was positively correlated with the length of the airway （P<0.001）. Conclusion:Mouth breathing leads to the shortening of the long axis of the tongue, the reduction of the contact area between the soft palate and the tongue, vertical distance between the mandible and the posterior pharyngeal wall, and the cross-sectional area of the epiglottis plane. These changes vary between OSAHS patients and controls. During mouth breathing, the diameters, areas and volumes of the RP area decreased, and were more significant in severe cases.
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Masculino , Adulto , Feminino , Humanos , Respiração Bucal , Apneia Obstrutiva do Sono/cirurgia , Faringe/cirurgia , Palato Mole , Úvula/cirurgia , SíndromeRESUMO
Objective:To investigate the value of periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) in improving ability of demonstrating ocular masses on 3.0 T MR scanner.Methods:This study was a multi-center prospective study involving 6 centers. From July 2018 to January 2020, totally 413 patients with ocular masses from 6 centers were prospectively enrolled, and all of them underwent T 1WI and T 2WI, PROPELLER T 1 FLAIR and T 2WI, and contrast-enhanced scans. The signal intensity of eyelid, vitreous body, lacrimal gland, intraorbital segment of optic nerve, and orbital masses of eyelid, intraocular, lacrimal gland and retrobulbar were measured by two radiologists, and the signal to noise ratio (SNR) and contrast noise ratio (CNR) were calculated. The 5-point scoring method was used to evaluate the motion artefacts, tumor edges and the relationship between the tumor and adjacent structures, and the overall score of image quality was calculated. Paired t-test or Wilcoxon signed rank test was used to compare the image quality between PROPELLER and non-PROPELLER images. Results:The SNR and CNR of PROPELLER T 2WI were higher than those of non-PROPELLER T 2WI (all P<0.001). The SNR and CNR of PROPELLER T 1 FLAIR were lower than those of non-PROPELLER T 1WI (all P<0.05). The scores of artefacts and overall image quality in PROPELLER images were higher than those in non-PROPELLER images (all P<0.001). The tumor edge and the relationship between the tumor and adjacent structures scores of eyelid, intraocular, and lacrimal gland masses in PROPELLER images were higher than those in non-PROPELLER images (all P<0.001),while compared to non-PROPELLER images, retro-global masses in PROPELLER images showed no significant differences (all P>0.05). Conclusion:PROPELLER can reduce ocular motion artefacts, effectively improve image quality and ability of demonstrating anterior (eyelid, intraocular, and lacrimal gland) masses.
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Objective:To assess the clinical and imaging features of NUT gene-related sinonasal carcinomas (NUT midline carcinome).Methods:The clinical data and pretreatment imaging findings of 5 cases with pathologically proven NUT sinonasal carcinomas were analyzed retrospectively in Beijing Tongren Hospital, Capital Medical University from January 2016 to December 2020. Of 5 cases, the tumors affected 4 females and 1 male with an age range of 15 to 48 years (median 19 years). Clinical data of all cases were available before surgery with both CT and MR examination. Tumor location, CT density, boney change, calcification, tumor size, T 1WI, T 2WI and diffusion weighted imaging (DWI) signal intensity, appearance diffusion coefficient (ADC), type of time intensity curve (TIC) of dynamic contrast-enhanced (DCE)-MRI were evaluated. Results:All five cases belonged to T4 stage of the clinic TNM system. The locations were nasal cavity ethmoid, sphenoid and maxillary sinus ( n=1), nasal and maxillary sinus ( n=1), nasal cavity and ethmoid sinus ( n=3). Iso-attenuated in 3 cases, heterogeneous with local necrosis in 2 cases, and heterogeneous with calcification in 3 cases on CT imaging. Bone erosion was found in 4 cases, and bone erosion with destruction in 1 case. The tumor sizes ranged from 4.2 to 4.9 cm (median 4.5 cm) on MR axial imaging. On T 1WI, 5 cases showed isointense compared with adjacent temporal muscles, with focal hypointense in 2 cases. On T 2WI, the tumor was graded as isointense in 3 cases, and hyperintense in 2 cases. Heterogeneous enhancement in all cases with mild in 3 cases, and moderate in 2 cases on postcontrast MR imaging. On DCE-MRI of 5 cases, there were 3 cases of type Ⅲ (washout-shaped curves), and 2 cases of type Ⅱ of the TIC (plateau-shaped curves). The range of ADC values was from 0.63×10 -3 to 1.17×10 -3 mm 2/s, and median ADC value was 0.84×10 -3 mm 2/s, of 5 cases with varying degrees of high signal on DWI. The Ki-67 index ranged from 30% to 80% of the tumor. An immunohistochemical study showed that the tumor cells of 5 cases were all positive for both NUT and INI-1 genes. One case was performed with biopsy and followed by chemotherapy, four cases were performed with surgery, combined with the following chemotherapy, and one also was implemented with radiation therapy. The follow-up time was 7-16 months. Five cases were all alive during the follow-up. Conclusions:The NUT midline sinonasal tract carcinoma is a rare, gene-related solid malignant tumor. The tumor is more commonly seen in young patients, mostly centered in the nasal and ethmoid region with invasive growth, more calcification on CT, and heterogeneous enhancement on MRI. These findings are some characteristics of the tumor.
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Objective:To investigate the uncertainty of the dose measurements of superficial organs and the image noise in CT scanning.Methods:GE Revolution CT was used to perform 20 repeated scans on the isolated skull specimen in sequential and helical mode. The chest phantom was scanned for 45 times with the pitch 1.0 and the collimation 80 mm for two scanners (GE Revolution CT, Philips Brilliance iCT) and 40 mm for the Siemens Somatom Definition Flash CT. The volume CT dose index (CTDI vol) was maintained during the above scannings. A dosimeter was used to measure the dose at the position of the right eye lens of the specimen and the center of right breast of the chest phantom. The position of dosimeter sensor remained unchanged. The standard deviation of CT values (image noise) in the air region of cross-sectional images at the center of the sensor reconstructed with lung/soft tissue algorithms were measured. The mean values ( Av), standard deviations ( SD), coefficients of variation ( CV) and relative ranges ( RR) of the dosimetric values and the standard deviations of CT values of 3, 5, 10, 20, 30 and 45 scans were calculated. Pearson and Spearman correlation analysis were used to evaluate the correlation between the dosimetric values and the standard deviations of CT values. Results:The measured dosimetric values of the skull specimen were almost unchanged in the sequential scannings. The relative range of dose in helical mode was 10.67%. The relative ranges of the measured values of the three CT scanners for 45 scans reached 43.83%, 25.31%, and 14.32%. The standard deviations of CT values of the lung/soft tissue images varied greatly and the differences were not completely related to the dosimetric values.Conclusions:The dosimetric values of superficial organs were stable in the sequential scanning mode. The dose measurements of superficial organs and the image noise changed greatly in helical scanning mode.
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Objective:To evaluate the CT characteristics of ossifying foci in sinonasal inverted papilloma (IP) and to compare with the tumor root shown intraoperatively.Methods:The clinical and CT imaging data of 127 patients with IP, which were proved by histopathology, were reviewed retrospectively from Beijing Tongren Hospital, Capital Medical University, during the period from January 2012 to December 2018. The number, location, shape, density of ossifying foci in sinonasal IP and the relationship with the wall of sinus were observed. The sites of ossification on CT scans were compared with the root of the tumors described in the corresponding patient′s operative records.Results:In 127 IP patients, 51 (40.2%) patients showed the ossification in the tumor on CT. Single ossifying foci were found in 35 cases and multiple in 16 cases. The ossification affected single site of the sinonasal tract ( n=16) or distributed diffusely ( n=35). In the 50 cases, the ossifying foci extended along the long axis of the affected sinus appearing as branched ( n=19), striped ( n=16), linear ( n=7), lumpy ( n=2) or mixed type ( n=6), and 1 case was located at the edge of the maxillary sinus. Totally 66.7% (34/51) of the ossifying focis contained peripherally hyperdense bone tissue and centrally hypodense adipose tissue, which corresponded to bone cortices and fatty marrow of the trabecular bone. And 96.1% (49/51) of the ossifying focis were attached to the adjacent bone of the sinus, and the sites of attachment were concordant with the actual origin of tumor confirmed in operation . Conclusions:Ossification can be seen in some sinonasal IPs. Tracing along ossifying focus to the site of attachment with sinus might facilitate preoperative prediction of the originating site of tumor.
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Objective:To investigate the contents of paranasal sinus CT reports about clinically pertinent lesions and anatomic variations in patients with chronic rhinosinusitis and analyze the lesions and the anatomic variations less described in CT reports to improve the quality of paranasal sinus CT reports.Methods:A national questionnaire survey on radiologists interpreting paranasal sinus CT was conducted online in March, 2020. Questions were focused on the frequency of the lesions or anatomic variations of the paranasal sinuses described in paranasal sinus CT reports, and the results were analyzed and compared among radiologists by different levels of the hospital, professional titles, years of CT reading experience, subspecialties, and education backgrounds.Results:A total of 6 525 valid questionnaires were obtained, in which 97.7%, 97.7%, and 92.8% of radiologists described mucosal thickening, hypertrophy of turbinate or deviation of the nasal septum, and space occupying lesions within paranasal sinuses in CT reports, respectively. Only 35.0%, 26.9%, and 22.5% of radiologists described frontal recess lesions, dehiscence of foramen rotundum or pterygoid canal, and anterior/posterior ethmoid artery anatomy in CT reports, respectively. The anatomic variations that predisposed patients to major surgical complications or recurrent rhinosinusitis were more frequently documented in CT reports by radiologists with experience of head and neck radiology, senior titles or more than 30 years of radiological experience in tertiary hospitals than other radiologists.Conclusions:Lesions within the paranasal sinus were almost documented in all paranasal sinus CT reports. However, the anatomic variations that predisposed patients to major surgical complications or recurrent rhinosinusitis were infrequently described, which needs to be optimized by improving the quality of paranasal sinus CT reports.
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Objective:To investigate the MRI features of the primary sinonasal malignant melanoma (SMM) and evaluate the signal pattern based on T 1WI and T 2WI, in order to improve the diagnostic accuracy of SMM. Methods:The MRI findings of 63 SMM cases confirmed by pathology from April 2007 to November 2018 at Beijing Tongren Hospital, Capital Medical University were analyzed retrospectively. The signal intensity of malignant melanoma was classified into four types(Ⅰ—Ⅳ) according to the proportion of signal areas of the largest slice of the tumor on T 1WI and T 2WI. The classification criteria according to T 1WI: type Ⅰ, the area of hyperintensity was ≥50%; type Ⅱ, the area of hyperintensity was <50%; type Ⅲ, the tumor did not show hyperintensity, and the area of isointensity was ≥50%; type Ⅳ, the tumor did not have high signal area, and the area of low signal was ≥50%. The classification criteria according to T 2WI: type Ⅰ, the area of low signal in the tumor was ≥50%; type Ⅱ, the area of low signal was <50%; type Ⅲ, the tumor did not contain low signal area, and the area of isointensity was ≥50%; type Ⅳ, the tumor did not have low signal area, and the area of high signal intensity was ≥50%. The proportion of each type was calculated. Results:According to T 1WI, typeⅠwas identified in 27 cases (42.9%, 27/63), typeⅡ in 25 cases (39.7%, 25/63), type Ⅲ in 4 cases (6.3%, 4/63), and type Ⅳ in 7 cases (11.1%, 7/63). According to T 2WI, type Ⅰwas demonstrated in 29 cases (46.0%, 29/63), type Ⅱ in 28 cases (44.4%, 28/63), type Ⅲ in 2 cases (3.3%, 2/63), and type Ⅳ in 4 cases (6.3%, 4/63). There were 16 cases classified as type I based on T 1WI and T 2WI. Conclusions:Typical and atypical SMM can be identified according to signal patterns. The typeⅠsignal pattern of SMM cases on T 1WI and T 2WI is typical and can be easily diagnosed, but the proportion was less than 50%. For atypical SMM, malignant melanoma should be strongly suspected if hyperintense on T 1WI or hypointense on T 2WI is found.
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Objective:To discuss the characteristics of ultrasound diagnosis of optic disc capillary hemangioma.Methods:The study analyzed retrospectively 7 cases of optic disc capillary hemangioma diagnosed in the Beijing Tongren Hospital from 2015 to 2018. The size, morphology, internal echo, and secondary changes of the lesion were analyzed during ultrasound examination.Color Doppler flow imaging was used to check the blood flow in the lesion.Results:Pre-optic disc occupying lesions could be detected in the ultrasound images of the 7 cases. Lesion size: average base diameters (5.39±1.90)mm×(4.79±1.28)mm, average height (3.61±1.37)mm. Lesion morphology: 5 cases were round, and 2 cases were irregular. Echo within the lesion: 3 cases had medium echo inside the lesion, and 4 cases had high echo inside the lesion. Internal echo characteristics: 5 cases had uniform echo, and 2 cases had uneven echo. Secondary changes: 6 cases had secondary retinal detachment and vitreous opacity, and 1 cases was accompanied by retinal hemangioma in other parts. In all cases, blood flow signals could be detected inside the space-occupying lesions, which were in the form of branches, stripes or spots, and the blood flow spectrum showed a parallel spectrum of arteries and veins.Conclusions:Ultrasound examination of optic disc capillary hemangioma has certain characteristics, which can provide a valuable follow-up basis for clinical diagnosis.
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Objective:To compare the agreement of biometric parameters measured by a new swept-source optical coherence tomography IOLMaster 700 and a new Scheimpflug imaging combined with partial coherence interferometry biometer Pentacam AXL in cataractous eyes.Methods:A cross-sectional study was performed.A total of 146 eyes from 76 cataract patients were enrolled in Beijing Tongren Eye Center from 2 to 11 in January 2018, including 69 eyes in 36 males and 77 eyes in 40 females, the age ranged from 35 to 88 years, the mean age was (64.52±11.36) years.Axial length (AL), mean keratometry (Km), anterior chamber depth (ACD), central corneal thickness (CCT) and white-to-white (WTW) were measured with IOLMaster 700 and Pentacam AXL, respectively.The differences and correlations of the biometry parameters between the two devices were assessed.Bland-Altman method was used to evaluate the agreement of these parameters between the two devices and the 95% limits of agreement was calculated.This study adhered to the tenets of the Declaration of Helsinki and was approved by an Ethics Committee of Beijing Tongren Hospital (TRECKY2018-049).Results:The mean values of the AL measured by IOLMaster 700 and Pentacam AXL were (24.03±1.72)mm and (23.98±1.73)mm, Km were (44.04±1.71)D and (43.88±1.72)D, ACD were (3.24±0.47)mm and (3.28±0.47)mm, WTW were (11.82±0.51)mm and (11.49±0.49)mm, respectively.Compared with the values in Pentacam AXL, the AL, Km and WTW were larger while ACD was smaller in IOLMaster 700 with significant differences ( t=18.06, 8.94, 23.83, -15.36, all at P<0.01). The mean CCT values from the IOLMaster 700 and Pentacam AXL were (534.18±30.12)μm and (533.42±28.71)μm, respectively, with no significant difference ( t=1.04, P=0.30). The AL, Km, ACD, CCT and WTW from IOLMaster 700 were highly correlated with those from Pentacam AXL ( r=0.999, 0.992, 0.998, 0.956, 0.942; all at P<0.01). The Bland Altman analysis showed that the 95% limits of agreement of AL, Km, ACD, CCT and WTW were-0.02-0.11 mm, -0.27-0.59 D, -0.10-0.02 mm, -16.5-18.1 μm and 0.00-0.67 mm. Conclusions:IOLMaster 700 and Pentacam AXL have good agreements and narrow 95% limits of agreement in the measurements of AL, ACD, CCT, which can be clinically interchangeable.The 95% limits of agreement of WTW and Km are out of the clinically acceptable range, so the WTW and Km measured by the two devices are not interchangeable.
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Objective@#To explore the effect of pre- and post-adaptive statistical iterative reconstruction-Veo (ASiR-V) on image quality and radiation dose in paranasal sinus CT, and to find the best combinations.@*Methods@#One head specimen was scanned with the routine spiral CT scanning parameters [noise index (NI)=8] and different levels of pre-ASiR-V (0—100%, with an interval of 10%). The images were reconstructed with different post-ASiR-V (0—100%, with an interval of 10%) for the bone algorithm and standard algorithm. All of 242 thin-layer images of paranasal sinuses were obtained. The region of interest (ROI) was selected to measure the CT value to calculate the contrast to noise ratio (CNR) and figure of merit (FOM). The volume CT dose index (CTDIvol) and Smart mA were recorded. The linear regression was conducted to analyze the relationship between CTDIvol, SmartmA, CNR and FOM. And with the same pose-ASiR-V level, the CNR of images which reconstructed by bone and soft algorithms were compared with pair-wise t test. The image quality was subjectively evaluated by three independent experienced radiologists using a 4-point scale (4 was the best).@*Results@#As the pre-ASiR-V levels (0—100%) increased, Smart mA and CTDIvol were reduced with a linear negative correlation (r=-0.981, -0.976, both P<0.001). The Smart mA decreased by 72.05% and CTDIvol by 71.22%. Keeping the same pre-ASiR-V level,the CNR increased with the increase of post-ASiR-V level (for the bone algorithm images:R2=0.976, 0.992, 0.982, 0.982, 0.975, 0.975, 0.979, 0.996, 0.952, 0.978, 0.965;for the standard algorithm images: R2=0.944, 0.990, 0.988, 0.993, 0.996, 0.987, 0.984, 0.996, 0.996, 0.990, 0.965).Under the same level of post-ASiR-V, the CNR and FOM fluctuated with the pre-ASiR-V level (for the bone algorithm images:R2=0.335, 0.341, 0.344, 0.364, 0.385, 0.405, 0.418, 0.429, 0.455, 0.474, 0.516; for the standard algorithm images: R2=0.223, 0.278, 0.327, 0.285, 0.309, 0.329, 0.325, 0.346, 0.360, 0.390, 0.380). All subjective image quality could meet the diagnostic requirements (the score≥3).@*Conclusion@#At NI=8, for the bone algorithm, the best combination is 80% pre-ASiR-V and 100% post-ASiR-V; for the standard algorithm, the best iteration combination is 100% and 100%. The appropriate choice of pre- and post-ASiR-V levels in paranasal sinus CT scan can effectively reduce the radiation dose under the premise of maintaining the image quality that meets the diagnostic needs.
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Objective To observe the application value with color Doppler flow imaging (CDFI) in the detection ofmacular diseases in senile cataract.Methods A cross-sectional descriptive study.From December 1 to December 30,2017,720 senile cataract patients (1380 eyes) diagnosed in Beijing Tongren Eye Center were included in this study.There were 330 males (629 eyes) and 390 females (751 eyes),with the mean age of 70.35 ± 19.05 years.There were 716 right eyes and 664 left eyes,with the visual acuity 0.05-0.8.The fundus of all the patients can be observed.All patients were examined by OCT using Cirrus HD-Model 5000 produced by German Carl Zeiss company and CDFI using MyLab90 color Doppler ultrasound system produced by ESAOTE S.P.A.Comparing the detection rate of macular lesions between the two methods by using X2 test.Using statistical methods to evaluate diagnostic tests,a crosstabulation was made to compare the consistency of frequency-domain OCT and CDFI in the diagnosis of macular lesions.Logistic regression analysis of correlation between detection of CDFI macular lesions and central foveal thickness (CFT),average thickness (AT),with or without macular anterior membrane,retinal folds,retinal cystoid edema,hard exudation,macular hole or lamellar macular hole,superficial detachment of neuroepithelium,detachment of pigment epithelium,vitreous macular traction.Results Two hundreds and thirty-nine eyes (17.3％) showed macular disease by OCT,and 161 eyes (11.7％) showed the abnormal echo in the macular region by CDFI.The detection rate of the macular disease between two methods were statistically significant (χ2=851.661,P＜ 0.001),however,the consistency was well (r=0.766,P=0.000).Logistic analysis showed that the detection rate of macular lesions was related to retinal folds,cysts in retina and CFT (r=1.396,1.041,0.12;P＜0.01).Conclusion CDFI can effectively detect macular lesions that affect the visual prognosis of senile cataract patients.
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Objective:To investigate the CT and MRI features of sinonasal lymphoepithelial carcinoma (LEC) and to compare functional MRI index of LEC with olfactory neuroblastoma (ONB) in this area.Methods:The clinical data, CT and MRI conventional findings of 7 patients were retrospectively reviewed . All of the patients, 5 males and 2 females, with age of 35-58 (45±9) years old, were histologically diagnosed as LEC of sinonasal tract at Beijing Tongren Hospital, Capital Medical University from February 2014 to November 2019. The semi-quantitative DCE-MRI parameters and ADC value were measured and compared with 18 cases of ONB which were collected during the same period. Independent sample t test or corrected t test, Fisher′s exact test were performed to compare the differences between the two groups. Results:In all of the 7 LEC patients, 6 lesions were located in naso-ethmoid area, 1 lesion was located in naso-orbital area. Six lesions were on the left side, and another one was sitted on both sides. All tumors manifested irregular soft tissue density with bony destruction, 3 of them showed bony sclerosis. All lesions showed homogeneous density or signal and obvious enhancement in solid portion accompanied with varying degrees of local invasion. Morphologically, two forms were observed: localized soft tissue mass and diffuse infiltration along mucosa. There were polypoid strips ( n=3), spherical masses ( n=3), and diffuse thickening of nasal cavity and turbinate mucosa ( n=1). DCE-MRI examinations were performed in six LEC patients. Maximum contrast enhancement index (CI max) was 1.51±0.46, wash out ratio (WR) was 14.26%±6.24%. Time intensity curve (TIC) showed a plateau pattern (type Ⅱ) in 4 cases and a washout pattern (type Ⅲ) in 2 cases. Time to peak (T peak) were (40.09±4.59)s, showing a rapid peak performance. Diffusion weighted imaging was performed in six LEC patients, and the ADC value was (0.80±0.14)×10 -3 mm 2/s. There were statistical differences in WR and ADC values between sinonasal LEC and ONB ( t=4.873, P=0.020 and t=3.255, P=0.025). Conclusion:The radiological manifestations of LEC have certain characteristics. The characteristics of conventional imaging findings and functional MRI index combined with clinical data are helpful in making differential diagnosis between LEC and other sinonasal malignant tumors.
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Objective:To investigate the imaging findings of incomplete partition type Ⅲ (IP-Ⅲ) cochlea malformation using high-resolution CT (HRCT) and MRI, and to measure the key anatomical structures, providing the accurate qualitative and quantitative data for cochlear implantation (CI).Methods:Totally 14 patients (28 ears) with IP-Ⅲ cochlea malformation who underwent cochlear implantation at Beijing Tongren Hospital, Capital Medical University from February 2012 to March 2019 were retrospectively collected. All the patients were male, aged 7 months to 27 years old, with the median age as 3 years old. All the 14 patients underwent preoperative HRCT and 9 of them underwent preoperative MRI. The development of inner ear structure, including cochlea, vestibule, semicircular canals, vestibular aqueduct and internal auditory canal (IAC) was reviewed and analyzed. The travel route and position of labyrinthine, tympanic and mastoid segment of facial nerve canal were evaluated; the width of labyrinthine segment of facial nerve canal and superior vestibular nerve canal, as well as the angle between first and second parts of the facial nerve canal were measured on HRCT. The shape of stapes and the development of cochlear nerve were analyzed on MRI.Results:All the 14 cases (28 ears) showed nearly normal shape of the cochlea, with the bony interscalar septa presenting while the modiolus completely absent. The lateral portion of the IAC was dilated, and the septum was absent between the base of the cochlea and the IAC, appearing as a"gourd-like"shape. A small saclike protrusion was formed in the vestibule and protruded into the upper semicircular canal in 10 cases (20 ears) (71.4%, 20/28). The beginning of the vestibular aqueduct enlarged in 12 cases (24 ears) (85.7%, 24/28). All the 14 cases (28 ears) showed that labyrinthine segment of facial nerve canal was located almost above the cochlea and showing stiffly. The labyrinthine segment of facial nerve canal widened in 7 cases (14 ears) (50.0%, 14/28) and the superior vestibular canal widened in 13 cases (26 ears) (92.9%, 26/28). The width of labyrinthine segment of facial nerve canal and the superior vestibular canal were (1.14±0.37) mm and (1.66±0.35) mm, respectively. The angle between the first and second parts of the facial nerve canal was 96.83°±15.63°. Eleven cases (22 ears) (78.6%, 22/28) showed thickened footplate of stapes and poor oval window, but the round window was clear. Nine cases (18 ears) showed normal development of the cochlear nerve on MRI.Conclusion:IP-Ⅲ cochlea malformation has the characteristic imaging features. Preoperation accurate assessment of the shape and location of important anatomical structures such as cochlea, internal auditory canal and facial nerve can provide valuable information for CI.
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Objective:To compare MRI findings of uveal melanomas and other intraocular masses in adults and to evaluate the optimal MRI features for the differential diagnosis.Methods:The MRI data of 254 patients with intraocular masses confirmed by histopathologic or clinical follow-up results from March 2005 to December 2015 in Beijing Tongren Hospital, Capital Medical University was analyzed retrospectively. A total of 128 patients with uveal melanoma and 126 patients with other intraocular masses were enrolled. MRI findings of the masses including the location, shape, margin, signal intensity on T 1WI and T 2WI compared to the gray matter and vitreous body, homogeneity and degree of enhancement of the mass, secondary retinal detachment, height, and ratio of basal diameter to height were compared between uveal melanoma and other intraocular masses by χ 2 test or independent t test. The logistic regression analysis was performed to identify the most discriminating MRI features. The diagnostic performance of different predictive models was analyzed by receiver operating characteristic (ROC) curve. The model of multiple parameters was established by logistic analysis, and the diagnostic efficacy was evaluated. Results:The location, shape, margin, signal intensity on T 1WI and T 2WI compared to the gray matter and vitreous body, homogeneity and degree of enhancement of the mass, secondary retinal detachment, height and ratio of basal diameter to height were significantly different between the uveal melanoma and other intraocular masses (all P<0.05). The results of logistic regression analysis showed that the signal intensity on T 1WI and T 2WI compared to the gray matter, height, shape, location, degree of enhancement of the mass, and secondary retinal detachment were associated with higher likelihood of uveal melanoma. The mass with hypointense on T 2WI (compared with gray matter) was the best MRI feature in the differential diagnosis of uveal melanoma and other intraocular masses (odds ratio 12.237), with the accuracy of 86.2%. The diagnostic accuracy of low signal on T 2WI and high signal on T 1WI (compared with gray matter) was significantly higher than those of vitreous (Delong test, P<0.001). The sensitivity, specificity and accuracy of the combination of height, degree of enhancement, T 1WI and T 2WI signal compared to the gray matter were 90.6%, 92.1% and 96.1%, respectively. The diagnostic performance of combination features was higher than that of each single sign ( P<0.001). Conclusion:MRI features including the signal intensity on T 1WI and T 2WI compared to the gray matter, height, shape, degree of enhancement of the mass, and secondary retinal detachment are helpful in the differential diagnosis between uveal melanoma and other intraocular masses. In addition, the gray matter as the reference is superior to the vitreous body in the evaluation of the signal intensity of intraocular masses.
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Objective:To explore the effect of pre- and post-adaptive statistical iterative reconstruction-Veo (ASiR-V) on image quality and radiation dose in paranasal sinus CT, and to find the best combinations.Methods:One head specimen was scanned with the routine spiral CT scanning parameters [noise index (NI)=8] and different levels of pre-ASiR-V (0—100%, with an interval of 10%). The images were reconstructed with different post-ASiR-V (0—100%, with an interval of 10%) for the bone algorithm and standard algorithm. All of 242 thin-layer images of paranasal sinuses were obtained. The region of interest (ROI) was selected to measure the CT value to calculate the contrast to noise ratio (CNR) and figure of merit (FOM). The volume CT dose index (CTDI vol) and Smart mA were recorded. The linear regression was conducted to analyze the relationship between CTDI vol, SmartmA, CNR and FOM. And with the same pose-ASiR-V level, the CNR of images which reconstructed by bone and soft algorithms were compared with pair-wise t test. The image quality was subjectively evaluated by three independent experienced radiologists using a 4-point scale (4 was the best). Results:As the pre-ASiR-V levels (0—100%) increased, Smart mA and CTDI vol were reduced with a linear negative correlation ( r=-0.981, -0.976, both P<0.001). The Smart mA decreased by 72.05% and CTDI vol by 71.22%. Keeping the same pre-ASiR-V level,the CNR increased with the increase of post-ASiR-V level (for the bone algorithm images: R2=0.976, 0.992, 0.982, 0.982, 0.975, 0.975, 0.979, 0.996, 0.952, 0.978, 0.965;for the standard algorithm images: R2=0.944, 0.990, 0.988, 0.993, 0.996, 0.987, 0.984, 0.996, 0.996, 0.990, 0.965).Under the same level of post-ASiR-V, the CNR and FOM fluctuated with the pre-ASiR-V level (for the bone algorithm images: R2=0.335, 0.341, 0.344, 0.364, 0.385, 0.405, 0.418, 0.429, 0.455, 0.474, 0.516; for the standard algorithm images: R2=0.223, 0.278, 0.327, 0.285, 0.309, 0.329, 0.325, 0.346, 0.360, 0.390, 0.380). All subjective image quality could meet the diagnostic requirements (the score≥3). Conclusion:At NI=8, for the bone algorithm, the best combination is 80% pre-ASiR-V and 100% post-ASiR-V; for the standard algorithm, the best iteration combination is 100% and 100%. The appropriate choice of pre- and post-ASiR-V levels in paranasal sinus CT scan can effectively reduce the radiation dose under the premise of maintaining the image quality that meets the diagnostic needs.
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Objective To investigate the correlation between quantitative parameters derived from iodine overlay images and the monochromatic images of dual‐energy CT and the differentiation degree of laryngeal and hypopharyngeal squamous cell carcinoma(LHSCC). Methods Retrospective analysis of clinical and imaging data of eighty patients with different differentiation degree of LHSCC who underwent dual‐energy CT enhanced scan in the arterial and venous phase from March 2016 to January 2017 (20, 42 and 18 patients with well, moderately and poorly differentiation, respectively) was performed.Among them, twenty‐eight cases were stage T1, twenty‐four cases were stage T2, twenty cases were stage T3 and eight cases were stage T4. All patients were not treated with radiotherapy and chemotherapy before operation. Iodine overlay images and the monochromatic images of arterial and venous phases were acquired from Syngo MultiModality Workplace dual‐energy post‐processing software of Siemens, respectively. The mean iodine concentration (IC), standardized iodine concentration (SIC), and the slope of spectral curve(λ) of different differentiation degrees of LHSCC were calculated and compared. The correlation between quantitative parameters of LHSCC and its differentiation degree was performed by Spearman rank sum test. One‐way analysis of variance was used to compare the quantitative parameters of different differentiation degree of LHSCC. Receiver operating characteristic (ROC) curve was used for analyzing diagnostic efficiency. Results The IC, SIC, and λ in the arterial phase, and IC in the venous phase correlated positively with differentiation degree in LHSCC (r=0.258, 0.350, 0.262 and 0.275, respectively; P<0.05) in this group. The IC, SIC, and λ of poorly differentiated LHSCC in the arterial phase [(3.13 ± 0.54) mg/ml, (0.38±0.10), (5.40±0.92)] were higher than those of well differentiated LHSCC [(2.38±1.02) mg/ml, (0.25± 0.09) and (4.19 ± 1.18); t=2.73, 3.36 and 2.75 respectively; P<0.05] and moderately differentiated LHSCC [(2.56±0.85) mg/ml, (0.28±0.16) and (4.56±1.41); t=2.38, 3.06 and 2.21, P<0.05]. IC of poorly differentiated LHSCC in the venous phase [(2.59 ± 0.62) mg/ml] was significantly higher than that of well differentiated LHSCC [(1.96±0.56) mg/ml,t=2.45,P<0.05] and moderately differentiated [(2.02±0.93) mg/ml,t=2.56,P<0.05] LHSCC. There was no significant difference in the SIC and λ between different differentiation degrees of LHSCC (P>0.05) in the venous phase. The standardized iodine concentration in the arterial phase was the best in distinguishing poorly and moderately differentiated LHSCC, and poorly and well differentiated LHSCC with the area under the receiver operating curve 0.77 and 0.81, respectively, the sensitivity 88.2% and 70.0%, respectively, and the specificity 69.0% and 70.0%, respectively. Conclusions Quantitative parameters derived from dual‐energy CT might be useful in the evaluation of different differentiated degrees of LHSCC. In addition, the standardized iodine concentration of LHSCC in the arterial phase was the best in the estimation of different differentiated degrees of LHSCC.
