Objective To summarize ultrasonography, CT and (or) MRI imaging features of cystic liver lesions so as to improve its diagnostic accuracy. Methods The literatures relevant imaging studies of different types of cystic liver lesions at home and abroad were searched. Then with the etiology as clue, the imaging fetures of ultrasonography, CT and (or) MRI plain scan and enhancement scan were summarized. Results The cystic liver lesions had many types, their imaging findings were different and existed overlaps. The diagnosis and differential diagnosis of atypical cases were difficult. ① For the simple hepatic cyst, it was a round cystic mass with water-like echo, density and signal. The boundary was clear, and there was no separation in the cyst, without contrast enhancement. The sensitivity and specificity of diagnosing were higher by ultrasonography and MRI as compared with CT. ② For the bile duct hamartoma and Caroli diease, they were manifested as multiple cysts, widely distributed in the whole liver, without enhancement for the most lesions. The multiple cystic lesions without communicating with the bile duct was the key sign of differential diagnosis for these two dieases. ③ Enhancing mural nodules were more common in cystadenocarcinoma than cystadenoma. The accurate diagnosis of biliary cystadenoma depended on combination of ultrasonography, CT, and MRI findings. ④ For the cystic liver metastatic tumor, it was multiple cystic neoplasms in the liver parenchyma or around the liver. CT was the main method for the diagnosis, and which showed that the density was lower than that of the liver parenchyma, peripheral ring-enhanced lesion as enhanced scan. It was easy to distinguish with simple hepatic cyst by MRI. ⑤ For the cystic hepatocellular carcinoma, it presented as a multilocular cystic solid tumor. The presence of tumor thrombus in portal vein could help to the diagnosis. ⑥ For the undifferentiated embryonal sarcoma, CT plain scan showed the cystic low density mass with clear boundary, the edge with calcification, enhanced scan showed that the soft tissue composition presented continuous strengthening sign. There was no specific signal in MRI plain scan, and the periphery of the tumor was slowly strengthening. ⑦ For the liver abscess, it was easy to diagnose because it had different characteristic features in different pathological phase, but it was misdiagnosis of intrahepatic cholangiocarcinoma when its symptoms were atypical. ⑧ The ultrasonography and the CT were the optimal methods for the hepatic cystic echinococcosis and the hepatic alveolar echinococcosis respectively. The significances of imaging were to determine the activity of hydatid cyst and to identify anatomy structure among alveolar echinococcosis, bile duct and blood vessel, and judge invasion or not, MRCP was important for diagnosis. Conclusions Abdominal ultrasonography could be used as the first choice for diagnosis of cystic liver lesions, CT and MRI could be used as effective supplementary methods for it. A combination of various imaging techniques is key to diagnosis. Moreover, number and morphology of lesion, and solid component or not are important imaging features of diagnosis and differential diagnosis of cystic liver lesion.
Objective To study the clinical and CT findings of bronchiolar adenoma. Methods Patients diagnosed with bronchiolar adenoma confirmed by surgical pathology at Linyi People's Hospital and Yantai Yuhuangding Hospital from 2016 to 2021 were collected. Their clinical and CT imaging features were retrospectively analyzed. ResultsFinally, 25 patients were collected, including 6 males and 19 females, aged 32-73 (58.6±10.1) years. The immunohistochemical Ki-67 (MIB1) of all lesions was <5%. The lesions were located in the upper and middle lobe of both lungs in 9 patients, lower lobes in 16 patients, extrapulmonary zone in 22 patients, intrapulmonary middle zone in 3 patients, round in 11 patients, irregular in 14 patients, well-defined in 22 patients, pure ground-glass/mixed ground-glass nodules in 6 patients, solid nodules in 19 patients. There were 11 patients with central small cavity, 18 patients with single bronchioles sign, 19 patients without adhesion with adjacent pleura, and 24 patients without mediastinal lymph node enlargement. ConclusionBronchiolar adenomas usually occur in the middle-aged and elderly, mostly in the lower lobe of both lungs and the distribution of the peripheral lung field, most of the patients do not have any clinical symptoms, and the postoperative prognosis is good. CT may show large nodules or masses, pure ground-glass/mixed ground-glass nodules, irregular solid nodules and central small cavities. Irregular stellate nodules, central small cavity shadow, and single bronchiolar vascular bundle connected with the lesions are relatively specific imaging findings of bronchiolar adenoma.
Objective To explore the diagnosis and treatment strategies for elderly patients with ground-glass opacity (GGO). MethodsThe imaging features and postoperative pathological findings of the elderly patients with pulmonary GGO receiving surgery in our hospital from 2017 to 2019 were retrospectively analyzed. The patients were divided into an elderly patient group and a non-elderly patient group based on their age. Results Finally 575 patients were included in the study. There were 281 elderly patients, including 83 males and 198 females, with an average age of (67.0±5.3) years. There were 294 non-elderly patients, including 88 males and 206 females, with an average age of (49.1±7.3) years. Compared with the non-elderly patients, elderly GGO patients showed the following distinct clinical features: long observation time for lesions (P=0.001), high proportion of rough edges of GGO (P<0.001), significant pleural signs (P＜0.001) and bronchial signs (P＜0.001), and high proportion of type Ⅱ-Ⅳ GGO (P<0.001), lobectomy type (P=0.013), and invasive lesions reported in postoperative pathology (P<0.001). There was no statistical difference in the average hospital stay between the two groups (P=0.106). Multivariate logistic regression analysis showed that GGO diameter and GGO type were the main factors affecting the operation. Observation time, GGO diameter, GGO type and pleural signs were the main influencing factors for postoperative pathological infiltrative lesions. The cut-off value of GGO diameter in predicting infiltrating lesions was 10.5 mm in the elderly patients group. Conclusion The size and type of GGO are important factors in predicting invasive lesions and selecting surgical methods. Elderly patients with radiographic manifestations of type Ⅱ-Ⅳ GGO lesions with a diameter greater than 10.5 mm should be closely followed up.
ObjectiveTo explore the efficiency of Ki-67 expression and CT imaging features in predicting the degree of invasion of lung adenocarcinoma. MethodsThe clinical data of 217 patients with pulmonary nodules, who were diagnosed as suspicious lung cancer by multi-disciplinary treatment clinic of pulmonary nodules in our hospital from September 2017 to August 2021, were retrospectively analyzed. There were 84 males and 133 females, aged 52 (25-84) years. The patients were divided into two groups according to the infiltration degree, including an adenocarcinoma in situ and microinvasive adenocarcinoma group (n=145) and an invasive adenocarcinoma group (n=72). ResultsThere was no statistical difference in the age and gender between the two groups (P>0.05). The univariate analysis showed that CK-7, P63, P40 and CK56 expressions were not different between the two groups (P=0.172, 0.468, 0.827, 0.313), while Napsin A, TTF-1 and Ki-67 expressions were statistically different (P=0.002, 0.020, <0.001). The multivariate analysis showed that Ki-67 expression was statistically different between the two groups (P<0.001). Ki-67 was positively correlated with malignant features of CT images and the degree of lung adenocarcinoma invasion (P<0.05). Ki-67 and CT imaging features alone could predict the degree of lung adenocarcinoma invasion, but their sensitivity and specificity were not high. Ki-67 combined with CT imaging features could achieve a higher prediction efficiency.ConclusionCompared with Ki-67 or CT imaging features alone, the combined prediction of Ki-67 and imaging features is more effective, which is of great significance for clinicians to select the appropriate operation occasion.
With high morbidity, branch retinal vein occlusion (BRVO) is a common retinal vascular disease in the clinic. Although the classic characteristics of BRVO have been recognized for a long time, the traditional understanding of BRVO has been challenged along with development and application of new imaging technologies, including the reasonable classification and staging of the disease, and the vascular characteristics at the occlusive site via multimodal imaging, etc. Thus, re-summarizing and refining these features as well as further improving and optimizing traditional imaging evaluation, can not only deepen the correct acknowledge of the entity, but also find biomarkers of prognosis of visual function, which is helpful to establish better diagnosis and treatment strategy. In the meanwhile, it is necessary that clinical characteristics of BRVO on imaging and the reliability of these imaging techniques are worth correct understanding and objective assessment.
ObjectiveTo explore value of CT imaging features in differentiating pathological grades of pancreatic neuroendocrine neoplasms (pNENs). MethodsThe patients with pNENs admitted to the Sichuan Provincial People’s Hospital from October 2017 to December 2023 were retrospectively collected. The enrolled patients were assigned into a low-grade (G1+G2) pNENs and high-grade (G3+neuroendocrine carcinoma) pNENs. Then, the differences in gender, age, presence of neuroendocrine symptoms, tumor location, tumor diameter, clarity of the tumor boundary, cystic change, capsule, dilation of the biliary and pancreatic ducts, pancreatic parenchymal atrophy, vascular invasion, liver metastasis, lymph node metastasis, tumor enhancement pattern, Ct values in each phase, and the ratio of Ct value of the tumor to that of the normal pancreas (T/N value) between the low-grade pNENs and high-grade pNENs were compared. Subsequently, the multivariate logistic regression analysis was used to screen the CT imaging features with statistical significance and the receiver operating characteristic (ROC) curve was use to differentiate high-grade from low-grade pNENs. ResultsA total of 47 pNENs patients were enrolled, including 36 low-grade and 11 high-grade cases. Compared with the low-grade pNENs, the patients with high-grade pNENs had higher proportions of pancreaticobiliary duct dilation (χ2=9.124, P=0.003) and vascular invasion (χ2=10.967, P=0.001), more mild enhancement (χ2=9.192, P=0.010), larger tumor diameter (Z=–2.378, P=0.017), and lower Ct values and T/N ratios in the arterial and venous phases (P=0.001, P=0.032, P=0.006, P=0.018). The multivariate logistic regression analysis showed that the pancreaticobiliary duct dilation, vascular invasion, and decreased Ct value in the arterial phase were the predictive factors for the high-grade pNENs. The areas under the ROC curves of these three indicators for distinguishing low-grade from high-grade pNENs were 0.760, 0.749, and 0.843, respectively, the Ct value in the arterial phase had the strongest discriminatory ability, and its cutoff value was 78 HU. ConclusionsThe results of this study suggest that pancreatic ductal dilation, vascular invasion, and Ct value in arterial phase play important roles in differentiating high-grade pNENs from low-grade pNENs. Ct value in arterial phase has the greatest diagnostic efficiency.
Objective To use imaging features of pulmonary nodules to predict the risk of lymph node metastasis in patients with cT1-stage non-small cell lung cancer (NSCLC), providing a reference for clinical decision-making. Methods A retrospective analysis was conducted on the imaging features and postoperative pathological results of cT1 NSCLC patients who underwent surgical treatment at Linyi People’s Hospital from July 2019 to July 2022. Patients were grouped and analyzed according to lymph node metastasis status. Results A total of 1 123 patients were included, comprising 471 males and 652 females, with a median age of 59 (52, 66) years. Comparative analysis revealed that sex, age, nodule location, nodule size on imaging, solid component size, consolidation tumor ratio (CTR), average CT value, and tumor proximity to the pleura all influenced lymph node metastasis. A nomogram was constructed, indicating that the probability of lymph node metastasis in cT1 NSCLC was positively correlated with solid component size, CTR, and average CT value of the pulmonary nodule, and negatively correlated with patient age. The area under the receiver operating characteristic curve was 0.929. Conclusion For cT1 NSCLC patients, the probability of lymph node metastasis can be predicted by measuring the solid component size, CTR, and average CT value of the pulmonary nodule, in conjunction with patient age. However, relying solely on pulmonary nodule imaging characteristics is insufficient to determine a specific lymph node dissection strategy.
Hepatic angiomyolipoma (HAML) is a rare benign mesenchymal tumor of the liver, which has highly variable imaging appearances, often leads to missed diagnosis and misdiagnosis. The images of 2 patients with HAML confirmed by pathology were presented in this study, and the typical imaging features of the HAML, the underlying pathophysiological mechanism, and the differential diagnosis were briefly summarized so as to deepen the understanding of HAML and to improve the diagnosis and differential diagnosis abilities of HAML, then reduce the rates of missed diagnosis and misdiagnosis of the HAML.
ObjectiveTo explore the CT imaging features and independent risk factors for cystic pulmonary nodules and establish a malignant probability prediction model. Methods The patients with cystic pulmonary nodules admitted to the Department of Thoracic Surgery of the First People's Hospital of Neijiang from January 2017 to February 2022 were retrospectively enrolled. They were divided into a malignant group and a benign group according to the pathological results. The clinical data and preoperative chest CT imaging features of the two groups were collected, and the independent risk factors for malignant cystic pulmonary nodules were screened out by logistic regression analysis, so as to establish a prediction model for benign and malignant cystic pulmonary nodules. ResultsA total of 107 patients were enrolled. There were 76 patients in the malignant group, including 36 males and 40 females, with an average age of 59.65±11.74 years. There were 31 patients in the benign group, including 16 males and 15 females, with an average age of 58.96±13.91 years. Multivariate logistic analysis showed that the special CT imaging features such as cystic wall nodules [OR=3.538, 95%CI (1.231, 10.164), P=0.019], short burrs [OR=4.106, 95%CI (1.454, 11.598), P=0.008], cystic wall morphology [OR=6.978, 95%CI (2.374, 20.505), P<0.001], and the number of cysts [OR=4.179, 95%CI (1.438, 12.146), P=0.009] were independent risk factors for cystic lung cancer. A prediction model was established: P=ex/(1+ex), X=–2.453+1.264×cystic wall nodules+1.412×short burrs+1.943×cystic wall morphology+1.430×the number of cysts. The area under the receiver operating charateristic curve was 0.830, the sensitivity was 82.9%, and the specificity was 74.2%. ConclusionCystic wall nodules, short burrs, cystic wall morphology, and the number of cysts are the independent risk factors for cystic lung cancer, and the established prediction model can be used as a screening method for cystic pulmonary nodules.
Objective To study the imaging features of the hip joint by measuring the imaging parameters of spine, pelvis, and hip joint before and after total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS) undergoing THA so as to provide reference for selection of operation methods and prosthesis. Methods Between January and July 2015, 38 patients (56 hips) with AS underwent primary THA as AS group, and 36 patients (45 hips) with osteonecrosis of the femoral head underwent THA as control group. There was no significant difference in side (χ2=1.14,P=0.95). The acetabular abduction angle (ABA), acetabular anteversion angle (AVA), center collum diaphyseal (CCD), offset, height from rotation center to lesser trochanter (HRCLT), femoral intertrochanteric distance (FID) were measured by CT three-dimensional morphology. The canal flare index (CFI), cortical thickness index (CTI), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured by X-ray film before operation. The AVA, ABA, and the filling ratio were measured on the postoperative X-ray film. Results There was no significant difference in preoperative AVA and ABA and postoperative ABA between 2 groups (P>0.05), but significant difference was found in postoperative AVA (t=6.71,P=0.00). The mean PI, SS, and PT in AS group were 48.37° (range, 41-58°), 5.64°(range, 2-11°), and 12.85° (range, 5-26°), respectively. There was significant difference in CCD, CFI, and CTI between 2 groups (t=3.63,P=0.04;t=5.12,P=0.02;t=3.91,P=0.04), but offset, HRCLT, and FID all showed no significant difference (t=0.41,P=0.36;t=0.33,P=0.56;t=0.59,P=0.12). On the basis of the Noble classification, medullary cavity of the femur was rated as chimney type, ordinary type, and champagne flute type in 32, 18, and 6 hips of AS group, and in 4, 28, and 13 hips of control group respectively. Filling ratio of distal segment in AS group was significantly lower than that in control group (t=5.64,P=0.02), but there was no significant difference in the filling ratio of middle and proximal segments between 2 groups (t=0.29,P=0.61;t=0.55,P=0.13). Conclusion Compared with patients having osteonecrosis of the femeral head, there is no significant difference in preoperative AVA and ABA, but postoperative AVA significantly increase in patients with AS. Because AS patients have mainly chimney type medullary cavity of the femur, the filling ratio of middle and distal segment is lower when tapered stems are used, and the filling ratio of anatomic stems is higher.