Objective To evaluate the diagnosis value of temporal Done high-resolution computed tornography (HRCT) in cholesteatoma. Methods There were 30 causes that had received the mastoid surgery because of cholesteatoma. Each patient’s mastoid plain films (Schuller’s and Mayer’s ) and HRCT had been taken and compared with each other and surgical findings and evaluated with health economic evaluation methods. Results The sensitivity rate in diagnosing cholesteatoma with HRCF was much higher than that with mastoid film (Plt;0.005). The more important benefit with HRCT was that it can afford the detail information in ear such as the ossicular chain, facial nerve canal, tympanic sinus, etc. which were basis for otologist in surgery to remove the focus thoroughly and reconstruct the middle ear function at the same time. In the view of health economic evaluation, HRCT is also much better than mastoid X-ray film. Conclusion HRCT should replace masloid Schuller’s and Mayer’s film in diagnosis cholesteatoma and HRCT should use as ordinary examination in chronic otitis media.
Objective To investigate the characteristics on chest high-resolution computed tomography (HRCT) of patients with interstitial pneumonia with positive myeloperoxidase antineutrophil cytoplasmic antibody (MPO-IP). Methods The extent of fibrosis and subtypes of emphysema on HRCT of MPO-IP patients were retrospectively analyzed and compared with idiopathic pulmonary fibrosis (IPF) cases admitted in the same period. Results From July 2014 to March 2016, 10 patients was diagnosed with IPF and 10 patients was diagnosed with MPO-IP. Emphysema was not different between two groups. Among the MPO-IP patients, 8 patients presented with a usual interstitial pneumonia (UIP) pattern. There existed statistical difference in the bronchial bifurcation level, the fibrosis score of lungs in the MPO-IP patients presented with UIP was lower than that in the IPF patients. Conclusions UIP is the predominant radiologic type of MPO-IP patients. Fibrosis in IPF is more serious than that in MPO-IP with UIP. Paraseptal and centrilobular emphysema are main forms in MPO-IP patients.
Objective To summarize the clinical characteristics of patients with diffuse parenchymal lung disease (DPLD) combined with hematological diseases in order to improve the clinicians’ knowledge of these diseases. Methods The clinical data of 46 patients was collected, who were hospitalized in Nanjing Drum Tower Hospital from January 2010 to October 2020 for DPLD combined with hematological diseases. Their clinical manifestations, laboratory tests, imaging features, diagnostic methods, treatment and prognosis were analyzed retrospectively. Results Among the 46 patients, there were 26 males and 20 females, with an average age of 60±13 years old. The main symptoms were cough and sputum, dyspnea, fever, chest tightness, and so on. Laboratory tests showed that some patients had pancytopenia or two-line cytopenia, and increase in lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate and β2-microglobulin. Bilateral ground glass opacity, consolidations, big or small nodules, reticular shadows, and traction bronchiectasis were showed on chest high-resolution computed tomography. Among the 13 patients who were diagnosed clearly by pathology, they had 5 cases of organizing pneumonia, 4 cases of pulmonary alveolar proteinosis, 2 cases of acute fibrinous and organizing pneumonia, 1 case of diffuse alveolar hemorrhage, and 1 case of lung amyloidosis. Thirty-three patients were clinically diagnosed, including 3-case drug-induced interstitial lung disease, and 1-case exogenous allergic alveolitis. The patients with diffuse pulmonary lesions as the first manifestation and subsequently diagnosed with hematological diseases accounted for 65.2% (30/46). Among these patients, 2 of them had two kinds of hematological diseases at the same time. In the rest of the 16 cases, hematological diseases were diagnosed before DPLD. Among the 46 cases, 26 patients improved after treatment, 18 of them were treated with glucocorticoid, 8 with N-acetylcysteine and pirfenidone, 4 with granulocyte-macrophage colony stimulating factor inhaling and/ or whole lung alveolar lavage, and 2 with clarithromycin for immune regulation, etc. Fifteen patients refused treatment and transferred back to local hospital after the diagnosis of hematological diseases. Five patients died, 2 of them died of respiratory failure and 3 of them died of diseases progression. Conclusions DPLD includes many kinds of diseases, with known or unknown etiology and lack of specificity in clinical manifestations. Therefore, diagnosis for them is quite difficult. Hematological diseases themselves can be the causes of DPLD. At the same time, the treatment for hematological diseases and the related immunosuppression after treatment can also cause DPLD. In the clinical practice, careful screening and systematic differentiation are urgently needed in order to treat different causes precisely, control the conditions and improve the prognosis.
Objective To explore the clinical value of artificial intelligence (AI) quantitative parameters of pulmonary ground-glass nodules (GGN) in predicting the degree of infiltration. Methods A retrospective analysis of 168 consecutive patients with 178 GGNs in our hospital from October 2019 to May 2021 was performed, including 43 males and 125 females, aged 21-78 (55.76±10.88) years. Different lesions of the same patient were analyzed as independent samples. Totally, 178 GGNs were divided into two groups, a non-invasive group (24 adenocarcinoma in situ and 77 minimally invasive adenocarcinoma), and an invasive group (77 invasive adenocarcinoma). We compared the difference of AI quantitative parameters between the two groups, and evaluated predictive valve by receiver operating characteristic curve and binary logistic regression model. Results (1) Except for the gender (P=0.115), the other parameters, such as maximal diameter [15.10 (11.50, 21.60) mm vs. 8.90 (7.65, 11.15) mm], minimum diameter [10.80 (8.85, 15.20) mm vs. 7.40 (6.10, 8.95) mm], proportion of consolidation/tumor ratio [13.58% (1.61%, 63.76%) vs. 0.00% (0.00%, 0.67%)], mean CT value [–347.00 (–492.00, –101.50) Hu vs. –598.00 (–657.50, –510.00) Hu], CT maximum value [40.00 (–40.00, 94.50) Hu vs. –218.00 (–347.00, –66.50) Hu], CT minimum value [–584.00 (–690.50, –350.00) Hu vs. –753.00 (–786.00, –700.00) Hu], danger rating (proportion of high-risk nodules, 92.2% vs. 66.3%), malignant probability [91.66% (85.62%, 94.92%) vs. 81.81% (59.98%, 90.29%)] and age (59.93±8.53 years vs. 52.04±12.10 years) were statistically significant between the invasive group and the non-invasive group (all P<0.001). (2) The highest predictive value of a single quantitative parameter was the maximal diameter (area under the curve=0.843), the lowest one was the risk classification (area under the curve=0.627), the combination of two among the three parameters (maximal diameter, mean CT value, and consolidation/tumor ratio) improved the predictive value entirely. (3) Logistic regression analysis showed that maximal diameter and mean CT value both were the independent risk factor for predicting invasive adenocarcinoma. (4) When the threshold of v was 1.775%, the diagnostic sensitivity of invasive adenocarcinoma was 0.753 and the specificity was 0.851. Conclusion AI quantitative parameters can effectively predict the degree of infiltration of GGNs and provide a reliable reference basis for clinicians.