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.
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.
ObjectiveTo analyze the pathological manifestations and imaging characteristics of bronchiolar adenoma (BA).MethodsThe clinical data of 11 patients with BA who received surgeries in our hospital from January 2019 to September 2020 were retrospectively analyzed, including 5 males and 6 females aged 40-73 (62.40±10.50) years. The intraoperative rapid freezing pathological diagnosis, postoperative pathological classification, cell growth pattern, nuclear proliferation index Ki-67 and other immunohistochemical staining combined with preoperative chest CT imaging characteristics were analyzed.ResultsThe average preoperative observation time was 381.10±278.28 d. The maximum diameter of imaging lesions was 5-27 (10.27±6.34) mm. Eight (72.7%) patients presented with irregular morphology of heterogeneous ground-glass lesions, and 3 (27.3%) patients presented with pure ground-glass lesions. There were 10 (90.9%) patients with vascular signs, 8 (72.7%) patients with vacuolar signs, 1 (9.1%) patient with bronchus sign, 3 (27.3%) patients with pleural traction and 9 (81.8%) patients with burr/lobular sign. The surgical methods included sub-lobectomy in 10 patients and lobectomy in 1 patient. Five (45.5%) patients were reported BA by intraoperative frozen pathology. The postoperative pathological classification included 8 patients with distal-type and 3 patients with proximal-type, and the maximum diameter of the lesions was 4-20 (8.18±5.06) mm. Eight (72.7%) patients showed characteristic bilayer cell structure under microscope, and 10 (90.9%) patients showed thyroid transcription factor 1 expression in pathological tissues. The expression of NapsinA in intracavity cells was found in 9 (81.8%) patients. The Ki-67 index of the lesion tissue was 1%-5% (3.22%±1.72%).ConclusionThe pathological features and imaging findings of BA confirm the premise that BA is a neoplastic lesion. However, to identify BA as a benign or inert tumor needs more clinical data and evidence of molecular pathological studies.
Objective To observe the multimodal imaging features and explore the treatment of parafoveal exudative vascular anomaly complex (PEVAC). Methods A retrospective study. Six patients (6 eyes) with PEVAC diagnosed in Tianjin Eye Hospital were included in this study from July 2018 to December 2021. All patients were female with monocular disease. The age was (61.1±9.3) years. All patients showed a sudden painless decline in monocular vision with metamorphopsia. All patients underwent best corrected visual acuity (BCVA), color fundus photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography (OCTA). Indocyanine green angiography (ICGA) was performed in 4 eyes. In 6 eyes, 3 eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drug; 5 eyes were treated with micropulse laser photocoagulation and/or local thermal laser photocoagulation; 1 eye was treated with photodynamic therapy. Five patients were followed up for (9.2±7.4) months, and 1 patient was lost. At follow-up, the same equipment and methods were used as at the initial diagnosis. The clinical manifestations, multimodal image features and treatment response were observed. Results Baseline BCVA of affected eyes were ranged from 0.1 to 0.5. PEVAC was isolated in 6 eyes, and the fundus showed isolated hemangioma-like leision, accompanied by small bleeding and hard exudation. There were 2 isolated hemangiomatous lesions adjacent to each other in 2 eyes. In the early stage of FFA, punctate high fluorescence lesions near the macular fovea were seen, and the leakage was enhanced in the late stage. There was no leakage in the early stage of ICGA, or slight leakage with late scouring. OCT showed an oval lesion with high reflection wall and uneven low reflection. The central macular thickness (CMT) was (431±76) μm. OCTA showed blood flow signals in PEVAC, 2 eyes in the superficial capillary plexus (SCP), and it was also observed in the deep capillary plexus (DCP), but the intensity of blood flow signal was slightly weaker than that in the SCP. The blood flow signal was visible only in DCP in 2 eyes. SCP and DCP showed similar intensity of blood flow signals in 2 eyes. After treatment, the bleeding was absorbed basically in 4 eyes, the hard exudation partially subsided, the CMT decreased, the intercortical cystic cavity of the fovea nerve decreased, the hemangiomatous lesions narrowed, and BCVA increased. In 1 eye, the macular sac was reduced and partially absorbed by hard exudation, which was later relapsed due to blood pressure fluctuation.ConclusionsThe majority of PEVAC patients had monocular onset. The fundus is characterized by solitary or structure with strong reflex walls, with or without retinal cysts, hard exudates, and subretinal fluid, and visible blood flow signals inside.
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.
Objective To explore the diagnosis and treatment strategies for elderly patients with ground-glass opacity (GGO) by reviewing the clinical data such as imaging features, surgical methods, postoperative pathological results and average hospital stay. MethodsThe imaging features and postoperative pathological findings of the elderly patients with pulmonary GGO in our hospital from January 2017 to December 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: the lesions were observed for a long time (P<0.001), the GGO margin was not smooth (P<0.001), the pleural signs (P<0.05) and bronchial signs (P<0.05) were obvious, there were more patients of type Ⅱ to Ⅳ GGO (P<0.001), more patients of lobectomy (P<0.05), and more patients of postoperative pathological reports of infiltrating lesions (P<0.05). There was no statistical difference in the average length of stay between the two groups (P>0.05). Multivariate logistic regression analysis showed that GGO diameter and GGO type were the main factors affecting the operation. Observation time, GGO diameter and GGO type 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 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 to Ⅳ GGO lesions with a diameter greater than 10.5 mm should be closely followed.
Objective To explore the correlation between the imaging features of peripheral ground-glass pulmonary nodules and the invasion degree of lung adenocarcinoma, and the high risk factors for infiltrating lung adenocarcinoma under thin-slice CT, which provides some reference for clinicians to plan the surgical methods of pulmonary nodules before operation and to better communicate with patients, and assists in building a clinical predictive model for invasive adenocarcinoma. MethodsClinical data of the patients with peripheral ground-glass pulmonary nodules (diameter≤3 cm) in thin-slice chest CT in the First Affiliated Hospital of Soochow University from January 2019 to January 2020 were continuously collected. All patients underwent thin-slice CT scan and thoracoscopic surgery in our center. According to the pathological examination results, they were divided into two groups: an adenocarcinoma lesions before infiltration group, and an invasive lung adenocarcinoma group. The thin-slice CT imaging parameters of pulmonary nodules were collected. The nodular diameter, mean CT value, consolidation tumor ratio (CTR), nodular shape, vacuolar sign, bronchial air sign, lobulation sign, burr sign, lesion boundary, pleural depression sign, vascular cluster sign and other clinical data were collected. Univariate and multivariate analyses were conducted to analyze the independent risk factors for the infiltrating lung adenocarcinoma, and to analyze the threshold value and efficacy of each factor for the identification of infiltrating lung adenocarcinoma. Results Finally 190 patients were enrolled. There were 110 patients in the adenocarcinoma lesions before infiltration group, including 21 males and 89 females with a mean age of 53.57±10.90 years, and 80 patients in the invasive lung adenocarcinoma group, including 31 males and 49 females with a mean age of 56.45±11.30 years. There was a statistical difference in the mean CT value, nodular diameter, CTR, gender, smoking, nodular type, nodular shape, vacuolar sign, lobulation sign, burr sign, lesion boundary, pleural depression sign, vascular cluster sign between the two groups (P＜0.05). However, there was no statistical difference between the two groups in age (P=0.081), lesion site (P=0.675), and bronchial air sign (P=0.051). Multiple logistic regression analysis showed that nodular diameter, mean CT value, CTR and lobulation sign were independent risk factors for differentiating preinvasive adenocarcinoma from invasive adenocarcinoma. At the same time, the threshold value was calculated by Youden index, indicating that the CTR was 0.45, the nodal diameter was 10.5 mm and the mean CT value was –452 Hu. Conclusion In the peripheral ground-glass pulmonary nodules, according to the patient's CT imaging features, such as mixed ground-glass nodules, irregular shapes, vacuoles, short burrs, clear boundaries, pleural indentations, and vascular clusters, have a certain reference value in the discrimination of the invasion degree of ground-glass pulmonary nodules. At the same time, it is found in this research that peripheral ground-glass pulmonary nodules with diameter greater than 10.5 mm, CT value greater than –452 Hu, CTR greater than 0.45 and lobulation sign are more likely to be infiltrating lung adenocarcinoma.
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 discuss the main pathological types and imaging features of pulmonary nodules highly suspected to be malignant in clinical practice but pathologically confirmed to be benign. Method A retrospective analysis was conducted on the clinical data of the patients with pulmonary nodules, who were initially highly suspected of malignancy but were pathologically confirmed as benign, treated at the First Affiliated Hospital of Xiamen University from December 2020 to April 2023. Based on the results of preoperative discussions, the patients were divided into a benign group and a suspicious malignancy group. Results Finally, 232 patients were collected, including 112 males and 120 females, with an average age of 51 years. There were 127 patients in the benign group, and 105 patients in the suspicious malignancy group. There was no statistical difference in age, gender, symptoms, smoking history, and tumor history between the two groups (P>0.05). However, there were statistical differences in nodule density, CT values, margins, shapes, andmalignant signs between the two groups (P<0.05). The analysis showed that in suspiciously malignant pulmonary nodules, the solid group was mainly characterized by collagen nodules and fibrous tissue hyperplasia (33.3%), tuberculosis (20.3%), and fungal infection (18.5%), while the non-solid group was primarily composed of collagen nodules and fibrous tissue hyperplasia (39.2%) and atypical adenomatous hyperplasia (17.6%). ConclusionThe benign pulmonary nodules suspected of malignancy are pathologically characterized by the presence of collagen nodules and fibrous tissue hyperplasia, tuberculosis, atypical adenomatous hyperplasia, and fungal infections. In terms of imaging features, they typically present as non-solid nodules, accompanied by signs of malignancy such as spiculation, lobulation, cavitation, and pleural retraction.
Objective To explore the clinical and imaging features of patients with acute dizziness and assess their associations with 3-month prognosis. Methods We enrolled adult patients with a chief complaint of acute dizziness, who were admitted to the Neurological Clinic at the Emergency Department of West China Hospital, Sichuan University between January 1st and May 31st 2022. We collected clinical and imaging features at baseline for each patient. The primary outcome was recurrent dizziness within 3 months after index dizziness. Secondary outcome was stroke within 3 months after index dizziness. Results A total of 1 322 patients who visited the Neurological Clinic were included, of which 617 (46.7%) had a chief complaint of acute dizziness. Among 222 patients who performed emergent brain and neck CT angiography, 1 patient presented with intracerebral haemorrhage. Among the remaining 221 patients, 206 patients completed 3-month follow-up, with 76 patients reported recurrent dizziness and 7 patients had stroke (6 ischaemic, 1 hemorrhagic). The multivariate logistic regression showed that chronic dizziness duration and parenchymal hypodensity on brain CT were each associated with a higher risk of recurrent dizziness. Compared with those who did not report stroke, the stroke patients were more likely to present with hypertension, headache symptoms, and exhibit parenchymal hypodensity on baseline CT (P<0.05). Conclusions In patients with acute dizziness, those with chronic dizziness duration and parenchymal hypodensity on baseline CT were associated with a higher risk of 3-month recurrent dizziness. Acute dizziness patients experiencing 3-month stroke often have hypertension, headache symptoms, and parenchymal hypodensity on baseline CT.