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He QH, Feng JJ, Wu LC, Wang Y, Zhang X, Jiang Q, Zeng QY, Yin SW, He WY, Lv FJ, Xiao MZ. Deep learning system for malignancy risk prediction in cystic renal lesions: a multicenter study. Insights Imaging 2024; 15:121. [PMID: 38763985 DOI: 10.1186/s13244-024-01700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/15/2024] [Indexed: 05/21/2024] Open
Abstract
OBJECTIVES To develop an interactive, non-invasive artificial intelligence (AI) system for malignancy risk prediction in cystic renal lesions (CRLs). METHODS In this retrospective, multicenter diagnostic study, we evaluated 715 patients. An interactive geodesic-based 3D segmentation model was created for CRLs segmentation. A CRLs classification model was developed using spatial encoder temporal decoder (SETD) architecture. The classification model combines a 3D-ResNet50 network for extracting spatial features and a gated recurrent unit (GRU) network for decoding temporal features from multi-phase CT images. We assessed the segmentation model using sensitivity (SEN), specificity (SPE), intersection over union (IOU), and dice similarity (Dice) metrics. The classification model's performance was evaluated using the area under the receiver operator characteristic curve (AUC), accuracy score (ACC), and decision curve analysis (DCA). RESULTS From 2012 to 2023, we included 477 CRLs (median age, 57 [IQR: 48-65]; 173 men) in the training cohort, 226 CRLs (median age, 60 [IQR: 52-69]; 77 men) in the validation cohort, and 239 CRLs (median age, 59 [IQR: 53-69]; 95 men) in the testing cohort (external validation cohort 1, cohort 2, and cohort 3). The segmentation model and SETD classifier exhibited excellent performance in both validation (AUC = 0.973, ACC = 0.916, Dice = 0.847, IOU = 0.743, SEN = 0.840, SPE = 1.000) and testing datasets (AUC = 0.998, ACC = 0.988, Dice = 0.861, IOU = 0.762, SEN = 0.876, SPE = 1.000). CONCLUSION The AI system demonstrated excellent benign-malignant discriminatory ability across both validation and testing datasets and illustrated improved clinical decision-making utility. CRITICAL RELEVANCE STATEMENT In this era when incidental CRLs are prevalent, this interactive, non-invasive AI system will facilitate accurate diagnosis of CRLs, reducing excessive follow-up and overtreatment. KEY POINTS The rising prevalence of CRLs necessitates better malignancy prediction strategies. The AI system demonstrated excellent diagnostic performance in identifying malignant CRL. The AI system illustrated improved clinical decision-making utility.
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Affiliation(s)
- Quan-Hao He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jia-Jun Feng
- Department of Medical Imaging, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ling-Cheng Wu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yun Wang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xuan Zhang
- Department of Urology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi-Yuan Zeng
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Si-Wen Yin
- Department of Urology, Chongqing University Fuling Hospital, Chongqing, People's Republic of China
| | - Wei-Yang He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
| | - Ming-Zhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
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Liu SZ, Yang SH, Ye M, Fu BJ, Lv FJ, Chu ZG. Bubble-like lucency in pulmonary ground glass nodules on computed tomography: a specific pattern of air-containing space for diagnosing neoplastic lesions. Cancer Imaging 2024; 24:47. [PMID: 38566150 PMCID: PMC10985942 DOI: 10.1186/s40644-024-00694-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/29/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE To investigate the computed tomography (CT) characteristics of air-containing space and its specific patterns in neoplastic and non-neoplastic ground glass nodules (GGNs) for clarifying their significance in differential diagnosis. MATERIALS AND METHODS From January 2015 to October 2022, 1328 patients with 1,350 neoplastic GGNs and 462 patients with 465 non-neoplastic GGNs were retrospectively enrolled. Their clinical and CT data were analyzed and compared with emphasis on revealing the differences of air-containing space and its specific patterns (air bronchogram and bubble-like lucency [BLL]) between neoplastic and non-neoplastic GGNs and their significance in differentiating them. RESULTS Compared with patients with non-neoplastic GGNs, female was more common (P < 0.001) and lesions were larger (P < 0.001) in those with neoplastic ones. Air bronchogram (30.1% vs. 17.2%), and BLL (13.0% vs. 2.6%) were all more frequent in neoplastic GGNs than in non-neoplastic ones (each P < 0.001), and the BLL had the highest specificity (93.6%) in differentiation. Among neoplastic GGNs, the BLL was more frequently detected in the larger (14.9 ± 6.0 mm vs. 11.4 ± 4.9 mm, P < 0.001) and part-solid (15.3% vs. 10.7%, P = 0.011) ones, and its incidence significantly increased along with the invasiveness (9.5-18.0%, P = 0.001), whereas no significant correlation was observed between the occurrence of BLL and lesion size, attenuation, or invasiveness. CONCLUSION The air containing space and its specific patterns are of great value in differentiating GGNs, while BLL is a more specific and independent sign of neoplasms.
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Affiliation(s)
- Si-Zhu Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, 400016, Chongqing, China
| | - Shi-Hai Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, 400016, Chongqing, China
- Department of Radiology, People's Hospital of Nanchuan district, 16# South street, Nanchuan district, 408400, Chongqing, China
| | - Min Ye
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, 400016, Chongqing, China
- Department of Radiology, The First People's Hospital of Neijiang, No.31 Tuozhong Road, Shizhong District, 641099, Neijiang, Sichuang Province, China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, 400016, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, 400016, Chongqing, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, 400016, Chongqing, China.
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Li WJ, Chu ZG, Li D, Jing WW, Shi QL, Lv FJ. Accuracy of solid portion size measured on multiplanar volume rendering images for assessing invasiveness in lung adenocarcinoma manifesting as subsolid nodules. Quant Imaging Med Surg 2024; 14:1971-1984. [PMID: 38415120 PMCID: PMC10895121 DOI: 10.21037/qims-23-942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/13/2023] [Indexed: 02/29/2024]
Abstract
Background The solid component of subsolid nodules (SSNs) is closely associated with the invasiveness of lung adenocarcinoma, and its accurate assessment is crucial for selecting treatment method. Therefore, this study aimed to evaluate the accuracy of solid component size within SSNs measured on multiplanar volume rendering (MPVR) and compare it with the dimensions of invasive components on pathology. Methods A pilot study was conducted using a chest phantom to determine the optimal MPVR threshold for the solid component within SSN, and then clinical validation was carried out by retrospective inclusion of patients with pathologically confirmed solitary SSN from October 2020 to October 2021. The radiological tumor size on MPVR and solid component size on MPVR (RSSm) and on lung window (RSSl) were measured. The size of the tumor and invasion were measured on the pathological section, and the invasion, fibrosis, and inflammation within SSNs were also recorded. The measurement difference between computed tomography (CT) and pathology, inter-observer and inter-measurement agreement were analyzed. Receiver operating characteristic (ROC) analysis and Bland-Altman plot were performed to evaluate the diagnostic efficiency of MPVR. Results A total of 142 patients (mean age, 54±11 years, 39 men) were retrospectively enrolled in the clinical study, with 26 adenocarcinomas in situ, 92 minimally invasive adenocarcinomas (MIAs), and 24 invasive adenocarcinomas (IAs). The RSSl was significantly smaller than pathological invasion size with fair inter-measurement agreement [intraclass correlation coefficient (ICC) =0.562, P<0.001] and moderate interobserver agreement (ICC =0.761, P<0.001). The RSSm was significantly larger than pathological invasion size with the excellent inter-measurement agreement (ICC =0.829, P<0.001) and excellent (ICC =0.952, P<0.001) interobserver agreement. ROC analysis showed that the cutoff value of RSSm for differentiating adenocarcinoma in situ from MIA and MIA from IA was 1.85 and 6.45 mm (sensitivity: 93.8% and 95.5%, specificity: 85.7% and 88.2%, 95% confidence internal: 0.914-0.993 and 0.900-0.983), respectively. The positive predictive value-and negative predictive value of MPVR in predicting invasiveness were 92.8% and 100%, respectively. Conclusions Using MPVR to predict the invasive degree of SSN had high accuracy and good inter-observer agreement, which is superior to lung window measurements and helpful for clinical decision-making.
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Affiliation(s)
- Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Li
- Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China
| | - Wei-Wei Jing
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiu-Ling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Institute of Medical Data, Chongqing Medical University, Chongqing, China
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Fu BJ, Zhang XC, Lv FJ, Chu ZG. Potential Role of Intrapulmonary Concomitant Lesions in Differentiating Non-Neoplastic and Neoplastic Ground Glass Nodules. J Inflamm Res 2023; 16:6155-6166. [PMID: 38107382 PMCID: PMC10725751 DOI: 10.2147/jir.s437419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To determine the value of intrapulmonary concomitant lesions in differentiating non-neoplastic and neoplastic ground-glass nodules (GGNs). Patients and Methods From January 2014 to March 2022, 395 and 583 patients with confirmed non-neoplastic and neoplastic GGNs were retrospectively enrolled. Their clinical and chest CT data were evaluated. The CT features of target GGNs and intrapulmonary concomitant lesions in these two groups were analyzed and compared, and the role of intrapulmonary concomitant lesions in improving differentiation was evaluated. Results The intrapulmonary concomitant lesions were more common in patients with non-neoplastic GGNs than in those with neoplastic ones (87.88% vs 82.18%, P = 0.015). Specifically, patients with non-neoplastic GGNs had a higher incidence of multiple solid nodules (SNs), patchy ground-glass opacity/consolidation, and fibrosis/calcification in any lung fields (each P < 0.05). Logistic regression analysis indicated that patients < 44 years old, diameter < 7.35 mm, irregular shape, and coarse margin or ill-defined boundary for target GGN, pleural thickening, and concomitant SNs in the same lobe and fibrosis or calcification in any lung field were independent indicators for predicting non-neoplastic GGNs. The AUC of the model for predicting non-neoplastic GGNs increased from 0.894 to 0.926 (sensitivity, 83.10%; specificity, 87.10%) after including the concomitant lesions in the patients' clinical characteristics and CT features of target GGNs (P < 0.0001). Conclusion Besides the patients' clinical characteristics and CT features of target GGNs, the concomitant multiple SNs in the same lobe and fibrosis/calcification in any lung field should be considered in further differentiating non-neoplastic and neoplastic GGNs.
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Affiliation(s)
- Bin-Jie Fu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiao-Chuan Zhang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Department of Radiology, Chonggang General Hospital, Chongqing, People’s Republic of China
| | - Fa-Jin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Liao HF, Huang XT, Li X, Lv FJ, Luo TY, Li Q. Solitary lung adenocarcinoma: follow-up CT, pathological-molecular characteristics, and surgical prognosis for different morphological classifications. Insights Imaging 2023; 14:209. [PMID: 38010599 PMCID: PMC10682316 DOI: 10.1186/s13244-023-01563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To investigate the dynamic changes during follow-up computed tomography (CT), histological subtypes, gene mutation status, and surgical prognosis for different morphological presentations of solitary lung adenocarcinomas (SLADC). MATERIALS AND METHODS This retrospective study compared dynamic tumor changes and volume doubling time (VDT) in 228 patients with SLADC (morphological types I-IV) who had intermittent growth during follow-ups. The correlation between the morphological classification and histological subtypes, gene mutation status, and surgical prognosis was evaluated. RESULTS Among the 228 patients, 66 (28.9%) were classified as type I, 123 (53.9%) as type II, 16 (7%) as type III, and 23 (10.1%) as type IV. Type I had the shortest VDT (254 days), followed by types IV (381 days) and III (501 days), and then type II (993 days) (p < 0.05 each). Type I had a greater proportion of solid/micropapillary-predominant pattern than type II, and the lepidic-predominant pattern was more common in type II and III than in type I (p < 0.05 each). Furthermore, type II and IV SLADCs were correlated with positive epidermal growth factor receptor mutation (p < 0.05 each). Lastly, the Kaplan-Meier curves showed that the disease-free survival was longest for patients with type II tumors, followed by those with type III and IV tumors, and then those with type I tumors (p < 0.001 each). CONCLUSION A good understanding of the natural progression and pathological-molecular characteristics of different morphological SLADC types can help make accurate diagnoses, develop individual treatment strategies, and predict patient outcomes. CRITICAL RELEVANCE STATEMENT A good understanding of the natural progression and pathological-molecular characteristics of different morphological solitary lung adenocarcinoma types can help make accurate diagnoses, develop individual treatment strategies, and predict patient outcomes. KEY POINTS • Type I-IV solitary lung adenocarcinomas exhibit varying natural progression on serial CT scans. • Morphological classification of solitary lung adenocarcinomas predicts histological subtype, gene status, and surgical prognosis. • This classification of solitary lung adenocarcinomas may help improve diagnostic, therapeutic, and prognosticating abilities.
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Affiliation(s)
- Hong-Fan Liao
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China
| | - Xing-Tao Huang
- Department of Radiology, the Fifth People's Hospital of Chongqing, Chongqing, 400062, China
| | - Xian Li
- Department of Pathology, Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Tian-You Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qi Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Jiang J, Lv FJ, Tao Y, Fu BJ, Li WJ, Lin RY, Chu ZG. Differentiation of pulmonary solid nodules attached to the pleura detected by thin-section CT. Insights Imaging 2023; 14:146. [PMID: 37697104 PMCID: PMC10495292 DOI: 10.1186/s13244-023-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Pulmonary solid pleura-attached nodules (SPANs) are not very commonly detected and thus not well studied and understood. This study aimed to identify the clinical and CT characteristics for differentiating benign and malignant SPANs. RESULTS From January 2017 to March 2023, a total of 295 patients with 300 SPANs (128 benign and 172 malignant) were retrospectively enrolled. Between benign and malignant SPANs, there were significant differences in patients' age, smoking history, clinical symptoms, CT features, nodule-pleura interface, adjacent pleural change, peripheral concomitant lesions, and lymph node enlargement. Multivariate analysis revealed that smoking history (odds ratio [OR], 2.016; 95% confidence interval [CI], 1.037-3.919; p = 0.039), abutting the mediastinal pleura (OR, 3.325; 95% CI, 1.235-8.949; p = 0.017), nodule diameter (> 15.6 mm) (OR, 2.266; 95% CI, 1.161-4.423; p = 0.016), lobulation (OR, 8.922; 95% CI, 4.567-17.431; p < 0.001), narrow basement to pleura (OR, 6.035; 95% CI, 2.847-12.795; p < 0.001), and simultaneous hilar and mediastinal lymph nodule enlargement (OR, 4.971; 95% CI, 1.526-16.198; p = 0.008) were independent predictors of malignant SPANs, and the area under the curve (AUC) of this model was 0.890 (sensitivity, 82.0%, specificity, 77.3%) (p < 0.001). CONCLUSION In patients with a smoking history, SPANs abutting the mediastinal pleura, having larger size (> 15.6 mm in diameter), lobulation, narrow basement, or simultaneous hilar and mediastinal lymph nodule enlargement are more likely to be malignant. CRITICAL RELEVANCE STATEMENT The benign and malignant SPANs have significant differences in clinical and CT features. Understanding the differences between benign and malignant SPANs is helpful for selecting the high-risk ones and avoiding unnecessary surgical resection. KEY POINTS • The solid pleura-attached nodules (SPANs) are closely related to the pleura. • Relationship between nodule and pleura and pleural changes are important for differentiating SPANs. • Benign SPANs frequently have broad pleural thickening or embed in thickened pleura. • Smoking history and lesions abutting the mediastinal pleura are indicators of malignant SPANs. • Malignant SPANs usually have larger diameters, lobulation signs, narrow basements, and lymphadenopathy.
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Affiliation(s)
- Jin Jiang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yang Tao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Zhang XC, Lv FJ, Fu BJ, Liang ZR, Chu ZG. Significance of marginal vessels in differentiating peripheral small-cell lung cancer and benign lung tumor. Acta Radiol 2023; 64:2526-2534. [PMID: 37464809 DOI: 10.1177/02841851231188060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Some peripheral small cell lung cancers (pSCLCs) and benign lung tumors (pBLTs) have similar morphological features but different treatment and prognosis. PURPOSE To determine the significance of marginal vessels in differentiating pSCLCs and pBLTs. MATERIAL AND METHODS A total of 57 and 95 patients with pathological confirmed nodular (≤3 cm) pSCLC and pBLT with similar morphological features were enrolled in this study retrospectively. The patients' clinical characteristics and computed tomography (CT) features of tumors and marginal vessels (vessels connecting with tumors) were analyzed and compared. RESULTS Compared with pBLTs, pSCLCs had a larger diameter (P = 0.001) but lower enhancement (P = 0.015) and fewer had calcification (P = 0.013). Compared with pBLTs, more lesions had proximal (70.2% vs. 22.1%) and distal (59.6% vs. 4.2%) marginal vessels in pSCLCs (each P < 0.0001). In addition, in pSCLCs, the numbers of proximal (1.3 ± 1.4 vs. 0.3 ± 0.6), distal (2.4 ± 3.1 vs. 0.1 ± 0.5), and total (3.6 ± 3.5 vs. 0.4 ± 1.0) marginal vessels were all more than those in pBLTs (each P < 0.001). Receiver operating characteristic curve analysis revealed the positive distal marginal vessel sign had the highest specificity (95.8%), and the number of total marginal vessels had the best performance in discriminating pSCLC from pBLT (cutoff value = 1.5, AUC = 0.80, 95% CI = 0.72-0.89, sensitivity = 70.2%, and specificity = 91.6%). CONCLUSION For peripheral solid nodules similar to pBLTs but without any calcification, the possibility of pSCLC should be considered if they have multiple marginal vessels (≥2), especially the distal ones.
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Affiliation(s)
- Xiao-Chuan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- Department of Radiology, Chonggang General Hospital, Chongqing, PR China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Zhang-Rui Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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Li YL, Zheng YN, Zhang LJ, Li ZQ, Deng L, Lv XN, Li Q, Lv FJ. Comparison of different noncontrast computed tomographic markers for predicting early perihematomal edema expansion in patients with intracerebral hemorrhage. J Clin Neurosci 2023; 112:1-5. [PMID: 37011516 DOI: 10.1016/j.jocn.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES Noncontrast computed tomography (NCCT) imaging markers are associated with early perihematomal edema (PHE) growth. The aim of this study was to compare the predictive value of different NCCT markers in predicting early PHE expansion. METHODS ICH patients who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan within 36 h between July 2011 and March 2017 were included in this study. The predictive value of hypodensity, satellite sign, heterogeneous density, irregular shape, blend sign, black hole sign, island sign and expansion-prone hematoma for early perihematomal edema expansion were assessed, separately. RESULTS 214 patients were included in our final analysis. After adjusting for ICH characteristics, hypodensity, blend sign, island sign and expansion-prone hematoma are still predictors of early perihematomal edema expansion in multivariable logistics regression analysis (all P < 0.05). The area under the receiver operating characteristic (ROC) curve of expansion-prone hematoma was significantly larger than the area under the ROC curve of hypodensity, blend sign and island sign in predicting PHE expansion (P = 0.003, P < 0.001 and P = 0.002, respectively). CONCLUSION Compared with single NCCT imaging markers, expansion-prone hematoma seems to be optimal predictor for early PHE expansion than any single NCCT imaging marker.
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Li YL, Chen C, Zhang LJ, Zheng YN, Lv XN, Zhao LB, Li Q, Lv FJ. Prediction of early perihematomal edema expansion based on Noncontrast Computed Tomography radiomics and machine learning in intracerebral hemorrhage. World Neurosurg 2023:S1878-8750(23)00388-1. [PMID: 36958717 DOI: 10.1016/j.wneu.2023.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVES To investigate the predictive value of noncontrast computed tomography (NCCT) models based on radiomics features and machine learning (ML) for early perihematomal edema (PHE) expansion in patients with spontaneous intracerebral hemorrhage (ICH). METHODS We retrospectively reviewed NCCT data from 214 patients with spontaneous intracerebral hemorrhage. All radiomics features were extracted from volume of interest (VOI) of hematomas on admission scans. A total of 8 machine learning methods were applied for constructing models in the training and the test set. Receiver operating characteristic (ROC) analysis and the areas under the curves (AUC) were used to evaluate the predictive value. RESULTS A total of 23 features were finally selected to establish models of early perihematomal edema expansion after feature screening. Patients were randomly assigned into training (n = 171) and test (n = 43) sets. The accuracy, sensitivity and specificity in the test set were 72.1%, 90.0% and 66.7% for the SVM model, 79.1%, 70.0% and 84.4% for the KNN model, 88.4%, 90.0% and 87.9% for the LR model, 74.4%, 90.0% and 69.7% for the ET model, 74.4%, 90.0% and 69.7% for the XGBoost model, 83.7%, 100% and 78.8% for the MLP model, 72.1%, 100% and 65.6% for the LightGBM model, 60.5%, 90.0% and 53.1% for the RF model, respectively. CONCLUSION The MLP model seemed to be the best model for prediction of PHE expansion in patients with ICH. NCCT models based on radiomics features and machine learning could predict early PHE expansion and improve the discrimination of identify spontaneous intracerebral hemorrhage patients at risk of early PHE expansion.
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Affiliation(s)
- Yu-Lun Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Chu Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Li-Juan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yi-Neng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Li-Bo Zhao
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing 402160, China; Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
| | - Qi Li
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230031, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing 402160, China.
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Lin RY, Zheng YN, Lv FJ, Fu BJ, Li WJ, Liang ZR, Chu ZG. A combined non-enhanced CT radiomics and clinical variable machine learning model for differentiating benign and malignant sub-centimeter pulmonary solid nodules. Med Phys 2023; 50:2835-2843. [PMID: 36810703 DOI: 10.1002/mp.16316] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Radiomics has been used to predict pulmonary nodule (PN) malignancy. However, most of the studies focused on pulmonary ground-glass nodules. The use of computed tomography (CT) radiomics in pulmonary solid nodules, particularly sub-centimeter solid nodules, is rare. PURPOSE This study aims to develop a radiomics model based on non-enhanced CT images that can distinguish between benign and malignant sub-centimeter pulmonary solid nodules (SPSNs, <1 cm). METHODS The clinical and CT data of 180 SPSNs confirmed by pathology were analyzed retrospectively. All SPSNs were divided into two groups: training set (n = 144) and testing set (n = 36). From non-enhanced chest CT images, over 1000 radiomics features were extracted. Radiomics feature selection was performed using the analysis of variance and principal component analysis. The selected radiomics features were fed into a support vector machine (SVM) to develop a radiomics model. The clinical and CT characteristics were used to develop a clinical model. Associating non-enhanced CT radiomics features with clinical factors were used to develop a combined model using SVM. The performance was evaluated using the area under the receiver-operating characteristic curve (AUC). RESULTS The radiomics model performed well in distinguishing between benign and malignant SPSNs, with an AUC of 0.913 (95% confidence interval [CI], 0.862-0.954) in the training set and an AUC of 0.877 (95% CI, 0.817-0.924) in the testing set. The combined model outperformed the clinical and radiomics models with an AUC of 0.940 (95% CI, 0.906-0.969) in the training set and an AUC of 0.903 (95% CI, 0.857-0.944) in the testing set. CONCLUSIONS Radiomics features based on non-enhanced CT images can be used to differentiate SPSNs. The combined model, which included radiomics and clinical factors, had the best discrimination power between benign and malignant SPSNs.
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Affiliation(s)
- Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi-Neng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhang-Rui Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lin RY, Lv ZM, Lv FJ, Fu BJ, Liang ZR, Chu ZG. Quantitative evaluation of density variability in the lesion-lung boundary zone to differentiate pulmonary subsolid nodules. Quant Imaging Med Surg 2023; 13:776-786. [PMID: 36819233 PMCID: PMC9929397 DOI: 10.21037/qims-22-510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/20/2022] [Indexed: 01/05/2023]
Abstract
Background Transition of the CT values from nodule to peripheral normal lung is related to pathological changes and may be a potential indicator for differential diagnosis. This study investigated the significance of the standard deviation (SD) values in the lesion-lung boundary zone when differentiating between benign and neoplastic subsolid nodules (SSNs). Methods From January 2012 to July 2021, a total of 229 neoplastic and 84 benign SSNs confirmed by pathological examination were retrospectively and nonconsecutively enrolled in this study. The diagnostic study was not registered with a clinical trial platform, and the study protocol was not published. Computed tomography (CT) values of the ground-glass component (CT1), adjacent normal lung tissue (CT2), and lesion-lung boundary zone (CT3) were measured consecutively. The SD of CT3 was recorded to assess density variability. The CT1, CT2, CT3, and SD values were compared between benign and neoplastic SSNs. Results No significant differences in CT1 and CT2 were observed between benign and neoplastic SSNs (each P value >0.05). CT3 (-736.1±51.0 vs. -792.6±73.9; P<0.001) and its SD (135.6±29.6 vs. 83.6±20.6; P<0.001) in neoplastic SSNs were significantly higher than those in benign SSNs. Moreover, the SD increased with the invasiveness degree of neoplastic SSNs (r=0.657; P<0.001). The receiver operating characteristic (ROC) curve revealed that the area under the curve was 0.927 (95% CI: 0.896-0.959) when using the SD (cutoff value =106.98) as a factor to distinguish SSNs, which increased to 0.966 (95% CI: 0.934-0.985) when including nodules with a CT1 of ≥-715 Hounsfield units (HU) only (cutoff of SD 109.9, sensitivity 0.930, and specificity 0.914). Conclusions The SD as an objective index is valuable for differentiating SSNs, especially for those with a CT1 of ≥-715 HU, which have a higher possibility of neoplasm if the SD is >109.9.
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Affiliation(s)
- Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhuo-Ma Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China;,Department of Radiology, The Second People’s Hospital of Yubei District, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhang-Rui Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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12
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He QH, Feng JJ, Lv FJ, Jiang Q, Xiao MZ. Deep learning and radiomic feature-based blending ensemble classifier for malignancy risk prediction in cystic renal lesions. Insights Imaging 2023; 14:6. [PMID: 36629980 PMCID: PMC9834471 DOI: 10.1186/s13244-022-01349-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/04/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The rising prevalence of cystic renal lesions (CRLs) detected by computed tomography necessitates better identification of the malignant cystic renal neoplasms since a significant majority of CRLs are benign renal cysts. Using arterial phase CT scans combined with pathology diagnosis results, a fusion feature-based blending ensemble machine learning model was created to identify malignant renal neoplasms from cystic renal lesions (CRLs). Histopathology results were adopted as diagnosis standard. Pretrained 3D-ResNet50 network was selected for non-handcrafted features extraction and pyradiomics toolbox was selected for handcrafted features extraction. Tenfold cross validated least absolute shrinkage and selection operator regression methods were selected to identify the most discriminative candidate features in the development cohort. Feature's reproducibility was evaluated by intra-class correlation coefficients and inter-class correlation coefficients. Pearson correlation coefficients for normal distribution and Spearman's rank correlation coefficients for non-normal distribution were utilized to remove redundant features. After that, a blending ensemble machine learning model were developed in training cohort. Area under the receiver operator characteristic curve (AUC), accuracy score (ACC), and decision curve analysis (DCA) were employed to evaluate the performance of the final model in testing cohort. RESULTS The fusion feature-based machine learning algorithm demonstrated excellent diagnostic performance in external validation dataset (AUC = 0.934, ACC = 0.905). Net benefits presented by DCA are higher than Bosniak-2019 version classification for stratifying patients with CRL to the appropriate surgery procedure. CONCLUSIONS Fusion feature-based classifier accurately distinguished malignant and benign CRLs which outperformed the Bosniak-2019 version classification and illustrated improved clinical decision-making utility.
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Affiliation(s)
- Quan-Hao He
- grid.452206.70000 0004 1758 417XDepartment of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Jia-Jun Feng
- grid.79703.3a0000 0004 1764 3838Department of Medical Imaging, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, 51000 People’s Republic of China
| | - Fa-Jin Lv
- grid.452206.70000 0004 1758 417XDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Qing Jiang
- grid.412461.40000 0004 9334 6536Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 People’s Republic of China
| | - Ming-Zhao Xiao
- grid.452206.70000 0004 1758 417XDepartment of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
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Liu XL, Lv FJ, Fu BJ, Lin RY, Li WJ, Chu ZG. Correlations Between Inflammatory Cell Infiltration and Relative Density and the Boundary Manifestation of Pulmonary Non-Neoplastic Ground Glass Nodules. J Inflamm Res 2023; 16:1147-1155. [PMID: 36945317 PMCID: PMC10024903 DOI: 10.2147/jir.s399953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
Purpose To investigate the influence factors for the various boundary manifestations of pulmonary non-neoplastic ground glass nodules (GGNs) on computed tomography (CT). Materials and Methods From January 2015 to March 2022, a total of 280 patients with 318 non-neoplastic GGNs were enrolled. The correlations between degree of inflammatory cell infiltration and relative density (ΔCT) and the boundary manifestations of lesions were evaluated, respectively. Results Nongranulomatous nodules (283, 89.0%) with fibrous tissue proliferation and/or inflammatory cells as the predominant pathological findings were the most common non-neoplastic GGNs, followed by granulomatous nodules (28, 8.8%). Among nongranulomatous GGNs, cases with more and less/no inflammatory cells were 15 (10.9%) and 122 (89.1%) in 137 well-defined ones with smooth margin, 16 (24.6%) and 49 (75.4%) in 65 well-defined ones with coarse margin, 43 (91.5%) and 4 (8.5%) in 47 ill-defined ones with higher ΔCT (>151HU), and 4 (11.8%) and 30 (88.2%) in 34 ill-defined ones with lower ΔCT (< 151HU). The proportion of cases with more inflammatory cells in well-defined nodules was similar to that in ill-defined ones with lower ΔCT (P = 0.587) but significantly lower than that in ill-defined ones with higher ΔCT (P < 0.001). Among the granulomatous nodules, ill-defined cases with higher ΔCT (16, 57.1%) were the most common, and they (7/8, 87.5%) frequently had changes during short-term follow-up. Conclusion Nongranulomatous nodules are the most common non-neoplastic GGNs, their diverse boundary manifestations closely correlate with degree of inflammatory cell infiltration and density difference.
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Affiliation(s)
- Xiang-Ling Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Zhi-Gang Chu, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86 18723032809, Fax +86 23 68811487, Email
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Deng L, Li ZQ, Yang WS, Li R, Lv XN, Li YL, Wang ZJ, Hu X, Zhao LB, Lv FJ, Yao ST, Cao F, Xie P, Li Q. Prehospital Ultra-Early Neurological Deterioration in Intracerebral Hemorrhage: Definition, Prevalence, and Association with Outcomes. Cerebrovasc Dis 2022; 52:471-479. [PMID: 36509082 DOI: 10.1159/000527545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The objective of this study was to define prehospital ultra-early neurological deterioration (UND) and to investigate the association with functional outcomes in patients with intracerebral hemorrhage (ICH). METHODS We conducted a prospective cohort study of consecutive acute ICH patients. The stroke severity at onset and hospital admission was assessed using the Chongqing Stroke Scale (CQSS), and prehospital UND was defined as a CQSS increase of ≥2 points between symptoms onset and admission. Early neurological deterioration (END) was defined as the increase of ≥4 points in NIHSS score within the first 24 h after admission. Poor outcome was defined as a modified Rankin Scale (mRS) of 4-6 at 3 months. RESULTS Prehospital UND occurred in 29 of 169 patients (17.2%). Patients with prehospital UND had a median admission NIHSS score of 17.0 as opposed to those without prehospital UND with a median NIHSS score of 8.5. There were three patterns of neurological deterioration: prehospital UND only in 21 of 169 patients (12.4%), END but without prehospital UND in 20 of 169 patients (11.8%), and continuous neurological deterioration in both phases in 8 patients (4.7%). Prehospital UND was associated with worse 3-month outcomes (median mRS score, 4.0 vs. 2.0, p = 0.002). After adjusting for age, time from onset to admission, END, and systolic blood pressure, prehospital UND was an independent predictor of poor outcome (odds ratio [OR] 3.27, 95% confidence interval [CI] 1.26-8.48, p = 0.015). CONCLUSION Prehospital UND occurs in approximately 1 in 7 patients between symptom onset and admission and is associated with poor functional outcome in patients with ICH. Further research is needed to investigate the prehospital UND in the prehospital phase in the triage of patients with ICH.
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Affiliation(s)
- Lan Deng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zuo-Qiao Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Lun Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Jie Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Hu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Bo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sheng-Tao Yao
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Fang Cao
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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He QH, Tan H, Liao FT, Zheng YN, Lv FJ, Jiang Q, Xiao MZ. Stratification of malignant renal neoplasms from cystic renal lesions using deep learning and radiomics features based on a stacking ensemble CT machine learning algorithm. Front Oncol 2022; 12:1028577. [DOI: 10.3389/fonc.2022.1028577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
Using nephrographic phase CT images combined with pathology diagnosis, we aim to develop and validate a fusion feature-based stacking ensemble machine learning model to distinguish malignant renal neoplasms from cystic renal lesions (CRLs). This retrospective research includes 166 individuals with CRLs for model training and 47 individuals with CRLs in another institution for model testing. Histopathology results are adopted as diagnosis criterion. Nephrographic phase CT scans are selected to build the fusion feature-based machine learning algorithms. The pretrained 3D-ResNet50 CNN model and radiomics methods are selected to extract deep features and radiomics features, respectively. Fivefold cross-validated least absolute shrinkage and selection operator (LASSO) regression methods are adopted to identify the most discriminative candidate features in the development cohort. Intraclass correlation coefficients and interclass correlation coefficients are employed to evaluate feature’s reproducibility. Pearson correlation coefficients for normal distribution features and Spearman’s rank correlation coefficients for non-normal distribution features are used to eliminate redundant features. After that, stacking ensemble machine learning models are developed in the training cohort. The area under the receiver operator characteristic curve (ROC), calibration curve, and decision curve analysis (DCA) are adopted in the testing cohort to evaluate the performance of each model. The stacking ensemble machine learning algorithm reached excellent diagnostic performance in the testing dataset. The calibration plot shows good stability when using the stacking ensemble model. Net benefits presented by DCA are higher than the Bosniak 2019 version classification when employing any machine learning algorithm. The fusion feature-based machine learning algorithm accurately distinguishes malignant renal neoplasms from CRLs, which outperformed the Bosniak 2019 version classification, and proves to be more applicable for clinical decision-making.
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Fu BJ, Lv ZM, Lv FJ, Li WJ, Lin RY, Chu ZG. Sensitivity and specificity of computed tomography hypodense sign when differentiating pulmonary inflammatory and malignant mass-like lesions. Quant Imaging Med Surg 2022; 12:4435-4447. [PMID: 36060594 PMCID: PMC9403586 DOI: 10.21037/qims-21-851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Background Hypodense sign (HyS) reportedly is associated with pulmonary fungal infection, while it also common in many non-fungal lesions. This study aims to determine the significance of a HyS presented on contrast-enhanced computed tomography (CECT) when distinguishing pulmonary inflammatory from malignant mass-like lesions. Methods From January 2013 to January 2021, we retrospectively evaluated the clinical and computed tomography (CT) data of patients with pathologically confirmed pulmonary inflammatory lesions (ILs) and malignant lesions (MLs). We analyzed and compared the CT features of the HyS in MLs and ILs, and then evaluated whether the HyS helped to differentiate MLs and ILs. Results There were significant differences in age and tumor markers between patients with ILs and MLs (both P<0.05). Compared with that in MLs, the occurrence of the HyS in ILs was higher (62.81% vs. 28.81%; P<0.0001). In ILs, more HyS were single, round or oval, well-defined, and had lower enhancement (ΔCT). Logistic regression analysis revealed that an ill-defined boundary, peripheral fibrosis, presence of a well-defined HyS, and a ΔCT value of the HyS <9.5 Hounsfield units (HU) were independent indicators for predicting ILs. After including the HyS CT features, the area under the curve (AUC) of the model predicting ILs increased from 0.953 to 0.986 with a sensitivity of 96.03% and a specificity of 94.03% (P=0.0027). Conclusions The HyS is more common in ILs than in MLs. A single, regular, and well-defined HyS with a ΔCT value of <9.5 HU on CECT is highly suggestive of ILs. Combining the HyS with other morphological features could improve the diagnosis accuracy of pulmonary mass-like lesions.
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Affiliation(s)
- Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhuo-Ma Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Radiology, The Second People’s Hospital of Yubei District, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yu RQ, Tan H, Wang ED, Huang J, Wang PJ, Li XM, Zheng HH, Lv FJ, Hu H. Antidepressants combined with psychodrama improve the coping style and cognitive control network in patients with childhood trauma-associated major depressive disorder. World J Psychiatry 2022; 12:1016-1030. [PMID: 36158310 PMCID: PMC9476846 DOI: 10.5498/wjp.v12.i8.1016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/24/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The use of antidepressant therapy alone has a limited efficacy in patients with childhood trauma-associated major depressive disorder (MDD). However, the effectiveness of antidepressant treatment combined with psychodrama in these patients is unclear.
AIM To evaluate the effectiveness of antidepressant treatment combined with psychodrama.
METHODS Patients with childhood trauma-associated MDD treated with antidepressants were randomly assigned to either the psychodrama intervention (observation group) or the general health education intervention (control group) and received combination treatment for 6 mo. The observation group received general health education given by the investigator together with the “semi-structured group intervention model” of Yi Shu psychodrama. A total of 46 patients were recruited, including 29 cases in the observation group and 17 cases in the control group. Symptoms of depression and anxiety as well as coping style and resting-state functional magnetic resonance imaging were assessed before and after the intervention.
RESULTS Symptoms of depression and anxiety, measured by the Hamilton Depression Scale, Beck Depression Inventory, and Beck Anxiety Inventory, were reduced after the intervention in both groups of patients. The coping style of the observation group improved significantly in contrast to the control group, which did not. In addition, an interaction between treatment and time in the right superior parietal gyrus node was found. Furthermore, functional connectivity between the right superior parietal gyrus and left inferior frontal gyrus in the observation group increased after the intervention, while in the control group the connectivity decreased.
CONCLUSION This study supports the use of combined treatment with antidepressants and psychodrama to improve the coping style of patients with childhood trauma-associated MDD. Functional connectivity between the superior parietal gyrus and inferior frontal gyrus was increased after this combined treatment. We speculate that psychodrama enhances the internal connectivity of the cognitive control network and corrects the negative attention bias of patients with childhood trauma-associated MDD. Elucidating the neurobiological features of patients with childhood trauma-associated MDD is important for the development of methods that can assist in early diagnosis and intervention.
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Affiliation(s)
- Ren-Qiang Yu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Huan Tan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Er-Dong Wang
- College of Art, Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jie Huang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 40016, China
| | - Pei-Jia Wang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 40016, China
| | - Xiao-Mei Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 40016, China
| | - Han-Han Zheng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 40016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hua Hu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 40016, China
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Huo JW, Luo TY, He XQ, Gong JW, Lv FJ, Li Q. Radiological classification, gene-mutation status, and surgical prognosis of synchronous multiple primary lung cancer. Eur Radiol 2022; 32:4264-4274. [PMID: 34989846 DOI: 10.1007/s00330-021-08464-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/19/2021] [Accepted: 11/08/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the radiological classification, gene-mutation status, and surgical prognosis of synchronous multiple primary lung cancer (sMPLC). METHODS From January 2013 to October 2019, 192 consecutive patients with sMPLC were investigated. The clinical, CT, molecular, and pathological features of all patients were analyzed. Furthermore, the prognosis of 89 patients who only underwent surgical resection was evaluated. RESULTS Among 192 patients, all lesions pathologically confirmed or highly suspected as tumors based on radiological findings were retrospectively analyzed, and the CT findings of sMPLC were classified into three types: (I) all lesions manifested as solid nodules/masses (14.06%, 27/192), (II) all lesions manifested as subsolid nodules/masses (43.23%, 83/192), and (III) tumor lesions manifested as a combination of ≥ 2 of the following patterns: solid nodules/masses, subsolid nodules/masses, cystic airspace, and focal consolidation (42.71%, 82/192). For 252 tumors undergoing epidermal growth factor receptor (EGFR)-mutation testing, the EGFR-mutation rate was higher in subsolid tumors than that in solid tumors (p < 0.05). Among 19 patients with all tumors undergoing surgery and driver-gene testing, genetic heterogeneity was prevalent among the multiple tumors (63.16%,12/19). The highest clinical stage of non-I, ipsilateral distribution of tumors, and CT classification of I indicated a poor prognosis for patients with sMPLC (all p < 0.05). CONCLUSION Subsolid lesions are the most common presentation of sMPLC. Genetic heterogeneity in driver mutations among sMPLC may be present. Prognosis in patients with sMPLC is determined by the highest clinical TNM stage, distribution, and radiological classification among the multiple tumors. KEY POINTS • Synchronous multiple primary lung cancer (sMPLC) has three types of CT findings. • Genetic heterogeneity may be prevalent among the multiple tumors. • Prognosis in patients with sMPLC is associated with the highest clinical TNM stage, distribution, and radiological classification among the multiple tumors.
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Affiliation(s)
- Ji-Wen Huo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, Chongqing, 400016, China
| | - Tian-You Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, Chongqing, 400016, China
| | - Xiao-Qun He
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, Chongqing, 400016, China
| | - Jun-Wei Gong
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, Chongqing, 400016, China
| | - Fa-Jin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, Chongqing, 400016, China
| | - Qi Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, Chongqing, 400016, China.
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He XQ, Li X, Wu Y, Wu S, Luo TY, Lv FJ, Li Q. Differential Diagnosis of Nonabsorbable Inflammatory and Malignant Subsolid Nodules with a Solid Component ≤5 mm. J Inflamm Res 2022; 15:1785-1796. [PMID: 35300212 PMCID: PMC8923683 DOI: 10.2147/jir.s355848] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the differential clinical and computed tomography (CT) characteristics of pulmonary nonabsorbable inflammatory and malignant subsolid nodules (SSNs) with a solid component ≤5 mm. Patients and Methods We retrospectively analyzed 576 consecutive patients who underwent surgical resection and had SSNs with a solid component ≤5 mm on CT images. These patients were divided into inflammatory and malignant groups according to pathology. Their clinical and imaging data were analyzed and compared. Multiple logistic regression analysis was used to identify independent prognostic factors differentiating inflammatory from malignant SSNs. Furthermore, 146 consecutive patients were included as internal validation cohort to test the prediction efficiency of this model. Results Significant differences in 11 clinical characteristics and CT features were found between both groups (P < 0.05). Presence of respiratory symptoms, distribution of middle/lower lobe, irregular shape, part-solid nodule (PSNs), CT value of ground-glass opacity (GGO) areas <−657 Hu, presence of abnormal intra-nodular vessel sign, and interlobular septal thickening were the most effective factors for diagnosing nonabsorbable inflammatory SSNs, with an AUC (95% CI), accuracy, sensitivity, and specificity of 0.843 (95% CI: 0.811–0.872), 89.76%, 72.86%, and 81.23%, respectively. The internal validation cohort obtained an AUC (95% CI), accuracy, sensitivity, and specificity of 0.830 (95% CI: 0.759–0.887), 83.56%, 73.91%, and 76.42%, respectively. Conclusion Nonabsorbable inflammatory and malignant SSNs with a solid component ≤5 mm exhibited different clinical and imaging characteristics.
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Affiliation(s)
- Xiao-Qun He
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xian Li
- Department of Pathology, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yan Wu
- Nursing School, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shun Wu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Tian-You Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Qi Li, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, Chongqing, 400016, People’s Republic of China, Tel +86 15823408652, Fax +86 23 68811487, Email
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Liang HW, Zhou Y, Zhang ZW, Yan GW, Du SL, Zhang XH, Li XY, Lv FJ, Zheng Q, Li YM. Dual-energy CT with virtual monoenergetic images to improve the visualization of pancreatic supplying arteries: the normal anatomy and variations. Insights Imaging 2022; 13:21. [PMID: 35122162 PMCID: PMC8816990 DOI: 10.1186/s13244-022-01157-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/07/2022] [Indexed: 12/31/2022] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) remains a malignancy with poor prognosis, appropriate surgical resection and neoadjuvant therapy depend on the accurate identification of pancreatic supplying arteries. We aim to evaluate the ability of monoenergetic images (MEI [+]) of dual-energy CT (DECT) to improve the visualization of pancreatic supplying arteries compared to conventional polyenergetic images (PEI) and investigate the implications of vascular variation in pancreatic surgery and transarterial interventions. Results One hundred patients without pancreatic diseases underwent DECT examinations were retrospectively enrolled in this study. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at 40-keV MEI (+) were significantly higher than those of PEI (p < 0.05). All subjective MEI (+) scores were significantly higher than those of PEI (p < 0.05). The visualization rates were significantly higher for posterior superior pancreaticoduodenal artery (PSPDA), anterior and posterior inferior pancreaticoduodenal artery (AIPDA, PIPDA), anterior and posterior pancreaticoduodenal arcade (APAC, PPAC), transverse and caudal pancreatic artery (TPA, PCA) at 40-keV MEI (+) than those of PEI (p < 0.05). However, there were no significant differences for visualizing anterior superior pancreaticoduodenal artery (ASPDA), inferior pancreaticoduodenal artery (IPDA), dorsal and magnificent pancreatic artery (DPA, MPA) between 40-keV MEI (+) and PEI (p > 0.05). Four types of variations were observed in the origin of DPA and three to five types in the origin of PSPDA, AIPDA and PIPDA. Conclusions 40-keV MEI (+) of DECT improves the visualization and objective and subjective image quality of pancreatic supplying arteries compared to PEI. Pancreatic supplying arteries have great variations, which has important implications for preoperative planning of technically challenging surgeries and transarterial interventions.
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Affiliation(s)
- Hong-Wei Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yang Zhou
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhi-Wei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Gao-Wu Yan
- Department of Radiology, Suining Central Hospital, Suining, 629000, China
| | - Si-Lin Du
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiao-Hui Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xin-You Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qiao Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Yong-Mei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Li WJ, Lv FJ, Tan YW, Fu BJ, Chu ZG. Benign and malignant pulmonary part-solid nodules: differentiation via thin-section computed tomography. Quant Imaging Med Surg 2022; 12:699-710. [PMID: 34993112 DOI: 10.21037/qims-21-145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pulmonary part-solid nodules (PSNs) reportedly have a high possibility of malignancy, while benign PSNs are common. This study aimed to reveal the differences between benign and malignant PSNs by comparing their thin-section computed tomography (CT) features. METHODS Patients with PSNs confirmed by postoperative pathological examination or follow-up (at the same period) were retrospectively enrolled from March 2016 to January 2020. The clinical data of patients and CT features of benign and malignant PSNs were reviewed and compared. Binary logistic regression analysis was performed to reveal the predictors of malignant PSNs. RESULTS A total of 119 PSNs in 117 patients [age (mean ± standard deviation), 56±11 years; 70 women] were evaluated. Of the 119 PSNs, 44 (37.0%) were benign, and 75 (63.0%) were malignant (12 adenocarcinomas in situ, 22 minimally invasive adenocarcinomas, and 41 invasive adenocarcinomas). There were significant differences in the patients' age and smoking history between benign and malignant PSNs. In terms of CT characteristics, malignant and benign lesions significantly differed in the following CT features: whole nodule, internal solid component, and peripheral ground-glass opacity. The binary logistic regression analysis revealed that well-defined border [odds ratio (OR), 4.574; 95% confidence interval (CI), 1.186-17.643; P=0.027] and lobulation (OR, 61.739; 95% CI, 5.230-728.860; P=0.001) of the nodule, as well as irregular shape (OR, 9.502; 95% CI, 1.788-50.482; P=0.008) and scattered distribution (OR, 13.238; 95% CI, 1.359-128.924; P=0.026) of the internal solid components were significant independent predictors distinguishing malignant PSNs. However, the lesion shape, density, and margin were similar between malignant and benign lesions. CONCLUSIONS Well-defined and lobulated PSNs with irregular and scattered solid components are highly likely to be malignant.
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Affiliation(s)
- Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi-Wen Tan
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wang XY, Tan H, Li X, Dai LQ, Zhang ZW, Lv FJ, Yu RQ. Resting-state functional magnetic resonance imaging-based identification of altered brain the fractional amplitude of low frequency fluctuation in adolescent major depressive disorder patients undergoing electroconvulsive therapy. Front Psychiatry 2022; 13:972968. [PMID: 35958635 PMCID: PMC9357980 DOI: 10.3389/fpsyt.2022.972968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE While electroconvulsive therapy (ECT) has been repeatedly been shown to effectively and efficiently treat the major depressive disorder (MDD), the mechanistic basis for such therapeutic efficacy remains to be firmly established. As such, further research exploring the ECT-based treatment of MDD in an adolescent population is warranted. METHODS This study included 30 treatment-naïve first-episode MDD patients and 30 healthy control (HC) individuals (aged 12-17 years). All participants were scanned using rs-fMRI, and the 30 MDD patients were scanned again after 2 weeks of the ECT treatment period. Intrinsic local activity in each voxel was assessed based on the fractional amplitude of low frequency fluctuation (fALFF) parameter, with all fALFF analyses being completed using the REST application. Correlations between ECT-related changes in fALFF and clinical parameters were additionally examined. RESULTS Relative to HCs, MDD patients exhibited increased fALFF values in the right inferior frontal gyrus (ORBinf), inferior occipital gyrus (IOG), and the left middle frontal gyrus (MFG) at baseline. Following ECT, these patients exhibited significant increases in fALFF values in the right medial superior frontal gyrus (SFGmed), dorsolateral superior frontal gyrus (SFGdor), anterior cingulate, and paracingulate gyrus (ACG), median cingulate and paracingulate gyrus (DCG), and left MFG. MDD patient HAMD scores were negatively correlated with fALFF values when analyzing pre-ECT vs. post-HCT ΔHAMD and fALFF values in the right SFGmed, SFGdor, and the left MFG. CONCLUSION These data suggest that ECT induced altered fALFF in some regions of the brain, suggesting that these alterations may serve as a neurobiological indicator of ECT effectiveness in MDD adolescents.
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Affiliation(s)
- Xing-Yu Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huan Tan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin-Qi Dai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Wei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ren-Qiang Yu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Chen F, Liu YB, Fu BJ, Lv FJ, Chu ZG. Clinical and Computed Tomography (CT) Characteristics of Pulmonary Nodules Caused by Cryptococcal Infection. Infect Drug Resist 2021; 14:4227-4235. [PMID: 34703249 PMCID: PMC8523807 DOI: 10.2147/idr.s330159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the clinical and computed tomography (CT) characteristics of pulmonary nodules caused by cryptococcal infection and gain a greater insight and understanding that will reduce misdiagnosis. Materials and Methods A total of 47 patients with confirmed pulmonary cryptococcosis (PC) manifested as nodules were retrospectively enrolled from January 2013 to December 2020. The clinical and CT data of patients with single and multiple nodules were analyzed and compared with emphasis on exploring the characteristics of the solitary ones. Results Among the 47 patients, single and multiple nodules were detected in 25 (53.2%) and 22 (46.8%) patients, respectively, with similar clinical characteristics. The diameter of solitary nodules was smaller than that of the largest ones of the multiple nodules (P = 0.000). Compared with multiple nodules, less solitary nodules were located in the subpleural zone (P = 0.031) and had a cavity or vacuole (P = 0.049). Regarding the solitary nodules, 22 (88.0%) and 3 (12.0%) were solid and subsolid, respectively. Eighteen (81.8%) solid solitary nodules exhibited either one of air bronchogram or vacuole, satellite lesions, and halo sign. Twenty-three (92.0%) of 25 patients with solitary nodules had follow-up CT data, and most of them had no changes (12, 52.1%) or increased in size and/or density (8, 34.8%), but only a few (3, 13.0%) decreased with or without anti-inflammatory therapy. Conclusion The clinical characteristics of patients with solitary and multiple nodules caused by PC are similar. The solitary nodules are smaller, more scattered, but less necrotic than multiple ones. For solitary nodules with air bronchogram or vacuole, satellite lesions, or halo sign, PC should be considered as one of the differential diagnosis.
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Affiliation(s)
- Fang Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Department of Radiology, Youyang Hospital, A Branch of The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuan-Bing Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Department of Radiology, Qijiang People's Hospital, Chongqing, People's Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Li Q, Li R, Zhao LB, Yang XM, Yang WS, Deng L, Lv XN, Wu GF, Tang ZP, Wei M, Zheng YN, Lv FJ, Sun XC, Goldstein JN, Xie P. Intraventricular Hemorrhage Growth: Definition, Prevalence and Association with Hematoma Expansion and Prognosis. Neurocrit Care 2021; 33:732-739. [PMID: 32219678 DOI: 10.1007/s12028-020-00958-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES The objective of this study is to propose a definition of intraventricular hemorrhage (IVH) growth and to investigate whether IVH growth is associated with ICH expansion and functional outcome. METHODS We performed a prospective observational study of ICH patients between July 2011 and March 2017 in a tertiary hospital. Patients were included if they had a baseline CT scan within 6 h after onset of symptoms and a follow-up CT within 36 h. IVH growth was defined as either any newly occurring intraventricular bleeding on follow-up CT scan in patients without baseline IVH or an increase in IVH volume ≥ 1 mL on follow-up CT scan in patients with initial IVH. Poor outcome was defined as modified Rankin Scale score of 3-6 at 90 days. The association between IVH growth and functional outcome was assessed by using multivariable logistic regression analysis. RESULTS IVH growth was observed in 59 (19.5%) of 303 patients. Patients with IVH growth had larger baseline hematoma volume, higher NIHSS score and lower GCS score than those without. Of 44 patients who had concurrent IVH growth and hematoma growth, 41 (93.2%) had poor functional outcome at 3-month follow-up. IVH growth (adjusted OR 4.15, 95% CI 1.31-13.20; P = 0.016) was an independent predictor of poor functional outcome (mRS 3-6) at 3 months in multivariable analysis. CONCLUSION IVH growth is not uncommon and independently predicts poor outcome in ICH patients. It may serve as a promising therapeutic target for intervention.
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Affiliation(s)
- Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Li-Bo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China.
| | - Xiao-Min Yang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lan Deng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Guo-Feng Wu
- Emergency Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550025, China
| | - Zhou-Ping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Miao Wei
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yi-Neng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Chuan Sun
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Joshua N Goldstein
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Lin RY, Lv FJ, Fu BJ, Li WJ, Liang ZR, Chu ZG. Features for Predicting Absorbable Pulmonary Solid Nodules as Depicted on Thin-Section Computed Tomography. J Inflamm Res 2021; 14:2933-2939. [PMID: 34239316 PMCID: PMC8259943 DOI: 10.2147/jir.s318125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the clinical and computed tomography (CT) characteristics of absorbable pulmonary solid nodules (PSNs) and to clarify CT features for distinguishing absorbable PSNs from malignant ones. Materials and Methods From January 2015 to February 2021, a total of 316 patients with 348 PSNs (171 absorbable and 177 size-matched malignant) were retrospectively enrolled. Their clinical and CT data were analyzed and compared to determine CT features for predicting absorbable PSNs. Results Between absorbable and malignant PSNs, there were significant differences in patients' age, lesions' locations, shapes, homogeneity, borders, distance from the pleura, vacuoles, air bronchograms, lobulation, spiculation, halo sign, multiple concomitant nodules and pleural indentation (each P < 0.05). Multivariate analysis revealed that the independent predictors of absorbable PSNs were the following: patient age ≤55 years (OR, 2.660; 95% CI, 1.432-4.942; P = 0.002), homogeneous density (OR, 2.487; 95% CI, 1.107-5.590; P = 0.027), ill-defined border (OR, 5.445; 95% CI, 1.661-17.846; P = 0.005), halo sign (OR, 3.135; 95% CI, 1.154-8.513; P = 0.025), multiple concomitant nodules (OR, 8.700; 95% CI, 4.401-17.197; P<0.001), and abutting pleura (OR, 3.759; 95% CI, 1.407-10.044; P = 0.008). The indicators for malignant PSNs were the following: lobulation (OR, 3.904; 95% CI, 1.956-7.791; P<0.001), spiculation (OR, 4.980; 95% CI, 2.202-11.266, P<0.001), and pleural indentation (OR, 4.514; 95% CI, 1.223-16.666; P = 0.024). Conclusion In patients younger than 55 years, PSNs with homogeneous density, ill-defined border, halo sign, multiple concomitant nodules, and abutting pleura should be highly suspected as absorbable ones.
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Affiliation(s)
- Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhang-Rui Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Li J, Sheng B, Qiu L, Yu F, Lv FJ, Lv FR, Yang H. A quantitative MRI investigation of the association between iliotibial band syndrome and patellofemoral malalignment. Quant Imaging Med Surg 2021; 11:3209-3218. [PMID: 34249647 DOI: 10.21037/qims-20-1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/10/2021] [Indexed: 11/06/2022]
Abstract
Background The iliotibial band (ITB) has a wide patellar insertion that provides lateral restraint to the patella and maintains the patellofemoral joint's stability. There has been limited investigation into the relationship between patellofemoral malalignment and iliotibial band syndrome (ITBS). Methods We retrospectively analyzed 47 knees with ITBS by retrieving magnetic resonance imaging (MRI) data collected over an approximately 6-year period from our database. The Insall-Salvati ratio, lateral patellofemoral angle (LPA), lateral patellar tilt (LPT), lateral trochlear length (LTL), angle of the non-weight-bearing facet of the lateral femoral condyle (nwb-LFCA), and the ITB-lateral femoral condyle (IT-LFC) distance were measured on MR images. The knees of 47 age- and gender-matched subjects were enrolled as the normal group. Results In the ITBS group, over one third (34%, 16/47) of knees had abnormal patellofemoral measurements, including 8 (17%, 8/47) knees with patellar alta, 11 (23.4%, 11/47) knees with an abnormally decreased LPA, and 5 (10.6%, 5/47) knees with an abnormally increased LPT indicating lateral patellar tilt. Moreover, 8 knees had simultaneous combinations of two or three abnormality parameters, and 8 (17%, 8/47) knees presented with superolateral Hoffa's fat pad edema. The Insall-Salvati ratio, LPT, and nwb-LFCA in the ITBS group were significantly higher than those in the normal group (P=0.001, P<0.001, and P<0.001, respectively); the LPA and IT-LFC distances in the ITBS group were significantly lower (P=0.003, P<0.001, respectively) than those in the normal group. There were mild to moderate correlations between the MRI parameters and ITBS (P=0.006, P<0.001, respectively). Conclusions This study confirmed that a higher position or lateral tilt of the patella and a steeper morphology of the anterior part of the lateral femoral condyle were associated with the development of ITBS, which is helpful in understanding and further exploring the mechanism of ITBS.
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Affiliation(s)
- Jia Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Sheng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lanyu Qiu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fan Yu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fu-Rong Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haitao Yang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Xiao YD, Lv FJ, Li WJ, Fu BJ, Lin RY, Chu ZG. Solitary Pulmonary Inflammatory Nodule: CT Features and Pathological Findings. J Inflamm Res 2021; 14:2741-2751. [PMID: 34211291 PMCID: PMC8242128 DOI: 10.2147/jir.s304431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/26/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Solitary pulmonary inflammatory nodules (SPINs) are frequently misdiagnosed as malignancy. We aimed to investigate CT features and pathological findings of SPINs for improving diagnosis strategies. Patients and Methods In this retrospective study, 225 and 310 consecutive patients with confirmed SPINs and lung cancerous nodules were enrolled from January 2013 to December 2020. Nodules were classified into different types based on the key CT features: I, homogeneous and well-defined nodules with smooth (Ia), coarse (Ib), or spiculated margins (Ic); II, nodules with blurred boundaries, peripheral patches, or both; III, nodules exhibiting heterogeneous density; and IV, polygonal nodules. The pathological findings of SPINs were simultaneously studied and summarized. Results Among the 225 SPINs, type I (Ia, Ib, and Ic), II, III, and IV were 137 (60.9%) (47 [20.9%], 33 [14.7%], and 57 [25.3%]), 62 (27.6%), 12 (5.3%) and 14 (6.2%), respectively. Correspondingly, those in 310 cancerous nodules were 275 (88.7%) (119 [38.4%], 70 [22.6%], and 86 [27.7%]), 20 (6.5%), 15 (4.8%), and 0, respectively. Compared with lung cancers, type I nodules were less common but type II and IV nodules were more common in SPINs (each P < 0.0001). Though the frequencies of subtype I (P = 0.095) and type III (P = 0.796) nodules were similar between two groups, their specific CT features were significantly different. The main pathological findings of each type of SPINs were most extensively identical (82.2 - 100%). Conclusion Between cancerous nodules and SPINs, differences in overall or specific CT features exist. The type II and IV nodules are highly indicative of SPINs, and each type of SPINs have almost similar pathological findings.
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Affiliation(s)
- Yun-Dan Xiao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Fu BJ, Lv FJ, Li WJ, Lin RY, Zheng YN, Chu ZG. Significance of intra-nodular vessel sign in differentiating benign and malignant pulmonary ground-glass nodules. Insights Imaging 2021; 12:65. [PMID: 34037864 PMCID: PMC8155149 DOI: 10.1186/s13244-021-01012-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of pulmonary vessels inside ground-glass nodules (GGNs) of different nature is a very common occurrence. This study aimed to reveal the significance of pulmonary vessels displayed in GGNs in their diagnosis and differential diagnosis. RESULTS A total of 149 malignant and 130 benign GGNs confirmed by postoperative pathological examination were retrospectively enrolled in this study. There were significant differences in size, shape, nodule-lung interface, pleural traction, lobulation, and spiculation (each p < 0.05) between benign and malignant GGNs. Compared with benign GGNs, intra-nodular vessels were more common in malignant GGNs (67.79% vs. 54.62%, p = 0.024), while the vascular categories were similar (p = 0.663). After adjusting the nodule size and the distance between the nodule center and adjacent pleura [radius-distance ratio, RDR], the occurrences of internal vessels between them were similar. The number of intra-nodular vessels was positively correlated with nodular diameter and RDR. Vascular changes were more common in malignant than benign GGNs (52.48% vs. 18.31%, p < 0.0001), which mainly manifested as distortion and/or dilation of pulmonary veins (61.19%). The occurrence rate, number, and changes of internal vessels had no significant differences among all the pre-invasive and invasive lesions (each p > 0.05). CONCLUSIONS The incidence of internal vessels in GGNs is mainly related to their size and the distance between nodule and pleura rather than the pathological nature. However, GGNs with dilated or distorted internal vessels, especially pulmonary veins, have a higher possibility of malignancy.
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Affiliation(s)
- Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Yi-Neng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.
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Li Q, Fan X, Luo TY, Lv FJ, Huang XT. Differentiating malignant and benign necrotic lung lesions using kVp-switching dual-energy spectral computed tomography. BMC Med Imaging 2021; 21:81. [PMID: 33985454 PMCID: PMC8117597 DOI: 10.1186/s12880-021-00611-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/28/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Necrotic pulmonary lesions manifest as relatively low-density internally on contrast-enhanced computed tomography (CT). However, using CT to differentiate malignant and benign necrotic pulmonary lesions is challenging, as these lesions have similar peripheral enhancement. With the introduction of dual-energy spectral CT (DESCT), more quantitative parameters can be obtained and the ability to differentiate material compositions has been highly promoted. This study investigated the use of kVp-switching DESCT in differentiating malignant from benign necrotic lung lesions. METHODS From October 2016 to February 2019, 40 patients with necrotic lung cancer (NLC) and 31 with necrotic pulmonary mass-like inflammatory lesion (NPMIL) were enrolled and underwent DESCT. The clinical characteristics of patients, CT morphological features, and DESCT quantitative parameters of lesions were compared between the two groups. Binary logistic regression analysis was performed to identify the independent prognostic factors differentiating NPMIL from NLC. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of single-parameter and multiparametric analyses. RESULTS Significant differences in age, C-reactive protein concentration, the slope of the spectral curve from 40 to 65 keV (K40-65 keV) of necrosis in non-contrast-enhanced scanning (NCS), arterial phase (AP) and venous phase (VP), effective atomic number of necrosis in NCS, and iodine concentration (IC) of the solid component in VP were observed between groups (all p < 0.05). The aforementioned parameters had area under the ROC curve (AUC) values of 0.747, 0.691, 0.841, 0.641, 0.660, 0.828, and 0.754, respectively, for distinguishing between NLC and NPMIL. Multiparametric analysis showed that age, K40-65 keV of necrosis in NCS, and IC of the solid component in VP were the most effective factors for differentiating NLC from NPMIL, with an AUC of 0.966 and percentage of correct class of 88.7%. CONCLUSIONS DESCT can differentiate malignant from benign necrotic lung lesions with a relatively high accuracy.
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Affiliation(s)
- Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Xiao Fan
- Department of Radiology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan Road Two, Yuzhong District, Chongqing, China
| | - Tian-You Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Xing-Tao Huang
- Department of Radiology, University of Chinese Academy of Sciences Chongqing Renji Hospital (Fifth People's Hospital of Chongqing), No. 24 Renji Road, Nan'an District, Chongqing, China.
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Li YL, Lv XN, Wei X, Yang WS, Li R, Deng L, Wei M, Li Q, Lv FJ. Relationship Between Non-contrast Computed Tomography Imaging Markers and Perihemorrhagic Edema Growth in Intracerebral Hemorrhage. Neurocrit Care 2021; 35:451-456. [PMID: 33942209 DOI: 10.1007/s12028-021-01188-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Perihemorrhagic edema (PHE) growth has been gradually considered as predictor for outcome of Intracerebral hemorrhage (ICH) patients. The aim of our study was to investigate correlation between non-contrast computed tomography (CT) markers and early PHE growth. METHODS ICH patients between July 2011 and March 2017 were included in this retrospective analysis. ICH and PHE volumes were measured by using a validated semiautomatic volumetric algorithm. Nonparametric test was used for comparing PHE volume at different time points of non-contrast computed tomography (NCCT) imaging markers. Multivariable linear regression was constructed to study the relationship between NCCT imaging markers and PHE growth over 36 h. RESULTS A total of 214 patients were included. Nonparametric test showed that PHE volume was significantly different between patients with and without NCCT imaging markers. (all p < 0.05) In multivariable linear regression analysis adjusted for ICH characteristics, blend sign (p = 0.011), black hole sign (p = 0.002), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001) were correlated with PHE growth. Follow-up PHE volume within 36 h after baseline CT scan was associated with blend sign (p = 0.001), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001). CONCLUSION NCCT imaging markers of hematoma expansion are associated with PHE growth. This suggests that early PHE growth can be predicted using radiology markers on admission CT scan.
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Affiliation(s)
- Yu-Lun Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao Wei
- Department of Traditional Chinese Medicine, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, China
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lan Deng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Miao Wei
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Li WJ, Lv FJ, Tan YW, Fu BJ, Chu ZG. Pulmonary Benign Ground-Glass Nodules: CT Features and Pathological Findings. Int J Gen Med 2021; 14:581-590. [PMID: 33679139 PMCID: PMC7930605 DOI: 10.2147/ijgm.s298517] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
Background Some pulmonary ground-glass nodules (GGNs) are benign and frequently misdiagnosed due to lack of understanding of their CT characteristics. This study aimed to reveal the CT features and corresponding pathological findings of pulmonary benign GGNs to help improve diagnostic accuracy. Patients and Methods From March 2016 to October 2019, patients with benign GGNs confirmed by operation or follow-up were enrolled retrospectively. According to overall CT manifestations, GGNs were classified into three types: I, GGO with internal high-attenuation zone; II, nodules lying on adjacent blood vessels; and other type, lesions without obvious common characteristics. CT features and pathological findings of each nodule type were evaluated. Results Among the 40 type I, 25 type II, and 14 other type GGNs, 24 (60.0%), 19 (76.0%), and 10 (71.4%) nodules were resected, respectively. Type I GGNs were usually irregular (25 of 40, 62.5%) with only one high-attenuation zone (38 of 40, 95.0%) (main pathological components: thickened alveolar walls with inflammatory cells, fibrous tissue, and exudation), which was usually centric (24 of 40, 60.0%), having blurred margin (38 of 40, 95.0%), and connecting to blood vessels (32 of 40, 80.0%). The peripheral GGO (main pathological component: a small amount of inflammatory cell infiltration with fibrous tissue proliferation) was usually ill-defined (28 of 40, 70.0%). Type II GGNs (main pathological components: focal interstitial fibrosis with or without inflammatory cell infiltration) lying on adjacent vessel branches were usually irregular (19 of 25, 76.0%) and well defined (16 of 25, 64.0%) but showed coarse margins (15 of 16, 93.8%). Other type GGNs had various CT manifestations but their pathological findings were similar to that of type II. Conclusion For subsolid nodules with CT features manifested in type I or II GGNs, follow-up should be firstly considered in further management.
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Affiliation(s)
- Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yi-Wen Tan
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Yang WS, Zhang SQ, Shen YQ, Wei X, Zhao LB, Xie XF, Deng L, Li XH, Lv XN, Lv FJ, Dowlatshahi D, Li Q, Xie P. Noncontrast Computed Tomography Markers as Predictors of Revised Hematoma Expansion in Acute Intracerebral Hemorrhage. J Am Heart Assoc 2021; 10:e018248. [PMID: 33506695 PMCID: PMC7955436 DOI: 10.1161/jaha.120.018248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Noncontrast computed tomography (NCCT) markers are the emerging predictors of hematoma expansion in intracerebral hemorrhage. However, the relationship between NCCT markers and the dynamic change of hematoma in parenchymal tissues and the ventricular system remains unclear. Methods and Results We included 314 consecutive patients with intracerebral hemorrhage admitted to our hospital from July 2011 to May 2017. The intracerebral hemorrhage volumes and intraventricular hemorrhage (IVH) volumes were measured using a semiautomated, computer-assisted technique. Revised hematoma expansion (RHE) was defined by incorporating the original definition of hematoma expansion into IVH growth. Receiver operating characteristic curve analysis was used to compare the performance of the NCCT markers in predicting the IVH growth and RHE. Of 314 patients in our study, 61 (19.4%) had IVH growth and 93 (23.9%) had RHE. After adjustment for potential confounding variables, blend sign, black hole sign, island sign, and expansion-prone hematoma could independently predict IVH growth and RHE in the multivariate logistic regression analysis. Expansion-prone hematoma had a higher predictive performance of RHE than any single marker. The diagnostic accuracy of RHE in predicting poor prognosis was significantly higher than that of hematoma expansion. Conclusions The NCCT markers are independently associated with IVH growth and RHE. Furthermore, the expansion-prone hematoma has a higher predictive accuracy for prediction of RHE and poor outcome than any single NCCT marker. These findings may assist in risk stratification of NCCT signs for predicting active bleeding.
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Affiliation(s)
- Wen-Song Yang
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China.,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Shu-Qiang Zhang
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China.,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Yi-Qing Shen
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China.,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Xiao Wei
- Department of Traditional Chinese Medicine Chongqing Medical and Pharmaceutical College Chongqing China
| | - Li-Bo Zhao
- Department of Neurology Yongchuan Hospital of Chongqing Medical University Chongqing China.,Chongqing Key Laboratory of Cerebrovascular Disease Research Yongchuan Hospital of Chongqing Medical University Chongqing China
| | - Xiong-Fei Xie
- Department of Radiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Lan Deng
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Xin-Hui Li
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China.,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Xin-Ni Lv
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Fa-Jin Lv
- Department of Radiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Dar Dowlatshahi
- Department of Medicine (Neurology) Ottawa Hospital Research InstituteUniversity of Ottawa Ontario Canada
| | - Qi Li
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China.,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases The First Affiliated Hospital of Chongqing Medical University Chongqing China.,Chongqing Key Laboratory of Cerebrovascular Disease Research Yongchuan Hospital of Chongqing Medical University Chongqing China
| | - Peng Xie
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China.,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases The First Affiliated Hospital of Chongqing Medical University Chongqing China.,Chongqing Key Laboratory of Cerebrovascular Disease Research Yongchuan Hospital of Chongqing Medical University Chongqing China
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Zhang L, Liu X, Gong B, Li Q, Luo T, Lv F, Zheng Y, Zheng W, Guo H. Increased Internal Carotid Artery Tortuosity is a Risk Factor for Spontaneous Cervicocerebral Artery Dissection. Eur J Vasc Endovasc Surg 2021; 61:542-549. [PMID: 33402322 DOI: 10.1016/j.ejvs.2020.11.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/06/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Spontaneous cervicocerebral artery dissection (sCCD) is an important cause of ischaemic stroke that often occurs in young and middle aged patients. The purpose of this study was to investigate the correlation between tortuosity of the carotid artery and sCCD. METHODS Patients with confirmed sCCD who underwent computed tomography angiography (CTA) were reviewed retrospectively. Age and sex matched patients having CTA were used as controls. The tortuosity indices of the cervical arteries were measured from the CTA images. The carotid siphon and the extracranial internal carotid artery (ICA) were evaluated according to morphological classification. The carotid siphons were classified into five types. The extracranial ICA was categorised as simple tortuosity, coiling or kinking. Independent risk factors for sCCD were investigated using multivariable analysis. RESULTS The study included sixty-six patients with sCCD and 66 controls. There were no differences in vascular risk factors between the two groups. The internal carotid tortuosity index (ICTI) (25.24 ± 12.37 vs. 15.90 ± 8.55, respectively; p < .001) and vertebral tortuosity index (VTI) (median 11.28; interquartile range [IQR] 6.88, 18.80 vs. median 8.38; IQR 6.02, 12.20, respectively; p = .008) were higher in the patients with sCCD than in the controls. Type III and Type IV carotid siphons were more common in the patients with sCCD (p = .001 and p < .001, respectively). The prevalence of any vessel tortuosity, coiling and kinking of the extracranial ICA was higher in the patients with sCCD (p < .001, p = .018 and p = .006, respectively). ICTI (odds ratio [OR] 2.964; p = .026), VTI (OR 5.141; p = .009), and Type III carotid siphons (OR 4.654; p = .003) were independently associated with the risk of sCCD. CONCLUSION Arterial tortuosity is associated with sCCD, and greater tortuosity of the cervical artery may indicate an increased risk of arterial dissection.
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Affiliation(s)
- Lijuan Zhang
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoshuang Liu
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Beibei Gong
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- The Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianyou Luo
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - FaJin Lv
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yineng Zheng
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wanlin Zheng
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haoming Guo
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Liu XY, Lv FJ, Lv SX, Fu BJ, Md WJL, Ouyang Y, Chu ZG. Completed absorption of coronavirus disease 2019 (COVID-19) pneumonia lesions: a preliminary study. Int J Med Sci 2021; 18:2321-2326. [PMID: 33967608 PMCID: PMC8100646 DOI: 10.7150/ijms.54675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Complete absorption of coronavirus disease 2019 (COVID-19) pneumonia in a short term was not detailedly reported. We aimed to investigate the clinical and imaging characteristics of COVID-19 patients with complete absorption of pulmonary lesions. Methods: Retrospectively collected the clinical and chest CT data of 224 patients with COVID-19 in one regional medical center. Currently, pulmonary lesions in 37 patients were completely absorbed. The clinical manifestations, laboratory examinations, and CT findings of lesions for these patients were summarized. Results: Among the 37 patients (age, 39.0 ± 12.4 [14-63] years, 20 males), disease in 36 (97.3%) was mild and in 1 (2.7%) was from severe to mild. The most common symptoms were cough (24/37, 64.9%) and fever (23/37, 62.2%). Their laboratory indicators at admission were usually normal, while the white blood cell and neutrophil count significantly increased at discharge (p = 0.004, p = 0.006). On initial CT images, all patients had various pulmonary lesions (mean involved lobes: 2.8 ± 1.5, range: 1-5; mean involved segments: 6.6 ± 4.3, range: 1-16), which mainly manifested as multiple patchy and or spherical ground glass opacities (GGOs) (30/37, 81.1%) with fibrous strips (19/30, 63.3%) or consolidation (11/30, 36.7%). After treatment, lesions in most (33/37, 89.2%) patients were continuously absorbed. At discharge, previous lesions were mostly absorbed in 11 patients (11/37, 29.7%), the main residues were GGOs (24/37, 64.9%), followed by fibrous strips (13/37, 35.1%). On the latest CT, all the pulmonary lesions were completely absorbed, the duration of lesions was 31.6 ± 11.4 days (range: 5-50 days). Conclusion: The pulmonary lesions in some mild COVID-19 patients (generally with normal laboratory indicators at admission, GGOs as the main manifestation on initial CT, and representation of continuous absorption after treatment) could be completely absorbed with a mean duration of 31.6 days.
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Affiliation(s)
- Xue-Yan Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Department of Radiology, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Sheng-Xiu Lv
- Department of Radiology, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wang-Jia Li Md
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yu Ouyang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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Yang WS, Shen YQ, Zhang XD, Zhao LB, Wei X, Xiong X, Xie XF, Li R, Deng L, Li XH, Lv XN, Lv FJ, Li Q, Xie P. Hydrocephalus Growth: Definition, Prevalence, Association with Poor Outcome in Acute Intracerebral Hemorrhage. Neurocrit Care 2020; 35:62-71. [PMID: 33174150 DOI: 10.1007/s12028-020-01140-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES To propose a novel definition for hydrocephalus growth and to further describe the association between hydrocephalus growth and poor outcome among patients with intracerebral hemorrhage (ICH). METHODS We analyzed consecutive patients who presented within 6 h after ICH ictus between July 2011 and June 2017. Follow-up CT scans were performed within 36 h after initial CT scans. The degree of hydrocephalus were evaluated by the hydrocephalus score of Diringer et al. The optimal increase of the hydrocephalus scores between initial and follow-up CT scan was estimated to define hydrocephalus growth. Poor long-term outcome was defined as a modified Rankin Scale of 4-6 at 3 months. Multivariate logistic regression analysis was performed to investigate the hydrocephalus growth for predicting 30-day mortality, 90-day mortality, and poor long-term outcome. RESULTS A total of 321 patients with ICH were included in the study. Of 64 patients with hydrocephalus growth, 34 (53.1%) patients presented with both concurrent hematoma expansion and intraventricular hemorrhage (IVH) growth. After adjusting for potential confounding factors, hydrocephalus growth independently predicted 30-day mortality, 90-day mortality, and 90-day poor long-term outcome in multivariate logistic regression analysis. Hydrocephalus growth showed higher accuracy for predicting 30-day mortality, 90-day mortality, and poor long-term outcome than IVH growth or hematoma expansion, respectively. CONCLUSIONS Hydrocephalus growth is defined by strongly predictive of short- or long-term mortality and poor outcome at 90 days, and might be a potential indicator for assisting clinicians for clinical decision-making.
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Affiliation(s)
- Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yi-Qing Shen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Dong Zhang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Li-Bo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Xiao Wei
- Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, China
| | - Xin Xiong
- Department of Neurology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400011, China
| | - Xiong-Fei Xie
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lan Deng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xin-Hui Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Long QX, Tang XJ, Shi QL, Li Q, Deng HJ, Yuan J, Hu JL, Xu W, Zhang Y, Lv FJ, Su K, Zhang F, Gong J, Wu B, Liu XM, Li JJ, Qiu JF, Chen J, Huang AL. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med 2020. [PMID: 32555424 DOI: 10.1038/s41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
The clinical features and immune responses of asymptomatic individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have not been well described. We studied 37 asymptomatic individuals in the Wanzhou District who were diagnosed with RT-PCR-confirmed SARS-CoV-2 infections but without any relevant clinical symptoms in the preceding 14 d and during hospitalization. Asymptomatic individuals were admitted to the government-designated Wanzhou People's Hospital for centralized isolation in accordance with policy1. The median duration of viral shedding in the asymptomatic group was 19 d (interquartile range (IQR), 15-26 d). The asymptomatic group had a significantly longer duration of viral shedding than the symptomatic group (log-rank P = 0.028). The virus-specific IgG levels in the asymptomatic group (median S/CO, 3.4; IQR, 1.6-10.7) were significantly lower (P = 0.005) relative to the symptomatic group (median S/CO, 20.5; IQR, 5.8-38.2) in the acute phase. Of asymptomatic individuals, 93.3% (28/30) and 81.1% (30/37) had reduction in IgG and neutralizing antibody levels, respectively, during the early convalescent phase, as compared to 96.8% (30/31) and 62.2% (23/37) of symptomatic patients. Forty percent of asymptomatic individuals became seronegative and 12.9% of the symptomatic group became negative for IgG in the early convalescent phase. In addition, asymptomatic individuals exhibited lower levels of 18 pro- and anti-inflammatory cytokines. These data suggest that asymptomatic individuals had a weaker immune response to SARS-CoV-2 infection. The reduction in IgG and neutralizing antibody levels in the early convalescent phase might have implications for immunity strategy and serological surveys.
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Affiliation(s)
- Quan-Xin Long
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Xiao-Jun Tang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Qiu-Lin Shi
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Qin Li
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Hai-Jun Deng
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Jun Yuan
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Jie-Li Hu
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Wei Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yong Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Su
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Fan Zhang
- Wanzhou People's Hospital, Chongqing, China
| | - Jiang Gong
- Wanzhou People's Hospital, Chongqing, China
| | - Bo Wu
- Wanzhou District Center for Disease Control and Prevention, Chongqing, China
| | - Xia-Mao Liu
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin-Jing Li
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing-Fu Qiu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China.
| | - Juan Chen
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China.
| | - Ai-Long Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China.
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Li Q, Yang WS, Shen YQ, Xie XF, Li R, Deng L, Yang TT, Lv FJ, Lv FR, Wu GF, Tang ZP, Goldstein JN, Xie P. Benign Intracerebral Hemorrhage: A Population at Low Risk for Hematoma Growth and Poor Outcome. J Am Heart Assoc 2020; 8:e011892. [PMID: 30971169 PMCID: PMC6507215 DOI: 10.1161/jaha.118.011892] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background To define benign intracerebral hemorrhage (ICH) and to investigate the association between benign ICH, hematoma expansion, and functional outcome. Methods and Results We analyzed a prospectively collected cohort of patients with ICH, who presented within 6 hours of symptom onset between July 2011 and February 2017 to a tertiary teaching hospital. Follow‐up computed tomographic scanning was performed within 36 hours after initial computed tomographic scanning. Benign ICH was operationally defined as homogeneous and regularly shaped small ICH. The presence of benign ICH was judged by 2 independent reviewers (Q.L., W.Y.) on the basis of the admission computed tomographic scan. Functional independence was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The associations between benign ICH, hematoma expansion, and functional outcome were assessed by using multivariable logistic regression analyses. A total of 288 patients with ICH were included. Benign ICH was found in 48 patients (16.7%). None of the patients with benign ICH had early hematoma expansion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of benign ICH for predicting functional independence at 3 months were 30.7%, 96.6%, 90.0%, 60.0%, and 0.637, respectively. Conclusions Patients with benign ICH are at low risk of hematoma expansion and poor outcome. These patients may be safe for less intensive monitoring and are unlikely to benefit from therapies aimed at preventing ICH expansion.
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Affiliation(s)
- Qi Li
- 1 Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Wen-Song Yang
- 1 Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Yi-Qing Shen
- 2 Department of Radiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Xiong-Fei Xie
- 2 Department of Radiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Rui Li
- 1 Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Lan Deng
- 1 Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Ting-Ting Yang
- 1 Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Fa-Jin Lv
- 2 Department of Radiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Fu-Rong Lv
- 2 Department of Radiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Guo-Feng Wu
- 3 Emergency Department The Affiliated Hospital of Guizhou Medical University Guiyang China
| | - Zhou-Ping Tang
- 4 Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Joshua N Goldstein
- 5 Division of Neurocritical Care and Emergency Neurology Massachusetts General Hospital Harvard Medical School Boston MA
| | - Peng Xie
- 1 Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
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Long QX, Tang XJ, Shi QL, Li Q, Deng HJ, Yuan J, Hu JL, Xu W, Zhang Y, Lv FJ, Su K, Zhang F, Gong J, Wu B, Liu XM, Li JJ, Qiu JF, Chen J, Huang AL. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med 2020. [PMID: 32555424 DOI: 10.1038/s41591‐020‐0965‐6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The clinical features and immune responses of asymptomatic individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have not been well described. We studied 37 asymptomatic individuals in the Wanzhou District who were diagnosed with RT-PCR-confirmed SARS-CoV-2 infections but without any relevant clinical symptoms in the preceding 14 d and during hospitalization. Asymptomatic individuals were admitted to the government-designated Wanzhou People's Hospital for centralized isolation in accordance with policy1. The median duration of viral shedding in the asymptomatic group was 19 d (interquartile range (IQR), 15-26 d). The asymptomatic group had a significantly longer duration of viral shedding than the symptomatic group (log-rank P = 0.028). The virus-specific IgG levels in the asymptomatic group (median S/CO, 3.4; IQR, 1.6-10.7) were significantly lower (P = 0.005) relative to the symptomatic group (median S/CO, 20.5; IQR, 5.8-38.2) in the acute phase. Of asymptomatic individuals, 93.3% (28/30) and 81.1% (30/37) had reduction in IgG and neutralizing antibody levels, respectively, during the early convalescent phase, as compared to 96.8% (30/31) and 62.2% (23/37) of symptomatic patients. Forty percent of asymptomatic individuals became seronegative and 12.9% of the symptomatic group became negative for IgG in the early convalescent phase. In addition, asymptomatic individuals exhibited lower levels of 18 pro- and anti-inflammatory cytokines. These data suggest that asymptomatic individuals had a weaker immune response to SARS-CoV-2 infection. The reduction in IgG and neutralizing antibody levels in the early convalescent phase might have implications for immunity strategy and serological surveys.
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Affiliation(s)
- Quan-Xin Long
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Xiao-Jun Tang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Qiu-Lin Shi
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Qin Li
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Hai-Jun Deng
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Jun Yuan
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Jie-Li Hu
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Wei Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yong Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Su
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Fan Zhang
- Wanzhou People's Hospital, Chongqing, China
| | - Jiang Gong
- Wanzhou People's Hospital, Chongqing, China
| | - Bo Wu
- Wanzhou District Center for Disease Control and Prevention, Chongqing, China
| | - Xia-Mao Liu
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin-Jing Li
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing-Fu Qiu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China.
| | - Juan Chen
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China.
| | - Ai-Long Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China.
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Zhang YJ, Xiao ZB, Lv FR, Sheng B, Li J, Zheng YN, Lv FJ, Chen JY. MRI evaluation of endopelvic fascial swelling and analysis of influencing factors in patients with uterine fibroids after high-intensity focused ultrasound ablation. Int J Hyperthermia 2020; 37:175-181. [PMID: 32031430 DOI: 10.1080/02656736.2019.1701100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Purpose: To evaluate endopelvic fascial swelling in patients with uterine fibroids after high-intensity focused ultrasound (HIFU) ablation on magnetic resonance imaging (MRI) and investigate the factors that influence endopelvic fascial swelling.Methods: MRI and clinical data from 188 patients with uterine fibroids who were treated with HIFU were analyzed retrospectively. The patients were divided into a fascial swelling group and a non-swelling group, and the degree of swelling was graded. Fascial swelling was set as the dependent variable, and factors such as baseline characteristics and HIFU parameters, were set as the independent variables. The relationship between these variables and fascial swelling was analyzed by univariate and multivariate analyses. Correlations between the factors and the degree of fascial swelling were evaluated by Kruskal-Wallis test.Results: The univariate analysis revealed that the fibroid location, distance from the fibroid to the sacrum, sonication time, treatment time, treatment intensity, therapeutic dose (TD), and energy efficiency (EEF) all affected the endopelvic fascial swelling (p < 0.05). Subsequently, multivariate analysis showed that the distance from the fibroid to the sacrum was significantly correlated with fascial swelling (p < 0.05). Moreover, TD and sonication time were significantly positively correlated with the degree of fascial swelling (p < 0.05). The incidence of sacrococcygeal pain was significantly correlated with fascial swelling (p < 0.05).Conclusion: The distance from the fibroid to the sacrum was a protective factor for fascial swelling. TD and sonication time were significantly positively correlated with the degree of fascial swelling.
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Affiliation(s)
- Ya-Jiao Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Zhi-Bo Xiao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Fu-Rong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Bo Sheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Yi-Neng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Jin-Yun Chen
- Therapeutic Center of Ultrasound Ablation, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
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Li Q, Song J, Li X, Luo T, Peng J, Lv F, Li Y, Huang Z, Wang A. <p>Differentiation of Intraspinal Tuberculosis and Metastatic Cancer Using Magnetic Resonance Imaging</p>. Infect Drug Resist 2020; 13:341-349. [PMID: 32099425 PMCID: PMC7007797 DOI: 10.2147/idr.s224238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- QuanJiang Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing400016, People’s Republic of China
| | - Juan Song
- Department of Gastroenterology & Endocrinology, Wuhan No. 9 Hospital, Wuhan, People’s Republic of China
| | - XinYou Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing400016, People’s Republic of China
| | - TianYou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing400016, People’s Republic of China
| | - Juan Peng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing400016, People’s Republic of China
- Correspondence: Juan Peng Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing400016, People’s Republic of ChinaTel +86 1 898 328 0171 Email
| | - FaJin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing400016, People’s Republic of China
| | - YongMei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing400016, People’s Republic of China
| | - ZhongXin Huang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing400016, People’s Republic of China
| | - AnRan Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing400016, People’s Republic of China
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Chu ZG, Zhang Y, Li WJ, Li Q, Zheng YN, Lv FJ. Primary solid lung cancerous nodules with different sizes: computed tomography features and their variations. BMC Cancer 2019; 19:1060. [PMID: 31699047 PMCID: PMC6836448 DOI: 10.1186/s12885-019-6274-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The computed tomography (CT) features of small solid lung cancers and their changing regularity as they grow have not been well studied. The purpose of this study was to analyze the CT features of solid lung cancerous nodules (SLCNs) with different sizes and their variations. METHODS Between February 2013 and April 2018, a consecutive cohort of 224 patients (225 nodules) with confirmed primary SLCNs was enrolled. The nodules were divided into four groups based on tumor diameter (A: diameter ≤ 1.0 cm, 35 lesions; B: 1.0 cm < diameter ≤ 1.5 cm, 60 lesions; C: 1.5 cm < diameter ≤ 2.0 cm, 63 lesions; and D: 2.0 cm < diameter ≤ 3.0 cm, 67 lesions). CT features of nodules within each group were summarized and compared. RESULTS Most nodules in different groups were located in upper lobes (groups A - D:50.8%-73.1%) and had a gap from the pleura (groups A - D:89.6%-100%). The main CT features of smaller (diameter ≤ 1 cm) and larger (diameter > 1 cm) nodules were significantly different. As nodule diameter increased, more lesions showed a regular shape, homogeneous density, clear but coarse tumor-lung interface, lobulation, spiculation, spinous protuberance, vascular convergence, pleural retraction, bronchial truncation, and beam-shaped opacity (p < 0.05 for all). The presence of halo sign in all groups was similar (17.5%-22.5%; p > 0.05). CONCLUSIONS The CT features vary among SLCNs with different sizes. Understanding their changing regularity is helpful for identifying smaller suspicious malignant nodules and early determining their nature in follow-up.
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Affiliation(s)
- Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, Chongqing, China
| | - Yan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, Chongqing, China.,Department of Radiology, Chongqing Three Gorges Medical College, Chongqing, China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, Chongqing, China
| | - Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, Chongqing, China
| | - Yi-Neng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, Chongqing, China.
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Deng L, Zhang G, Wei X, Yang WS, Li R, Shen YQ, Xie XF, Lv XN, Li YL, Zhao LB, Lv FJ, Qin XY, Xie P, Li Q. Comparison of Satellite Sign and Island Sign in Predicting Hematoma Growth and Poor Outcome in Patients with Primary Intracerebral Hemorrhage. World Neurosurg 2019; 127:e818-e825. [PMID: 30954737 DOI: 10.1016/j.wneu.2019.03.273] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Satellite sign (SS) and island sign (IS) are novel noncontrast computed tomography (CT) predictors of hematoma growth. The aim of this study was to compare diagnostic performance of IS and SS in predicting hematoma growth and functional outcome in patients with intracerebral hemorrhage (ICH). METHODS The study included patients with ICH who underwent baseline CT scan within 6 hours of symptom onset and follow-up CT scan within 36 hours after initial CT between July 2012 and April 2017. Sensitivity, specificity, positive predictive value, and negative predictive value of IS and SS in predicting hematoma growth and functional outcome were assessed. Accuracy of the 2 signs in predicting hematoma growth and functional outcome was analyzed using receiver operating characteristic analysis. Association between the presence of IS and SS and ICH growth was assessed using multivariate logistic regression. RESULTS Of 307 patients with ICH, IS was observed in 46 patients (15.0%), and SS was observed in 151 patients (49.2%). Rates of hematoma growth were 40.4% in SS+ patients, 91.3% in IS+ patients, 18.4% in SS-IS- patients, 21.1% in SS+IS- patients, 100% in SS-IS+ patients, and 90.5% in SS+IS+ patients. After adjusting for potential confounders, IS remained an independent predictor for hematoma growth and poor functional outcome. The area under the curve of IS was significantly larger than the area under the curve of SS in predicting hematoma growth (P = 0.001). CONCLUSIONS IS seems to be an optimal shape irregularity imaging marker for predicting hematoma growth and functional outcome in patients with ICH.
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Affiliation(s)
- Lan Deng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Zhang
- Department of Cerebrovascular Diseases, The First People's Hospital of Zunyi, Zunyi, China
| | - Xiao Wei
- Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi-Qing Shen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiong-Fei Xie
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Lun Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Bo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Yue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Liu X, Chen L, Cheng R, Luo T, Lv F, Fang W, Gong J, Jiang P. Altered functional connectivity in patients with subcortical ischemic vascular disease: A resting-state fMRI study. Brain Res 2019; 1715:126-133. [PMID: 30910630 DOI: 10.1016/j.brainres.2019.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
Patients with subcortical ischemic vascular disease (SIVD) may hold a high risk of cognitive impairment (CI) by affecting the functional connectivity (FC) of resting-state networks (RSNs). Current studies have mainly focused on the patients with CI but have ignored the prodromal stage when people suffered subcortical vascular damage, but without CI. Independent component analysis (ICA) of rs-fMRI could detect altered FC in RSNs at the early stage of the disease. 81 SIVD patients with CI (SVCI = 29) and without CI (pre-SVCI = 25), and 27 normal controls (NCs) were scanned with rs-fMRI, analyzed by ICA and assessed by neuropsychological examinations. We found significantly altered FC within the RSNs of sensorimotor network (SMN), posterior default mode networks (pDMN), right frontoparietal network (rFPN) and language network (LN) (P < 0.05, AlphaSim corrected). The pre-SVCI group showed significantly increased FC in brain regions of the multiple RSNs when compared with the other two groups. The mean values extracted from the right inferior frontal gyrus (IFG.R) and the left posterior cingulate gyrus (PCG.L) were significantly correlated with clock drawing test (CDT). The right precentral/postcentral gyrus (PreCG.R/PoCG.R) and the right supramarginal gyrus (SMG.R) were positively correlated with Stroop-1 Test. We concluded the FC in RSNs had already been changed at the early stage of the disease as the maladaptive response or compensatory reallocation of the cognitive resources. The ICA of rs-fMRI can be applied as a potential approach to identify the underlying mechanisms of SIVD.
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Affiliation(s)
- Xiaoshuang Liu
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Chen
- The Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Runtian Cheng
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianyou Luo
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - FaJin Lv
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weidong Fang
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junwei Gong
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peiling Jiang
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Liu X, Cheng R, Chen L, Luo T, Lv F, Gong J, Jiang P. Alterations of White Matter Integrity in Subcortical Ischemic Vascular Disease with and Without Cognitive Impairment: a TBSS Study. J Mol Neurosci 2019; 67:595-603. [PMID: 30685818 DOI: 10.1007/s12031-019-01266-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
Patients with subcortical ischemic vascular disease (SIVD) may exhibit a high risk of cognitive impairment (CI) by disruption of white matter (WM) integrity. Diffusion tensor imaging (DTI) is recommended as a sensitive method to explore whole brain WM alterations at an asymptomatic stage of the disease, which might be correlated with underlying cognitive disorders. We aim to investigate alterations in WM microstructures and evaluate the relationships between the mean values of diffusion metrics (FA, MD, AD, and RD) and cognitive assessments in SIVD patients. Fifty SIVD patients with (SVCI, N = 25) and without (pre-SVCI, N = 25) cognitive impairments and normal controls (NC, N = 23) underwent DTI and neuropsychological examinations. DTI data were analyzed via TBSS to detect significant changes in WM tracts. Spearman correlation analysis was performed to evaluate relationships between the mean values of diffusion indices and the cognitive assessments. In general, extensive symmetrically altered areas that involved approximately the entire cerebral WM were noted in the pre-SVCI group but were less distinct than that noted in the SVCI group compared with NCs. The genu of corpus callosum exhibited the most damaged WM fiber. Throughout WM, FA was decreased, whereas MD, AD, and RD were increased. Some specific WM tracts in patient groups were significantly correlated with the severity of white matter hyperintensity (WMH), cognitive assessments about executive functions and processing speed. WM integrity has already been damaged at the pre-SVCI stage, which would be associate with future cognitive dysfunction. DTI could potentially establish early biomarkers to detect underlying mechanisms of SIVD.
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Affiliation(s)
- Xiaoshuang Liu
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Runtian Cheng
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Chen
- The Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tianyou Luo
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - FaJin Lv
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junwei Gong
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peiling Jiang
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Li Q, Yang WS, Chen SL, Lv FR, Lv FJ, Hu X, Zhu D, Cao D, Wang XC, Li R, Yuan L, Qin XY, Xie P. Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage. Cerebrovasc Dis 2018; 45:48-53. [DOI: 10.1159/000486163] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/05/2017] [Indexed: 11/19/2022] Open
Abstract
Background: In spontaneous intracerebral hemorrhage (ICH), black hole sign has been proposed as a promising imaging marker that predicts hematoma expansion in patients with ICH. The aim of our study was to investigate whether admission CT black hole sign predicts hematoma growth in patients with ICH. Methods: From July 2011 till February 2016, patients with spontaneous ICH who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. The presence of black hole sign on admission non-enhanced CT was independently assessed by 2 readers. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Univariate and multivariable logistic regression analyses were performed to assess the association between the presence of the black hole sign and functional outcome. Results: A total of 225 patients (67.6% male, mean age 60.3 years) were included in our study. Black hole sign was identified in 32 of 225 (14.2%) patients on admission CT scan. The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, baseline ICH volume, admission Glasgow Coma Scale score, and presence of black hole sign on baseline CT independently predict poor functional outcome at 90 days. There are significantly more patients with a poor functional outcome (defined as mRS ≥4) among patients with black hole sign than those without (84.4 vs. 32.1%, p < 0.001; OR 8.19, p = 0.001). Conclusions: The CT black hole sign independently predicts poor outcome in patients with ICH. Early identification of black hole sign is useful in prognostic stratification and may serve as a potential therapeutic target for anti-expansion clinical trials.
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Li Q, Yang WS, Wang XC, Cao D, Zhu D, Lv FJ, Liu Y, Yuan L, Zhang G, Xiong X, Li R, Hu YX, Qin XY, Xie P. Blend sign predicts poor outcome in patients with intracerebral hemorrhage. PLoS One 2017; 12:e0183082. [PMID: 28829797 PMCID: PMC5568736 DOI: 10.1371/journal.pone.0183082] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/29/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction Blend sign has been recently described as a novel imaging marker that predicts hematoma expansion. The purpose of our study was to investigate the prognostic value of CT blend sign in patients with ICH. Objectives and methods Patients with intracerebral hemorrhage who underwent baseline CT scan within 6 hours were included. The presence of blend sign on admission nonenhanced CT was independently assessed by two readers. The functional outcome was assessed by using the modified Rankin Scale (mRS) at 90 days. Results Blend sign was identified in 40 of 238 (16.8%) patients on admission CT scan. The proportion of patients with a poor functional outcome was significantly higher in patients with blend sign than those without blend sign (75.0% versus 47.5%, P = 0.001). The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, admission GCS score, baseline hematoma volume and presence of blend sign on baseline CT independently predict poor functional outcome at 90 days. The CT blend sign independently predicts poor outcome in patients with ICH (odds ratio 3.61, 95% confidence interval [1.47–8.89];p = 0.005). Conclusions Early identification of blend sign is useful in prognostic stratification and may serve as a potential therapeutic target for prospective interventional studies.
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Affiliation(s)
- Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail: (QL); (PX)
| | - Wen-Song Yang
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xing-Chen Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Du Cao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Zhu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liang Yuan
- Department of Radiology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Xiong
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yun-Xin Hu
- Department of Neurology, Chongqing Jiulongpo People’s Hospital, Chongqing, China
| | - Xin-Yue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail: (QL); (PX)
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Peng J, Qu H, Peng J, Luo TY, Lv FJ, chen L, Wang ZN, Ouyang Y, Cheng QF. Abnormal spontaneous brain activity in type 2 diabetes with and without microangiopathy revealed by regional homogeneity. Eur J Radiol 2016; 85:607-15. [DOI: 10.1016/j.ejrad.2015.12.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/12/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022]
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Li Q, Zhang G, Huang YJ, Dong MX, Lv FJ, Wei X, Chen JJ, Zhang LJ, Qin XY, Xie P. Blend Sign on Computed Tomography. Stroke 2015; 46:2119-23. [PMID: 26089330 DOI: 10.1161/strokeaha.115.009185] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/21/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Early hematoma growth is not uncommon in patients with intracerebral hemorrhage and is an independent predictor of poor functional outcome. The purpose of our study was to report and validate the use of our newly identified computed tomographic (CT) blend sign in predicting early hematoma growth.
Methods—
Patients with intracerebral hemorrhage who underwent baseline CT scan within 6 hours after onset of symptoms were included. The follow-up CT scan was performed within 24 hours after the baseline CT scan. Significant hematoma growth was defined as an increase in hematoma volume of >33% or an absolute increase of hematoma volume of >12.5 mL. The blend sign on admission nonenhanced CT was defined as blending of hypoattenuating area and hyperattenuating region with a well-defined margin. Univariate and multivariable logistic regression analyses were performed to assess the relationship between the presence of the blend sign on nonenhanced admission CT and early hematoma growth.
Results—
A total of 172 patients were included in our study. Blend sign was observed in 29 of 172 (16.9%) patients with intracerebral hemorrhage on baseline nonenhanced CT scan. Of the 61 patients with hematoma growth, 24 (39.3%) had blend sign on admission CT scan. Interobserver agreement for identifying blend sign was excellent between the 2 readers (κ=0.957). The multivariate logistic regression analysis demonstrated that the time to baseline CT scan, initial hematoma volume, and presence of blend sign on baseline CT scan to be independent predictors of early hematoma growth. The sensitivity, specificity, positive and negative predictive values of blend sign for predicting hematoma growth were 39.3%, 95.5%, 82.7%, and 74.1%, respectively.
Conclusions—
The CT blend sign could be easily identified on regular nonenhanced CT and is highly specific for predicting hematoma growth.
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Affiliation(s)
- Qi Li
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
| | - Gang Zhang
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
| | - Yuan-Jun Huang
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
| | - Mei-Xue Dong
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
| | - Fa-Jin Lv
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
| | - Xiao Wei
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
| | - Jian-Jun Chen
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
| | - Li-Juan Zhang
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
| | - Xin-Yue Qin
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
| | - Peng Xie
- From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.)
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Li Q, Huang YJ, Zhang G, Lv FJ, Wei X, Dong MX, Chen JJ, Zhang LJ, Qin XY, Xie P. Intraventricular Hemorrhage and Early Hematoma Expansion in Patients with Intracerebral Hemorrhage. Sci Rep 2015; 5:11357. [PMID: 26087142 PMCID: PMC4471897 DOI: 10.1038/srep11357] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 05/22/2015] [Indexed: 12/31/2022] Open
Abstract
Intraventricular hemorrhage is associated with poor functional outcomes in patients with intracerebral hemorrhage (ICH). We aimed to investigate the association between intraventricular hemorrhage and early hematoma expansion in patients with ICH. Patients with ICH who underwent a baseline CT scan within six hours after onset of symptoms were included. The follow-up CT scan was performed within 24 hours after the baseline CT scan. Univariate and multivariable logistic regression were used to assess the relationship between presence of intraventricular hemorrhage and early hematoma expansion. A total of 160 patients were included in the study. Significant hematoma growth was observed in 52 (32.5%) patients presenting within six hours after onset of symptoms. Intraventricular hemorrhage was observed in 66 (41.25%) patients with ICH. Multivariate analyses demonstrated that a short time from onset to baseline CT scan, the initial hematoma volume, and the presence of intraventricular hemorrhage on follow-up CT scan were independently associated with hematoma enlargement. The presence of intraventricular hemorrhage on follow-up CT scan can be associated with hematoma expansion in patients with ICH.
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Affiliation(s)
- Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yuan-Jun Huang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Gang Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao Wei
- Department of Medical Technology, Chongqing Medical and Pharmaceutical College 400030, Chongqing, China
| | - Mei-Xue Dong
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jian-Jun Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Li-Juan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin-Yue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Li Q, Fan X, Huang XT, Luo TY, Chu ZG, Chen L, Zhang ZW, Li YQ, Wu JQ, Ouyang Y, Lv FJ, Ma CH. Tree-in-bud pattern in central lung cancer: CT findings and pathologic correlation. Lung Cancer 2015; 88:260-6. [PMID: 25843041 DOI: 10.1016/j.lungcan.2015.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/07/2015] [Accepted: 03/10/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Tree-in-bud (TIB) pattern can be found with central lung cancer on chest CT scans. However, few reports have described it so far. We aim to determine its incidence, CT findings and pathologic basis. MATERIALS AND METHODS 652 consecutive patients with confirmed central lung cancer were enrolled in our study. The incidence, CT findings and pathologic features of TIB pattern were analyzed retrospectively. RESULTS In total, TIB pattern was found in 22.5% (147/652) of patients. It was more common in patients with squamous cell carcinoma than those with non-squamous cell carcinoma (P=0.000). The most important associated CT finding was obstructive bronchial mucoid impaction distal to the cancer (100%, 147/147), followed by consolidation and ground-glass opacities (62.6%, 92/147). TIB pattern was confined to the areas of lung supplied by the involved bronchi (100%, 147/147) and had a focal distribution predominantly (94.6%, 139/147). Pathologically, it correlated with bronchiolectasis, bronchiolar lumen filled by mucus and inflammatory exudates, wall thickening with inflammatory cells infiltration. CONCLUSIONS TIB pattern is commonly detected in central lung squamous cell carcinoma on thoracic CT scan. It usually has a localized distribution with a predominant associated CT finding of obstructive bronchial mucoid impaction. This pattern corresponds to the mucoid impaction of bronchioles and bronchiolitis pathologically. A full understanding of TIB pattern in central lung cancer can be useful in preventing diagnostic errors.
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Affiliation(s)
- Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Xiao Fan
- Department of Radiology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan Road Two, Yuzhong District, Chongqing, China
| | - Xing-Tao Huang
- Department of Radiology, The Fifth People's Hospital of Chongqing, No. 24 Renji Road, Nan'an District, Chongqing, China
| | - Tian-You Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China.
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Li Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Zhi-Wei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yan-Qing Li
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Jing-Quan Wu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yu Ouyang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Chao-Hao Ma
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
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