Nowadays,pyogenic liver abscess(PLA)is still a common and severe intra-abdominal infection,and Klebsiella pneumoniae had emerged as the most common pathogenic bacteria worldwide in the past ten years.Our study aims to...Nowadays,pyogenic liver abscess(PLA)is still a common and severe intra-abdominal infection,and Klebsiella pneumoniae had emerged as the most common pathogenic bacteria worldwide in the past ten years.Our study aims to achieve an early pathogenic diagnosis and rational therapy modality for Klebsiella pneumoniae liver abscess(KLA)through clinical data analysis.A total of 197 inpatients in Zhongshan Hospital,Shanghai,diagnosed as having liver abscess between March 2001 and September 2009 were enrolled.Patients with monomicrobial infection were divided into two groups:patients with K.pneumoniae liver abscess(KLA group,n=106)and those with non-Klebsiella pneumoniae liver abscess(NKLA group,n=56).A retrospective analysis was made between these two groups on the aspects of underlying diseases,clinical characteristics,laboratory data,culture results,and imaging findings.To evaluate the effects of different medical interventions,monomicrobial KLA patients were further divided into four subgroups(percutaneous liver aspiration,aspiration plus antibiotics flushing,aspiration plus retained catheter,and aspiration plus antibiotics flushing and retained catheter),and corresponding therapeutic effects were analyzed.KLA was more likely to occur in patients with coexisting diseases such as diabetes mellitus(53.77%vs 25.00%,P=0.001)and hepatic adipose infiltration(16.04%vs 5.36%,P=0.029).Compared to NKLA group,clinical characteristics including abdominal pain(40.57%vs 57.14%,P=0.044),hypodynamia(19.81%vs 46.43%,P=0.001),and hepatomegaly(4.72%vs 14.29%,P=0.033)were much milder,but with a higher fasting blood glucose level(7.84±0.36 vs 5.76±0.30,P=0.001)on admission in KLA group.In addition,KLA abscess often appeared singly in the right lobe of the liver with gas forming nature(32.88%vs 13.51%,P=0.039),unsmooth rim(71.23%vs 40.54%,P=0.002),and dynamic septum enhancement(41.10%vs 16.22%,P=0.009).Compared to mono aspiration subgroup,additional antibiotic flushing could not further improve clinical outcomes of KLA patients(P>0.05);how展开更多
Pneumo-computed tomography (PnCT) is a technique primarily developed and used to study stenotic lesions of the esophagus, gastroesophageal junction and stom-ach for pre-surgical planning. It helps to define both upper...Pneumo-computed tomography (PnCT) is a technique primarily developed and used to study stenotic lesions of the esophagus, gastroesophageal junction and stom-ach for pre-surgical planning. It helps to define both upper and lower borders of neoplasms located in the aforementioned areas. It achieves maximum lumen distension with CO2 highlighting thickened areas of the esophageal wall, thus allowing an accurate quantifica-tion of their extents. Although there are other alterna-tives for distension (oral contrast agents, water and ef-fervescent granules), they may be suboptimal. Patients with locally advanced esophageal cancer have a dismal prognosis despite surgical resection. Therefore, neo-adjuvant treatment strategies using radiation therapy and chemotherapy were developed to improve sur-vival. Neoadjuvant therapy improves esophageal tumor prognosis in a substantial proportion of patients, and the use of imaging techniques is mandatory to detect their response. PnCT combined with virtual endoscopy and multiplanar reconstruction enhances morphologic details in esophageal cancer, and thus would allow animproved assessment of response to neoadjuvant treat-ment. Therefore, more information could be provided to assess the efficacy of pre-surgical treatment. We de-scribe the potential use of PnCT to assess the response to neoadjuvant therapy in esophageal cancer with an imaging pathologic correlation.展开更多
The process of bone remodelling plays an essential role in the emergence and maintenance of bone geometry and its internal structure.Osteoclasts are one of the three main bone cell types that play a crucial role in th...The process of bone remodelling plays an essential role in the emergence and maintenance of bone geometry and its internal structure.Osteoclasts are one of the three main bone cell types that play a crucial role in the bone remodelling cycle.At the microstructural level,osteoclasts create bone deficits by eroding resorption cavities.Understanding how these cavities impair the mechanical quality of the bone is not only relevant in quantifying the impact of resorption cavities in healthy bone and normal aging,but maybe even more so in quantifying their role in metabolic bone diseases.Meta-bolic bone diseases and their treatment are both known to affect the bone remodelling cycle;hence,the bone mechanical competence can and will be affected.How-ever,the current knowledge of the precise dimensions of these cavities and their effect on bone competence is rather limited.This is not surprising considering the difficulties in deriving three-dimensional(3D)properties from two-dimensional(2D)histological sections.The measurement difficulties are reflected in the evalua-tion of how resorption cavities affect bone competence.Although detailed 3D models are generally being used to quantify the mechanical impact of the cavities,the representation of the cavities themselves has basicallybeen limited to simplified shapes and averaged cavityproperties.Qualitatively,these models indicate that cav-ity size and location are important,and that the effectof cavities is larger than can be expected from simplebone loss.In summary,the dimensions of osteoclastresorption cavities were until recently estimated from2D measures;hence,a careful interpretation of resorp-tion cavity dimensions is necessary.More effort needsto go into correctly quantifying resorption cavities usingmodern 3D imaging techniques like micro-computedtomography(micro-CT)and synchrotron radiation CT.Osteoclast resorption cavities affect bone competence.The structure-function relationships have been ana-lysed using computational models that,on one hand,provide rather det展开更多
Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the ...Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum.The bowel wall was normal in non-enhanced images,and normal or inconspicuous in arterial phase enhanced images.In one of the three cases,the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images.No filling defect was seen in the lumen of the superior mesenteric artery and vein.No peritoneal effusion or mesentery abnormality was found.Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time.Only one patient suffered mild diarrhea after scanning which had resolved by the following day.The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms.Differential diagnosis may include inflammatory and ischemic bowel disease,as well as neoplasms.A three-phase CT protocol and good under-standing of this disorder are fundamentally important in the diagnosis of this condition.The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions.The predilection location of transient anaphylactic bowel angioedema is the small intestine,particularly the proximal segment.A speculated cause may be the richer supply of vessels in the small intestine,ample mucous folds and loose connective tissue in the duodenum and the jejunum.展开更多
We implemented a new protocol—multiphase dynamic helical scan to acquire CT angiography(CTA)and whole brain CT perfusion(CTP)images simulta-neously with single scan on 16 multidetector CT(MDCT).A total of 90 patients...We implemented a new protocol—multiphase dynamic helical scan to acquire CT angiography(CTA)and whole brain CT perfusion(CTP)images simulta-neously with single scan on 16 multidetector CT(MDCT).A total of 90 patients who were randomly assigned into 3 groups were included in our study.Each group underwent CT scan by using the new protocol,traditional CTA and CTP protocol,respectively.The image quality of CTA,the CTP parameter values and the X-ray doses were measured and compared between the new protocol and the traditional protocols.There was no statistically significant difference in the CTA image quality between the above methods(P=0.55).For CTP parameters,the new protocol tended to overestimate the blood volume(BV)and bloodflow(BF)value,and to underestimate the mean transit time(MTT)value compared with the traditional method.However,there was no statistically significant difference in BV,BF,and MTT value between the two methods except permeability surface(PS)(P>0.05).The volume CT dose index(CTDIvol)and dose length product(DLP)of our protocol were lower than the traditional one.The new protocol can obtain valuable diagnostic information in a shorter time without significant compromise in image quality.In addition,it reduces the radiation dose as well as contrast medium usage on the patient.展开更多
Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the commonest malignant neoplasms of the diaphragm; however, only a few(less than 20) cases have ...Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the commonest malignant neoplasms of the diaphragm; however, only a few(less than 20) cases have been reported to date. We present the case of an extremely rare tumor of the diaphragm mimicking a liver mass. The patient, a young 28-year-old woman, presented with an 8-month-history of mildly progressive upper abdominal pain and early fullness after meals. Computed tomography scan of the abdomen revealed a mass located in the region of the left lobe of the liver with non visualized left lobe and partial vascular supply of the mass from the left hepatic artery. The tumor was also seen to draw its vascularity from bilateral internal mammary arteries. Surgical excision and hepatectomy was planned, keeping in mind the diagnosis of an atypical left hepatic mass. Laparotomy revealed a left diaphragmatic tumor growing caudally into the upper abdomen, compressing and splaying the liver along the left medial surface where the tumorwas virtually adherent to it. Successful excision of the mass and subsequent histopathological and immunochemistry examination of the specimen revealed low grade fibromyxoid sarcoma of the diaphragm. This case highlights the unusual presentation of a diaphragmatic mesenchymal tumor and how it can be mistaken as an atypical liver mass. It also emphasizes the tumoral vascular supply as an indicator of its organ of origin.展开更多
Paraneoplastic neurological syndromes(PNS) is a series of rare neurologic disorders which happen with an underlying malignancy. It has various clinical symptoms proceding to the diagnosis of tumors. Although the abnor...Paraneoplastic neurological syndromes(PNS) is a series of rare neurologic disorders which happen with an underlying malignancy. It has various clinical symptoms proceding to the diagnosis of tumors. Although the abnormality of anti-neuronal antibodies is suggestive of PNS and tumors, there exist many false positive and false negative cases. The diagnosis of PNS is usually a challenge in clinic. Positron emission tomography/computed tomography(PET/CT) imaging is an anatomical and functional fusion imaging method, which provides the whole-body information by single scan. Fluorodeoxyglucose(FDG) PET/CT imaging can not only detect potential malignant lesions in the whole body, but also assess functional abnormality in the brain. In this review, the mechanism, clinical manifestation, diagnostic procedure and the recent progress of the utility of FDG PET/CT in PNS are introduced respectively.展开更多
目的分析基于从头训练模式深度学习-卷积神经网络模型[the deep learning convolutional neural network model trained from scratch,DL-CNN(fs)]的人工智能算法评估急性肺动脉血栓栓塞(acute pulmonary thromboembolism,APE)的价值。...目的分析基于从头训练模式深度学习-卷积神经网络模型[the deep learning convolutional neural network model trained from scratch,DL-CNN(fs)]的人工智能算法评估急性肺动脉血栓栓塞(acute pulmonary thromboembolism,APE)的价值。方法回顾性纳入214例可疑APE行CT肺动脉造影(CTPA)的住院患者,包括急性肺动脉血栓栓塞137例,阴性77例。放射科医师根据CTPA图像判断有无APE,并计算Qanadli评分、Mastora评分和其他CTPA参数。采用DL-CNN(fs)训练网络模型自动检测栓子的分布及容积。评估DL-CNN(fs)模型测量血栓分布的价值,计算血栓负荷与Qanadli评分、Mastora评分和其他CTPA参数的相关性。结果DL-CNN(fs)测算的中心肺动脉栓子敏感度、特异度、感兴趣区曲线下面积(AUC)分别为100%、16.8%、0.584(95%CI,0.508~0.661);DL-CNN(fs)测算的外周肺动脉栓子敏感度、特异度、AUC均较高(R1-R9,60.8%~95.2%,67.9%~87.1%,0.740~0.844;L1-L10,64.6%~93.4%,62.7%~83.1%,0.732~0.791)。DL-CNN(fs)测算的栓子体积与Qanadli score肺栓塞指数显著正相关(r=0.867,P<0.001),与Mastora score肺栓塞指数显著正相关(r=0.854,P<0.001),与右心室及左心室最大横径比、右心室及左心室最大面积比呈正相关(r=0.549,0.559,P<0.01)。结论DL-CNN(fs)模型检测外周肺动脉栓子具有较高的价值,对中心肺动脉栓子诊断特异度有待进一步提高。DL-CNN(fs)模型自动提供APE患者的栓子体积,可以一定程度反映栓塞程度及右心功能,能够辅助医生对于APE患者血栓负荷及危险分层的快速评估。展开更多
文摘Nowadays,pyogenic liver abscess(PLA)is still a common and severe intra-abdominal infection,and Klebsiella pneumoniae had emerged as the most common pathogenic bacteria worldwide in the past ten years.Our study aims to achieve an early pathogenic diagnosis and rational therapy modality for Klebsiella pneumoniae liver abscess(KLA)through clinical data analysis.A total of 197 inpatients in Zhongshan Hospital,Shanghai,diagnosed as having liver abscess between March 2001 and September 2009 were enrolled.Patients with monomicrobial infection were divided into two groups:patients with K.pneumoniae liver abscess(KLA group,n=106)and those with non-Klebsiella pneumoniae liver abscess(NKLA group,n=56).A retrospective analysis was made between these two groups on the aspects of underlying diseases,clinical characteristics,laboratory data,culture results,and imaging findings.To evaluate the effects of different medical interventions,monomicrobial KLA patients were further divided into four subgroups(percutaneous liver aspiration,aspiration plus antibiotics flushing,aspiration plus retained catheter,and aspiration plus antibiotics flushing and retained catheter),and corresponding therapeutic effects were analyzed.KLA was more likely to occur in patients with coexisting diseases such as diabetes mellitus(53.77%vs 25.00%,P=0.001)and hepatic adipose infiltration(16.04%vs 5.36%,P=0.029).Compared to NKLA group,clinical characteristics including abdominal pain(40.57%vs 57.14%,P=0.044),hypodynamia(19.81%vs 46.43%,P=0.001),and hepatomegaly(4.72%vs 14.29%,P=0.033)were much milder,but with a higher fasting blood glucose level(7.84±0.36 vs 5.76±0.30,P=0.001)on admission in KLA group.In addition,KLA abscess often appeared singly in the right lobe of the liver with gas forming nature(32.88%vs 13.51%,P=0.039),unsmooth rim(71.23%vs 40.54%,P=0.002),and dynamic septum enhancement(41.10%vs 16.22%,P=0.009).Compared to mono aspiration subgroup,additional antibiotic flushing could not further improve clinical outcomes of KLA patients(P>0.05);how
文摘Pneumo-computed tomography (PnCT) is a technique primarily developed and used to study stenotic lesions of the esophagus, gastroesophageal junction and stom-ach for pre-surgical planning. It helps to define both upper and lower borders of neoplasms located in the aforementioned areas. It achieves maximum lumen distension with CO2 highlighting thickened areas of the esophageal wall, thus allowing an accurate quantifica-tion of their extents. Although there are other alterna-tives for distension (oral contrast agents, water and ef-fervescent granules), they may be suboptimal. Patients with locally advanced esophageal cancer have a dismal prognosis despite surgical resection. Therefore, neo-adjuvant treatment strategies using radiation therapy and chemotherapy were developed to improve sur-vival. Neoadjuvant therapy improves esophageal tumor prognosis in a substantial proportion of patients, and the use of imaging techniques is mandatory to detect their response. PnCT combined with virtual endoscopy and multiplanar reconstruction enhances morphologic details in esophageal cancer, and thus would allow animproved assessment of response to neoadjuvant treat-ment. Therefore, more information could be provided to assess the efficacy of pre-surgical treatment. We de-scribe the potential use of PnCT to assess the response to neoadjuvant therapy in esophageal cancer with an imaging pathologic correlation.
文摘The process of bone remodelling plays an essential role in the emergence and maintenance of bone geometry and its internal structure.Osteoclasts are one of the three main bone cell types that play a crucial role in the bone remodelling cycle.At the microstructural level,osteoclasts create bone deficits by eroding resorption cavities.Understanding how these cavities impair the mechanical quality of the bone is not only relevant in quantifying the impact of resorption cavities in healthy bone and normal aging,but maybe even more so in quantifying their role in metabolic bone diseases.Meta-bolic bone diseases and their treatment are both known to affect the bone remodelling cycle;hence,the bone mechanical competence can and will be affected.How-ever,the current knowledge of the precise dimensions of these cavities and their effect on bone competence is rather limited.This is not surprising considering the difficulties in deriving three-dimensional(3D)properties from two-dimensional(2D)histological sections.The measurement difficulties are reflected in the evalua-tion of how resorption cavities affect bone competence.Although detailed 3D models are generally being used to quantify the mechanical impact of the cavities,the representation of the cavities themselves has basicallybeen limited to simplified shapes and averaged cavityproperties.Qualitatively,these models indicate that cav-ity size and location are important,and that the effectof cavities is larger than can be expected from simplebone loss.In summary,the dimensions of osteoclastresorption cavities were until recently estimated from2D measures;hence,a careful interpretation of resorp-tion cavity dimensions is necessary.More effort needsto go into correctly quantifying resorption cavities usingmodern 3D imaging techniques like micro-computedtomography(micro-CT)and synchrotron radiation CT.Osteoclast resorption cavities affect bone competence.The structure-function relationships have been ana-lysed using computational models that,on one hand,provide rather det
文摘Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum.The bowel wall was normal in non-enhanced images,and normal or inconspicuous in arterial phase enhanced images.In one of the three cases,the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images.No filling defect was seen in the lumen of the superior mesenteric artery and vein.No peritoneal effusion or mesentery abnormality was found.Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time.Only one patient suffered mild diarrhea after scanning which had resolved by the following day.The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms.Differential diagnosis may include inflammatory and ischemic bowel disease,as well as neoplasms.A three-phase CT protocol and good under-standing of this disorder are fundamentally important in the diagnosis of this condition.The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions.The predilection location of transient anaphylactic bowel angioedema is the small intestine,particularly the proximal segment.A speculated cause may be the richer supply of vessels in the small intestine,ample mucous folds and loose connective tissue in the duodenum and the jejunum.
文摘We implemented a new protocol—multiphase dynamic helical scan to acquire CT angiography(CTA)and whole brain CT perfusion(CTP)images simulta-neously with single scan on 16 multidetector CT(MDCT).A total of 90 patients who were randomly assigned into 3 groups were included in our study.Each group underwent CT scan by using the new protocol,traditional CTA and CTP protocol,respectively.The image quality of CTA,the CTP parameter values and the X-ray doses were measured and compared between the new protocol and the traditional protocols.There was no statistically significant difference in the CTA image quality between the above methods(P=0.55).For CTP parameters,the new protocol tended to overestimate the blood volume(BV)and bloodflow(BF)value,and to underestimate the mean transit time(MTT)value compared with the traditional method.However,there was no statistically significant difference in BV,BF,and MTT value between the two methods except permeability surface(PS)(P>0.05).The volume CT dose index(CTDIvol)and dose length product(DLP)of our protocol were lower than the traditional one.The new protocol can obtain valuable diagnostic information in a shorter time without significant compromise in image quality.In addition,it reduces the radiation dose as well as contrast medium usage on the patient.
文摘Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the commonest malignant neoplasms of the diaphragm; however, only a few(less than 20) cases have been reported to date. We present the case of an extremely rare tumor of the diaphragm mimicking a liver mass. The patient, a young 28-year-old woman, presented with an 8-month-history of mildly progressive upper abdominal pain and early fullness after meals. Computed tomography scan of the abdomen revealed a mass located in the region of the left lobe of the liver with non visualized left lobe and partial vascular supply of the mass from the left hepatic artery. The tumor was also seen to draw its vascularity from bilateral internal mammary arteries. Surgical excision and hepatectomy was planned, keeping in mind the diagnosis of an atypical left hepatic mass. Laparotomy revealed a left diaphragmatic tumor growing caudally into the upper abdomen, compressing and splaying the liver along the left medial surface where the tumorwas virtually adherent to it. Successful excision of the mass and subsequent histopathological and immunochemistry examination of the specimen revealed low grade fibromyxoid sarcoma of the diaphragm. This case highlights the unusual presentation of a diaphragmatic mesenchymal tumor and how it can be mistaken as an atypical liver mass. It also emphasizes the tumoral vascular supply as an indicator of its organ of origin.
基金Supported by grants from the National Natural Science Foundation of China(No.81101065,31100604)Higher Education Doctoral Program of China Research Fund for New Teacher(No.20110001120043)+1 种基金National Major Scientific Equipment Special Fund(No.2011YQ03011409)Beijing Capital Special Development Application Program(No.Z141107002514159)
文摘Paraneoplastic neurological syndromes(PNS) is a series of rare neurologic disorders which happen with an underlying malignancy. It has various clinical symptoms proceding to the diagnosis of tumors. Although the abnormality of anti-neuronal antibodies is suggestive of PNS and tumors, there exist many false positive and false negative cases. The diagnosis of PNS is usually a challenge in clinic. Positron emission tomography/computed tomography(PET/CT) imaging is an anatomical and functional fusion imaging method, which provides the whole-body information by single scan. Fluorodeoxyglucose(FDG) PET/CT imaging can not only detect potential malignant lesions in the whole body, but also assess functional abnormality in the brain. In this review, the mechanism, clinical manifestation, diagnostic procedure and the recent progress of the utility of FDG PET/CT in PNS are introduced respectively.
文摘目的分析基于从头训练模式深度学习-卷积神经网络模型[the deep learning convolutional neural network model trained from scratch,DL-CNN(fs)]的人工智能算法评估急性肺动脉血栓栓塞(acute pulmonary thromboembolism,APE)的价值。方法回顾性纳入214例可疑APE行CT肺动脉造影(CTPA)的住院患者,包括急性肺动脉血栓栓塞137例,阴性77例。放射科医师根据CTPA图像判断有无APE,并计算Qanadli评分、Mastora评分和其他CTPA参数。采用DL-CNN(fs)训练网络模型自动检测栓子的分布及容积。评估DL-CNN(fs)模型测量血栓分布的价值,计算血栓负荷与Qanadli评分、Mastora评分和其他CTPA参数的相关性。结果DL-CNN(fs)测算的中心肺动脉栓子敏感度、特异度、感兴趣区曲线下面积(AUC)分别为100%、16.8%、0.584(95%CI,0.508~0.661);DL-CNN(fs)测算的外周肺动脉栓子敏感度、特异度、AUC均较高(R1-R9,60.8%~95.2%,67.9%~87.1%,0.740~0.844;L1-L10,64.6%~93.4%,62.7%~83.1%,0.732~0.791)。DL-CNN(fs)测算的栓子体积与Qanadli score肺栓塞指数显著正相关(r=0.867,P<0.001),与Mastora score肺栓塞指数显著正相关(r=0.854,P<0.001),与右心室及左心室最大横径比、右心室及左心室最大面积比呈正相关(r=0.549,0.559,P<0.01)。结论DL-CNN(fs)模型检测外周肺动脉栓子具有较高的价值,对中心肺动脉栓子诊断特异度有待进一步提高。DL-CNN(fs)模型自动提供APE患者的栓子体积,可以一定程度反映栓塞程度及右心功能,能够辅助医生对于APE患者血栓负荷及危险分层的快速评估。
