Computed Tomography Features Research Articles

CT target scanning in the diagnosis of solid pseudopapillary tumor of the pancreas

ObjectiveTo discuss the value of computed tomography (CT) iterative reconstruction technique combined with target scanning in the diagnosis of solid pseudopapillary tumor of the pancreas (SPTP).MethodsThe clinical information and CT examination data of 27 patients with SPTP were retrospectively analyzed, and the general condition and CT performance of the patients were observed. The CT image reconstruction algorithm of all patients used iterative reconstruction technique combined with the application of target scanning technique.ResultsA total of 27 patients were included in this study, including 6 males and 21 females, aged 14–72 years with a mean age of 39.6 ± 13.6 years. SPTP was more common in young and middle-aged females, with a low level of tumor markers, dominated by cystic-solid tumors. The combination of CT iterative reconstruction technology and targeted scanning revealed the following: the capsule of SPTP was clear and complete, where calcifications were visible, solid components were progressively enhanced, and rare pancreatic and bile duct dilation was seen. Tumors were cystic-solid in 18 of 27 patients with SPTP, of which the solid components showed isodensity or slightly low-density, with calcifications. The solid components and cyst walls were mildly enhanced during the arterial phase, and were progressively enhanced during the parenchymal phase, portal vein phase, and delayed phase, with their enhancement degree lower than that of normal pancreatic parenchyma, and pancreatic and bile duct dilation was rare. There were no statistical differences in tumor location, morphology, growth pattern, integrity of capsule, cystic or solid, calcifications, and enhancement features between the male group and the female group (P > 0.05).ConclusionThe iterative reconstruction combined with target scanning clearly displayed the CT features of tumors, helping the diagnosis and clinical treatment of the disease.

Correlation between chest computed tomography findings and pulmonary function test results in the post-recovery phase of COVID-19.

The radiological and functional lung sequelae in COVID-19 survivors remain unclear. We compared the chest computed tomography findings of COVID-19 patients with normal and abnormal pulmonary function test results in the post-recovery phase. The data of consecutive patients who underwent pulmonary function tests and chest computed tomography within 14 days after recovery from COVID-19 at two medical centers between May and October 2020 were collected retrospectively. Two thoracic radiologists who were blinded to the clinical information and pulmonary function test results classified the patients according to the computed tomography features, evidence of fibrotic-like changes, and semi-quantitative quantification of the extent of pulmonary abnormalities. The clinical characteristics and computed tomography findings of patients with normal pulmonary function test results were compared with those of patients with abnormal results. A total of 101 COVID-19 survivors, comprising 48 ambulatory and 53 hospitalized patients, were included at a median of 95 days from initial symptom onset. Computed tomography revealed fibrotic-like changes in 10.9% of patients. A reduction in the diffusion capacity of carbon monoxide was the most common lung function abnormality (19.8%). Abnormal diffusion capacity of carbon monoxide was associated with the presence and extension of lung opacities on chest computed tomography scans and fibrotic pulmonary abnormalities. The sensitivity, specificity, and accuracy of reduced diffusion capacity of carbon monoxide for detecting fibrotic-like pulmonary changes on chest computed tomography scans were 72.7%, 87.8%, and 86.1%, respectively. Our study suggests that the presence of an abnormal diffusion capacity of carbon monoxide in the post-recovery phase of COVID-19 is associated with a greater risk of long-term parenchymal lung disease, as evidenced by the presence of fibrotic-like changes on chest computed tomography scans, such as traction bronchiectasis and architectural distortion.

Possibility of Using Conventional Computed Tomography Features and Histogram Texture Analysis Parameters as Imaging Biomarkers for Preoperative Prediction of High-Risk Gastrointestinal Stromal Tumors of the Stomach.

The objective of this study is to determine the morphological computed tomography features of the tumor and texture analysis parameters, which may be a useful diagnostic tool for the preoperative prediction of high-risk gastrointestinal stromal tumors (HR GISTs). This is a prospective cohort study that was carried out in the period from 2019 to 2022. The study included 79 patients who underwent CT examination, texture analysis, surgical resection of a lesion that was suspicious for GIST as well as pathohistological and immunohistochemical analysis. Textural analysis pointed out min norm (p = 0.032) as a histogram parameter that significantly differed between HR and LR GISTs, while min norm (p = 0.007), skewness (p = 0.035) and kurtosis (p = 0.003) showed significant differences between high-grade and low-grade tumors. Univariate regression analysis identified tumor diameter, margin appearance, growth pattern, lesion shape, structure, mucosal continuity, enlarged peri- and intra-tumoral feeding or draining vessel (EFDV) and max norm as significant predictive factors for HR GISTs. Interrupted mucosa (p < 0.001) and presence of EFDV (p < 0.001) were obtained by multivariate regression analysis as independent predictive factors of high-risk GISTs with an AUC of 0.878 (CI: 0.797-0.959), sensitivity of 94%, specificity of 77% and accuracy of 88%. This result shows that morphological CT features of GIST are of great importance in the prediction of non-invasive preoperative metastatic risk. The incorporation of texture analysis into basic imaging protocols may further improve the preoperative assessment of risk stratification.

Pulmonary extranodal natural killer/T-cell lymphoma: clinical presentation, CT characteristics, and patient outcomes.

Due to the extreme rarity of pulmonary extranodal natural killer/T-cell lymphoma (ENKTCL), studies on this lymphoma type are limited. We aimed to investigate the clinical presentations, computed tomography (CT) findings, CT dynamic changes, and outcomes of patients diagnosed with pulmonary ENKTCL. We conducted a retrospective cohort study on ENKTCL, nasal type, at West China Hospital, from January 2010 to January 2023. Out of 27 initial cases with pulmonary ENKTCL, we excluded 4 due to the lack of chest CT images, resulting in a final cohort of 23 patients. Our evaluation covered clinical features, laboratory findings, CT presentations, treatment strategies, and survival outcomes. Survival analyses were performed using the Kaplan-Meier method, with log-rank tests for survival curve comparisons. Given the small sample size, our interpretation of the data is mainly descriptive. The most common CT presentations in our institution was solitary or multiple nodules (7/23, 30.4%). The halo sign (78.3%) and floating vessels sign (83.3%) were commonly observed in pulmonary ENKTCL. Elevated lactate dehydrogenase (LDH) levels were observed in 20 (86.9%) patients. The median overall survival (OS) for pulmonary ENKTCL patients was 1 month; 3 cases displayed a favorable prognosis, maintaining complete remission (CR) status for 1.5-7 years after receiving chemotherapy. Chemotherapy led to improved prognosis, with a median survival of 5 months seen in patients who received chemotherapy. Patients with bilateral lung involvement had worse outcomes compared to those with unilateral lesions. Pulmonary ENKTCL is a rare and aggressive disease, often misdiagnosed due to nonspecific clinical and CT features. Laboratory tests, failure of antibiotic treatment, and "floating vessels sign" on enhanced CT scans may aid in diagnosis. Timely chemotherapy may improve survival, emphasizing the importance of early detection and prompt treatment.

Clinicopathological and computed tomography features associated with recurrence-free survival of patients with small-sized peripheral invasive lung adenocarcinoma after sublobectomy.

Sublobar resection is gradually becoming a standard treatment for small-sized (≤2 cm) peripheral non-small cell lung cancer (NSCLC), with lung adenocarcinoma (LADC) being the most frequent histologic subtype. However, the prognostic predictors for preoperatively determining whether sublobectomy is feasible for patients with early LADC have not yet been well identified. Therefore, this study aimed to investigate the clinicopathological and computed tomography (CT) features associated with the recurrence-free survival (RFS) of patients with small-sized invasive LADC (SILADC) after sublobar resection. This retrospective cohort study analyzed 107 patients with SILADC who underwent preoperative chest CT scan and sublobar resection from December 2012 to March 2019. The Kaplan-Meier survival was used to analyze the relationship between clinicopathological characteristics, preoperative chest CT findings, and RFS. The Cox proportional hazards regression was used to identify independent prognostic factors of poor RFS. For clinicopathological characteristics, RFS was shorter in patients aged ≥70 years, smokers, and those with micropapillary/solid-predominant adenocarcinomas (all P values <0.05). For preoperative CT features, RFS was shorter in patients with tumor size ≥1.4 cm, solid component size ≥1.1 cm, proportion of solid component ≥72%, solid density, spiculation, vascular convergence sign, peripheral fibrosis, and type II pleural tag (all P values <0.05). Multivariate analysis showed proportion of solid component ≥72% [hazard ratio (HR): 5.920; P=0.006; 95% confidence interval (CI): 1.686-20.794], spiculation (HR: 5.026; P=0.001; 95% CI: 2.008-12.581), and type II pleural tag (HR: 4.638; P=0.002; 95% CI: 1.773-12.136) were independent risk factors for poor prognosis in patients with SILADC after sub-lobectomy. Clinicopathological and CT characteristics are helpful for predicting the RFS of patients with SILADC after sublobar resection and can be used as an auxiliary tool for thoracic surgeons to choose the best surgical mode.

Transbronchial cryobiopsy using an ultrathin cryoprobe with a guide sheath for the diagnosis of pulmonary mucosa-associated lymphoid tissue lymphoma.

Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is difficult to diagnose and relatively rare. Tissue sampling through transbronchial biopsy is often inadequate, necessitating surgical lung biopsy. However, a recently developed technique, transbronchial lung cryobiopsy (TBLC), has shown promise for obtaining larger specimens. A 1.1 mm cryoprobe has recently become available, and its usefulness has been increasingly reported. Use of a conventional cryoprobe for TBLC in diagnosing pulmonary MALT lymphoma has been previously reported; however, there are no reports on the use of a 1.1 mm ultrathin cryoprobe and guide sheath (GS). We aimed to assess the effectiveness and safety of using a 1.1 mm ultrathin cryoprobe in combination with a GS for diagnosing pulmonary MALT lymphoma using a simpler and safer method. We retrospectively analyzed the findings for four patients showing characteristic computed tomography (CT) findings of MALT lymphoma, including peripheral pulmonary lesions, air bronchogram nodules, and bronchiectasis, at our hospital. Each patient underwent endobronchial ultrasound (EBUS) with a GS, followed by TBLC using a 1.1 mm cryoprobe. Morphological diagnosis, immunohistochemical examination, and molecular testing were performed on the biopsy specimens to establish the diagnosis. Complications during the procedure were also monitored. We obtained 8-16 biopsy specimens in all four cases using a cryoprobe. Histopathological analysis of two cases revealed the infiltration of small lymphocytes with numerous lymphoepithelial lesions, confirming MALT lymphoma. Immunohistochemical examination further demonstrated B-cell lymphocyte proliferation and light-chain restriction, confirming monoclonality and providing a definitive diagnosis. In the remaining two cases, histopathological evidence of pulmonary MALT lymphoma was lacking. However, molecular testing using polymerase chain reaction to analyze immunoglobulin gene rearrangements revealed B-cell clonality, which supported the diagnosis. Molecular testing proved particularly useful when histopathological diagnosis alone was inconclusive. No complications such as pneumothorax or hemorrhage occurred during the procedure. The combination of a GS and EBUS facilitated specimen collection at the same location as EBUS, with the GS providing compression hemostasis and eliminating the need for an additional hemostatic device. Therefore, TBLC with a GS is a useful and safe method for diagnosing pulmonary MALT lymphomas and reproducibly yielded sufficient quantities of good-quality biopsy specimens.

Machine Learning Model with Computed Tomography Radiomics and Clinicobiochemical Characteristics Predict the Subtypes of Patients with Primary Aldosteronism

Adrenal venous sampling (AVS) is the primary method for differentiating between primary aldosterone (PA) subtypes. The aim of study is to develop prediction models for subtyping of patients with PA using computed tomography (CT) radiomics and clinicobiochemical characteristics associated with PA. This study retrospectively enrolled 158 patients with PA who underwent AVS between January 2014 and March 2021. Neural network machine learning models were developed using a two-stage analysis of triple-phase abdominal CT and clinicobiochemical characteristics. In the first stage, the models were constructed to classify unilateral or bilateral PA; in the second stage, they were designed to determine the predominant side in patients with unilateral PA. The final proposed model combined the best-performing models from both stages. The model's performance was evaluated using repeated stratified five-fold cross-validation. We employed paired t-tests to compare its performance with the conventional imaging evaluations made by radiologists, which categorize patients as either having bilateral PA or unilateral PA on one side. In the first stage, the integrated model that combines CT radiomic and clinicobiochemical characteristics exhibited the highest performance, surpassing both the radiomic-alone and clinicobiochemical-alone models. It achieved an accuracy and F1 score of 80.6%±3.0% and 74.8%±5.2% (area under the receiver operating curve [AUC] = 0.778±0.050). In the second stage, the accuracy and F1 score of the radiomic-based model were 88%±4.9% and 81.9%±6.2% (AUC=0.831±0.087). The proposed model achieved an accuracy and F1 score of 77.5%±3.9% and 70.5%±7.1% (AUC=0.771±0.046) in subtype diagnosis and lateralization, surpassing the accuracy and F1 score achieved by radiologists' evaluation (p<.05). The proposed machine learning model can predict the subtypes and lateralization of PA. It yields superior results compared toconventional imaging evaluation and has potential to supplement the diagnostic process in PA.

CT Findings of Stage IA Ovarian Cancer: Comparison between Borderline Tumor and Stage IC Ovarian Cancer.

Ovarian cancer is a common gynecological malignant tumor in women. Most patients have reached the advanced stage when they visit the hospital. In order to diagnose ovarian cancer at an early stage, treat it at an early stage, and improve the survival rate of patients, this study has used the imaging computed tomography (CT) method to diagnose stage IA ovarian cancer. The purpose of this work was to study CT features of stage IA ovarian cancer, and compare the borderline tumor and stage IC ovarian cancer at the same time so as to improve the CT diagnosis of early ovarian cancer. We retrospectively collected clinical and CT data of patients with stage I ovarian cancer and borderline ovarian tumor admitted to Nantong Tumor Hospital from 2013 to 2021. Altogether, 23 cases of patients (borderline ovarian tumor, 9 cases; stage IA ovarian cancer, 5 cases; stage IC ovarian cancer, 9 cases) were involved. CT characteristics of these patients were analyzed in terms of the tumor diameter, cystic solid structure, solid component, septation, enhancement, peritoneal thickening, ascites, and abdominal lymph nodes. CT features of stage IA ovarian cancer included large tumor size (average diameter: 15 cm), cystic solid structure (4/5; 80%), septation (4/5; 80%), and enhanced cystic wall, septum, or solid components of the tumor on contrast-enhanced CT (5/5; 100%) no peritoneal thickening (0/5; 0%), no ascites (0/5; 0%), and no abdominal lymph node enlargement (0/5; 0%). The tumor structure did not differ significantly between stage IA and IC ovarian cancers (p > 0.05), while intraperitoneal ascites did (χ2 = 0.031; p < 0.05). Stage IA and borderline ovarian tumors did not differ significantly in ovarian tumor structure (p > 0.05). CT features of stage IA ovarian cancer included large tumor size, cystic solid structure, septation, and enhanced cystic wall and solid parts in the tumors. No pelvic or abdominal metastasis was observed.

The role of computed tomography features in assessing response to neoadjuvant chemotherapy in locally advanced gastric cancer

ObjectiveTo compare the computed tomography (CT) images of patients with locally advanced gastric cancer (GC) before and after neoadjuvant chemotherapy (NAC) in order to identify CT features that could predict pathological response to NAC.MethodsWe included patients with locally advanced GC who underwent gastrectomy after NAC from September 2016 to September 2021. We retrieved and collected the patients’ clinicopathological characteristics and CT images before and after NAC. We analyzed CT features that could differentiate responders from non-responders and established a logistic regression equation based on these features.ResultsWe included 97 patients (69 [71.1%] men; median [range] age, 60 [26–75] years) in this study, including 66 (68.0%) responders and 31 (32.0%) non-responders. No clinicopathological variable prior to treatment was significantly associated with pathological response. Out of 16 features, three features (ratio of tumor thickness reduction, ratio of reduction of primary tumor attenuation in arterial phase, and ratio of reduction of largest lymph node attenuation in venous phase) on logistic regression analysis were used to establish a regression equation that demonstrated good discrimination performance in predicting pathological response (area under receiver operating characteristic curve 0.955; 95% CI, 0.911–0.998).ConclusionLogistic regression equation based on three CT features can help predict the pathological response of patients with locally advanced GC to NAC.

Development and validation of a radiomics nomogram for diagnosis of malignant pleural effusion

ObjectiveWe aimed to develop a radiomics nomogram based on computed tomography (CT) scan features and high-throughput radiomics features for diagnosis of malignant pleural effusion (MPE).MethodsIn this study, 507 eligible patients with PE (207 malignant and 300 benign) were collected retrospectively. Patients were divided into training (n = 355) and validation cohorts (n = 152). Radiomics features were extracted from initial unenhanced CT images. CT scan features of PE were also collected. We used the variance threshold algorithm and least absolute shrinkage and selection operator (LASSO) to select optimal features to build a radiomics model for predicting the nature of PE. Univariate and multivariable logistic regression analyzes were used to identify significant independent factors associated with MPE, which were then included in the radiomics nomogram.ResultsA total of four CT features were retained as significant independent factors, including massive PE, obstructive atelectasis or pneumonia, pleural thickening > 10 mm, and pulmonary nodules and/or masses. The radiomics nomogram constructed from 13 radiomics parameters and four CT features showed good predictive efficacy in training cohort [area under the curve (AUC) = 0.926, 95% CI 0.894, 0.951] and validation cohort (AUC = 0.916, 95% CI 0.860, 0.955). The calibration curve and decision curve analysis showed that the nomogram helped differentiate MPE from benign pleural effusion (BPE) in clinical practice.ConclusionThis study presents a nomogram model incorporating CT scan features and radiomics features to help physicians differentiate MPE from BPE.

Radiomics Signature of Epicardial Adipose Tissue for Predicting Postoperative Atrial Fibrillation after Off-Pump Coronary Artery Bypass Surgery.

Postoperative new atrial fibrillation (POAF) is a commonly observed complication after off-pump coronary artery bypass surgery (OPCABG), and models based on radiomics features of epicardial adipose tissue (EAT) on non-enhanced computer tomography (CT) to predict the occurrence of POAF after OPCABG remains unclear. This study aims to establish and validate models based on radiomics signature to predict POAF after OPCABG. Clinical characteristics, radiomics signature and features of non-enhanced CT images of 96 patients who underwent OPCABG were collected. The participants were divided into a training and a validation cohort randomly, with a ratio of 7:3. Clinical characteristics and EAT CT features with statistical significance in the multivariate logistic regression analysis were utilized to build the clinical model. The least absolute shrinkage and selection operator (LASSO) algorithm was used to identify significant radiomics features to establish the radiomics model. The combined model was constructed by integrating the clinical and radiomics models. The area under the curve (AUC) of the clinical model in the training and validation cohorts were 0.761 (95% CI: 0.634-0.888) and 0.797 (95% CI: 0.587-1.000), respectively. The radiomics model showed better discrimination ability than the clinical model, with AUC of 0.884 (95% CI: 0.806-0.961) and 0.891 (95% CI: 0.772-1.000) respectively for the training and the validation cohort. The combined model performed best and exhibited the best predictive ability among the three models, with AUC of 0.922 (95% CI: 0.853-0.990) in the training cohort and 0.913 (95% CI: 0.798-1.000) in the validation cohort. The calibration curve demonstrated strong concordance between the predicted and actual observations in both cohorts. Furthermore, the Hosmer-Lemeshow test yielded p value of 0.241 and 0.277 for the training and validation cohorts, respectively, indicating satisfactory calibration. The superior performance of the combined model suggests that integrating of clinical characteristics, radiomics signature and features on non-enhanced CT images of EAT may enhance the accuracy of predicting POAF after OPCABG.

CT features of calcified micro-gastric gastrointestinal stromal tumors: a case series

BackgroundDue to the lack of corresponding clinical symptoms, small calcified gastric gastrointestinal stromal tumors (GISTs) are often overlooked in clinical practice. Therefore, there is an unmet need to define the imaging features of calcified micro-gastric GISTs to facilitate diagnosis. This study retrospectively analyzed the computed tomography (CT) features of pathologically confirmed calcified micro-gastric GISTs.MethodsThe medical records (gastroscopy, pre-treatment gastric CT imaging [pre- and post-contrast scans], pathology) of patients with calcified gastric GISTs < 1 cm in diameter confirmed pathologically after endoscopic submucosal dissection, endoscopic submucosal excavation, or endoscopic full-thickness resection were retrospectively reviewed.ResultsSeven patients had 8 calcified gastric GISTs < 1 cm in diameter. Six patients hadsingle lesions, and 1patients had multiple lesions. Six patients had lesions in the gastric fundus, 1 patient had a lesion in the body of the stomach. Lesions had a mean diameter of 5.2 mm (range, 1.3 mm ~ 7 mm). Unenhanced CT scans showed spots and high-density nodular calcifications in 3 submucosal lesions, 2 lesions in the muscularis propria, and 3 subserosal lesions that protruded outside the stomach. Among the 8 lesions, only two had solid soft tissue components surrounding the calcification, with one of these two showing post contrast enhancement of the solid soft tissue component.ConclusionsNovel CT features of gastric GISTs included: commonly found in the gastric antrum, small size (< 1 cm in diameter), calcification, few solid soft tissue components, and no abnormal enhancement in most cases.

Relationship between the shape of intracranial pressure pulse waveform and computed tomography characteristics in patients after traumatic brain injury

BackgroundMidline shift and mass lesions may occur with traumatic brain injury (TBI) and are associated with higher mortality and morbidity. The shape of intracranial pressure (ICP) pulse waveform reflects the state of cerebrospinal pressure–volume compensation which may be disturbed by brain injury. We aimed to investigate the link between ICP pulse shape and pathological computed tomography (CT) features.MethodsICP recordings and CT scans from 130 TBI patients from the CENTER-TBI high-resolution sub-study were analyzed retrospectively. Midline shift, lesion volume, Marshall and Rotterdam scores were assessed in the first CT scan after admission and compared with indices derived from the first 24 h of ICP recording: mean ICP, pulse amplitude of ICP (AmpICP) and pulse shape index (PSI). A neural network model was applied to automatically group ICP pulses into four classes ranging from 1 (normal) to 4 (pathological), with PSI calculated as the weighted sum of class numbers. The relationship between each metric and CT measures was assessed using Mann–Whitney U test (groups with midline shift > 5 mm or lesions > 25 cm3 present/absent) and the Spearman correlation coefficient. Performance of ICP-derived metrics in identifying patients with pathological CT findings was assessed using the area under the receiver operating characteristic curve (AUC).ResultsPSI was significantly higher in patients with mass lesions (with lesions: 2.4 [1.9–3.1] vs. 1.8 [1.1–2.3] in those without; p << 0.001) and those with midline shift (2.5 [1.9–3.4] vs. 1.8 [1.2–2.4]; p < 0.001), whereas mean ICP and AmpICP were comparable. PSI was significantly correlated with the extent of midline shift, total lesion volume and the Marshall and Rotterdam scores. PSI showed AUCs > 0.7 in classification of patients as presenting pathological CT features compared to AUCs ≤ 0.6 for mean ICP and AmpICP.ConclusionsICP pulse shape reflects the reduction in cerebrospinal compensatory reserve related to space-occupying lesions despite comparable mean ICP and AmpICP levels. Future validation of PSI is necessary to explore its association with volume imbalance in the intracranial space and a potential complementary role to the existing monitoring strategies.

Quantitative CT features on admission combined with laboratory biomarkers for predicting severe acute pancreatitis

To assess the association of quantitative computed tomography (CT) features on admission with acute pancreatitis (AP) severity, and to explore the performance of combined CT and laboratory markers for predicting severe AP (SAP). Data from 208 AP patients were reviewed retrospectively. Pancreas volume, the area of extrapancreatic inflammation, extrapancreatic fluid collection volume, and number were calculated based on CT images on admission. Laboratory biomarkers within 24 h of admission were collected. Interobserver agreement for CT measurements was measured by calculating interclass correlation coefficient (ICC). The associations of quantitative CT features with AP severity were evaluated. Predictive models for SAP were constructed based on CT and laboratory markers. Performances of single marker and the models were evaluated using receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). Pancreas volume, area of extrapancreatic inflammation, extrapancreatic fluid collection volume, and number were significantly different between severe and non-severe AP groups. In predicting SAP, the AUCs of quantitative CT indicators ranged from 0.72 to 0.79; the AUCs of laboratory biomarkers were between 0.53 and 0.66. The combined model of area of extrapancreatic inflammation, serum calcium, and haematocrit yielded an AUC of 0.84, significantly higher than that of the laboratory model, single CT, or laboratory marker. Interobserver agreements for quantitative CT indicators were excellent, with ICC ranging from 0.91 to 0.98. Quantitative CT features on admission were significantly associated with AP severity; the combination of extrapancreatic inflammation area, serum calcium, and haematocrit could be taken as a new method for predicting SAP.

Rare primary pulmonary mucosa-associated lymphoid tissue lymphoma misdiagnosed with tuberculosis: A case report.

Primary pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) is a rare subtype of non-Hodgkin lymphoma with a relatively low incidence rate clinically. Atypical clinical symptoms and nonspecific chest computed tomography features of the disease make it difficult to determine and treatment is delayed. We discuss the diagnosis and treatment of a patient with primary pulmonary MALToma to raise clinicians' awareness of this condition. A 66-year-old male patient with a medical history of tuberculosis has been experiencing progressive exacerbation of respiratory symptoms and nonresponsive treatment without an unclear diagnosis for 5 years. He was transferred to our hospital because a nonspecific soft tissue mass in the right upper lobe of the lung was found on his chest computed tomography. Laboratory results with serum immunofixation electrophoresis showed polyclonal immunoglobulin (Ig) G, IgM, IgA, and λ-light chain on admission. Pathological examination and immunohistochemical staining of lung biopsy revealed a definitive diagnosis of pulmonary MALToma with stage IV. The patient received immunotherapy with anti-CD20 monoclonal antibody (rituximab), and showed significant clinical improvement at the 6-month follow-up. Diagnosis of primary pulmonary MALToma mainly relies on histopathological examination, and comprehensive laboratory examinations are also necessary. Clinicians should combine laboratory tests (such as immunofixation electrophoresis in our case) to assist in medical diagnosis in cases of atypical clinical manifestations and imaging characteristics. Immunotherapy appears to be the main treatment protocol for advanced patients.

Routine preoperative screening computed tomography of the thorax for cardiac surgery.

This study aimed to evaluate the role of screening computed tomography (CT) of the thorax in cardiac surgery by analysing the presence of CT aortic calcifications in association with changes in operative strategy and postoperative stroke, and the CT features of emphysema with development of pneumonia. All patients who underwent cardiac surgery from January 2013 to October 2017 by a single surgeon were retrospectively studied. Patients who underwent screening CT thorax before cardiac surgery (CT group) were compared to those who did not (no CT group). Multivariate subgroup analyses were performed to determine significant association with postoperative outcomes. A total of 392 patients were included, of which 156 patients underwent preoperative screening CT thorax. Patients in the CT group were older (63.9 vs. 59.0 years, P = 0.001), had fewer recent myocardial infarctions preoperatively (41% vs. 56.4%, P = 0.003) and had better ejection fraction (>30%; P = 0.02). Operative strategy was changed in 4.3% of patients, and 4.9% of patients suffered stroke postoperatively. The presence of CT aortic calcifications was significantly associated with change in operative strategy (P = 0.016) but not with postoperative stroke (P = 0.33). Age was an independent risk factor for change in operative strategy among patients with CT thorax (P = 0.02). Multivariate age-adjusted analysis showed only palpable plaque to be significantly associated with change in operative strategy (P < 0.001). None of the patients with CT emphysema features developed pneumonia. The results of this study do not support routine use of preoperative screening CT thorax. Contrasted CT may be advisable in older patients and for other operative planning purposes.

The prevalence of urolithiasis in subjects undergoing computer tomography in selected referral diagnostic centers in Mogadishu, Somalia.

Somalia was predicted to be in the global stone belt with high urolithiasis prevalence. We aimed to determine the prevalence of urolithiasis and their demographic and computer tomography (CT) characteristics among subjects under CT scans in Mogadishu, Somalia. Materials and Methods: From March 2014 to November 2022, a total of 7,276 patients who underwent an abdominopelvic non-contrast CT scan for various indications were retrospectively reviewed. The mean age was 45.6 years with a standard deviation of 21.1 (range, 0.2-110 years). Patients were subdivided into two categories: adults (≥18 years) and pediatric (≤17 years). Of the 7,276 patients, 1,075 (14.8%) were diagnosed with urolithiasis. Among those with urolithiasis, 702 (65.3%) were male patients, and 373 (34.7%) were female patients. Among them, adults accounted for 92.7%, while children were 7.3%. Renal stones (nephrolithiasis) were the most common, representing 57% followed by ureteric stones at 35.5%, making upper urinary stones 92.5%. Approximately 70 patients (6.5%) had bladder stones; of these, 26 of them (37%) were accompanied by benign prostatic hyperplasia (BPH). There were 10 urethral stones (0.9%) recorded in the study, all were found in male patients, 8 localized in prostatic urethra, and 2 in the bulbar urethra. The overall mean stone size was 13.2 mm, and 60% of them ranged from 5 to 22 mm. Only 24% of the patients were asymptomatic. Single stones were almost 70%, while staghorn calculi were 8.2%. More than 60% of the patients with urolithiasis showed some degree of hydronephrosis ranging between mild to severe. A CT scan-based urolithiasis prevalence indicates 14.8% in Mogadishu, Somalia, and these results are consistent with the probability calculation of the weights-of-evidence (WofE) methodology based on several risk factors including temperature, climate change, mineral deposit, drinking water quality, and distribution of carbonated rocks. Considering the high prevalence of the disease, Somalia needs to invest more in prevention and treatment facilities while also training urologists that are capable of utilizing minimally invasive techniques in the country.

The application of dual-phase enhanced CT scan in distinguishing adrenal ganglioneuromas from adrenal lipid-poor adenomas

BackgroundThe utility of dual-phase enhanced computerized tomography (CT) scan in distinguishing adrenal ganglioneuromas from lipid-poor adenomas has not been reported. We aimed to retrospectively compare dual-phase enhanced CT findings which were helpful in distinguishing adrenal ganglioneuromas from adrenal lipid-poor adenomas.MethodsWe estimated the dual-phase enhanced CT findings of 258 adrenal masses (42 ganglioneuromas, 216 lipid-poor adenomas) in 258 patients from July 2008 to July 2020 with ganglioneuromas and July 2016 to July 2020 with lipid-poor adenomas. The CT features between ganglioneuromas and lipid-poor adenomas were compared using independent two-sample t test, Mann–Whitney test, and ROC analysis.ResultsSignificant differences were detected in CT value of unenhanced (CTU), CT value of arterial phase (CTA), CT value of venous phase (CTV), degree of enhancement in arterial phase, degree of enhancement in portal venous phase, age, tumor size [longest dimension, shortest dimension, mean dimension], shape, calcification between the ganglioneuroma and lipid-poor adenoma groups (P < 0.05). The results of receiver operating characteristics (ROC) analyses showed that areas under ROC curves of CTU, CTA and CTV were 0.713, 0.878, and 0.914, respectively. When the cut-off values were set at 22.5 HU, 51.5 HU, and 53.5 HU for CTU, CTA, and CTV, respectively, the three parameters had a sensitivity of 46.8%, 67.6%, and 88.0% and a specificity of 100%, 100%, and 88.1% in distinguishing ganglioneuromas from lipid-poor adenomas.ConclusionsDual-phase enhanced abdominal CT can exhibit some of the primary imaging characteristics of ganglioneuromas and lipid-poor adenomas used to distinguish between these two entities.

Clinical predictive scores for detection of sub-clinical atrial fibrillation after cryptogenic or embolic stroke of undetermined source: A brief systematic review

Subclinical atrial fibrillation (SAF) is the primary underlying cause of cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS), particularly in patients over 65 years of age. Therefore, it is strongly recommended screening for SAF in these patients. The development of tools designed to determine the priority of SAF screening is essential for optimizing the diagnostic workup. The aim of our study was to investigate the clinical predictive scores available for SAF detection in patients with CS or ESUS. We gathered data from articles published on the PubMed database from January 1, 2000, to January 31, 2023. Our search yielded eight scores for CS and three for ESUS. SAF diagnosis was established using various methods: 12-lead ECG or 24-h ECG monitoring during 1-year follow-up in three scores; 72-h non-implantable ECG monitoring in two scores; 2 or 3-week non-implantable ECG monitoring in three scores; and implantable ECG monitoring in one score. In two scores, ECG monitoring was performed using a non-implantable and/or implantable loop recorder. Overall, the rate of SAF detection was approximately 6% when using devices for monitoring lasting no more than 72 h and increased to nearly 22% employing 2 or 3-week non-implantable or implantable devices. SAF was defined differently in various scores; five scores considered any episode, even if shorter than 30 s, while six scores required episodes to last at least 30 s. Advanced age was included as a variable in 10 of 11 scores, whereas left atrial enlargement, premature atrial beats, and brain computed tomography characteristics were features in four scores. The area under the curve values of these scores ranged from 0.72 to 0.94. In conclusion, it is still challenging to put the currently available clinical scores to use due to a lack of validation. To provide more comprehensive guidance, it is essential to conduct large prospective multicenter trials in the future.

Comparison of sacroiliac CT findings in patients with and without ankylosing spondylitis aged over 50 years

Diagnosis of axial spondyloarthritis (axSpA) is nowadays commonly made with the help of pelvic radiography or magnetic resonance imaging (MRI). However, there is an important inter-observer variability in radiography, and MRI is subject to possible false positives and is not the best modality for studying structural lesions. Conversely, pelvic computed tomography (CT) has excellent specificity and appears to be more effective than radiography for the diagnosis of ankylosing spondylitis (AS). However, its findings in patients over 50 years of age have not yet been studied. The objectives of this study were to describe the CT characteristics of sacro-iliac joints (SIJ) and the presence of intra-articular gas in patients with AS aged over 50 years and to compare them with controls of the same age and sex. This two-center, cross-sectional, observational study was performed using the medical records of the rheumatology departments of two University Hospitals. We included patients with a clinical diagnosis of axSpA, who had both definite radiographic sacroiliitis according to the modified New York criteria and met the ASAS 2009 criteria for axSpA (that is, AS), and who had undergone any CT scan including the whole SIJ. Each patient was matched for age and sex to a control randomly selected on the Picture Archiving and Communication System (PACS), symptomatic or asymptomatic, and without spondyloarthritis. For each individual, CT scans were interpreted blindly by two independent rheumatologists and scored for joint space narrowing (JSN), erosions, sclerosis, intra-articular gas, and diffuse idiopathic skeletal hyperostosis (DISH). Ninety patients and 90 controls were included in the study. The rates of positive JSN, erosion, and sclerosis scores were higher in the AS group (91% vs. 21%, p < 0.0001; 31% vs. 2%, p < 0.0001; 27% vs. 13%, p = 0.03, respectively), but the rates of intra-articular gas and DISH were higher in the control group (24% vs. 68%, p < 0.0001; 7% vs. 33%, p < 0.0001, respectively). 58% of patients had complete bilateral ankylosis. A total of 83 (92.2%) patients had a CT scan considered positive for AS, compared with only seven controls (7.8%). Sclerosis and erosions were predominantly on the anterosuperior part and iliac side of the joint in controls and were more diffuse in patients with AS. CT findings in patients with AS over 50 years of age are mostly represented by changes in the joint space; patients with AS have more erosions and sclerosis changes, but less intra-articular gas than controls.