CT-negative Group Research Articles

Clinical significance of CA 19-9 elevation during postoperative surveillance for extrahepatic bile duct cancer: a nomogram-based approach for the prediction of short-term recurrence

BackgroundThis study aimed to assess the significance of elevated carbohydrate antigen (CA) 19-9 in postoperative surveillance of extrahepatic bile duct cancer and to identify short-term recurrence predictors. MethodsThis retrospective study included patients with elevated CA 19-9 post-curative surgery. Patients were categorized into positive and negative CT groups based on the detection of recurrence at CA 19-9 elevation. Short-term recurrence was defined as recurrence within 6 months in the negative CT group. We identified the factors associated with short-term recurrence and devised a predictive nomogram. ResultsAmong the 190 patients, 91 (47.9%) exhibited tumor recurrence with CA 19-9 elevation (CT-positive group), whereas 99 (52.1%) showed no recurrence (CT-negative group). In the CT-negative group (n=99), 22 (22.2%) experienced short-term tumor recurrence within 6 months. Preoperative CA 19-9 (odds ratio [OR]: 1.5, p=0.016), postoperative CA 19-9 (OR: 1.9, p=0.047), adjuvant treatment (OR: 3.5, p=0.032), and the absence of inflammation (OR: 3.5, p=0.045) were predictors of short-term recurrence. The area under the curve of the nomogram was 0.80 (95% CI: 0.69–0.90). DiscussionDespite elevated CA 19-9 levels, approximately 50% of patients exhibited no recurrence during postoperative surveillance for extrahepatic bile duct cancer. Factors influencing short-term recurrence encompass pre- and postoperative CA 19-9, adjuvant treatment, and inflammatory status.

Prediction of Bone Marrow Metastases Using Computed Tomography (CT) Radiomics in Patients with Gastric Cancer: Uncovering Invisible Metastases.

We investigated whether radiomics of computed tomography (CT) image data enables the differentiation of bone metastases not visible on CT from unaffected bone, using pathologically confirmed bone metastasis as the reference standard, in patients with gastric cancer. In this retrospective study, 96 patients (mean age, 58.4 ± 13.3 years; range, 28-85 years) with pathologically confirmed bone metastasis in iliac bones were included. The dataset was categorized into three feature sets: (1) mean and standard deviation values of attenuation in the region of interest (ROI), (2) radiomic features extracted from the same ROI, and (3) combined features of (1) and (2). Five machine learning models were developed and evaluated using these feature sets, and their predictive performance was assessed. The predictive performance of the best-performing model in the test set (based on the area under the curve [AUC] value) was validated in the external validation group. A Random Forest classifier applied to the combined radiomics and attenuation dataset achieved the highest performance in predicting bone marrow metastasis in patients with gastric cancer (AUC, 0.96), outperforming models using only radiomics or attenuation datasets. Even in the pathology-positive CT-negative group, the model demonstrated the best performance (AUC, 0.93). The model's performance was validated both internally and with an external validation cohort, consistently demonstrating excellent predictive accuracy. Radiomic features derived from CT images can serve as effective imaging biomarkers for predicting bone marrow metastasis in patients with gastric cancer. These findings indicate promising potential for their clinical utility in diagnosing and predicting bone marrow metastasis through routine evaluation of abdominopelvic CT images during follow-up.

Oncologic outcomes of calcitonin-negative medullary thyroid carcinoma.

Calcitonin (Ct)-negative medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor. This study aimed to clarify its incidence, clinicopathologic characteristics, management, and treatment outcome. We retrospectively analyzed data of patients with primary MTC. Patients were divided into two groups according to the preoperative serum Ct level (Ct-negative and Ct-positive). The demographic, pathologic, and molecular characteristics, and treatment outcomes were compared between the two groups. In the Ct-negative group, we analyzed the association between the operation type and treatment outcome. Of the total 312 patients, 24 were diagnosed with Ct-negative MTC. The rate of lymph node metastasis was significantly higher in the Ct-positive than in the Ct-negative group (47.9% vs. 0%, p<0.001). The proportion of patients with Ki-67 ≤10% was significantly higher in the Ct-negative than in the Ct-positive group (87.5% vs. 38.2%, p<0.001). Excellent response was achieved by 91.7% and 34.7% of patients in the Ct-negative and Ct-positive groups, respectively (p<0.001). In the Ct-negative group, excellent response was achieved by all female patients, but only 50% of male patients. Ct-negative MTC is rare and unlikely to develop lymph node metastasis. Unilateral lobectomy tends to provide a satisfactory chance of excellent response; however, this requires further validation.

Unresected small lymph node assessment predicts prognosis for patients with pT3N0M0 thoracic esophageal squamous cell carcinoma

BackgroundThe role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed. The aim of the study was to investigate the role of unresected small LNs assessment using computed tomography (CT) in prognostic estimates of pT3N0M0 TESCC patients.MethodsBetween January 2009 and December 2017, 294 patients who underwent esophagectomy with R0 resection at Sichuan Cancer Hospital were retrospectively examined, and the last follow-up time was July 2018. Patients were classified into CT-suspect and CT-negative groups according to the shortest diameter and the shape (axial ratio) of the unresected small LNs on preoperative CT. The Kaplan–Meier method was used to compare survival differences in prognostic factors. Univariate and multivariate analyses were performed to identify prognostic factors for survival and recurrence.ResultsEighty-four patients (28.6%) were classified as CT-suspect group according to the diagnostic criteria; survival analysis suggested that CT-suspect group of patients had a relatively poorer prognosis (P<0.05). Cox regression analysis indicated that unresected small LNs status, tumor grade, and postoperative adjuvant therapy were independent prognostic factors for patients with pT3N0M0 TESCC (P<0.05). Further analysis shown the rates of total recurrence (TR) and locoregional recurrence (LR) in the CT-suspect group were significantly higher than that in the CT-negative group (TR, P<0.001; LR, P<0.001). Among the LRs, the rate of supraclavicular lymph node recurrence in the CT-suspect group was significantly higher than that in the CT-negative group (P<0.001).ConclusionsUnresected small lymph node assessment is critically important and predict prognosis for pT3N0M0 TESCC patients.

The relationship between C-reactive protein/albumin ratio and radiological findings in patients with COVID-19

Aim: Our aim in this study is to determine the C-reactive protein/Albumin ratio (CAR) values of computed tomography (CT) -positive COVID-19 patients and CT-negative COVID-19 patients who are Real-Time Polymerase Chain Reaction (RT-PCR) and to investigate the relationship between C-reactive protein / Albumin ratio and radiological images of RT-PCR positive patients.&#x0D; Material and Methods: 100 RT-PCR positive COVID-19 patients over the age of 18 were included in our study. C-reactive protein (CRP), albumin levels, other data and lung CT scan were collected. The patients were divided into two sections: CT-positive and CT-negative. The relationship between CT and CAR was investigated in patients with and excluding comorbidity.&#x0D; Results: The measured CRP levels and CAR in the CT-positive group were significantly higher than CT-negative group (37.76±64, 9.05±22, p

Assessment of Clinical Characteristics and Chest CT Findings of COVID-19 Prediagnosed Patients Admitted to the Emergency Department: A Retrospective Study

Introduction: This study aimed to define the clinical features and laboratory findings that may be associated with COVID-19 pneumonia in patients with suspected COVID-19 pneumonia who presented to the emergency department in order to be able to recognize the disease early until molecular tests are available, and thus to isolate sick people as soon as possible. Patients and Methods: We retrospectively examined patients who were evaluated with the suspicion of COVID-19 between March 2020 and August 2020. We used the patient information management system to record patient demographic and clinical features, laboratory findings, and CT results. In subgroups with and without pneumonia, we compared these characteristics in confirmed COVID-19 patients. Results: Our study included 1,277 patients who were evaluated for suspected COVID-19. COVID-19 pneumonia was detected in 71.2% (n=210) of a total of 295 (23.4%) patients with a diagnosis of COVID-19 who were confirmed by RT-PCR positivity. Although 56.2% (n=18) of those with pneumonia were men, no statistically significant relationship was detected between gender distribution and CT findings (p=0.449). When we compared the patients in 3 subgroups according to age groups, it was observed that 59.4% (n=38) of those with negative CT findings were in the 18-44 age group, and 44.8% (n=94) of those with positive CT findings were 65 and over age group, and this distribution was found to be statistically significant (p&lt;0.001). Pneumonia was detected in 58.3% (n=49) of COVID-19 cases (n=84) with a suspected exposure history (p=0.008). The most common symptoms in patients with positive CT findings (n=210) were fever (40.5% n=85) and fatigue (40.5% n=85), cough (32.9% n=69), and shortness of breath (28.6% n=60). The most common comorbidity in cases diagnosed with COVID-19 was HT (33.9%; n=100/295), followed by AF (19.3%; n=57/295), and the rates of HT and AF in those with COVID-19 pneumonia were statistically significantly higher compared to the CT-negative group (p&lt;0.001 and p=0.002, respectively).COVID-19 pneumonia was more common in hospitalized patients (n=124), and hospitalization lengths were longer in both emergency and ICU admissions (p&lt;0.001 and p=0.008). In our analysis in terms of the survival relationship, it was observed that 87.5% (n=35) of the COVID-19 cases who died had pneumonia (p&lt;0.042). Low saturation and high respiratory rate per minute at the time of admission were associated with COVID-19 pneumonia (p&lt;0.001). In the group with COVID-19 pneumonia, haemoglobin, GFR, and pCO2 values were recorded lower at the time of admission compared to patients with negative CT (p&lt;0.001, p&lt;0.001, p&lt;0.05, respectively), while leukocytes, neutrophils, CRP, D-dimer, LDH, hs-troponin, AST and bilirubin were recorded as higher (p&lt;0.05, p&lt;0.01, p&lt;0.001, p&lt;0.001, p&lt;0.001, p&lt;0.001, p=0.01, p=0.01, respectively). Conclusion: Identifying patient features linked with COVID-19 pneumonia at the time of admission may influence our decision to have CT scans in emergency departments, regardless of the RT-PCR result, and may result in early disease identification and treatment.

The role of chest CT in management of asymptomatic SARS-CoV-2 infections: A longitudinal multi-center study in Chongqing, China.

Background: Multiple societies including the Fleischner Society do not recommend that CT is routinely used in asymptomatic SARS-CoV-2 infections; however, this advice is based on the limited evidence. In this study, we aim to confirm whether it is necessary to do CT scans in SARS-CoV-2 asymptomatic infections by summarizing the longitudinal chest CT and clinical features of asymptomatic SARS-CoV-2 infections.Methods: A total of 33 individuals (14 men and 19 women) with asymptomatic SARS-CoV-2 infections were retrospectively enrolled. Clinical data of CT positive and negative groups were compared. Longitudinal chest CT scans were reviewed for CT features and analyzed for temporal change.Results: Thirty-two (97%) individuals had positive results for first RT-PCR testing. For clinical data, only monocyte count showed a significant difference between CT positive and negative groups. For first chest CT, only eighteen (54.5%) individuals had abnormal manifestations, common CT features were GGO (88.9%) and consolidation (33.3%), the median number of segments involved was 3.0 (1.0-7.5). No case in CT negative group was abnormal on the follow-up CT. Three patterns of evolution throughout series of CT were observed in CT positive group, including gradual improvement (12, 66.7%), mismatch to improvement (3, 16.7%) and mild progression to improvement (3, 16.7%). On last CT scans, most cases had radiographic improvement but residual abnormalities. Significant differences were exhibited in density, long diameter, number of lung segments involved, and percentage of consolidation between the first and last CT scans. All cases had stable conditions and finally confirmed negative for SARS-CoV-2 RT-PCR tests without developing into severe pneumonia.Conclusion: Considering poor performance of CT in screening, stable conditions during followup, and good outcomes in asymptomatic SARS-CoV-2 infections, we confirm that it is unnecessary to do CT scans in asymptomatic SARS-CoV-2 infections.

The Relation Between Otolaryngology-Specific Symptoms and Computed Tomography Findings in Ambulatory Care COVID-19 Patients.

Objective:This study aimed to conduct a study to evaluate the relation between otolaryngology-specific symptoms and computed tomography findings in ambulatory care COVID-19 patients.Patient and Methods:The study was conducted with medical records of 987 (82%) patients with confirmed COVID-19 virus via real-time reverse transcription-polymerase chain reaction between March 11, 2020, and April 21, 2020. Patients were divided into 2 groups as computed tomography (CT)-negative and CT-positive groups considering the presence of the CT findings depicting COVID-19 disease.Results:The mean age was significantly higher in CT-positive group than CT-negative group (41.53 ± 12.82 vs 36.61 ± 11.81, P < .001). Cough and shortness of the breath were observed with a significantly higher rate in CT-positive group than that of CT-negative group (44% vs 29.9%, P = .001 and 18.4% vs 9.7%, P = .002, respectively).Conclusions:In conclusion, advanced age, cough, and shortness of breath could be related to CT scan positivity.

H-FABP: A new biomarker to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury

The majority of patients with mild traumatic brain injury (mTBI) will have normal Glasgow coma scale (GCS) of 15. Furthermore, only 5%–8% of them will be CT-positive for an mTBI. Having a useful biomarker would help clinicians evaluate a patient’s risk of developing intracranial lesions. The S100B protein is currently the most studied and promising biomarker for this purpose. Heart fatty-acid binding protein (H-FABP) has been highlighted in brain injury models and investigated as a biomarker for stroke and severe TBI, for example. Here, we evaluate the performances of S100B and H-FABP for differentiating between CT-positive and CT-negative patients. A total of 261 patients with a GCS score of 15 and at least one clinical symptom of mTBI were recruited at three different European sites. Blood samples from 172 of them were collected ≤ 6 h after trauma. Patients underwent a CT scan and were dichotomised into CT-positive and CT-negative groups for statistical analyses. H-FABP and S100B levels were measured using commercial kits, and their capacities to detect all CT-positive scans were evaluated, with sensitivity set to 100%. For patients recruited ≤ 6 h after trauma, the CT-positive group demonstrated significantly higher levels of both H-FABP (p = 0.004) and S100B (p = 0.003) than the CT-negative group. At 100% sensitivity, specificity reached 6% (95% CI 2.8–10.7) for S100B and 29% (95% CI 21.4–37.1) for H-FABP. Similar results were obtained when including all the patients recruited, i.e. hospital arrival within 24 h of trauma onset. H-FABP out-performed S100B and thus seems to be an interesting protein for detecting all CT-positive mTBI patients with a GCS score of 15 and at least one clinical symptom.

FDG uptake observed around the lumbar spinous process: relevance to Baastrup disease.

In positron emission tomography (PET) with F-18-fluorodeoxyglucose (FDG), non-tumorous focal uptake is often observed around the lumbar spinous processes (LSPs). Close approximation of LSPs with sclerosis is often seen, which is called Baastrup disease. The aim of this study was to characterize this finding in terms of location and subjects' age and investigate the relation between PET and CT findings. The PET/CT scans of 40 patients each in the fifth, sixth, seventh, eighth, and ninth decades were screened for FDG uptake around the LSPs from L1-2 through L5-S1. Patients with metastasis to the lumbar spine or recent chemotherapy or rheumatoid arthritis-related disease were excluded. Focal uptake greater than blood pool activity was considered positive. Positive uptake was compared among the ages and locations. We also evaluated the relationship between FDG uptake and CT morphology. Overall, focal uptake was observed in 122 LSPs in 71 patients. At least one positive uptake was seen in 9, 21, 15, 12, and 14 of 40 patients (16, 30, 30, 20, and 26 of 200 regions) in each age group of 40s through 80s, respectively (p = 0.12). As for the location, uptake around L1-2, L2-3, L3-4, L4-5, and L5-S1 was observed in 19, 22, 39, 35, and 7 regions, respectively (p < 0.01). There was no statistically significant difference in PET positivity among the five age groups, but positive uptake was predominantly seen in L3-4. Degeneration on CT was apparent in 58, 74, 108, 123, and 144 regions in each age group, respectively (p < 0.01), and in 38, 79, 131, 151, and 108 regions in each location, respectively (p < 0.01). The PET positive ratio was higher in CT positive group than in CT negative group (14 vs. 10 %, p < 0.05), but there was no significant difference of quantitative values (p = 0.10). Of 42 regions in 27 patients who had serial PET/CT scans that were initially PET-positive, 35 regions (83 %) turned negative on a later PET-scan. Focal uptake around the LSPs was commonly seen in the mid-lumbar vertebrae, independent of age, and was not always correlated with morphological changes. This uptake should not be assumed to represent osseous metastasis.

The value of Serum BNP for diagnosis of intracranial injury in minor head trauma

ObjectiveHead injury is the main cause of death among individuals younger than 45 years old. Cranial Computerized tomography (CT) is commonly used for diagnosis of head injury. Brain Natriuretic Peptide (BNP) is a peptide originally isolated from brain ventricles. The main aim of this study is to investigate BNP as an indicator of head injury among patients presenting to emergency department (ED) with minor head trauma.MethodsThis was a prospective study conducted at the emergency department of the Numune Training and Research Hospital. A total of 162 patients who presented to the ED with minor head injury were enrolled. The patients were categorized into 2 groups as the cranial CT-negative and positive groups. The normality of the data was tested using One Sample Kolmogorov Smirnov test. Mann–Whitney U test was used to compare 2 independent groups while the Kruskal-Wallis test was utilized for comparison of more than 2 groups. A p-value of <0.05 was considered to be significant.ResultsNinety-six (59.3%) patients were male and 66 (40.7%) were female. The cranial CT-negative group had a median BNP level of 14.5 pg/ml while the cranial CT-positive group had a median BNP level of 13 pg/ml. There was no statistically significant difference between these two groups for serum BNP levels (p > 0.05).ConclusionThis study suggested that serum BNP level wasn’t used in defined of intracranial injury.

Role of chest computed tomography at diagnosis in the management of Wilms' tumor: a study by the United Kingdom Children's Cancer Study Group.

This study sought to determine whether the identification of minimal pulmonary metastatic disease by chest computed tomography (CT) performed at diagnosis in patients with Wilms' tumor and normal chest x-rays (CXR) could predict a subgroup of children at increased risk of pulmonary relapse. A retrospective analysis was carried out of the records of 449 children entered onto the United Kingdom Childrens' Cancer Study Group Second Wilms' Tumor Study between July 1986 and September 1991. The imaging protocol did not stipulate chest CT at diagnosis, but 141 children who had normal frontal and lateral CXRs and a chest CT scan performed at diagnosis were eligible for analysis. After surgery, children with stage I Wilms' tumor received single-agent chemotherapy (vincristine), whereas children with stages II, III, and bilateral Wilms' tumor received combination chemotherapy. Most children with stage III tumors were also treated with abdominal radiotherapy (20 Gy). In 31 patients (22%), pulmonary nodules were visible on chest CT; eight experienced relapse, four (15%) in the lungs. When only stage I patients were analyzed, there was a significant difference between the pulmonary relapse rate of 43% (three of seven) in the CT-positive group and 10% (five of 48) in the CT-negative group (P =.02). Four of eight patients with stage I disease with pulmonary relapse died. CT seemed to identify a subgroup of stage I patients who were at increased risk of pulmonary relapse. These children had received only single-agent chemotherapy. A prospective randomized trial is needed to clarify whether these children would benefit from combination chemotherapy.