Small Solid Nodules Research Articles

Pulmonary Langerhans Cells Histiocytosis (Clinical Case)

We describe a clinical case of pulmonary histiocytosis from Langerhans cells. Patient P. is 57 years old, lives in a village. The disease began in October 2022 with complaints of morning cough, shortness of breath during physical activity. Complaints persisted for about 6 months and increased in dynamics. Over the past 3 months, he has lost 3 kg. He sought medical care from his family doctor, where on 07.04.2023 a computed tomography scan of the chest was performed and severe pathological changes in the lungs were detected. The patient was referred to a pulmonologist for consultation, and after further examination was hospitalized in the pulmonology department of the Ternopil Regional Phthisiopulmonology Medical Center. His medical history revealed that he had been in contact with pigeons for about 50 years. He was engaged in repair work and did not use respiratory protection. Additional examination methods were performed. Computed tomography of the chest cavity dated 07.04.2023, conclusion — diffuse interstitial changes in the lung parenchyma. Bilateral multisegmental pulmonary nodules and thin-walled pulmonary cysts. Bronchoscopy and pathological examination were performed. The patient was consulted by a cardiologist. The clinical diagnosis was «Pulmonary Langerhans cell histiocytosis, active phase, first detected. «Honeycomb lungs». Bilateral diffuse pneumofibrosis. Chronic pulmonary heart disease. Metabolic cardiomyopathy. Transient extrasystole. Heart failure, stage I. Incomplete blockade of the right leg of the bundle of his». Treatment was prescribed according to the clinical guidelines. On 12.05.2023 he was discharged for outpatient treatment with improvement of his general condition.In December 2023, the patient completed the course of treatment and began to notice an increase in shortness of breath with minimal physical activity, dry cough, and therefore on January 16, 2024, the patient consulted a pulmonologist, where, after further examination, he was hospitalized in the pulmonology department. After the examination the patient was diagnosed with: Chronic Obstructive Pulmonary Disease (COPD) stage II, group E, fase of infectious exacerbation. Pulmonary Langerhans cell histiocytosis, sluggishly progressive course, active phase. «Honeycomb lungs». Bilateral diffuse pneumofibrosis, coronary artery disease. Cardiosclerosis. Aortosclerosis. Incomplete blockade of the right pedicle of the bundle of His. Chronic pulmonary heart disease. Heart failure, stage I, functional class I.It has been established that pulmonary Langerhans cell histiocytosis is a systemic pathology that in most cases leads to chronicity of the process, damage to the bronchopulmonary system (in this case, the onset of COPD); cardiovascular system (development of coronary heart disease), which requires constant pharmacological treatment and medical monitoring. In the case of a typical CT picture (widespread cystic lung disease with cysts of varying sizes and shapes with relative sparing of the lung bases and small solid nodules), a patient should be guided by a general practitioner (family doctor) to the pulmonologist to confirm or exclude pulmonary Langerhans cell histiocytosis. This allows for early diagnosis and treatment.

Clinical and ultrasound features of fibrous pseudotumor of tunica vaginalis of the testis: eight cases and literature review.

To investigate the clinical and ultrasound features of fibrous pseudotumor of tunica vaginalis of the testis. The clinical and ultrasound features of fibrous pseudotumor of the tunica vaginalis diagnosed by pathology in West China Hospital of Sichuan University from 2006 to 2023 were retrospectively analyzed. The study included 8 patients diagnosed with fibrous pseudotumor of the tunica vaginalis. The average age was 51.8 ± 17 years(range:25 to 80 years). Painless nodules or masses were present in 87.5% of cases, while 12.5% presented with painless scrotal enlargement. Ultrasound findings were as follows: Lesions were nodular in 7 cases and diffuse in 1 case (left side 50%, right side 50%). 75% involved the tunica vaginalis wall; 25% involved the epididymis with concurrent epididymitis. The tunica vaginalis wall on the affected side was significantly thicker than the contralateral side (4.58 ± 2.19mm vs. 2.59 ± 0.48mm, P=0.012). Hydrocele was present in 62.5% of the affected cases, poor sound transmission was noted in 62.5%, and septation was observed in 12.5%. 62.5% of cases exhibited multiple small solid nodules, with a maximum diameter ranging from 8∼19 mm. Nodules were well-circumscribed, regularly shaped and isoechoic or slightly hyperechoic. In 37.5% of cases, adjacent nodules were fused and 37.5% exhibited posterior attenuation. Punctate calcifications were present in 25% of cases. There is usually less blood flow in the lesion. This study demonstrates that fibrous pseudotumor of the tunica vaginalis is a rare scrotal disease affecting primarily middle-aged and elderly men. It typically presents unilaterally and carries a favorable prognosis following surgical treatment. Ultrasound commonly reveals multiple slightly hyperechoic or isoechoic solid nodules with ipsilateral thickening of the tunica vaginalis wall. In some cases, nodules may involve the epididymis, with associated epididymitis, fusion of adjacent nodules, occasional calcification, and posterior echo attenuation. Most lesions exhibit poor blood flow, and hydrocele is frequently present on the affected side. The distinct clinical and ultrasound features of the disease make non-radiative ultrasound imaging an effective tool for rapid detection, differential diagnosis, and guidance for appropriate clinical treatment.

Interobserver Variability in Manual Versus Semi-Automatic CT Assessments of Small Lung Nodule Diameter and Volume.

This study aimed to assess the interobserver variability of semi-automatic diameter and volumetric measurements versus manual diameter measurements for small lung nodules identified on computed tomography scans. The radiological patient database was searched for CT thorax examinations with at least one noncalcified solid nodule (∼3-10 mm). Three radiologists with four to six years of experience evaluated each nodule in accordance with the Fleischner Society guidelines using standard diameter measurements, semi-automatic lesion diameter measurements, and volumetric assessments. Spearman's correlation coefficient measured intermeasurement agreement. We used descriptive Bland-Altman plots to visualize agreement in the measured data. Potential discrepancies were analyzed. We studied a total of twenty-six nodules. Spearman's test showed that there was a much stronger relationship (p < 0.05) between reviewers for the semi-automatic diameter and volume measurements (avg. r = 0.97 ± 0.017 and 0.99 ± 0.005, respectively) than for the manual method (avg. r = 0.91 ± 0.017). In the Bland-Altman test, the semi-automatic diameter measure outperformed the manual method for all comparisons, while the volumetric method had better results in two out of three comparisons. The incidence of reviewers modifying the software's automatic outline varied between 62% and 92%. Semi-automatic techniques significantly reduced interobserver variability for small solid nodules, which has important implications for diagnostic assessments and screening. Both the semi-automatic diameter and semi-automatic volume measurements showed improvements over the manual measurement approach. Training could further diminish observer variability, given the considerable diversity in the number of adjustments among reviewers.

The scoring system combined with radiomics and imaging features in predicting the malignant potential of incidental indeterminate small (

ObjectiveDevelop a practical scoring system based on radiomics and imaging features, for predicting the malignant potential of incidental indeterminate small solid pulmonary nodules (IISSPNs) smaller than 20 mm.MethodsA total of 360 patients with malignant IISSPNs (n = 213) and benign IISSPNs (n = 147) confirmed after surgery were retrospectively analyzed. The whole cohort was randomly divided into training and validation groups at a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) algorithm was used to debase the dimensions of radiomics features. Multivariate logistic analysis was performed to establish models. The receiver operating characteristic (ROC) curve, area under the curve (AUC), 95% confidence interval (CI), sensitivity and specificity of each model were recorded. Scoring system based on odds ratio was developed.ResultsThree radiomics features were selected for further model establishment. After multivariate logistic analysis, the combined model including Mean, age, emphysema, lobulated and size, reached highest AUC of 0.877 (95%CI: 0.830–0.915), accuracy rate of 83.3%, sensitivity of 85.3% and specificity of 80.2% in the training group, followed by radiomics model (AUC: 0.804) and imaging model (AUC: 0.773). A scoring system with a cutoff value greater than 4 points was developed. If the score was larger than 8 points, the possibility of diagnosing malignant IISSPNs could reach at least 92.7%.ConclusionThe combined model demonstrated good diagnostic performance in predicting the malignant potential of IISSPNs. A perfect accuracy rate of 100% can be achieved with a score exceeding 12 points in the user-friendly scoring system.

Camper’s and Scarpa’s fasciae: Anatomic landmark to differentiate between lymph node and abdominal wall involvement in a case of lymphoma

Cutaneous involvement of MALT lymphoma can either be primary or secondary, Secondary spread to the skin is considered disseminated extra-nodal disease involvement, which is classifies as a stage IV disease. We described a case of a 44-year-old woman with MALT lymphoma of the lacrimal glands with biopsy-proven lymphoma involvement in the subcutaneous tissue of the anterior abdominal wall. This involvement is manifested as multiple small discrete solid enhancing subcutaneous nodules. Although such findings on conventional CT scans are usually non-specific and may present in various systemic conditions, the knowledge of the patient’s prior clinical history should alert interpreting radiologists to be aware of cutaneous and subcutaneous involvement of lymphoma. This awareness can help plan the use of imaging-guided tissue biopsy for a minimally-invasive and safe acquisition of tissue specimen for histopathological diagnosis.

Radiological evidence of rapid growth acceleration of a small part solid nodule found to be large-cell carcinoma of the lung

BackgroundWith the widespread use of low-dose computed tomography for lung cancer screening, the detection rate of pulmonary lesions manifesting as ground-glass opacities (GGOs) has been increasing dramatically. The volume doubling time (VDT) has been introduced in clinical practice to monitor the potential growth rate of GGOs during long-term follow-up periods.Case presentationA 72-year-old never-smoker female diagnosed with mixed GGO manifested abruptly accelerated growth with sudden decreased VDT from 400 to 36 days. A thoracoscopic left lower lobectomy with mediastinal lymph node dissection was performed, and the diagnosis was stage IB large-cell neuroendocrine carcinoma (LCNEC). Next-generation sequencing of the tumor highlights an EML4-ALK gene fusion.ConclusionsThe LCNEC may present as GGO with longer VDT in the early stage. VDT should calculate by the whole size either on the entire tumor diameter or on consolidation diameter. It is recommended that meticulous long-term follow-up with dynamic VDT monitoring may help select high-risk GGOs performing timely semi-elective surgical resection in clinical practice.

An integrated convolutional neural network for classifying small pulmonary solid nodules.

Achieving accurate classification of benign and malignant pulmonary nodules is essential for treating some diseases. However, traditional typing methods have difficulty obtaining satisfactory results on small pulmonary solid nodules, mainly caused by two aspects: (1) noise interference from other tissue information; (2) missing features of small nodules caused by downsampling in traditional convolutional neural networks. To solve these problems, this paper proposes a new typing method to improve the diagnosis rate of small pulmonary solid nodules in CT images. Specifically, first, we introduce the Otsu thresholding algorithm to preprocess the data and filter the interference information. Then, to acquire more small nodule features, we add parallel radiomics to the 3D convolutional neural network. Radiomics can extract a large number of quantitative features from medical images. Finally, the classifier generated more accurate results by the visual and radiomic features. In the experiments, we tested the proposed method on multiple data sets, and the proposed method outperformed other methods in the small pulmonary solid nodule classification task. In addition, various groups of ablation experiments demonstrated that the Otsu thresholding algorithm and radiomics are helpful for the judgment of small nodules and proved that the Otsu thresholding algorithm is more flexible than the manual thresholding algorithm.

VueBox® perfusion analysis of dynamic contrast enhanced ultrasound provides added value in the diagnosis of small thyroid nodules.

To explore the potential added value of dynamic contrast enhanced ultrasound (DCE-US) using VueBox® software for the diagnosis of small solid thyroid nodules (≤1.0 cm). This prospective study was approved by the institutional review board and it was performed at two hospitals from January 2020 to October 2020. B mode ultrasound and contrast enhanced ultrasound (CEUS) images were obtained for 79 small solid thyroid nodules (≤1.0 cm) confirmed by ultrasound-guided fine needle aspiration cytology results in 79 consecutive patients (55 women and 24 men, median age: 41 years). The CEUS time-intensity curves (TICs) of thyroid nodules and surrounding parenchyma were created by VueBox® software (Bracco, Italy). The CEUS quantitative parameters were obtained after curve fitting. The diagnostic performance of CEUS and DCE-US was evaluated and compared. The weighted kappa statistic (κ) was performed to assess the interobserver agreement and consistency between the diagnosis of CEUS and DCE-US. Among the 79 thyroid nodules, 56 (70.9 %) were malignant and 23 (29.1 %) were benign lesions. Hypoenhancement during the arterial phase of CEUS was associated with malignancy (P < 0.001), with an AUC of 0.705 (sensitivity 71.4 %, specificity 69.6 %). Among all CEUS quantitative parameters, the peak enhancement (PE), wash-in rate (WiR), and wash-out rate (WoR) of DCE-US in malignancies were significantly lower than those in benign nodules (P = 0.049, P = 0.046, and P = 0.020, respectively). The area under the receiver operating characteristic curves (AUCs) of PE, WiR, and WoR were 0.642 (sensitivity 65.2 %, specificity 67.9 %), 0.643 (sensitivity 43.5 %, specificity 91.1 %), and 0.667 (sensitivity 69.6 %, specificity 69.6 %) in differentiation between benign and malignant small solid thyroid nodules (≤1.0 cm), respectively. Comparing the quantitative parameters of DCE-US between small solid thyroid nodules and surrounding normal thyroid parenchyma, the PE, WiAUC, WiR, wash-in perfusion index (WiPI), WoAUC, WiWoAUC, and WoR of the nodules were significantly lower than those of normal thyroid tissue (P = 0.008, P < 0.001, P = 0.037, P = 0.009, P = 0.003, P = 0.002, P = 0.049, respectively). A total of 16 (20.3 %) nodules showed isoenhancement during the arterial phase of CEUS, while the median PE ratio of surrounding tissue and thyroid nodules was 1.70 (IQR: 1.33-1.89). VueBox® is a helpful tool for the evaluation of dynamic microvascularization of thyroid nodules, and DCE-US using VueBox® perfusion analysis could provide added values for differential diagnosis of small solid thyroid nodules (≤1.0 cm).

MRI findings of sporadic/simple lymphoepithelial cyst of the parotid gland.

This study aimed to determine the MRI features of sporadic/simple lymphoepithelial cyst (SLEC) of the parotid gland. Ten patients (seven men, three women; mean age, 60years; age range, 38-77years) with histopathologically and clinically proven SLEC of the parotid gland who underwent MRI before surgical resection were enrolled in this study. No enrolled patient had HIV infection or Sjögren syndrome. MRI findings of SLEC were retrospectively assessed. We confirmed 10 SLECs larger than 10mm with a mean maximum diameter of 26.6mm (range, 12-42mm). Nine patients (90%) had a single cyst, and one (10%) had a large cyst accompanied by small cysts (<10mm) within the ipsilateral parotid gland. Eight SLECs (80%) were unilocular, and two (20%) were bilocular, with complete septa. Among seven SLECs (70%) with internal septa, five unilocular SLECs (50%) had incomplete septa. Six SLECs (60%) had eccentric cyst wall thickening, and five (50%) were surrounded by small solid nodules that were isointense relative to lymph node. On T1-weighted images, all cyst contents were homogeneously hyperintense relative to cerebrospinal fluid. SLECs of the parotid gland are usually single unilocular lesions. Internal septa, eccentric cyst wall thickening, and small solid nodules surrounding the lesion were often observed. Cyst contents are always homogeneously hyperintense on T1-weighted images.

Computed-tomography-based radiomic nomogram for predicting the risk of indeterminate small (5-20 mm) solid pulmonary nodules

This study aims to develop a diagnostic model that combines computed tomography (CT) images and radiomic features to differentiate indeterminate small (5-20 mm) solid pulmonary nodules (SSPNs). This study retrospectively enrolled 413 patients who had had SSPNs surgically removed and histologically confirmed between 2017 and 2019. The SSPNs included solid malignant pulmonary nodules (n = 210) and benign pulmonary nodules (n = 203). The least absolute shrinkage and selection operator was used for radiomic feature selection, and random forest algorithms were used for radiomic model construction. The clinical model and nomogram were established using univariate and multivariable logistic regression analyses combined with clinical symptoms, subjective CT findings, and radiomic features. The area under the curve (AUC) of the receiver operating characteristic curve was used to evaluate the performance of the models. The AUC for the clinical model was 0.77 in the training cohort [n = 289; 95% confidence interval (CI): 0.71-0.82; P = 0.001] and 0.75 in the validation cohort (n = 124; 95% CI: 0.66-0.83; P = 0.016). The AUCs for the nomogram were 0.92 (95% CI: 0.89-0.95; P < 0.001) and 0.85 (95% CI: 0.78-0.91; P < 0.001), respectively. The radiomic score (Rad-score), sex, pleural indentation, and age were the independent predictors that were used to build the nomogram. The radiomic nomogram derived from clinical features, subjective CT signs, and the Rad-score can potentially identify the risk of indeterminate SSPNs and aid in the patient's preoperative diagnosis.

Cystic Meningioma With Interesting Imaging Characteristics in Frontal Region: A Case Report

Introduction: Cystic meningioma is an unusual shape of meningioma, and the imaging manifestations and site of the solid/cystic components of the mass increase our difficulties in making a diagnosis. Case report: We report a case of a 78-year-old right-handed woman who presented with right-sided hemiparesis, urinary incontinency, and Broca aphasia. A large left-sided frontal region cystic extra-axial mass with a suspicious small solid nodule and adjacent bony erosion was detected on non-contrast CT of the brain. Brain Magnetic resonance imaging (MRI) with gadolinium depicted the cystic and solid components exactly. A probable diagnosis of cystic meningioma was made and subsequently confirmed by histological study after surgical resection of the tumor. To confirm the category and subtypes of the tumor, a histopathological examination of the tumor cells should be done. Conclusion: Cystic or solid cystic intracranial lesions have several differential diagnoses making the final diagnosis difficult in some cases. There are four types of cystic meningiomas according to the Nauta classification that was revised by Jung et al. Determination of the type of cystic meningioma is crucial for surgical planning. To confirm the category and subtypes of the tumor, a histopathological examination of the tumor cells should be done. Our case was a type IV cystic meningioma with a small mural enhancing solid nodule but an associated adjacent bony invasion.

An incidental papillary renal cell carcinoma in a unilocular renal cyst: A case report

Cystic renal cell carcinoma (RCC) is a malignant epithelial tumor arising in a pre-existing renal cyst. The renal cyst maybe multilocular or unilocular with the latter being an even rarer occurrence. Cystic renal malignancy arising in a unilocular cyst is quite rare with only a few cases reported till date, most of which are clear cell RCCs. Literature available with regard to staging tumor nodule in a benign unilocular cyst is limited. We report a case of a 52-year-old male presenting with a single large unilocular cyst which had a small solid nodule of papillary RCC in its posterior wall which was detected on microsopy. On pathologic examination, all cases of clinically/ radiologically benign renal cysts should be examined with a high index of suspicion as a small tumor focus may be present in the form of a nodule or in the free wall of the cyst which was initially missed.

Developing of risk models for small solid and subsolid pulmonary nodules based on clinical and quantitative radiomics features.

BackgroundAccurate evaluation of pulmonary nodule malignancy is important for lung cancer management. This current study aimed to develop risk models for small solid and subsolid pulmonary nodules based on clinical and quantitative radiomics features.MethodsThis study enrolled 5–20 mm pulmonary nodules detected on thoracic high-resolution computed tomography (HRCT), which were all confirmed pathologically. There were 548 solid nodules (242 malignant vs. 306 benign) and 623 subsolid nodules (SSNs 519 malignant vs. 104 benign). Relevant clinical characteristics were recorded. The CT image prior to the initial treatment was chosen for manual segmentation of the targeted nodule using the ITK-SNAP software. Subsequently, the marked image was processed to quantitatively extract 1218 radiomics features using PyRadiomics. We performed five-fold cross-validation to select potential predictors from clinical and radiomics features using the LASSO method and to evaluate the performance of the established models. In total, four types of models were tried: random forest, XGBOOST, SVM, and logistic models. The established models were compared with the Mayo model.ResultsLung cancer risk models were developed among four nodule groups: all nodules (410 benign vs. 761 malignant; 1:1.86), nodules ≤10 mm (185 benign vs. 224 malignant; 1:1.21), solid nodules (306 benign vs. 242 malignant; 1.26:1), and SSNs (104 benign vs. 104 malignant; 1:1 matched). Significant clinical and radiomics predictors were selected for each group. The accuracy, area under the ROC curve, sensitivity, and specificity of the best model on validation dataset was 0.86, 0.91, 0.93, 0.73 for all nodules (XGBOOST), 0.82, 0.90, 0.86, 0.76 for nodules ≤10 mm (XGBOOST), 0.80, 0.89, 0.78, 0.82 for solid nodules (XGBOOST) and 0.70, 0.73, 0.73, 0.67 for SSNs (Random Forest). Except for the SSN models, the established clinical-radiomics models were superior to the Mayo model.ConclusionsPredictive models based on both clinical and radiomics features can be used to assess the malignancy of small solid and subsolid pulmonary nodules, even for nodules that are 10 mm or smaller.

Subsolid Lesions Exceeding 3 Centimeters: The Ground-Glass Opacity Component Still Matters

Recent studies on the favorable prognosis of ground-glass opacities (GGO) featured lung adenocarcinoma compared with solid nodules were limited to small tumors measuring 3.0 cm or less. This study investigated whether the GGO component could predict better prognosis in patients with large subsolid lesions exceeding 3 cm compared with small solid nodules within the same clinical T category. From 2010 to 2015, 1010 patients with completely resected clinical N0 lung adenocarcinoma were enrolled, including 860 solid lesions and 150 subsolid lesions exceeding 3 cm. To analyze the prognostic significance of the GGO component, propensity score matching adjusting the solid component size was performed. After propensity score matching, 144 pairs of patients were analyzed. The mean size of the solid component was 23.7 mm in the GGO group and 24.4 mm in the solid group (P= .450). The GGO group had significantly better overall survival (P= .011) and recurrence-free survival (P= .003), which were also validated in patients with solid-predominant lesions. Subgroup analysis showed the GGO group was associated with better prognosis in each clinical T category. The prognosis of patients with GGO lesions exceeding 3 cm was better than that of patients with small solid lesions, even within the same clinical T category. Clinical T classification incorporating the GGO component may provide better prognostic prediction for patients with lung cancer exceeding 3 cm.

The Usefulness of Contrast-Enhanced Ultrasound to Evaluate Small Solid Thyroid Nodules Compared to TI-RADS

Clinical ThyroidologyVol. 33, No. 3 Thyroid NodulesThe Usefulness of Contrast-Enhanced Ultrasound to Evaluate Small Solid Thyroid Nodules Compared to TI-RADSErivelto VolpiErivelto VolpiDepartment of Head and Neck Surgery, Oncology Center, Oswaldo Cruz German Hospital, CETRUS Medical School, São Paulo, BrazilSearch for more papers by this authorPublished Online:8 Mar 2021https://doi.org/10.1089/ct.2021;33.114-116AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 33Issue 3Mar 2021 InformationCopyright 2021 American Thyroid Association, Inc.To cite this article:Erivelto Volpi.The Usefulness of Contrast-Enhanced Ultrasound to Evaluate Small Solid Thyroid Nodules Compared to TI-RADS.Clinical Thyroidology.Mar 2021.114-116.http://doi.org/10.1089/ct.2021;33.114-116Published in Volume: 33 Issue 3: March 8, 2021PDF download

Multivariate Analysis of Solid Pulmonary Nodules Smaller than 1 cm in Distinguishing Lung Cancer from Intrapulmonary Lymph Nodes

背景与目的肺实性小结节的术前诊断及鉴别诊断十分困难。计算机断层扫描（computed tomography, CT）作为肺癌筛查的常用手段，被广泛应用于临床。本研究旨在对 < 1 cm的肺实性结节临床诊疗中肺恶性结节与肺内淋巴结患者的临床资料进行分析，为两者的鉴别提供参考。方法回顾性分析2017年6月-2020年6月行手术治疗的肺实性结节患者。共收集了145个结节（肺腺癌60个，肺类癌2个，恶性间皮瘤1个，肉瘤样癌1个，淋巴结81个）的患者临床资料，最终分为肺腺癌和肺内淋巴结两组，并对其临床资料进行了统计分析。根据单因素分析（χ2检验、t检验）结果筛选有统计学差异的变量，纳入Logistic回归多因素分析，确定预测变量并绘制受试者工作曲线（receiver operating characteristic, ROC）曲线，得到曲线下面积（area under the curve, AUC）值。结果Logistic回归分析显示结节最长径、Max CT值、分叶征和毛刺征是肺腺癌与肺内淋巴结鉴别的重要指标，风险比分别为106.645（95%CI: 3.828-2, 971.220, P < 0.01）、0.980（95%CI: 0.969-0.991, P < 0.01）、3.550（95%CI: 1.299-9.701, P=0.01）、3.618（95%CI: 1.288-10.163, P=0.02）。根据Logistic回归分析结果确定预测模型，绘制ROC曲线，计算曲线下面积AUC值=0.877（95%CI: 0.821-0.933, P < 0.01）。结论对于 < 1 cm的肺实性结节，在众多因素中，肺结节最长径、Max CT值、分叶征和毛刺征对鉴别肺恶性结节和肺内淋巴结更为重要。

The utility of a convolutional neural network (CNN) model score for cancer risk in indeterminate small solid pulmonary nodules, compared to clinical practice according to British Thoracic Society guidelines

To determine how implementation of an artificial intelligence nodule algorithm, the Lung Cancer Prediction Convolutional Neural Network (LCP-CNN), at the point of incidental nodule detection would have influenced further investigation and management using a series of threshold scores at both the benign and malignant end of the spectrum. An observational retrospective study was performed in the assessment of nodules between 5-15 mm (158 benign, 32 malignant) detected on CT scans, which were performed as part of routine practice. The LCP-CNN was applied to the baseline CT scan producing a percentage score, and subsequent imaging and management determined for each threshold group. We hypothesized that the 5% low risk threshold group requires only one follow-up, the 0.56% very low risk threshold group requires no follow-up and the 80% high risk threshold group warrants expedited intervention. The 158 benign nodules had an LCP-CNN score between 0.1 and 70.8%, median 5.5% (IQR 1.4-18.0), whilst the 32 cancer nodules had an LCP-CNN score between 10.1 and 98.7%, median 59.0% (IQR 37.1-83.9). 24/61 CT scans in the 0.56-5% group (n = 37) and 21/21 CT scans <0.56% group (n = 13) could be obviated resulting in an overall reduction of 18.6% (45/242) CT scans in the benign cohort. In the 80% group (n = 10), expedited intervention of malignant nodules could result in a 3.6-month reduction in time delay in 5 cancer patients. We show the potential of artificial intelligence to reduce the need for follow-up scans and intervention in low-scoring benign nodules, whilst potentially accelerating the investigation and treatment of high-scoring cancer nodules.

Evaluate the performance of four artificial intelligence-aided diagnostic systems in identifying and measuring four types of pulmonary nodules.

PurposeThis study aims to evaluate the performance of four artificial intelligence‐aided diagnostic systems in identifying and measuring four types of pulmonary nodules.MethodsFour types of nodules were implanted in a commercial lung phantom. The phantom was scanned with multislice spiral computed tomography, after which four systems (A, B, C, D) were used to identify the nodules and measure their volumes.ResultsThe relative volume error (RVE) of system A was the lowest for all nodules, except for small ground glass nodules (SGGNs). System C had the smallest RVE for SGGNs, −0.13 (−0.56, 0.00). In the Bland–Altman test, only systems A and C passed the consistency test, P = 0.40. In terms of precision, the miss rate (MR) of system C was 0.00% for small solid nodules (SSNs), ground glass nodules (GGNs), and solid nodules (SNs) but 4.17% for SGGNs. The comparable system D MRs for SGGNs, SSNs, and GGNs were 71.30%, 25.93%, and 47.22%, respectively, the highest among all the systems. Receiver operating characteristic curve analysis indicated that system A had the best performance in recognizing SSNs and GGNs, with areas under the curve of 0.91 and 0.68. System C had the best performance for SGGNs (AUC = 0.91).ConclusionAmong four types nodules, SGGNs are the most difficult to recognize, indicating the need to improve higher accuracy and precision of artificial systems. System A most accurately measured nodule volume. System C was most precise in recognizing all four types of nodules, especially SGGN.

Solid Component Volume as a Proxy to Identify Distinct Hemangioblastoma Populations

Posterior fossa hemangioblastomas usually consist of a small solid nodule with a large cyst, while more rarely they present as a large solid mass with a small or absent cyst, which can be surgically challenging. We sought to investigate the potential existence of multiple distinct hemangioblastoma populations using tumor volumetric data as an indicator. We conducted a retrospective review of surgically treated hemangioblastomas between 2005 and 2019 in our unit, including clinical notes, preoperative magnetic resonance imaging volumetric analysis of the solid component of the tumor, and pathology. Finite Gaussian mixture modeling was applied on the solid component volume dataset to identify potential underlying Gaussian distributions with their associated characteristics. Nonparametric Mann-Whitney U tests were used to investigate significance of differences (P < 0.05) in solid component volume and different variables (Von Hippel-Lindau disease, extent of resection, outcome). A total of 68 consecutive patients were included. Solid component volumes followed a multimodal distribution (median= 1287 mm3, interquartile range of 3428 mm3). The best-fit finite Gaussian mixture modeling model identified 3 statistically significant different (P= 0.001) potential mixture components: X1 (219 ± 187 mm3), X2 (2686 ± 1299 mm3), and X3 (10,800 ± 5514 mm3). The second-best model detected 2 significantly different (P= 9.99e-08) mixture components Y1 (222 ± 189 mm3) and Y2 (5391 ± 5094 mm3). A significant difference in solid component volume was found between patients with favorable and unfavorable outcome (P= 0.002). This study has shown preliminary evidence that large solid hemangioblastomas may constitute a completely distinct population, rather than a variant of one large group of hemangioblastomas.

Diagnostic Value of Mean Elasticity Index as a Quantitative Shear Wave Elastography Parameter for Prediction of Malignancy in Small Suspicious Solid Thyroid Nodules

To determine the diagnostic accuracy of mean elasticity index (Emean) on quantitative shear wave elastography (SWE) in detection of malignancy in small solid suspected malignant thyroid nodules on ultrasound, taking histopathology as the gold standard. Analytical study. Department of Radiology, Dow Medical College, Dow University of Health Sciences (DUHS) and Dr. Ruth K. M. Pfau Civil Hospital, Karachi from September 2017 to March 2018. Adult patients of either gender with suspected malignant thyroid nodules (solid, ≤10 mm) were subjected to SWE examination. All patients underwent thyroid surgery later. Histopathological findings were used as the gold standard for determining sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy, at a cut-off Emean of 66 kilo pascals (KPa). These values were further stratified for gender, age (below or above 40 years), single or multiple nodule(s), and known duration of nodules (more or less than 10 months). The average age of 109 women (69.43%) and 48 men (30.57%, n=157) was 37.64 ±9.44 years. The mean nodule size was 6.83 ±3.16 mm. The overall sensitivity, specificity, PPV, NPV and accuracy of the studied parameter in detection of malignancy was 81.5%, 92.3%, 68.8%, 96% and 90.5%, respectively. Diagnostic accuracy was higher for females, age over 40 years, single nodule, and known duration for longer than 10 months. Emean - a quantitative SWE parameter - showed high diagnostic accuracy in predicting thyroid malignancy, particularly in older adults with sub-cm solid nodules of more than 10 months duration. Where available, SWE should be used to complement routine thyroid ultrasonography, which may be helpful to reduce unnecessary intervention. Key Words: Mean elasticity index (Emean), Thyroid nodule, Malignancy, Shear wave elastography, Solid nodule.