Spiral CT Scan Research Articles

A diagnostic challenge presented in a 37-year-old man with severe weight loss and

[1] A 37-year-old man, Iranian resident in Zanjan, presented to the gastroenterology clinic of Taleghani Hospital; a teaching referral hospital in Tehran, Iran, with chief complaint of a significant weight loss about 20 kg in recent 4 months. He denied any concomitant systemic signs and symptoms except for a generalized malaise. He did not mention any change in bowel habit and eating pattern but a slight decrease in appetite without nausea and vomiting. He denied smoking and use of any illicit drug or alcohol. His past medical history was negative. He was admitted for further work regarding his unexplained weight loss. On admission, he was well with stable vital signs. His blood pressure was 110/70 mmHg, body temperature: 36.5 o C, heart rate: 84 bites per minute, and respiratory rate: 13 per minute all within normal limits. His physical exam was only notable for a mild epigastric and right upper quadrant (RUQ) tenderness. His laboratory tests were normal except for a normochromic normocytic anemia with a hemoglobin concentration of 12 mg/dl. Serum iron level was 37 mcg/dl with a total iron binding capacity (TIBC) level of 275 mcg/dl and a ferritin level of 10 mcg/l revealing an iron deficient erythropoiesis. Further laboratory tests evaluating tumor markers, thyroid function tests, liver function tests, serum bilirubin level, urine analysis and stool examination were all normal. We decided to proceed with an upper gastrointestinal endoscopy and colonoscopy in the next step of the management of the patient with significant weight loss. Total colonoscopy was unremarkable and esophagogastroduodenoscopy demonstrated a sessile polyp in antrum pathologically consistent with hyperplastic polyp. His spiral chest CT scan was normal but an abdominopelvic CT scan revealed dilation of intrahepatic ducts disseminated all over the liver prominently in the periphery of the right hepatic lobe. Periductal parenchyma was enhanced in some parts indicative of infective or neoplastic processes. Scattered celiac and mesentric lymph nodes with maximum diameter of 6 mm were also detected (figure 1). To have a better visualization of extrahepatic ducts besides intrahepatic ducts, an endoscopic ultrasound (EUS) was performed. As reflected in figure-2, findings of EUS were unremarkable except for 3 hypoechoic and round hilar lymph nodes with the largest diameter of 21mm, most probably indicative of reactive lymph nodes. This patient’s signs and symptoms continued to remain stable, so he was discharged and was advised to follow other diagnostic modalities in the outpatient clinic. Some months later, he referred to the gastroenterology clinic with similar complaints of inability to weight gain and anorexia. Given the previous history of intrahepatic duct dilation, an MRCP was demanded which revealed heterogeneity of the liver parenchyma due to multiple masses or microabscesses in the liver. Laboratory results were negative for infectious, helminthic and parasitic disorders for this kind of liver involvement, and imaging reports were unable to rule out a neoplastic process and give a definite diagnosis. This made us proceed with a liver biopsy. What is your diagnosis? What is the next step? Received: 24 September 2020 Accepted: 8 December 2020 Reprint or Correspondence: Saeed Abdi, MD. Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: saeedabdi75@yahoo.com ORCID ID: 0000-0002-2375-3748

The height and type of the main septum in the sphenoid sinuses - evaluation before the fess.

The purpose of this study was to examine the height of the main septum (MS) in the sphenoid sinuses and its type, depending on the percentage prevalence of its tissue composition (osseous and membranous) in the adult population. Materials and Methods: A retrospective analysis of 296 computed tomography (CT) scans (147 females, 149 males) of the paranasal sinuses was conducted. The patients did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were carried out with a spiral CT scanner (Siemens Somatom Sensation 16) in a standard procedure, in the option Siemens CARE Dose 4D. No contrast medium was used. Having obtained the transversal planes, a secondary reconstruction tool (multiplans reconstruction - MPR) was used in furtherance of gleaning sagittal and frontal planes. R e s u l t s: In all cases, the height of the MS was measured by using a straight line running parallel to the course of the septum (when the MS was regarded as straight) or curved (when the MS was regarded as irregularly shaped). The average height of the MS was 2.1 ± 0.41 cm in the whole research group. Completely osseous MS was found in 32.77% of the patients. In 63.85% of them, the MS was partially membranous. The rarest was the MS which was not even partially ossified - a membranous type, that was observed in 3.38% of the patients. C o n c l u s i o n s: Variant anatomy of the paranasal sinuses may lead to complications encountered during a surgery, hence a CT scan is advised before the planned treatment.

English

BACKGROUND Road traffic accidents are the most common cause of thoracic and abdominal trauma. The role of point of care ultrasound especially in developing countries is gaining evidence in management of acutely ill. We wanted to test the reliability of Fast and E-Fast in blunt abdominal and thoracic trauma cases and evaluate their role in the management of RTAs. METHODS A cross sectional study was conducted over a 12-month period among patients presenting at Emergency Medicine Department at Government Medical College, Kannur (then known as Academy of Medical Sciences, Pariyaram). After clinical examination and recording details, fast and E-Fast was done in the emergency department by emergency physicians trained in ATLS using a standard curvilinear probe of 2 - 5 MHz using Sonosite M-Turbo portable ultrasound machine (Fujifilm Sonosite) and compared with the gold standard CT. The CT used was 16 slice Spiral CT scan machine by GE Healthcare (Chicago, Illinois, United States). Results on continuous measurements presented on mean + SD (min-max) and results on categorical measurements were presented in numbers (%). Sensitivity and specificity were computed for analysis. RESULTS The overall sensitivity of Fast is 72.8 % and the specificity is 92 %. The overall sensitivity and specificity of E-Fast are 87 % and 92.3 % respectively. The reliability of point of care ultrasound as a screening tool to triage patients with blunt abdominal and thoracic trauma is 100 %. CONCLUSIONS Fast and E-Fast are quite reliable as screening tools in the management of acutely ill blunt trauma abdomen and chest patients. KEYWORDS Point of Care, Ultrasound, Blunt Trauma, Sensitivity, Fast, E-Fast

Use of computed tomography to assess subcutaneous drug dispersion with recombinant human hyaluronidase PH20 in a swine model

IntroductionSubcutaneous (SC) formulations of therapeutics with recombinant human hyaluronidase PH20 (rHuPH20) are currently approved across various disease indications. The rHuPH20-mediated enzymatic degradation of SC hyaluronan (HA) facilitates bulk fluid flow and dispersion of co-administered therapeutics. However, current methods of quantifying dispersion in the SC space are limited. Here, a novel method is outlined to quantify and follow rapid SC volumetric dispersion of a representative therapeutic fluid in the presence of rHuPH20 using computed tomography (CT). MethodsTen Yucatan miniature swine were randomized to three groups. Animals received simultaneous infusions of contrast agent (CA) alone (left side of the animal) or in combination with rHuPH20 (right side) at infusion rates of 2.5, 5, or 10 mL/min. Spiral CT scans (1.5 mm thickness) were conducted before and after the infusion and at regular time intervals throughout. Scans were used to create three-dimensional (3D) reconstructions of the fluid pockets and analyze surface area, volume, and sphericity. Results3D reconstruction showed increased dispersion of CA with rHuPH20 compared with CA alone, with fenestration and increased dispersion in the craniocaudal and lateromedial directions. The CA with rHuPH20 fluid pockets showed an average increase of 46% in surface area (p = 0.001), a 35% increase in volume (p = 0.001) and a 17% decrease in sphericity post-infusion compared with CA alone at 30 min post-infusion. DiscussionThis exploratory study confirms the value of CT imaging as a non-invasive method of assessing real-time spatial and temporal behavior of SC-administered fluids. This technique could help to assess the dispersion pattern of novel rHuPH20 SC co-formulations.

Airflow of the Two-Port Velopharyngeal Closure: Study Using Computational Fluid Dynamics.

Posterior pharyngeal flap palatoplasty is used to restore the function of velopharyngeal (VP) closure, after which 2 ports remain between the nasal and oral cavity. The authors hypothesized that the airflow dynamics of the upper airway is different in PPF patients compared to health subjects, who only has 1 movable port. Twenty adults who have multislice spiral computed tomography scan were included in this study. Two cylinders (radius, 2.00 mm; height, 4.5 mm) were used to recapitulate the 2-port VP structure after PPF palatoplasty. The areas of ports were modified by changing the radius of 2 cylinders. Real-time computational fluid dynamics simulation was used to capture the airflow velocity and pressures through the 2 ports. The airflow velocity and pressure of upper airway were recorded as the total areas of 2 VP ports increased. The total orifice areas of the 2-port VP closure for 4 VP conditions, including adequate closure, adequate/borderline closure, borderline/inadequate closure, and inadequate closure, were demonstrated. Significant differences between the 2-port VP function for demonstrating PPF reconstruction and the 1-port VP function were found. Airflow dynamics is dependent on the VP structure. The 2-port airflow model for mimicking VP closure after PPF palatoplasty demonstrated airflow characteristics that were significantly different from the 1-port model in normal VP closure.

Chest Computed Tomography findings in patients with corona virus disease 2019 (COVID-19): An initial experience in three centres in Ghana, West Africa

BackgroundRadiological examinations have a significant role in the diagnosis and management of Coronavirus disease 2019 (COVID-19), the disease caused by the novel coronavirus SARS-CoV-2. Many COVID-19 patients show typical Chest Computed Tomography (CT Scan) features which can aid in the diagnoses and triaging of such patients. This is especially so in resource-limited settings where access to molecular diagnostic techniques such as Reverse Transcription Polymerase Chain Reaction (RT-PCR) is not optimal. We report chest CT findings in 28 patients diagnosed with COVID-19 in Ghana. ObjectiveTo document common chest CT scan findings amongst patients with COVID-19 infection in Ghana. MethodChest CT scans of twenty-eight COVID-19 patients (n = 28) were retrieved and reviewed independently by two experienced radiologists and their findings documented. Two 64 and one 32 slice spiral CT scanners were used at three centres. ResultsChest CT Images from 16 males (57.1.7%) and 12 females (42.9%) patients aged between 36 and 65 years with mean age of 55.9 years (SD-8.4years) were evaluated. Of these, 21 (75.0%) of them were COVID-19 patients who were undiagnosed at the time of imaging while 7 (25.0%) were known confirmed COVID-19 patients. On the chest CT scans (n = 28), 17 (66.7%) patients showed predominantly ground glass opacities while 12 (42.9%) had evidence of consolidation predominantly. In 26 (92.9%) of the patients, the opacities were bilateral and peripheral in distribution. None of these patients had pleural effusion. ConclusionCOVID-19 patients tend to manifest typical imaging features on chest CT scan. The most common chest imaging finding was bilateral, peripheral and predominantly basal ground glass opacities. Importantly, these findings were frequently obtained before PCR diagnosis. Chest CT scan can help in the diagnosis and triaging of suspected or confirmed COVID-19 patients in jurisdictions with limited PCR diagnostic capacity and can improve early isolation, contact tracing and treatment thus helping to reduce community spread, morbidity and mortality.

Assigning computed tomography involvement score in COVID-19 patients: prognosis prediction and impact on management.

Objective:Chest CT can provide a simple quantitative assessment of the extent of the parenchymal opacities in COVID-19 patients. In this study, we postulate that CT findings can be used to ascertain the overall disease burden and predict the clinical outcome.Methods:In this prospective study undertaken from March 28, 2020, until May 20, 2020, 142 patients with CT features suggestive of viral pneumonia, and positive RT-PCR for COVID-19 were enrolled. A dedicated spiral CT scanner was used for all COVID-19 suspects. CT features were reported as typical, indeterminate, or atypical for COVID-19 pneumonia. A CT involvement score (CT-IS) was given to each scan and assigned mild, moderate, or severe category depending on the score range. The patients were followed up for at least 15 days.Results:Ground glass opacity was present in 100% of the patients. There was a significant association between CT-IS and the final outcome of the patients. A statistically significant increasing trend of mortality and requirement of critical medical attention was observed with the rising value of CT-IS in COVID-19.Conclusion:The severe CT-IS score group has a high mortality. The CT-IS score could be valuable in predicting clinical outcome and could also be useful in triage of patients needing hospital admission. In situations where healthcare resources are limited, and patient load high, a more careful approach for patients with higher CT-IS scores could be indispensable.Advances in knowledge:CT-IS is a simple quantitative method for assessing the disease burden of COVID-19 cases. It can be invaluable in places with limited resources and high patient load to segregate patients requiring critical medical attention.

The Role of Spiral CT Pulmonary Angiography in the Diagnosis of Postoperative Complications in Patients with Acute Pulmonary Embolism

The purpose is to explore the effect of iterative model reconstruction (IMR) algorithm on improving quality of spiral computed tomography angiography (SCTA) image and its clinical application in the diagnosis of acute pulmonary embolism (PE) complications. 88 patients with acute PE who visited Chongqing Zhongxian People’s Hospital hospital from October 2017 to October 2019 were selected as the study objects, and their CT values, standard deviation (SD) value of background noise, CT volume dose index, and dose length product of pulmonary artery trunk and the erector spines of the spinal column were measured by spiral CT scanning at the tube voltage of 80 kv and 100 kv, respectively. As for image reconstruction, IMR, IDose4 algorithm in hybrid iterative reconstruction (HIR) and Filtering back-projection (FBP) were utilized. By comparing signal-noise ratio (SNR), contrast-noise ratio (CNR) and figure of merit (FOM), the image quality, radiation dose, sensitivity and specificity of different reconstruction algorithms in diagnosis of acute PE were analyzed. The results showed that the background noise of the IMR reconstruction algorithm was lower than that of IDose4 and FBP, and the difference was statistically significant (P < 0.05). The CT value of IMR reconstruction algorithm was significantly higher than that of IDose4 and FBP reconstruction algorithm, and the difference was not statistically significant (P > 0.05). The SNR and CNR of IMR were significantly higher than those of IDose4 and FBP, and the difference was statistically significant (P < 0.05). The FOM values of IMR were significantly higher than those of IDose4 and FBP, and the differences were statistically significant (P < 0.05). CT volume dose index, dose length product, and effective dose of the 80 kv tube voltage group were all lower than that of the 100 kv tube voltage group, accounting for 49.34%, 50.50%, and 52.53% of the 100 kv tube voltage group. And the FOM of 80 kv tube voltage group was higher than that of 100 kv tube voltage group. The sensitivity and specificity of IMR reconstructed images in diagnosis of acute PE complications were higher than those of reconstructed images of IDose4 and FBP, which were 97.67% and 92.0%, respectively. Therefore, the improved SCTA information technology based on the IMR algorithm has better image quality than the IDose4 and FBP reconstruction algorithms, and the image quality index of low-dose scan (80 kv) of the improved SCTA information technology based on the IMR algorithm is higher than that of normal-dose scan (100 kv).

Computed tomography (CT)-guided percutaneous coaxial biopsy combined with microwave ablation for the treatment of renal masses

Purpose This study aimed to investigate the feasibility, safety, and efficacy of computed tomography (CT)-guided percutaneous coaxial biopsy combined with microwave ablation (MWA) for the treatment of renal masses. Material and methods The clinical data of ten patients (14 tumors) treated with CT-guided percutaneous coaxial biopsy combined with MWA from January 2017 to November 2019 were retrospectively analyzed. The patients were followed up for 2–33 months. The outcomes were evaluated with plain and contrast spiral CT scans. Renal function was assessed using the estimated glomerular filtration rate. Results No severe MWA-related complication was observed. All the tumors were successfully ablated. There was no imaging evidence of local residual tumor, local tumor recurrence, or disease progression during the follow-up period. Conclusions CT-guided percutaneous coaxial biopsy combined with MWA might be an effective option for the diagnosis and treatment of renal masses in selected patients.

Impact of epicardial fat on the duration of radiofrequency energy delivery during catheter ablation of atrial fibrillation

AimsThis study aimed to determine the impact of the volume of epicardial fat on the duration of radiofrequency (RF) energy delivery during the procedure of ablation of atrial fibrillation (AF). MethodsThe volume of epicardial fat was measured from spiral computerized tomography scan. The primary endpoint was the duration of RF delivery for pulmonary vein isolation (PVI), and the overall total duration of RF application. Secondary endpoint was conversion of AF to sinus rhythm or organisation of the arrhythmia after PVI. ResultsFrom March 2015 to May 2018, 222 patients (45.5% with persistent AF) underwent a first RF catheter ablation procedure for AF. The total duration of RF delivery, and the duration of RF delivery specifically for PVI were significantly associated with higher total volume of epicardial fat (p = 0.0002; p = 0.009 respectively), periatrial (p = 0.003; p = 0.045) and periventricular epicardial fat (p = 0.001; p = 0.012). In multivariate analysis, total epicardial fat volume was not significantly associated with total RF delivery duration (p = 0.743). For patients with arrhythmia at the time of the procedure, patients who achieved conversion or organisation of their arrhythmia after PVI had similar levels of total epicardial fat to those whose arrhythmia persisted (65 ± 35.2 vs 74.5 ± 31.2 ml; p = 0.192). ConclusionWe observed a significant relation between total, periatrial, and periventricular epicardial fat, and the duration of RF delivery during ablation of AF. This relation was not significant by multivariate analysis meaning that epicardial fat may be a marker, but not an independent factor, of ablation complexity.

The influence of the SARS-CoV-2 pandemic on esophagogastric cancer services: an international survey of esophagogastric surgeons.

BackgroundSeveral guidelines to guide clinical practice among esophagogastric surgeons during the COVID-19 pandemic were produced. However, none provide reflection of current service provision. This international survey aimed to clarify the changes observed in esophageal and gastric cancer management and surgery during the COVID-19 pandemic.MethodsAn online survey covering key areas for esophagogastric cancer services, including staging investigations and oncological and surgical therapy before and during (at two separate time-points—24th March 2020 and 18th April 2020) the COVID-19 pandemic were developed.ResultsA total of 234 respondents from 225 centers and 49 countries spanning six continents completed the first round of the online survey, of which 79% (n = 184) completed round 2. There was variation in the availability of staging investigations ranging from 26.5% for endoscopic ultrasound to 62.8% for spiral computed tomography scan. Definitive chemoradiotherapy was offered in 14.8% (adenocarcinoma) and 47.0% (squamous cell carcinoma) of respondents and significantly increased by almost three-fold and two-fold, respectively, in both round 1 and 2. There were uncertainty and heterogeneity surrounding prioritization of patients undergoing cancer resections. Of the surgeons symptomatic with COVID-19, only 40.2% (33/82) had routine access to COVID-19 polymerase chain reaction testing for staff. Of those who had testing available (n = 33), only 12.1% (4/33) had tested positive.ConclusionsThese data highlight management challenges and several practice variations in caring for patients with esophagogastric cancers. Therefore, there is a need for clear consistent guidelines to be in place in the event of a further pandemic to ensure a standardized level of oncological care for patients with esophagogastric cancers.

Frontline brentuximab vedotin in Hodgkin lymphoma and CD30-expressing peripheral T-cell lymphoma for older patients and those with comorbidities.

TPS8069 Background: Older patients and those with significant comorbidities have not attained outcomes seen in younger patients with classical Hodgkin lymphoma (cHL) and CD30-expressing peripheral T-cell lymphoma (PTCL). Five-year progression-free survival (PFS) was 30%–45% in older HL patients treated with combination chemotherapy versus 75%–80% in younger patients (Evens 2008; Proctor 2009). Similarly, when adjusted for age, a Charleston Comorbidity Index ≥2 was independently associated with worse overall survival (HR=1.63) and PFS (HR=1.54) (Ellin 2018). Brentuximab vedotin (BV, ADCETRIS), a CD30-directed antibody-drug conjugate, has robust activity in cHL patients refractory to several lines of chemotherapy. BV monotherapy in 27 cHL patients aged ≥60 years had a 92% objective response rate (ORR) and 73% achieved complete remission (Forero-Torres, 2015). BV was also active and well-tolerated in CD30-expressing PTCL patients with relapsed or refractory disease (Horwitz 2014). Frontline BV monotherapy may have the potential to be an active and well-tolerated treatment for cHL and PTCL patients who are older or have significant comorbidities, which are populations with high unmet need. Methods: This phase II, open-label study, SGN35-015 (NCT01716806), has added 2 cohorts to evaluate the efficacy and tolerability of BV monotherapy in treatment naive patients with cHL, (Part E), or CD30-expressing PTCL (Part F, n~50 each) who are unsuitable for conventional combination therapy due to comorbidity-related factors as determined by a Cumulative Illness Rating Scale (CIRS) score ≥10 or dependence on others for any instrumental activities of daily living. Eligible patients must also have an Eastern Cooperative Oncology Group (ECOG) performance status ≤3 and measurable disease ≥1.5 cm per radiographic techniques. BV (1.8 mg/kg) will be administered as a single intravenous infusion on day 1 of each 2-day cycle. Patients achieving a complete remission, partial remission, or stable disease will receive up to 16 cycles of treatment. Response will be assessed by blinded independent central review of spiral CT and PET scans at Cycles 2, 6, 11, and at end of treatment to be graded per Lugano 2014. The primary objective of these cohorts is to assess ORR of frontline therapy with single-agent BV in patients who have significant comorbidities. Clinical trial information: NCT01716806 .

A study to assess the role of contrast-enhanced multiphasic, multidetector computed tomography in the evaluation of renal lesions

Aim: To assess the role of Contrast-Enhanced Multiphasic Multidetector Computed Tomography in the evaluation of renal lesions and its potential role in differentiating benign from malignant lesions. Material and Method: This prospective study was done in the Department of Radiodiagnosis Chirayu Medical College and Hospital Bhopal. A total of 100 patients to our department with strong clinical suspicion of renal lesions and those diagnosed by ultrasonography underwent Contrast-Enhanced Multiphasic Multidetector Computed Tomographic evaluation of abdomen using 64 Multislice Spiral CT scanner from August 2015 to July 2019. Results: The majority of patients presenting with renal lesions were each of the age groups 40 years. Most of the patients were males 57%. The most common clinical complaint was renal colic 58(46%) and hematuria. The most common pathology was calculus 35(35%) second most common pathology was congenital anomalies 23(23%). The CT accuracy for detection of benign cystic lesion in this study was 94.7%, benign lesions were 92.6%and for malignant lesions was 86.6% in the present study. Conclusion: The accuracy of Contrast-Enhanced Multiphasic Multidetector Computed Tomography in detecting and characterizing renal lesions is high and it should be considered in the imaging workup of any patient with a renal complaint

Intelligent 4D CT sequence scanning (i4DCT): First scanner prototype implementation and phantom measurements of automated breathing signal-guided 4D CT.

Four-dimensional (4D) computed tomography (CT) imaging is an essential part of current 4D radiotherapy treatment planning workflows, but clinical 4D CT images are often affected by artifacts. The artifacts are mainly caused by breathing irregularity during data acquisition, which leads to projection data coverage issues for currently available commercial 4D CT protocols. It was proposed to improve projection data coverage by online respiratory signal analysis and signal-guided CT tube control, but related work was always theoretical and presented as pure in silico studies. The present work demonstrates a first CT prototype implementation along with respective phantom measurements for the recently introduced intelligent 4D CT (i4DCT) sequence scanning concept (https://doi.org/10.1002/mp.13632). Intelligent 4D CT was implemented on the Siemens SOMATOM go platform. Four-dimensional CT measurements were performed using the CIRS motion phantom. Motion curves were programmed to systematically vary from regular to very irregular, covering typical irregular patterns that are known to result in image artifacts using standard 4D CT imaging protocols. Corresponding measurements were performed using i4DCT and routine spiral 4D CT with similar imaging parameters (e.g., mAs setting and gantry rotation time, retrospective ten-phase reconstruction) to allow for a direct comparison of the image data. Following technological implementation of i4DCT on the clinical CT scanner platform, 4D CT motion artifacts were significantly reduced for all investigated levels of breathing irregularity when compared to routine spiral 4D CT scanning. The present study confirms feasibility of fully automated respiratory signal-guided 4D CT scanning by means of a first implementation of i4DCT on a CT scanner. The measurements thereby support the conclusions of respective in silico studies and demonstrate that respiratory signal-guided 4D CT (here: i4DCT) is ready for integration into clinical CT scanners.

The use of three-dimensional model construction of virtual technology in orthopedic treatment.

ObjectiveThe objective of this study is to explore the construction of a digital three-dimensional model of virtual technology that plays an auxiliary role in orthopedic treatment.MethodsThree fracture patients were selected, with no abnormality was observed in bone examination, no musculoskeletal disease in the past; and spiral CT scan of the spine and pelvis, upper limbs, and lower limbs was performed. The virtual technology was used to build a digital 3D model, mainly using the editing software Mimics10.0 software. In addition, the virtual three-dimensional model was verified by virtual surgery, data storage security, work efficiency of the model, model validity, three-dimensional characteristics of the model, the interaction mode of the model, and the data accuracy of the model were studied.ResultsThe digital 3D model was successfully established by Mimics10.0 software. The data fitting efficiency was very high. The data storage security of the 3D model was greatly improved compared with the 2D model, and the work efficiency was improved by at least 50%. There was also a significant change in the accuracy and interaction of data acquisition. Therefore, the detection of digital 3D model work through virtual surgery simulation fully demonstrated the positive auxiliary role of 3D model in orthopedic treatment.ConclusionThe digital 3D model based on Mimics10.0 software is efficient and accurate in obtaining data. It is very effective for subsequent adjuvant therapy in the field of orthopedics, reducing the probability of misdiagnosis by doctors, saving time and improving efficiency, reducing patient's physical pain and unnecessary economic expenses.

Amiodarone‐Induced Neuropathy with chronic inflammatory demyelinating polyneuropathy‐like presentation

AbstractLong‐term administration of amiodarone may have various neurological complications and systemic involvement. Herein, we report a 46‐year‐old male patient who was admitted as a result of paresthesia and progressive four‐limb weakness started six months before. Spiral chest CT scan showed bilateral hyper‐dense consolidations predominately seen in peripheral and lower lobes. We checked the serum level of amiodarone that was 3.1 mg/L (therapeutic range: 1.5 and 2.5 µg/mL). According to the characteristic pulmonary findings in lung CT scan, demyelinating polyneuropathy, and lack of response to treatment, with the suspicion of amiodarone toxicity, CT‐guided percutaneous core needle biopsy was performed. The pathological assessment revealed chronic interstitial inflammation and fibrosis, and exudation of macrophages with finely cytoplasmic vacuolization associated with hyperplasia of type II pneumocytes in alveoli with necrosis. These findings are consistent with amiodarone‐induced pulmonary toxicity. Chronic use of amiodarone may present as a CIDP‐like presentation, which may be overlooked if clinical suspicion is not high upon presentation.

Langerhans cell histiocytosis (LCH) presenting as pneumothorax and neck lymphadenopathy

Langerhans Cell Histiocytosis (LCH) is a rare clonal disease characterized by dendritic cells infiltration in various main organs. We report a 6-month-old infant with severe respiratory distress, cervical lymphadenopathy, and reddish skin rashes on face. Diagnostic work up revealed spontaneous pneumothorax on Chest X-ray (CXR). Multiple thin-walled lung cysts and emphysema was discovered on spiral chest CT scan. Lung tissue and cervical lymph node biopsy revealed dendritic cells infiltration. Broncho alveolar lavage (BAL), cervical lymph node and lung tissue biopsy was performed and histopathology was assessed. It was suggestive of LCH with positive immunohistochemistry markers including CD1a, CD68 and S100.

Experimental study on the effect of adaptive statistical iterative reconstruction algorithms on image quality and radiation dose in paranasal sinus CT

Objective To explore the effect of pre- and post-adaptive statistical iterative reconstruction-Veo (ASiR-V) on image quality and radiation dose in paranasal sinus CT, and to find the best combinations. Methods One head specimen was scanned with the routine spiral CT scanning parameters [noise index (NI)=8] and different levels of pre-ASiR-V (0—100%, with an interval of 10%). The images were reconstructed with different post-ASiR-V (0—100%, with an interval of 10%) for the bone algorithm and standard algorithm. All of 242 thin-layer images of paranasal sinuses were obtained. The region of interest (ROI) was selected to measure the CT value to calculate the contrast to noise ratio (CNR) and figure of merit (FOM). The volume CT dose index (CTDIvol) and Smart mA were recorded. The linear regression was conducted to analyze the relationship between CTDIvol, SmartmA, CNR and FOM. And with the same pose-ASiR-V level, the CNR of images which reconstructed by bone and soft algorithms were compared with pair-wise t test. The image quality was subjectively evaluated by three independent experienced radiologists using a 4-point scale (4 was the best). Results As the pre-ASiR-V levels (0—100%) increased, Smart mA and CTDIvol were reduced with a linear negative correlation (r=-0.981, -0.976, both P<0.001). The Smart mA decreased by 72.05% and CTDIvol by 71.22%. Keeping the same pre-ASiR-V level,the CNR increased with the increase of post-ASiR-V level (for the bone algorithm images:R2=0.976, 0.992, 0.982, 0.982, 0.975, 0.975, 0.979, 0.996, 0.952, 0.978, 0.965;for the standard algorithm images: R2=0.944, 0.990, 0.988, 0.993, 0.996, 0.987, 0.984, 0.996, 0.996, 0.990, 0.965).Under the same level of post-ASiR-V, the CNR and FOM fluctuated with the pre-ASiR-V level (for the bone algorithm images:R2=0.335, 0.341, 0.344, 0.364, 0.385, 0.405, 0.418, 0.429, 0.455, 0.474, 0.516; for the standard algorithm images: R2=0.223, 0.278, 0.327, 0.285, 0.309, 0.329, 0.325, 0.346, 0.360, 0.390, 0.380). All subjective image quality could meet the diagnostic requirements (the score≥3). Conclusion At NI=8, for the bone algorithm, the best combination is 80% pre-ASiR-V and 100% post-ASiR-V; for the standard algorithm, the best iteration combination is 100% and 100%. The appropriate choice of pre- and post-ASiR-V levels in paranasal sinus CT scan can effectively reduce the radiation dose under the premise of maintaining the image quality that meets the diagnostic needs. Key words: Paranasal sinuses; Tomography, X-ray computed; Radiation dosage; Image processing, computer-assisted; Image quality

Application of Computed Tomography Scan Combined with Electrocardiographic Gating in Hypertensive Patients with Brain and Nerve Diseases

In this paper, 64-slice spiral computed tomography (CT) retrospective electrocardiographic (ECG) gating technology was used to perform coronary CT angiography scans. The aorta and aortic pulmonary artery diameter were measured quantitatively in healthy people and patients with hypertension and cerebrovascular disease. Corresponding aortic pulmonary artery ratios were obtained through calculation, and the changes of aortic diameter, aortic pulmonary artery ratio, and aortic diameter difference between different cardiac phases, ages, sexes, and levels of hypertension were discussed. Through research, it can be concluded that 64-row spiral CT scan combined with ECG gating technology can accurately measure the dynamic changes of the aortic diameter with the cardiac cycle. At the same time, the aortic diameter measured by multidetector CT scan combined with ECG gating technology and the phase difference between different phases can objectively reflect the degree of arterial damage in patients with hypertension; therefore, early screening of aortic diseases in patients with hypertension can be performed. Diagnosis to detect abnormalities as early as possible and start treatment as early as possible to prevent the disease from progressing and even affecting other tissues and organs can also be obtained.

A clinical performance study of modified CT angiography in detecting bronchial artery-pulmonary artery fistula

Objective: To evaluate the clinical value of modified computed tomography angiography(CTA) in detecting bronchial artery-pulmonary artery fistula(BPF). Methods: Retrospective analysis was performed on 246 patients with hemoptysis admitted to the First Affiliated Hospital of Wenzhou Medical University from July 2017 to December 2018, who underwent modified CTA and DSA examination at the same time. CT was performed with Toshiba Aquilion one 320 row 640-slice spiral CT scanner. All modified CTA images were read blindly by two radiologists above the attending doctors. The sensitivity, specificity and accuracy of the modified CTA in diagnosing BPF were calculated with the DSA results as the reference,and the consistency of the two tests was analyzed. Results: DSA detected 186 cases of positive and 60 cases of negative, modified CTA detected 160 cases of positive and 86 cases of negative. The sensitivity,specificity and accuracy of modified CTA for BPF diagnosis was 85.5%(159/186),98.3%(59/60), 88.6%(218/246) respectively, and they were with high consistency with DSA examination results (kappa=0.73,P<0.01). Conclusion: Modified CTA has high diagnostic specificity for BPF,which can be used as the preferred method for non-invasive screening of suspected BPF patients.