Publications by authors named "Fa-Jin Lv"

38 Publications

A quantitative MRI investigation of the association between iliotibial band syndrome and patellofemoral malalignment.

Quant Imaging Med Surg 2021 Jul;11(7):3209-3218

Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Background: The iliotibial band (ITB) has a wide patellar insertion that provides lateral restraint to the patella and maintains the patellofemoral joint's stability. There has been limited investigation into the relationship between patellofemoral malalignment and iliotibial band syndrome (ITBS).

Methods: We retrospectively analyzed 47 knees with ITBS by retrieving magnetic resonance imaging (MRI) data collected over an approximately 6-year period from our database. The Insall-Salvati ratio, lateral patellofemoral angle (LPA), lateral patellar tilt (LPT), lateral trochlear length (LTL), angle of the non-weight-bearing facet of the lateral femoral condyle (nwb-LFCA), and the ITB-lateral femoral condyle (IT-LFC) distance were measured on MR images. The knees of 47 age- and gender-matched subjects were enrolled as the normal group.

Results: In the ITBS group, over one third (34%, 16/47) of knees had abnormal patellofemoral measurements, including 8 (17%, 8/47) knees with patellar alta, 11 (23.4%, 11/47) knees with an abnormally decreased LPA, and 5 (10.6%, 5/47) knees with an abnormally increased LPT indicating lateral patellar tilt. Moreover, 8 knees had simultaneous combinations of two or three abnormality parameters, and 8 (17%, 8/47) knees presented with superolateral Hoffa's fat pad edema. The Insall-Salvati ratio, LPT, and nwb-LFCA in the ITBS group were significantly higher than those in the normal group (P=0.001, P<0.001, and P<0.001, respectively); the LPA and IT-LFC distances in the ITBS group were significantly lower (P=0.003, P<0.001, respectively) than those in the normal group. There were mild to moderate correlations between the MRI parameters and ITBS (P=0.006, P<0.001, respectively).

Conclusions: This study confirmed that a higher position or lateral tilt of the patella and a steeper morphology of the anterior part of the lateral femoral condyle were associated with the development of ITBS, which is helpful in understanding and further exploring the mechanism of ITBS.
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http://dx.doi.org/10.21037/qims-20-1101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250009PMC
July 2021

Features for Predicting Absorbable Pulmonary Solid Nodules as Depicted on Thin-Section Computed Tomography.

J Inflamm Res 2021 2;14:2933-2939. Epub 2021 Jul 2.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.

Purpose: To investigate the clinical and computed tomography (CT) characteristics of absorbable pulmonary solid nodules (PSNs) and to clarify CT features for distinguishing absorbable PSNs from malignant ones.

Materials And Methods: From January 2015 to February 2021, a total of 316 patients with 348 PSNs (171 absorbable and 177 size-matched malignant) were retrospectively enrolled. Their clinical and CT data were analyzed and compared to determine CT features for predicting absorbable PSNs.

Results: Between absorbable and malignant PSNs, there were significant differences in patients' age, lesions' locations, shapes, homogeneity, borders, distance from the pleura, vacuoles, air bronchograms, lobulation, spiculation, halo sign, multiple concomitant nodules and pleural indentation (each < 0.05). Multivariate analysis revealed that the independent predictors of absorbable PSNs were the following: patient age ≤55 years (OR, 2.660; 95% CI, 1.432-4.942; = 0.002), homogeneous density (OR, 2.487; 95% CI, 1.107-5.590; = 0.027), ill-defined border (OR, 5.445; 95% CI, 1.661-17.846; = 0.005), halo sign (OR, 3.135; 95% CI, 1.154-8.513; = 0.025), multiple concomitant nodules (OR, 8.700; 95% CI, 4.401-17.197; <0.001), and abutting pleura (OR, 3.759; 95% CI, 1.407-10.044; = 0.008). The indicators for malignant PSNs were the following: lobulation (OR, 3.904; 95% CI, 1.956-7.791; <0.001), spiculation (OR, 4.980; 95% CI, 2.202-11.266, <0.001), and pleural indentation (OR, 4.514; 95% CI, 1.223-16.666; = 0.024).

Conclusion: In patients younger than 55 years, PSNs with homogeneous density, ill-defined border, halo sign, multiple concomitant nodules, and abutting pleura should be highly suspected as absorbable ones.
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http://dx.doi.org/10.2147/JIR.S318125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259943PMC
July 2021

Solitary Pulmonary Inflammatory Nodule: CT Features and Pathological Findings.

J Inflamm Res 2021 25;14:2741-2751. Epub 2021 Jun 25.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.

Purpose: Solitary pulmonary inflammatory nodules (SPINs) are frequently misdiagnosed as malignancy. We aimed to investigate CT features and pathological findings of SPINs for improving diagnosis strategies.

Patients And Methods: In this retrospective study, 225 and 310 consecutive patients with confirmed SPINs and lung cancerous nodules were enrolled from January 2013 to December 2020. Nodules were classified into different types based on the key CT features: I, homogeneous and well-defined nodules with smooth (Ia), coarse (Ib), or spiculated margins (Ic); II, nodules with blurred boundaries, peripheral patches, or both; III, nodules exhibiting heterogeneous density; and IV, polygonal nodules. The pathological findings of SPINs were simultaneously studied and summarized.

Results: Among the 225 SPINs, type I (Ia, Ib, and Ic), II, III, and IV were 137 (60.9%) (47 [20.9%], 33 [14.7%], and 57 [25.3%]), 62 (27.6%), 12 (5.3%) and 14 (6.2%), respectively. Correspondingly, those in 310 cancerous nodules were 275 (88.7%) (119 [38.4%], 70 [22.6%], and 86 [27.7%]), 20 (6.5%), 15 (4.8%), and 0, respectively. Compared with lung cancers, type I nodules were less common but type II and IV nodules were more common in SPINs (each < 0.0001). Though the frequencies of subtype I ( = 0.095) and type III ( = 0.796) nodules were similar between two groups, their specific CT features were significantly different. The main pathological findings of each type of SPINs were most extensively identical (82.2 - 100%).

Conclusion: Between cancerous nodules and SPINs, differences in overall or specific CT features exist. The type II and IV nodules are highly indicative of SPINs, and each type of SPINs have almost similar pathological findings.
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http://dx.doi.org/10.2147/JIR.S304431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242128PMC
June 2021

Significance of intra-nodular vessel sign in differentiating benign and malignant pulmonary ground-glass nodules.

Insights Imaging 2021 May 26;12(1):65. Epub 2021 May 26.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.

Background: The presence of pulmonary vessels inside ground-glass nodules (GGNs) of different nature is a very common occurrence. This study aimed to reveal the significance of pulmonary vessels displayed in GGNs in their diagnosis and differential diagnosis.

Results: A total of 149 malignant and 130 benign GGNs confirmed by postoperative pathological examination were retrospectively enrolled in this study. There were significant differences in size, shape, nodule-lung interface, pleural traction, lobulation, and spiculation (each p < 0.05) between benign and malignant GGNs. Compared with benign GGNs, intra-nodular vessels were more common in malignant GGNs (67.79% vs. 54.62%, p = 0.024), while the vascular categories were similar (p = 0.663). After adjusting the nodule size and the distance between the nodule center and adjacent pleura [radius-distance ratio, RDR], the occurrences of internal vessels between them were similar. The number of intra-nodular vessels was positively correlated with nodular diameter and RDR. Vascular changes were more common in malignant than benign GGNs (52.48% vs. 18.31%, p < 0.0001), which mainly manifested as distortion and/or dilation of pulmonary veins (61.19%). The occurrence rate, number, and changes of internal vessels had no significant differences among all the pre-invasive and invasive lesions (each p > 0.05).

Conclusions: The incidence of internal vessels in GGNs is mainly related to their size and the distance between nodule and pleura rather than the pathological nature. However, GGNs with dilated or distorted internal vessels, especially pulmonary veins, have a higher possibility of malignancy.
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http://dx.doi.org/10.1186/s13244-021-01012-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8155149PMC
May 2021

Differentiating malignant and benign necrotic lung lesions using kVp-switching dual-energy spectral computed tomography.

BMC Med Imaging 2021 May 13;21(1):81. Epub 2021 May 13.

Department of Radiology, University of Chinese Academy of Sciences Chongqing Renji Hospital (Fifth People's Hospital of Chongqing), No. 24 Renji Road, Nan'an District, Chongqing, China.

Background: Necrotic pulmonary lesions manifest as relatively low-density internally on contrast-enhanced computed tomography (CT). However, using CT to differentiate malignant and benign necrotic pulmonary lesions is challenging, as these lesions have similar peripheral enhancement. With the introduction of dual-energy spectral CT (DESCT), more quantitative parameters can be obtained and the ability to differentiate material compositions has been highly promoted. This study investigated the use of kVp-switching DESCT in differentiating malignant from benign necrotic lung lesions.

Methods: From October 2016 to February 2019, 40 patients with necrotic lung cancer (NLC) and 31 with necrotic pulmonary mass-like inflammatory lesion (NPMIL) were enrolled and underwent DESCT. The clinical characteristics of patients, CT morphological features, and DESCT quantitative parameters of lesions were compared between the two groups. Binary logistic regression analysis was performed to identify the independent prognostic factors differentiating NPMIL from NLC. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of single-parameter and multiparametric analyses.

Results: Significant differences in age, C-reactive protein concentration, the slope of the spectral curve from 40 to 65 keV (K) of necrosis in non-contrast-enhanced scanning (NCS), arterial phase (AP) and venous phase (VP), effective atomic number of necrosis in NCS, and iodine concentration (IC) of the solid component in VP were observed between groups (all p < 0.05). The aforementioned parameters had area under the ROC curve (AUC) values of 0.747, 0.691, 0.841, 0.641, 0.660, 0.828, and 0.754, respectively, for distinguishing between NLC and NPMIL. Multiparametric analysis showed that age, K of necrosis in NCS, and IC of the solid component in VP were the most effective factors for differentiating NLC from NPMIL, with an AUC of 0.966 and percentage of correct class of 88.7%.

Conclusions: DESCT can differentiate malignant from benign necrotic lung lesions with a relatively high accuracy.
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http://dx.doi.org/10.1186/s12880-021-00611-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117597PMC
May 2021

Completed absorption of coronavirus disease 2019 (COVID-19) pneumonia lesions: a preliminary study.

Int J Med Sci 2021 3;18(11):2321-2326. Epub 2021 Apr 3.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Complete absorption of coronavirus disease 2019 (COVID-19) pneumonia in a short term was not detailedly reported. We aimed to investigate the clinical and imaging characteristics of COVID-19 patients with complete absorption of pulmonary lesions. Retrospectively collected the clinical and chest CT data of 224 patients with COVID-19 in one regional medical center. Currently, pulmonary lesions in 37 patients were completely absorbed. The clinical manifestations, laboratory examinations, and CT findings of lesions for these patients were summarized. Among the 37 patients (age, 39.0 ± 12.4 [14-63] years, 20 males), disease in 36 (97.3%) was mild and in 1 (2.7%) was from severe to mild. The most common symptoms were cough (24/37, 64.9%) and fever (23/37, 62.2%). Their laboratory indicators at admission were usually normal, while the white blood cell and neutrophil count significantly increased at discharge (p = 0.004, p = 0.006). On initial CT images, all patients had various pulmonary lesions (mean involved lobes: 2.8 ± 1.5, range: 1-5; mean involved segments: 6.6 ± 4.3, range: 1-16), which mainly manifested as multiple patchy and or spherical ground glass opacities (GGOs) (30/37, 81.1%) with fibrous strips (19/30, 63.3%) or consolidation (11/30, 36.7%). After treatment, lesions in most (33/37, 89.2%) patients were continuously absorbed. At discharge, previous lesions were mostly absorbed in 11 patients (11/37, 29.7%), the main residues were GGOs (24/37, 64.9%), followed by fibrous strips (13/37, 35.1%). On the latest CT, all the pulmonary lesions were completely absorbed, the duration of lesions was 31.6 ± 11.4 days (range: 5-50 days). The pulmonary lesions in some mild COVID-19 patients (generally with normal laboratory indicators at admission, GGOs as the main manifestation on initial CT, and representation of continuous absorption after treatment) could be completely absorbed with a mean duration of 31.6 days.
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http://dx.doi.org/10.7150/ijms.54675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100646PMC
May 2021

Relationship Between Non-contrast Computed Tomography Imaging Markers and Perihemorrhagic Edema Growth in Intracerebral Hemorrhage.

Neurocrit Care 2021 May 3. Epub 2021 May 3.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Objectives: Perihemorrhagic edema (PHE) growth has been gradually considered as predictor for outcome of Intracerebral hemorrhage (ICH) patients. The aim of our study was to investigate correlation between non-contrast computed tomography (CT) markers and early PHE growth.

Methods: ICH patients between July 2011 and March 2017 were included in this retrospective analysis. ICH and PHE volumes were measured by using a validated semiautomatic volumetric algorithm. Nonparametric test was used for comparing PHE volume at different time points of non-contrast computed tomography (NCCT) imaging markers. Multivariable linear regression was constructed to study the relationship between NCCT imaging markers and PHE growth over 36 h.

Results: A total of 214 patients were included. Nonparametric test showed that PHE volume was significantly different between patients with and without NCCT imaging markers. (all p < 0.05) In multivariable linear regression analysis adjusted for ICH characteristics, blend sign (p = 0.011), black hole sign (p = 0.002), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001) were correlated with PHE growth. Follow-up PHE volume within 36 h after baseline CT scan was associated with blend sign (p = 0.001), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001).

Conclusion: NCCT imaging markers of hematoma expansion are associated with PHE growth. This suggests that early PHE growth can be predicted using radiology markers on admission CT scan.
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http://dx.doi.org/10.1007/s12028-021-01188-2DOI Listing
May 2021

Pulmonary Benign Ground-Glass Nodules: CT Features and Pathological Findings.

Int J Gen Med 2021 24;14:581-590. Epub 2021 Feb 24.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.

Background: Some pulmonary ground-glass nodules (GGNs) are benign and frequently misdiagnosed due to lack of understanding of their CT characteristics. This study aimed to reveal the CT features and corresponding pathological findings of pulmonary benign GGNs to help improve diagnostic accuracy.

Patients And Methods: From March 2016 to October 2019, patients with benign GGNs confirmed by operation or follow-up were enrolled retrospectively. According to overall CT manifestations, GGNs were classified into three types: I, GGO with internal high-attenuation zone; II, nodules lying on adjacent blood vessels; and other type, lesions without obvious common characteristics. CT features and pathological findings of each nodule type were evaluated.

Results: Among the 40 type I, 25 type II, and 14 other type GGNs, 24 (60.0%), 19 (76.0%), and 10 (71.4%) nodules were resected, respectively. Type I GGNs were usually irregular (25 of 40, 62.5%) with only one high-attenuation zone (38 of 40, 95.0%) (main pathological components: thickened alveolar walls with inflammatory cells, fibrous tissue, and exudation), which was usually centric (24 of 40, 60.0%), having blurred margin (38 of 40, 95.0%), and connecting to blood vessels (32 of 40, 80.0%). The peripheral GGO (main pathological component: a small amount of inflammatory cell infiltration with fibrous tissue proliferation) was usually ill-defined (28 of 40, 70.0%). Type II GGNs (main pathological components: focal interstitial fibrosis with or without inflammatory cell infiltration) lying on adjacent vessel branches were usually irregular (19 of 25, 76.0%) and well defined (16 of 25, 64.0%) but showed coarse margins (15 of 16, 93.8%). Other type GGNs had various CT manifestations but their pathological findings were similar to that of type II.

Conclusion: For subsolid nodules with CT features manifested in type I or II GGNs, follow-up should be firstly considered in further management.
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http://dx.doi.org/10.2147/IJGM.S298517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930605PMC
February 2021

Noncontrast Computed Tomography Markers as Predictors of Revised Hematoma Expansion in Acute Intracerebral Hemorrhage.

J Am Heart Assoc 2021 02 28;10(3):e018248. Epub 2021 Jan 28.

Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China.

Background Noncontrast computed tomography (NCCT) markers are the emerging predictors of hematoma expansion in intracerebral hemorrhage. However, the relationship between NCCT markers and the dynamic change of hematoma in parenchymal tissues and the ventricular system remains unclear. Methods and Results We included 314 consecutive patients with intracerebral hemorrhage admitted to our hospital from July 2011 to May 2017. The intracerebral hemorrhage volumes and intraventricular hemorrhage (IVH) volumes were measured using a semiautomated, computer-assisted technique. Revised hematoma expansion (RHE) was defined by incorporating the original definition of hematoma expansion into IVH growth. Receiver operating characteristic curve analysis was used to compare the performance of the NCCT markers in predicting the IVH growth and RHE. Of 314 patients in our study, 61 (19.4%) had IVH growth and 93 (23.9%) had RHE. After adjustment for potential confounding variables, blend sign, black hole sign, island sign, and expansion-prone hematoma could independently predict IVH growth and RHE in the multivariate logistic regression analysis. Expansion-prone hematoma had a higher predictive performance of RHE than any single marker. The diagnostic accuracy of RHE in predicting poor prognosis was significantly higher than that of hematoma expansion. Conclusions The NCCT markers are independently associated with IVH growth and RHE. Furthermore, the expansion-prone hematoma has a higher predictive accuracy for prediction of RHE and poor outcome than any single NCCT marker. These findings may assist in risk stratification of NCCT signs for predicting active bleeding.
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http://dx.doi.org/10.1161/JAHA.120.018248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955436PMC
February 2021

CT features of coronavirus disease 2019 (COVID-19) with an emphasis on the vascular enlargement pattern.

Eur J Radiol 2021 Jan 27;134:109442. Epub 2020 Nov 27.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China. Electronic address:

Purpose: The vascular enlargement (VE) pattern differs from previously described imaging patterns for pneumonia. This study aimed to investigate the incidence, computed tomography (CT) characteristics, and diagnostic value of the VE pattern in coronavirus disease 2019 (COVID-19).

Method: The CT data of 106 patients with COVID-19 from January 19 to February 29, 2020, and 52 patients with influenza virus pneumonia (IVP) from January 2018 to February 2020 were retrospectively collected. The incidences of the VE pattern between the two groups were compared. The CT manifestations of COVID-19 were analyzed with a particular focus on the VE pattern's specific CT signs, dynamic changes, and relationships with lesion size and disease severity.

Results: Peripheral and multilobar ground-glass opacities (GGOs) or mixed GGOs with various sizes and morphologies were typical features of COVID-19 on initial CT. The VE pattern was more common in COVID-19 (88/106, 83.02 %) than in IVP (10/52, 19.23 %) on initial CT (P < 0.001). Three special VE-pattern-specific CT signs, including central vascular sign, ginkgo leaf sign, and comb sign, were identified. Four types of dynamic changes in the VE pattern were observed on initial and follow-up CT, which were closely associated with the evolution of lesions and the time interval from the onset of symptoms to initial CT scan. The VE pattern in COVID-19 was more commonly seen in larger lesions and patients with severe-critical type (all P < 0.001).

Conclusions: The VE pattern is a valuable CT sign for differentiating COVID-19 from IVP, which correlates with more extensive or serious disease. A good understanding of the CT characteristics of the VE pattern may contribute to the early and accurate diagnosis of COVID-19 and prediction of the evolution of lesions.
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http://dx.doi.org/10.1016/j.ejrad.2020.109442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694475PMC
January 2021

Hydrocephalus Growth: Definition, Prevalence, Association with Poor Outcome in Acute Intracerebral Hemorrhage.

Neurocrit Care 2021 Aug 10;35(1):62-71. Epub 2020 Nov 10.

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Background/objectives: To propose a novel definition for hydrocephalus growth and to further describe the association between hydrocephalus growth and poor outcome among patients with intracerebral hemorrhage (ICH).

Methods: We analyzed consecutive patients who presented within 6 h after ICH ictus between July 2011 and June 2017. Follow-up CT scans were performed within 36 h after initial CT scans. The degree of hydrocephalus were evaluated by the hydrocephalus score of Diringer et al. The optimal increase of the hydrocephalus scores between initial and follow-up CT scan was estimated to define hydrocephalus growth. Poor long-term outcome was defined as a modified Rankin Scale of 4-6 at 3 months. Multivariate logistic regression analysis was performed to investigate the hydrocephalus growth for predicting 30-day mortality, 90-day mortality, and poor long-term outcome.

Results: A total of 321 patients with ICH were included in the study. Of 64 patients with hydrocephalus growth, 34 (53.1%) patients presented with both concurrent hematoma expansion and intraventricular hemorrhage (IVH) growth. After adjusting for potential confounding factors, hydrocephalus growth independently predicted 30-day mortality, 90-day mortality, and 90-day poor long-term outcome in multivariate logistic regression analysis. Hydrocephalus growth showed higher accuracy for predicting 30-day mortality, 90-day mortality, and poor long-term outcome than IVH growth or hematoma expansion, respectively.

Conclusions: Hydrocephalus growth is defined by strongly predictive of short- or long-term mortality and poor outcome at 90 days, and might be a potential indicator for assisting clinicians for clinical decision-making.
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http://dx.doi.org/10.1007/s12028-020-01140-wDOI Listing
August 2021

CT features and outcomes of newly developed pulmonary lesions in patients with Coronavirus Disease 2019 (COVID-19).

Int J Med Sci 2020 29;17(15):2373-2378. Epub 2020 Aug 29.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China, 40016.

: In patients with coronavirus disease 2019 (COVID-19) pneumonia, whether new pulmonary lesions will continue to develop after treatment was unknown. This study aimed to determine whether new pulmonary lesions will develop after treatment in patients with COVID-19 pneumonia, and investigate their CT features and outcomes. This retrospective study included 56 consecutive patients with confirmed COVID-19 pneumonia from January 20 to March 5, 2020. Their initial and follow-up CT images and clinical data were reviewed. The CT manifestations of primary and newly developed pulmonary lesions and their changes after treatment were mainly evaluated. Among the 56 patients (mean age: 48±15 years, 35 men) with COVID-19 pneumonia, 42 (75.0%) patients developed new pulmonary lesions during treatment. All new lesions developed before the nucleic acid test turned negative. Patients with new lesions were more likely to have lymphopenia (=0.041) or increased C-reactive protein (CRP) levels (0.001) than those without new lesions. Of the 42 patients, 30 (71.4%) patients developed new lesions once, and 12 (28.6%) twice or thrice, which usually appeared when primary lesions were progressing (37, 88.1%) and 1-15 days after treatment. The newly developed lesions were usually multiple (38, 90.5%), distributed in the previously involved (39, 92.9%) or uninvolved (27, 64.3%) lobes, and manifested as ground-glass opacities (GGOs) with consolidation (23, 54.8%) or pure GGOs (19, 45.2%). After their occurrence, the new lesions in most patients (32, 76.2%) showed direct absorption, whereas those in some patients (10, 23.8%) progressed before absorption. During treatment, most patients with COVID-19 pneumonia will develop new pulmonary lesions, which usually manifest as multiple GGOs distributed around the primary lesions or in previously uninvolved lobes, and are subsequently absorbed directly.
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http://dx.doi.org/10.7150/ijms.47587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484640PMC
September 2020

Spectral CT in Lung Cancer: Usefulness of Iodine Concentration for Evaluation of Tumor Angiogenesis and Prognosis.

AJR Am J Roentgenol 2020 09 22;215(3):595-602. Epub 2020 Jun 22.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Rd, Yuzhong District, Chongqing 400016, China.

The purpose of this study was to investigate the correlation between iodine concentration (IC) derived from spectral CT and angiogenesis and the relationships between IC and clinical-pathologic features associated with lung cancer prognosis. Sixty patients with lung cancer were enrolled and underwent spectral CT. The IC, IC difference (ICD), and normalized IC (NIC) of tumors were measured in the arterial phase, venous phase (VP), and delayed phase. The microvessel densities (MVDs) of CD34-stained specimens were evaluated. Correlation analysis was performed for IC and MVD. The relationships between the IC index showing the best correlations with MVD and clinical-pathologic findings of pathologic types, histologic differentiation, tumor size, lymph node status, pathologic TNM stage, and intratumoral necrosis were investigated. The mean (± IQR) MVD of all tumors was 42.00 ± 27.50 vessels per field at ×400 magnification, with two MVD distribution types. The MVD of lung cancer correlated positively with the IC, ICD, and NIC on three-phase contrast-enhanced scanning ( range, 0.581-0.800; all < 0.001), and the IC in the VP showed the strongest correlation with MVD ( = 0.800; < 0.001). The correlations between IC and MVD, ICD and MVD, and NIC and MVD varied depending on whether the same scanning phase or same IC index was used. The IC in the VP showed statistically significant differences in the pathologic types of adenocarcinoma and squamous cell carcinoma, histologic differentiation, tumor size, and status of intratumoral necrosis of lung cancer ( < 0.05), but was not associated with nodal metastasis and pathologic TNM stages ( > 0.05). IC indexes derived from spectral CT, especially the IC in the VP, were useful indicators for evaluating tumor angiogenesis and prognosis.
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http://dx.doi.org/10.2214/AJR.19.22688DOI Listing
September 2020

Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections.

Nat Med 2020 08 18;26(8):1200-1204. Epub 2020 Jun 18.

Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China.

The clinical features and immune responses of asymptomatic individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have not been well described. We studied 37 asymptomatic individuals in the Wanzhou District who were diagnosed with RT-PCR-confirmed SARS-CoV-2 infections but without any relevant clinical symptoms in the preceding 14 d and during hospitalization. Asymptomatic individuals were admitted to the government-designated Wanzhou People's Hospital for centralized isolation in accordance with policy. The median duration of viral shedding in the asymptomatic group was 19 d (interquartile range (IQR), 15-26 d). The asymptomatic group had a significantly longer duration of viral shedding than the symptomatic group (log-rank P = 0.028). The virus-specific IgG levels in the asymptomatic group (median S/CO, 3.4; IQR, 1.6-10.7) were significantly lower (P = 0.005) relative to the symptomatic group (median S/CO, 20.5; IQR, 5.8-38.2) in the acute phase. Of asymptomatic individuals, 93.3% (28/30) and 81.1% (30/37) had reduction in IgG and neutralizing antibody levels, respectively, during the early convalescent phase, as compared to 96.8% (30/31) and 62.2% (23/37) of symptomatic patients. Forty percent of asymptomatic individuals became seronegative and 12.9% of the symptomatic group became negative for IgG in the early convalescent phase. In addition, asymptomatic individuals exhibited lower levels of 18 pro- and anti-inflammatory cytokines. These data suggest that asymptomatic individuals had a weaker immune response to SARS-CoV-2 infection. The reduction in IgG and neutralizing antibody levels in the early convalescent phase might have implications for immunity strategy and serological surveys.
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http://dx.doi.org/10.1038/s41591-020-0965-6DOI Listing
August 2020

CT Characteristics for Predicting Invasiveness in Pulmonary Pure Ground-Glass Nodules.

AJR Am J Roentgenol 2020 08 29;215(2):351-358. Epub 2020 Apr 29.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing 40016, China.

The objective of our study was to investigate the differences in the CT features of atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IA) manifesting as a pure ground-glass nodule (pGGN) with the aim of determining parameters predictive of invasiveness. A total of 161 patients with 172 pGGNs (14 AAHs, 59 AISs, 68 MIAs, and 31 IAs) were retrospectively enrolled. The following CT features of each histopathologic subtype of nodule were analyzed and compared: lesion location, diameter, area, shape, attenuation, uniformity of density, margin, nodule-lung interface, and internal and surrounding changes. ROC curves revealed that nodule diameter and area (cutoff value, 10.5 mm and 86.5 mm; sensitivity, 87.1% and 87.1%; specificity, 70.9% and 65.2%) were significantly larger in IAs than in AAHs, AISs, and MIAs ( < 0.001), whereas the latter three were similar in size ( > 0.050). CT attenuation higher than -632 HU in pGGNs indicated invasiveness (sensitivity, 78.8%; specificity, 59.8%). As opposed to noninvasive pGGNs (AAHs and AISs), invasive pGGNs (MIAs and IAs) usually had heterogeneous density, irregular shape, coarse margin, lobulation, spiculation, pleural indentation, and dilated or distorted vessels (each, < 0.050). Multivariate analysis showed that mean CT attenuation and presence of lobulation were predictors for invasive pGGNs ( ≤ 0.001). The likelihood of invasiveness is greater in pGGNs with larger size (> 10.5 mm or > 86.5 mm), higher attenuation (> -632 HU), heterogeneous density, irregular shape, coarse margin, spiculation, lobulation, pleural indentation, and dilated or distorted vessels.
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http://dx.doi.org/10.2214/AJR.19.22381DOI Listing
August 2020

Intraventricular Hemorrhage Growth: Definition, Prevalence and Association with Hematoma Expansion and Prognosis.

Neurocrit Care 2020 12;33(3):732-739

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Background/objectives: The objective of this study is to propose a definition of intraventricular hemorrhage (IVH) growth and to investigate whether IVH growth is associated with ICH expansion and functional outcome.

Methods: We performed a prospective observational study of ICH patients between July 2011 and March 2017 in a tertiary hospital. Patients were included if they had a baseline CT scan within 6 h after onset of symptoms and a follow-up CT within 36 h. IVH growth was defined as either any newly occurring intraventricular bleeding on follow-up CT scan in patients without baseline IVH or an increase in IVH volume ≥ 1 mL on follow-up CT scan in patients with initial IVH. Poor outcome was defined as modified Rankin Scale score of 3-6 at 90 days. The association between IVH growth and functional outcome was assessed by using multivariable logistic regression analysis.

Results: IVH growth was observed in 59 (19.5%) of 303 patients. Patients with IVH growth had larger baseline hematoma volume, higher NIHSS score and lower GCS score than those without. Of 44 patients who had concurrent IVH growth and hematoma growth, 41 (93.2%) had poor functional outcome at 3-month follow-up. IVH growth (adjusted OR 4.15, 95% CI 1.31-13.20; P = 0.016) was an independent predictor of poor functional outcome (mRS 3-6) at 3 months in multivariable analysis.

Conclusion: IVH growth is not uncommon and independently predicts poor outcome in ICH patients. It may serve as a promising therapeutic target for intervention.
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http://dx.doi.org/10.1007/s12028-020-00958-8DOI Listing
December 2020

MRI evaluation of endopelvic fascial swelling and analysis of influencing factors in patients with uterine fibroids after high-intensity focused ultrasound ablation.

Int J Hyperthermia 2020 ;37(1):175-181

Therapeutic Center of Ultrasound Ablation, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.

To evaluate endopelvic fascial swelling in patients with uterine fibroids after high-intensity focused ultrasound (HIFU) ablation on magnetic resonance imaging (MRI) and investigate the factors that influence endopelvic fascial swelling. MRI and clinical data from 188 patients with uterine fibroids who were treated with HIFU were analyzed retrospectively. The patients were divided into a fascial swelling group and a non-swelling group, and the degree of swelling was graded. Fascial swelling was set as the dependent variable, and factors such as baseline characteristics and HIFU parameters, were set as the independent variables. The relationship between these variables and fascial swelling was analyzed by univariate and multivariate analyses. Correlations between the factors and the degree of fascial swelling were evaluated by Kruskal-Wallis test. The univariate analysis revealed that the fibroid location, distance from the fibroid to the sacrum, sonication time, treatment time, treatment intensity, therapeutic dose (TD), and energy efficiency (EEF) all affected the endopelvic fascial swelling ( < 0.05). Subsequently, multivariate analysis showed that the distance from the fibroid to the sacrum was significantly correlated with fascial swelling ( < 0.05). Moreover, TD and sonication time were significantly positively correlated with the degree of fascial swelling ( < 0.05). The incidence of sacrococcygeal pain was significantly correlated with fascial swelling ( < 0.05). The distance from the fibroid to the sacrum was a protective factor for fascial swelling. TD and sonication time were significantly positively correlated with the degree of fascial swelling.
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http://dx.doi.org/10.1080/02656736.2019.1701100DOI Listing
October 2020

Primary solid lung cancerous nodules with different sizes: computed tomography features and their variations.

BMC Cancer 2019 Nov 7;19(1):1060. Epub 2019 Nov 7.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, Chongqing, China.

Background: The computed tomography (CT) features of small solid lung cancers and their changing regularity as they grow have not been well studied. The purpose of this study was to analyze the CT features of solid lung cancerous nodules (SLCNs) with different sizes and their variations.

Methods: Between February 2013 and April 2018, a consecutive cohort of 224 patients (225 nodules) with confirmed primary SLCNs was enrolled. The nodules were divided into four groups based on tumor diameter (A: diameter ≤ 1.0 cm, 35 lesions; B: 1.0 cm < diameter ≤ 1.5 cm, 60 lesions; C: 1.5 cm < diameter ≤ 2.0 cm, 63 lesions; and D: 2.0 cm < diameter ≤ 3.0 cm, 67 lesions). CT features of nodules within each group were summarized and compared.

Results: Most nodules in different groups were located in upper lobes (groups A - D:50.8%-73.1%) and had a gap from the pleura (groups A - D:89.6%-100%). The main CT features of smaller (diameter ≤ 1 cm) and larger (diameter > 1 cm) nodules were significantly different. As nodule diameter increased, more lesions showed a regular shape, homogeneous density, clear but coarse tumor-lung interface, lobulation, spiculation, spinous protuberance, vascular convergence, pleural retraction, bronchial truncation, and beam-shaped opacity (p < 0.05 for all). The presence of halo sign in all groups was similar (17.5%-22.5%; p > 0.05).

Conclusions: The CT features vary among SLCNs with different sizes. Understanding their changing regularity is helpful for identifying smaller suspicious malignant nodules and early determining their nature in follow-up.
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http://dx.doi.org/10.1186/s12885-019-6274-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836448PMC
November 2019

Effect of Slab Thickness on the Detection of Pulmonary Nodules by Use of CT Maximum and Minimum Intensity Projection.

AJR Am J Roentgenol 2019 09 7;213(3):562-567. Epub 2019 May 7.

Department of Radiology, First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong, Chongqing 40016, China.

The purpose of this study was to investigate the effect of slab thickness on the detection of pulmonary nodules by use of maximum-intensity-projection (MIP) and minimum-intensity-projection (MinIP) to process CT images. Chest CT data of 221 patients with pulmonary nodules were retrospectively analyzed. Nodules were categorized into two groups according to density: solid nodules (SNs) and subsolid nodules (SSNs). Pulmonary nodules were independently evaluated by two radiologists using axial CT images with 1-mm and 5-mm section thickness and MIP and MinIP images. MIP images for SN detection and MinIP images for SSN detection were separately reconstructed with four (5, 10, 15, 20 mm) and three (3, 8, 15 mm) slab thicknesses. The numbers and locations of detected nodules were recorded, and interobserver agreement was assessed. For each reader, the differences in nodule detection rates were evaluated in different series of images. Among the different series of images, interobserver agreements for detecting nodules were all good to excellent (κ ≥ 0.687). For total SNs and SNs with a diameter < 5 mm, detection rates on 10-mm MIP images were significantly higher than in other series of images (reader 1, 84.5% and 83.8%; reader 2, 83.6% and 82.2%). For total SSNs and SSNs < 5 mm, detection rates on 3-mm MinIP images were significantly higher than those in other series of images, except for 1-mm (reader 1, 93.3% and 78.6%; reader 2, 95.0% and 81.0%). Ten-millimeter MIP images are extremely efficient for detecting SNs. Three-millimeter MinIP images are more useful for visualizing SSNs, the efficiency being comparable to that achieved by use of 1-mm axial images.
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http://dx.doi.org/10.2214/AJR.19.21325DOI Listing
September 2019

Benign Intracerebral Hemorrhage: A Population at Low Risk for Hematoma Growth and Poor Outcome.

J Am Heart Assoc 2019 04;8(8):e011892

1 Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China.

Background To define benign intracerebral hemorrhage ( ICH ) and to investigate the association between benign ICH , hematoma expansion, and functional outcome. Methods and Results We analyzed a prospectively collected cohort of patients with ICH, who presented within 6 hours of symptom onset between July 2011 and February 2017 to a tertiary teaching hospital. Follow-up computed tomographic scanning was performed within 36 hours after initial computed tomographic scanning. Benign ICH was operationally defined as homogeneous and regularly shaped small ICH . The presence of benign ICH was judged by 2 independent reviewers (Q.L., W.Y.) on the basis of the admission computed tomographic scan. Functional independence was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The associations between benign ICH , hematoma expansion, and functional outcome were assessed by using multivariable logistic regression analyses. A total of 288 patients with ICH were included. Benign ICH was found in 48 patients (16.7%). None of the patients with benign ICH had early hematoma expansion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of benign ICH for predicting functional independence at 3 months were 30.7%, 96.6%, 90.0%, 60.0%, and 0.637, respectively. Conclusions Patients with benign ICH are at low risk of hematoma expansion and poor outcome. These patients may be safe for less intensive monitoring and are unlikely to benefit from therapies aimed at preventing ICH expansion.
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http://dx.doi.org/10.1161/JAHA.118.011892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6507215PMC
April 2019

Comparison of Satellite Sign and Island Sign in Predicting Hematoma Growth and Poor Outcome in Patients with Primary Intracerebral Hemorrhage.

World Neurosurg 2019 Jul 4;127:e818-e825. Epub 2019 Apr 4.

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address:

Objective: Satellite sign (SS) and island sign (IS) are novel noncontrast computed tomography (CT) predictors of hematoma growth. The aim of this study was to compare diagnostic performance of IS and SS in predicting hematoma growth and functional outcome in patients with intracerebral hemorrhage (ICH).

Methods: The study included patients with ICH who underwent baseline CT scan within 6 hours of symptom onset and follow-up CT scan within 36 hours after initial CT between July 2012 and April 2017. Sensitivity, specificity, positive predictive value, and negative predictive value of IS and SS in predicting hematoma growth and functional outcome were assessed. Accuracy of the 2 signs in predicting hematoma growth and functional outcome was analyzed using receiver operating characteristic analysis. Association between the presence of IS and SS and ICH growth was assessed using multivariate logistic regression.

Results: Of 307 patients with ICH, IS was observed in 46 patients (15.0%), and SS was observed in 151 patients (49.2%). Rates of hematoma growth were 40.4% in SS+ patients, 91.3% in IS+ patients, 18.4% in SS-IS- patients, 21.1% in SS+IS- patients, 100% in SS-IS+ patients, and 90.5% in SS+IS+ patients. After adjusting for potential confounders, IS remained an independent predictor for hematoma growth and poor functional outcome. The area under the curve of IS was significantly larger than the area under the curve of SS in predicting hematoma growth (P = 0.001).

Conclusions: IS seems to be an optimal shape irregularity imaging marker for predicting hematoma growth and functional outcome in patients with ICH.
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http://dx.doi.org/10.1016/j.wneu.2019.03.273DOI Listing
July 2019

Expansion-Prone Hematoma: Defining a Population at High Risk of Hematoma Growth and Poor Outcome.

Neurocrit Care 2019 06;30(3):601-608

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Background: Noncontrast computed tomography (CT) markers are increasingly used for predicting hematoma expansion. The aim of our study was to investigate the predictive value of expansion-prone hematoma in predicting hematoma expansion and outcome in patients with intracerebral hemorrhage (ICH).

Methods: Between July 2011 and January 2017, ICH patients who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. Expansion-prone hematoma was defined as the presence of one or more of the following imaging markers: blend sign, black hole sign, or island sign. The diagnostic performance of blend sign, black hole sign, island sign, and expansion-prone hematoma in predicting hematoma expansion was assessed. Predictors of hematoma growth and poor outcome were analyzed using multivariable logistical regression analysis.

Results: A total of 282 patients were included in our final analysis. Of 88 patients with early hematoma growth, 69 (78.4%) had expansion-prone hematoma. Expansion-prone hematoma had a higher sensitivity and accuracy for predicting hematoma expansion and poor outcome when compared with any single imaging marker. After adjustment for potential confounders, expansion-prone hematoma independently predicted hematoma expansion (OR 28.33; 95% CI 12.95-61.98) and poor outcome (OR 5.67; 95% CI 2.82-11.40) in multivariable logistic model.

Conclusion: Expansion-prone hematoma seems to be a better predictor than any single noncontrast CT marker for predicting hematoma expansion and poor outcome. Considering the high risk of hematoma expansion in these patients, expansion-prone hematoma may be a potential therapeutic target for anti-expansion treatment in future clinical studies.
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http://dx.doi.org/10.1007/s12028-018-0644-3DOI Listing
June 2019

Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage.

Cerebrovasc Dis 2018 10;45(1-2):48-53. Epub 2018 Jan 10.

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Background: In spontaneous intracerebral hemorrhage (ICH), black hole sign has been proposed as a promising imaging marker that predicts hematoma expansion in patients with ICH. The aim of our study was to investigate whether admission CT black hole sign predicts hematoma growth in patients with ICH.

Methods: From July 2011 till February 2016, patients with spontaneous ICH who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. The presence of black hole sign on admission non-enhanced CT was independently assessed by 2 readers. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Univariate and multivariable logistic regression analyses were performed to assess the association between the presence of the black hole sign and functional outcome.

Results: A total of 225 patients (67.6% male, mean age 60.3 years) were included in our study. Black hole sign was identified in 32 of 225 (14.2%) patients on admission CT scan. The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, baseline ICH volume, admission Glasgow Coma Scale score, and presence of black hole sign on baseline CT independently predict poor functional outcome at 90 days. There are significantly more patients with a poor functional outcome (defined as mRS ≥4) among patients with black hole sign than those without (84.4 vs. 32.1%, p < 0.001; OR 8.19, p = 0.001).

Conclusions: The CT black hole sign independently predicts poor outcome in patients with ICH. Early identification of black hole sign is useful in prognostic stratification and may serve as a potential therapeutic target for anti-expansion clinical trials.
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http://dx.doi.org/10.1159/000486163DOI Listing
March 2019

Blend sign predicts poor outcome in patients with intracerebral hemorrhage.

PLoS One 2017 22;12(8):e0183082. Epub 2017 Aug 22.

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Introduction: Blend sign has been recently described as a novel imaging marker that predicts hematoma expansion. The purpose of our study was to investigate the prognostic value of CT blend sign in patients with ICH.

Objectives And Methods: Patients with intracerebral hemorrhage who underwent baseline CT scan within 6 hours were included. The presence of blend sign on admission nonenhanced CT was independently assessed by two readers. The functional outcome was assessed by using the modified Rankin Scale (mRS) at 90 days.

Results: Blend sign was identified in 40 of 238 (16.8%) patients on admission CT scan. The proportion of patients with a poor functional outcome was significantly higher in patients with blend sign than those without blend sign (75.0% versus 47.5%, P = 0.001). The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, admission GCS score, baseline hematoma volume and presence of blend sign on baseline CT independently predict poor functional outcome at 90 days. The CT blend sign independently predicts poor outcome in patients with ICH (odds ratio 3.61, 95% confidence interval [1.47-8.89];p = 0.005).

Conclusions: Early identification of blend sign is useful in prognostic stratification and may serve as a potential therapeutic target for prospective interventional studies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183082PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568736PMC
October 2017

Differential Diagnosis of Solitary Pulmonary Inflammatory Lesions and Peripheral Lung Cancers with Contrast-enhanced Computed Tomography.

Clinics (Sao Paulo) 2016 Oct 1;71(10):555-561. Epub 2016 Oct 1.

The First Affiliated Hospital of Chongqing Medical University, Department of Radiology, Chongqing, China.

Objectives:: To clarify differences between solitary pulmonary inflammatory lesions and peripheral lung cancers with contrast-enhanced computed tomography.

Methods:: In total, 64 and 132 patients with solitary pulmonary inflammatory masses/nodules and peripheral lung cancers, respectively, were enrolled in this study. Their computed tomographic findings were summarized and compared retrospectively.

Results:: Compared with the peripheral lung cancers, the inflammatory lesions were located closer to the pleura (p<0.0001). The majority of the inflammatory lesions were patchy and oval-shaped (82.8%), whereas most of the tumors were lobulated (82.6%). Almost all the inflammatory cases were unclear (93.8%), whereas most of the tumors had spiculated margins (72.7%). Computed tomography values were significantly higher for the inflammatory lesions than for the cancers (p<0.0001). More than half of the inflammatory lesions had defined necrosis (59.3%). Furthermore, 49.2% of the cancers enhanced inhomogeneously, but only 24.6% had ill-defined necrosis or cavities. The peripheral zones of 98.4% of the inflammatory lesions and 72.7% of the tumors were unclear, with peripheral scattered patches (92.2%) and beam-shaped opacity (66.7%) being the most common findings, respectively. Adjacent pleural thickening was more frequent for the inflammatory lesions than the cancers (95.3% vs. 21.1%, p<0.0001), whereas pleural indentation was found in 67.4% of the subjects with cancer. In addition, hilar (p=0.034) and mediastinal (p=0.003) lymphadenopathy were more commonly detected in the cancers than in the inflammatory cases.

Conclusions:: Contrast-enhanced computed tomography findings for pulmonary inflammatory lesions and peripheral lung cancers were significantly different in many aspects. Developing a comprehensive understanding of these differences is helpful for directing their management.
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http://dx.doi.org/10.6061/clinics/2016(10)01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054773PMC
October 2016

Pelvic retroperitoneal pleomorphic hyalinizing angiectatic tumor (PHAT) of soft tissue: a case report.

BMC Med Imaging 2016 Apr 5;16:28. Epub 2016 Apr 5.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi street, Chongqing, 400016, China.

Background: Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare soft tissue tumor of low malignant potential, which most often arises in the lower extremities. Lesions occurred in other anatomic locations have been rarely reported. Moreover, their imaging features have not been well discussed. Here we report a case of PHAT arising primarily in the pelvic retroperitoneum. To our knowledge, this is the first radiological description for retroperitoneum PHAT.

Case Presentation: A 26-year-old female was referred to our hospital for evaluation of a pelvic mass incidentally noted in routine pre-pregnancy ultrasonography examination. Magnetic resonance imaging (MRI) and computed tomography (CT) scan revealed an irregular mass with clear boundary in the pelvic retroperitoneum. Its signal intensity or density was inhomogeneous. On MRI images, it mainly showed isointense and slight hypointense on T1 weighted image and isointense and hyperintense on T2 weighted image. On contrast-enhanced images, it showed marked but heterogenous enhancement. With the delay time increasing, the enhanced area in the lesion increased but the CT value decreased. Dilated vessels and hemorrhage were detected in the tumor. With patience and careful separation, it was completely excised with great amount of bleeding during operation. Pathological and immunohistochemistry analysis confirmed the diagnosis of PHAT of the soft parts. We found no evidence of recurrence 18 months after operation.

Conclusion: We present an extremely rare case of PHAT arising primarily in the pelvic retroperitoneum. To our knowledge, this is the first radiological description for retroperitoneum PHAT. The provided information is useful for summarizing the characteristics of this kind of tumor. It should be included in the differential diagnosis of a well-defined, inhomogenously enhanced hypervascular soft-tissue mass in pelvic cavity.
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http://dx.doi.org/10.1186/s12880-016-0130-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820911PMC
April 2016

Abnormal spontaneous brain activity in type 2 diabetes with and without microangiopathy revealed by regional homogeneity.

Eur J Radiol 2016 Mar 2;85(3):607-15. Epub 2016 Jan 2.

Department of Endocrinology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. Electronic address:

Purpose: To investigate whether global spontaneous brain activity changes in type 2 diabetes mellitus (T2DM) patients and these changes vary according to the degree of microangiopathy.

Materials And Methods: T2DM patients with (M(+), n=26) and without (M(-), n=22) microangiopathy as well as 28 healthy nondiabetic subjects were enrolled in this study. All the subjects completed a resting-state functional magnetic resonance imaging (rs-fMRI) examination and neuropsychological assessment. Regional homogeneity (ReHo) values, representing spontaneous brain activity, were calculated and compared between M(+) and M(-) T2DM patients and nondiabetic controls.

Results: In both M(+) and M(-) T2DM patients, ReHo values were decreased in the occipital lobe, temporal lobe, postcentral gyrus, and cerebellum, while increased in the bilateral precuneus, superior/middle frontal gyrus, and insula. Compared with the M(-) group, M(+) patients showed decreased ReHo values in the left cuneus and superior occipital gyrus. The ReHo values in the lingual gyrus/calcarine cortex and MTG were related to clinical parameters in T2DM patients.

Conclusion: The abnormalities of spontaneous brain activity revealed by ReHo values in both M(+)and M(-) T2DM patients may provide insights into the neurological pathophysiology underlying diabetes-related cognitive impairments. M(+) patients showed more decreased brain activity related to severely impaired function of visual processing and visual memory.
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http://dx.doi.org/10.1016/j.ejrad.2015.12.024DOI Listing
March 2016

Blend Sign on Computed Tomography: Novel and Reliable Predictor for Early Hematoma Growth in Patients With Intracerebral Hemorrhage.

Stroke 2015 Aug 18;46(8):2119-23. Epub 2015 Jun 18.

From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).

Background And Purpose: Early hematoma growth is not uncommon in patients with intracerebral hemorrhage and is an independent predictor of poor functional outcome. The purpose of our study was to report and validate the use of our newly identified computed tomographic (CT) blend sign in predicting early hematoma growth.

Methods: Patients with intracerebral hemorrhage who underwent baseline CT scan within 6 hours after onset of symptoms were included. The follow-up CT scan was performed within 24 hours after the baseline CT scan. Significant hematoma growth was defined as an increase in hematoma volume of >33% or an absolute increase of hematoma volume of >12.5 mL. The blend sign on admission nonenhanced CT was defined as blending of hypoattenuating area and hyperattenuating region with a well-defined margin. Univariate and multivariable logistic regression analyses were performed to assess the relationship between the presence of the blend sign on nonenhanced admission CT and early hematoma growth.

Results: A total of 172 patients were included in our study. Blend sign was observed in 29 of 172 (16.9%) patients with intracerebral hemorrhage on baseline nonenhanced CT scan. Of the 61 patients with hematoma growth, 24 (39.3%) had blend sign on admission CT scan. Interobserver agreement for identifying blend sign was excellent between the 2 readers (κ=0.957). The multivariate logistic regression analysis demonstrated that the time to baseline CT scan, initial hematoma volume, and presence of blend sign on baseline CT scan to be independent predictors of early hematoma growth. The sensitivity, specificity, positive and negative predictive values of blend sign for predicting hematoma growth were 39.3%, 95.5%, 82.7%, and 74.1%, respectively.

Conclusions: The CT blend sign could be easily identified on regular nonenhanced CT and is highly specific for predicting hematoma growth.
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http://dx.doi.org/10.1161/STROKEAHA.115.009185DOI Listing
August 2015

Intraventricular Hemorrhage and Early Hematoma Expansion in Patients with Intracerebral Hemorrhage.

Sci Rep 2015 Jun 18;5:11357. Epub 2015 Jun 18.

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.

Intraventricular hemorrhage is associated with poor functional outcomes in patients with intracerebral hemorrhage (ICH). We aimed to investigate the association between intraventricular hemorrhage and early hematoma expansion in patients with ICH. Patients with ICH who underwent a baseline CT scan within six hours after onset of symptoms were included. The follow-up CT scan was performed within 24 hours after the baseline CT scan. Univariate and multivariable logistic regression were used to assess the relationship between presence of intraventricular hemorrhage and early hematoma expansion. A total of 160 patients were included in the study. Significant hematoma growth was observed in 52 (32.5%) patients presenting within six hours after onset of symptoms. Intraventricular hemorrhage was observed in 66 (41.25%) patients with ICH. Multivariate analyses demonstrated that a short time from onset to baseline CT scan, the initial hematoma volume, and the presence of intraventricular hemorrhage on follow-up CT scan were independently associated with hematoma enlargement. The presence of intraventricular hemorrhage on follow-up CT scan can be associated with hematoma expansion in patients with ICH.
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http://dx.doi.org/10.1038/srep11357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471897PMC
June 2015

Tree-in-bud pattern in central lung cancer: CT findings and pathologic correlation.

Lung Cancer 2015 Jun 18;88(3):260-6. Epub 2015 Mar 18.

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China.

Objectives: Tree-in-bud (TIB) pattern can be found with central lung cancer on chest CT scans. However, few reports have described it so far. We aim to determine its incidence, CT findings and pathologic basis.

Materials And Methods: 652 consecutive patients with confirmed central lung cancer were enrolled in our study. The incidence, CT findings and pathologic features of TIB pattern were analyzed retrospectively.

Results: In total, TIB pattern was found in 22.5% (147/652) of patients. It was more common in patients with squamous cell carcinoma than those with non-squamous cell carcinoma (P=0.000). The most important associated CT finding was obstructive bronchial mucoid impaction distal to the cancer (100%, 147/147), followed by consolidation and ground-glass opacities (62.6%, 92/147). TIB pattern was confined to the areas of lung supplied by the involved bronchi (100%, 147/147) and had a focal distribution predominantly (94.6%, 139/147). Pathologically, it correlated with bronchiolectasis, bronchiolar lumen filled by mucus and inflammatory exudates, wall thickening with inflammatory cells infiltration.

Conclusions: TIB pattern is commonly detected in central lung squamous cell carcinoma on thoracic CT scan. It usually has a localized distribution with a predominant associated CT finding of obstructive bronchial mucoid impaction. This pattern corresponds to the mucoid impaction of bronchioles and bronchiolitis pathologically. A full understanding of TIB pattern in central lung cancer can be useful in preventing diagnostic errors.
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http://dx.doi.org/10.1016/j.lungcan.2015.03.009DOI Listing
June 2015
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