Publications by authors named "Zhi-Gang Chu"

51 Publications

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
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

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

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

J Appl Clin Med Phys 2021 Jan 24;22(1):318-326. Epub 2020 Dec 24.

School of Public Health and Management, Chongqing Medical University, Chongqing, China.

Purpose: This study aims to evaluate the performance of four artificial intelligence-aided diagnostic systems in identifying and measuring four types of pulmonary nodules.

Methods: Four types of nodules were implanted in a commercial lung phantom. The phantom was scanned with multislice spiral computed tomography, after which four systems (A, B, C, D) were used to identify the nodules and measure their volumes.

Results: The relative volume error (RVE) of system A was the lowest for all nodules, except for small ground glass nodules (SGGNs). System C had the smallest RVE for SGGNs, -0.13 (-0.56, 0.00). In the Bland-Altman test, only systems A and C passed the consistency test, P = 0.40. In terms of precision, the miss rate (MR) of system C was 0.00% for small solid nodules (SSNs), ground glass nodules (GGNs), and solid nodules (SNs) but 4.17% for SGGNs. The comparable system D MRs for SGGNs, SSNs, and GGNs were 71.30%, 25.93%, and 47.22%, respectively, the highest among all the systems. Receiver operating characteristic curve analysis indicated that system A had the best performance in recognizing SSNs and GGNs, with areas under the curve of 0.91 and 0.68. System C had the best performance for SGGNs (AUC = 0.91).

Conclusion: Among four types nodules, SGGNs are the most difficult to recognize, indicating the need to improve higher accuracy and precision of artificial systems. System A most accurately measured nodule volume. System C was most precise in recognizing all four types of nodules, especially SGGN.
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http://dx.doi.org/10.1002/acm2.13142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856495PMC
January 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

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

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

PI3K-AKT Pathway Protects Cardiomyocytes Against Hypoxia-Induced Apoptosis by MitoKATP-Mediated Mitochondrial Translocation of pAKT.

Cell Physiol Biochem 2018 30;49(2):717-727. Epub 2018 Aug 30.

Institute of Burns, State Key Laboratory of Trauma, Burn and Combined Injury, South-west Hospital, Third Military Medical University, Chongqing, China.

Background/aims: The phosphatidylinositol-3-kinase -AKT (PI3K-AKT) is an important intracellular signal pathway in regulating cell proliferation, differentiation and apoptosis. In previous studies, we've demonstrated that PI3K-AKT pathway protects cardiomyocytes from ischemic and hypoxic apoptosis through mitochondrial function. However, the molecular mechanisms underlying hypoxia-induced cardiomyocyte apoptosis via PI3K-AKT pathway remain ill-defined. Here, we addressed this question.

Methods: Cardiomyocytes were exposed to hypoxia, with/without different inhibitors and then protein levels were assessed by Western blotting.

Results: We found that the PI3K-AKT pathway was activated in cardiomyocytes that were exposed to hypoxia. Moreover, the phospho-AKT (pAKT) translocated from cytosol to mitochondria via mitochondrial adenosine triphosphate-dependent potassium (mitoKATP), leading to an increase in cytochrome c oxidase (CcO) activity to suppress apoptosis. On the other hand, the mitoKATP specific blocker, 5-hydroxydecanote (5-HD), or suppression of CcO using siRNA, inhibited the pAKT mitochondrial translocation to maintain the CcO activity, resulting in mitochondrial dysfunction and cellular apoptosis induced by hypoxia.

Conclusion: These findings suggest that the anti-apoptotic effect of the PI3K-AKT pathway through pAKT translocation to mitochondrial via mitoKATP may be conducted through modification of CcO activity.
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http://dx.doi.org/10.1159/000493037DOI Listing
September 2018

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

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

Ectopic pancreas in the anterior mediastinum: A report of two cases and review of the literature.

Oncol Lett 2014 Apr 29;7(4):1053-1056. Epub 2014 Jan 29.

Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.

Ectopia of the pancreatic tissue is a developmental anomaly found in ~2% of all autopsies, and 70~90% of these anomalies are located in the gastrointestinal tract. Mediastinal localization of an ectopic pancreas is extremely rare. Herein, we report two cases with mediastinal ectopic pancreas clarified by pathology and shown by thoracic contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI). In addition, a brief review of the relevant literatures is presented. Although CT and MRI manifestations of this lesion are nonspecific, certain notable findings need to be focused on. When there is a mass in the anterior mediastinum with marked and heterogeneous enhancement, along with necrotic and liquefied non-enhanced areas in the center, ectopic pancreas should be considered and differentiated from other neoplasms in this region.
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http://dx.doi.org/10.3892/ol.2014.1840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961199PMC
April 2014

Cardiac fibromas in the adult.

J Card Surg 2014 Mar 25;29(2):159-62. Epub 2013 Nov 25.

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

Background: Cardiac fibromas are primarily detected in infants and children but are extremely rare in adults.

Methods: We report a case of a cardiac fibroma in a 37 year old male and review the literature on this subject.

Result: The patient was referred for evaluation of a cardiac mass. Echocardiography and computed tomography examinations revealed it as an inhomogeneous mass with calcifications. Subsequently, the lesion was completely excised and confirmed to be a cardiac fibroma. Cardiac fibromas account for only a very small percentage of all cardiac tumors. The occurrence and severity of symptoms caused by cardiac fibromas are primarily determined by the sites and size of lesions. Imaging techniques are very sensitive in diagnosing cardiac fibromas, defining the extent and planning surgical approach. Surgical treatment of cardiac fibromas gives excellent early and late survival.

Conclusion: Although cardiac fibromas are benign, their behavior is unpredictable. Surgery appears to be the optimal treatment for patients with resectable tumors.
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http://dx.doi.org/10.1111/jocs.12251DOI Listing
March 2014

Extrahepatic primary adrenal alveolar echinococcosis: a review.

Surg Infect (Larchmt) 2013 Aug 16;14(4):418-21. Epub 2013 Jul 16.

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

Background: Primary echinococcosis, and especially primary alveolar echinococcosis (AE) is rare among adrenal lesions.

Methods: We report a case of primary AE in a 28-year-old male with low backache and occasional upper limb pain lasting for six months, and review the pertinent but sparse literature on this disorder.

Results: Evaluation of the patient revealed an abdominal mass as right adrenal AE. The adrenal gland is a rare extrahepatic site of occurrence of echinococcosis, and particularly of AE. Patients with adrenal echinococcosis usually have nonspecific clinical symptoms. Imaging examinations revealed clearly the features of AE and its surrounding pathology. Alveolar echinococcosis was seen as an inhomogeneous pseudotumor with irregular boundaries, an irregular central pseudocystic appearance, and infiltration into surrounding structures. On contrast-enhanced computed tomography, the periphery of the mass in AE may be enhanced and multicentric vesicles may be seen. Magnetic resonance imaging may show the multivesicular morphology of lesions. The definitive diagnosis of AE should be confirmed by pathologic or serologic examination. Radical surgical resection of the removable parasitic lesion, followed by anti-infective therapy with benzimidazoles, is the primary method for treating AE.

Conclusion: Although primary adrenal AE is rare, it should be included in the differential diagnosis of adrenal masses, especially in regions where AE is endemic.
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http://dx.doi.org/10.1089/sur.2012.037DOI Listing
August 2013

Earthquake-related crush fractures and non-earthquake-related fractures of the extremities: a comparative radiological study.

Emerg Med Australas 2012 Dec 28;24(6):663-9. Epub 2012 Aug 28.

Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.

Objective: To determine the features that differentiate earthquake-related crush extremity fractures from non-earthquake-related extremity fractures by using digital radiography (DR) and multidetector row computed tomography (MDCT).

Methods: Six hundred and twenty-three consecutive victims with crush extremity fractures arising from the 2008 Sichuan earthquake, including 611 undergoing DR and 12 undergoing MDCT, entered the test group, and 316 consecutive victims with non-earthquake-related extremity fractures, including 301 undergoing DR and 15 undergoing MDCT, were enrolled in the control group. Image data were reviewed retrospectively and statistically between groups focusing on the anatomic distributions, numbers and types of extremity fractures.

Results: Fractures involving multiple extremities were more likely in the test group than the control group (88/623 vs 27/316 victims, P < 0.05). Fractures involving multiple bones (336/623 vs 112/316 victims) and comminuted fractures (324/623 vs 78/316 victims) were seen more frequently in the test group than the control group with both occurring predominantly in the tibia and fibula (all P < 0.05).

Conclusion: Earthquake-related crush fractures of extremities are more likely than non-earthquake-related extremity fractures to involve multiple extremities, multiple bones and to be comminuted. The lower extremities, predominantly the tibia and fibula, are more likely to be involved. This has implications for emergency and disaster planning in earthquake-prone regions.
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http://dx.doi.org/10.1111/j.1742-6723.2012.01594.xDOI Listing
December 2012

Ghost cell odontogenic carcinoma arising from calcifying cystic odontogenic tumor: a case report.

Korean J Pathol 2012 Oct 25;46(5):478-82. Epub 2012 Oct 25.

Department of Pathology, West China Hospital of Stomatology, Sichuan University, Sichuan, China.

Ghost cell odontogenic carcinoma (GCOC) is an exceptionally rare and malignant odontogenic tumor with aggressive growth characteristics. We describe a case of GCOC which was considerably derived from a previously resected calcifying cystic odontogenic tumor (CCOT). Cellular atypia, mitotic activity, Ki-67 labeling index and matrix metalloprotease-9 positive expression rate were all increased in the currently resected specimen compared to the initial one. This is a rare case of malignant transformation of CCOT to GCOC with respect to its histopathological and immunohistochemical findings.
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http://dx.doi.org/10.4132/KoreanJPathol.2012.46.5.478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490111PMC
October 2012

CT evaluation of hepatic paragonimiasis with simultaneous duodenal or splenic involvement.

Clin Imaging 2012 Jul-Aug;36(4):394-7. Epub 2012 Jun 8.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

Paragonimiasis is a parasitic infection caused by the genus Paragonimus and usually leads to pulmonary disease. Hepatic paragonimiasis is rare, but duodenal and splenic involvement of this disease has not yet been reported in the literature. Herein, we report two rare cases of hepatic paragonimiasis with simultaneous duodenal or splenic involvement, respectively, and described their CT features. Both patients were lifelong residents of an endemic area of paragonimiasis and were confirmed clinicopathologically.
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http://dx.doi.org/10.1016/j.clinimag.2011.09.008DOI Listing
November 2012

Left atrial diverticula in patients referred for radiofrequency ablation of atrial fibrillation: assessment of prevalence and morphologic characteristics by dual-source computed tomography.

Circ Arrhythm Electrophysiol 2012 Apr 16;5(2):345-50. Epub 2012 Feb 16.

Department of Radiology, Sichuan University, Chengdu, Sichuan, China.

Background: The anatomic features of left atrial diverticula (LAD) are still unclear in patients with atrial fibrillation (AF). The purpose of this study was to evaluate the prevalence and morphological characteristics of LAD in patients referred for radiofrequency transcatheter ablation of AF with dual-source computed tomography.

Methods And Results: Dual-source computed tomography images were obtained in 214 patients referred for AF catheter ablation and 214 sex- and age-matched control subjects. Images were analyzed to determine the prevalence and morphological characteristics of LAD and their relationship with adjacent pulmonary veins and left atrial appendage. In AF patients 77 (36.0%) (95% confidence interval, 29.6-42.4%) had 90 LAD, whereas in control subjects 70 (32.7%) (95% confidence interval, 26.4-39.0%) had 81 LAD (P=0.551). In patients with AF, LAD locations were right anterosuperior (47.8%), left anterosuperior (8.9%), left lateral (32.2%), interatrial septum (4.4%), right inferior (5.6%), and posterosuperior (1.1%) walls, respectively. The mean size of LAD was 5.3±2.9×5.6±3.3 mm. The wall of the LAD was much thinner than that of adjacent left atrium (0.89±0.46 versus 2.39±0.83 mm). Most LAD were located close to a pulmonary vein or atrial appendage ostium, with a mean distance of 8.7-13.1 mm.

Conclusions: LAD are common, with a prevalence of 36.0% in patients with AF, which is not statistically greater than that in patients without AF. Thin-walled LAD are more commonly located on the superior anterior wall of left atrium and close to common ablation sites.
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http://dx.doi.org/10.1161/CIRCEP.111.965665DOI Listing
April 2012

Small peripheral lung adenocarcinoma: CT and histopathologic characteristics and prognostic implications.

Cancer Imaging 2011 Dec 28;11:237-46. Epub 2011 Dec 28.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Since the introduction of computed tomography (CT), detection of small lung cancer, especially small peripheral adenocarcinoma, is common. Recently, the morphological characteristics, including thin-section CT and pathologic findings, and prognosis of small peripheral lung adenocarcinomas have been studied extensively. The radiologic and microscopic findings correlate well with each other and are closely associated with tumour prognosis. Most importantly, some subtypes of small lung adenocarcinomas with specific CT or pathologic features are curable. Therefore, all defining characteristics (CT, pathologic and prognostic) of this kind of tumour should be integrated to improve our understanding, provide guidelines for management and accurately assess its prognosis.
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http://dx.doi.org/10.1102/1470-7330.2011.0033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266590PMC
December 2011

Digital radiography of crush thoracic trauma in the Sichuan earthquake.

World J Radiol 2011 Nov;3(11):273-8

Zhi-Hui Dong, Heng Shao, Tian-Wu Chen, Zhi-Gang Chu, Wen Deng, Si-Shi Tang, Jing Chen, Zhi-Gang Yang, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.

Aim: To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography (CDR).

Methods: We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake. Patient age ranged from 0.5 to 103 years. CDR was performed between May 12, 2008 and June 7, 2008. We looked for injury to the thoracic cage, pulmonary parenchyma and the pleura.

Results: Antero-posterior (AP) and lateral CDR were obtained in 349 patients, the remaining 423 patients underwent only AP CDR. Thoracic cage fractures, pulmonary contusion and pleural injuries were noted in 331 (42.9%; 95% CI: 39.4%-46.4%), 67 and 135 patients, respectively. Of the 256 patients with rib fractures, the mean number of fractured ribs per patient was 3. Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib. Rib fractures had a significant positive association with non-rib thoracic fractures, pulmonary contusion and pleural injuries (P < 0.001). The number of rib fractures and pulmonary contusions were significant factors associated with patient death.

Conclusion: Earthquake-related crush thoracic trauma has the potential for multiple fractures. The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment.
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http://dx.doi.org/10.4329/wjr.v3.i11.273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226961PMC
November 2011

Comparative study of earthquake-related and non-earthquake-related head traumas using multidetector computed tomography.

Clinics (Sao Paulo) 2011 ;66(10):1735-42

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Objective: The features of earthquake-related head injuries may be different from those of injuries obtained in daily life because of differences in circumstances. We aim to compare the features of head traumas caused by the Sichuan earthquake with those of other common head traumas using multidetector computed tomography.

Methods: In total, 221 patients with earthquake-related head traumas (the earthquake group) and 221 patients with other common head traumas (the non-earthquake group) were enrolled in our study, and their computed tomographic findings were compared. We focused the differences between fractures and intracranial injuries and the relationships between extracranial and intracranial injuries.

Results: More earthquake-related cases had only extracranial soft tissue injuries (50.7% vs. 26.2%, RR = 1.9), and fewer cases had intracranial injuries (17.2% vs. 50.7%, RR = 0.3) compared with the non-earthquake group. For patients with fractures and intracranial injuries, there were fewer cases with craniocerebral injuries in the earthquake group (60.6% vs. 77.9%, RR = 0.8), and the earthquake-injured patients had fewer fractures and intracranial injuries overall (1.5 + 0.9 vs. 2.5 +1.8; 1.3 + 0.5 vs. 2.1 + 1.1). Compared with the non-earthquake group, the incidences of soft tissue injuries and cranial fractures combined with intracranial injuries in the earthquake group were significantly lower (9.8% vs. 43.7%, RR = 0.2; 35.1% vs. 82.2%, RR = 0.4).

Conclusion: As depicted with computed tomography, the severity of earthquake-related head traumas in survivors was milder, and isolated extracranial injuries were more common in earthquake-related head traumas than in non-earthquake-related injuries, which may have been the result of different injury causes, mechanisms and settings.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180155PMC
http://dx.doi.org/10.1590/s1807-59322011001000011DOI Listing
February 2012

[Distinguishing benign and malignant lesions with time-signal intensity curve of dynamic contrast-enhanced breast MRI scanning].

Sichuan Da Xue Xue Bao Yi Xue Ban 2011 Jul;42(4):556-9

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To determine the diagnostic value of time-signal intensity curve (TIC) in distinguishing breast malignant tumors from benign lesions.

Methods: Forty-four patients with 50 breast lesions were recruited in the study, including 24 pathologically confirmed benign lesions and 26 malignant tumors. All patients received dynamic contrast-enhanced breast MRI scanning a week before surgery. The time-signal intensity curves in the regions of interest (ROI) and eight items of TIC including shape, T peak, E peak, Slope(i), E1, E2, W peak-7, and W peak-9 were compared between benign lesions and malignant tumors. The receive operating characteristic curves (ROC) were depicted for those indicators with significant statistical differences.

Results: Six items of TIC including shape, T peak, Slope(i), E1, E2, and W peak-9 were significantly different (P<0.05) between malignant tumors and benign lesions. The sensitivities of shape, T peak, Slope(i), E1, E2, and W peak-9 for diagnosing breast malignant tumors were 92.3%, 95.83%, 80.77%, 61.53%, 69.23%, and 69.23% respectively. Their specificities were 87.5%, 92.3%, 95.8%, 87.5%, 79.17%, and 79.17% respectively. TIC curve shape, T peak and Slope(i) were better than E1, E2 and W peak-9 in diagnosing breast malignant lesions (P<0.05).

Conclusion: Benign and malignant breast tumors can be differentiated according to TIC. TIC curve shape, T peak and Slope(i) are better than E1, E2 and W peak-9 in distinguishing malignant breast tumors from benign lesions.
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July 2011

Thoracic Injuries in earthquake-related versus non-earthquake-related trauma patients: differentiation via Multi-detector Computed Tomography.

Clinics (Sao Paulo) 2011 ;66(5):817-22

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.

Purpose: Massive earthquakes are harmful to humankind. This study of a historical cohort aimed to investigate the difference between earthquake-related crush thoracic traumas and thoracic traumas unrelated to earthquakes using a multi-detector Computed Tomography (CT).

Methods: We retrospectively compared an earthquake-exposed cohort of 215 thoracic trauma crush victims of the Sichuan earthquake to a cohort of 215 non-earthquake-related thoracic trauma patients, focusing on the lesions and coexisting injuries to the thoracic cage and the pulmonary parenchyma and pleura using a multi-detector CT.

Results: The incidence of rib fracture was elevated in the earthquake-exposed cohort (143 vs. 66 patients in the non-earthquake-exposed cohort, Risk Ratio (RR) = 2.2; p<0.001). Among these patients, those with more than 3 fractured ribs (106/143 vs. 41/66 patients, RR=1.2; p<0.05) or flail chest (45/143 vs. 11/66 patients, RR=1.9; p<0.05) were more frequently seen in the earthquake cohort. Earthquake-related crush injuries more frequently resulted in bilateral rib fractures (66/143 vs. 18/66 patients, RR= 1.7; p<0.01). Additionally, the incidence of non-rib fracture was higher in the earthquake cohort (85 vs. 60 patients, RR= 1.4; p<0.01). Pulmonary parenchymal and pleural injuries were more frequently seen in earthquake-related crush injuries (117 vs. 80 patients, RR=1.5 for parenchymal and 146 vs. 74 patients, RR = 2.0 for pleural injuries; p<0.001). Non-rib fractures, pulmonary parenchymal and pleural injuries had significant positive correlation with rib fractures in these two cohorts.

Conclusions: Thoracic crush traumas resulting from the earthquake were life threatening with a high incidence of bony thoracic fractures. The ribs were frequently involved in bilateral and severe types of fractures, which were accompanied by non-rib fractures, pulmonary parenchymal and pleural injuries.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109381PMC
http://dx.doi.org/10.1590/s1807-59322011000500018DOI Listing
June 2012

Abdominal crush injury in the Sichuan earthquake evaluated by multidetector computed tomography.

World J Radiol 2011 May;3(5):135-40

Tian-Wu Chen, Zhi-Gang Yang, Zhi-Hui Dong, Heng Shao, Zhi-Gang Chu, Si-Shi Tang, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.

Aim: To investigate the features of abdominal crush injuries resulting from an earthquake using multidetector computed tomography (MDCT).

Methods: Fifty-one survivors with abdominal crush injuries due to the 2008 Sichuan earthquake underwent emergency non-enhanced scans with 16-row MDCT. Data were reviewed focusing on anatomic regions including lumbar vertebrae, abdominal wall soft tissue, retroperitoneum and intraperitoneal space; and types of traumatic lesions.

Results: Fractures of lumbar vertebrae and abdominal wall soft tissue injuries were more common than retro- and intraperitoneal injuries (P < 0.05). With regard to the 49 lumbar vertebral fractures in 24 patients, these occurred predominantly in the transverse process (P < 0.05), and 66.67% of patients (16/24) had fractures of multiple vertebrae, predominantly two vertebrae in 62.5% of patients (10/16), mainly in L1-3 vertebrae in 81.63% of the vertebrae (40/49). Retroperitoneal injuries occurred more frequently than intraperitoneal injuries (P < 0.05), and renal and liver injuries were most often seen in the retroperitoneum and in the intraperitoneal space, respectively (all P < 0.05).

Conclusion: Transverse process fractures in two vertebrae among L1-3 vertebrae, injury of abdominal wall soft tissue, and renal injury might be features of earthquake-related crush abdominal injury.
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http://dx.doi.org/10.4329/wjr.v3.i5.135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110915PMC
May 2011

Earthquake-related pelvic crush fracture vs. non-earthquake fracture on digital radiography and MDCT: a comparative study.

Clinics (Sao Paulo) 2011 ;66(4):629-34

Department of Radiology, West China Hospital, Sichuan University, China.

Objective: To determine the features of earthquake-related pelvic crush fractures versus non-earthquake fractures with digital radiography and multidetector row computed tomography.

Methods: One hundred and sixty-seven survivors with pelvic crush fractures in the 2008 Sichuan earthquake were entered in our study as the earthquake-related group (139 underwent digital radiography, 28 underwent multidetector row computed tomography); 70 victims with non-earthquake pelvic fractures were enrolled into this study as the non-earthquake group (54 underwent digital radiography, 16 underwent multidetector row computed tomography). Data were reviewed retrospectively between groups, focusing on anatomic distributions, status of pelvic bone fractures, numbers of pelvic bones involved, and classification of pelvic ring fractures according to the Tile classification system.

Results: Pelvic fractures occurred more frequently in the pubis in the earthquake-related group than in the non-earthquake group (135/167, 81% vs. 48/70, 69%). In addition, comminuted fractures were more common in the earthquake-related group than in the non-earthquake group (55/167, 33% vs. 10/70, 14%). Multiple fractures were less common in the earthquake-related group than in the non-earthquake group (81/167, 49% vs. 46/70, 66%). Regarding the classification of pelvic ring fractures, Type C predominantly composed of subtype C3 occurred more frequently (64/167, 38% vs. 12/70, 17%), and Type A was less common in the earthquake-related group than in the non-earthquake group (31/167, 19% vs. 23/70, 32%). All differences were statistically significant (p<0.05). No difference was found in Type B fractures between the groups (72/167, 43% vs. 35/70, 50%).

Conclusion: Earthquake-related pelvic crush fractures can be characterized by a high incidence of pelvic fractures occurring in the pubis, comminuted fractures, and Type C fractures predominantly composed by subtype C3, despite a low incidence of multiple fractures.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093794PMC
http://dx.doi.org/10.1590/s1807-59322011000400018DOI Listing
December 2011

Earthquake-related injuries: evaluation with multidetector computed tomography and digital radiography of 1491 patients.

J Crit Care 2012 Feb 21;27(1):103.e1-6. Epub 2011 Apr 21.

Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China.

Purpose: The aim of this study was to evaluate the common features of earthquake-related injuries using radiography and computed tomography.

Materials And Methods: We retrospectively reviewed the radiography and multidetector computed tomography features of 1491 patients injured in 2008 Sichuan earthquake. We categorized patients by age group (<35, 35-64, and ≥ 65 years) and time to imaging. Injuries were categorized by anatomical distribution.

Results: We detected earthquake-related trauma in 1197 patients (80.28%), including head injuries, facial fractures, thoracic injuries, abdominal injuries, pelvic fractures, spinal injuries, and extremity fractures in 91, 41, 354, 30, 204, 299, and 732 (61.15%) patients, respectively (χ(2) = 1844.747, P < .001). Injuries in 2 or more anatomical locations occurred in 384 cases. We discovered significant difference in the anatomical distribution of injuries among the 3 age groups (χ(2) = 104.113, P < .001) and among the time-to-imaging categories (χ(2) = 64.420, P < .001). Twenty-two patients (1.48%) eventually died. Abdominal injuries (B = 2.285, P = .004), head injuries (B = 2.194, P < .001), thoracic injuries (B = 1.989, P < .001), and age (B = 1.539, P < .001) were all associated with patient death.

Conclusions: The Sichuan earthquake most commonly resulted in extremity fractures, but there was a high incidence of injuries to multiple body areas. Head, abdominal, and thoracic injuries and age older than 64 years all were significant risk factors for earthquake mortality.
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http://dx.doi.org/10.1016/j.jcrc.2011.03.007DOI Listing
February 2012

Correlations between MDCT features and clinicopathological findings of hepatic paragonimiasis.

Eur J Radiol 2012 Apr 26;81(4):e421-5. Epub 2011 Mar 26.

Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China.

Aim: To illustrate the MDCT features of hepatic paragonimiasis and correlate the results with clinicopathological findings.

Materials And Methods: Eighteen patients (8 male, 10 female; mean age 37years) with hepatic paragonimiasis were included in this study. MDCT features of their hepatic lesions were retrospectively reviewed and correlated with clinicopathological findings.

Results: All patients were lifelong residents in endemic areas of paragonimiasis, especially Paragonimiasis skrjabini variety. Abdominal pain or discomfort, fever and high eosinophil percentage were the predominant clinical features. In total, 21 lesions were detected on MDCT images, 18 (85.7%) directly contacted the hepatic capsule and 3 (14.3%) were adjacent to the capsule. Segment V (26%), VIII (26%) and VI (18.5%) were the most commonly involved sites. Sixteen lesions (76%) were conglomerated cystic or multilocular and 5 (24%) were solid. On plain MDCT scan, the margin and internal detail of the lesions were not clear except for one cystic variety, while they were clearly demonstrated on enhanced images. Single or multiple cysts with different diameters were commonly detected in the non-solid lesions, and some of them were mutually connected with tortuous tract formation. Among the solid lesions, 2 and 3 showed tubular and homogeneous enhancement, respectively.

Conclusion: Peripherally distributed lesions, mutually connected cysts with tortuous tract formation, and tubular enhancement, which may be closely associated with the infection route and migration of the worm, could be seen as the main MDCT features of hepatic paragonimiasis.
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http://dx.doi.org/10.1016/j.ejrad.2011.03.019DOI Listing
April 2012