Xiao-e Xu

Perfusion computed tomography evaluation of angiogenesis in liver cancer

ObjectiveTo investigate the value of computed tomography (CT) perfusion imaging for assessment of angiogenesis in liver cancer.MethodsTwenty-one patients with histologically proven liver cancer underwent CT perfusion examination. We compared the following perfusion parameters in the tumour area versus the non-tumour area: total blood flow (TBF), hepatic arterial perfusion (HAP), hepatic portal perfusion (HPP) and hepatic arterial perfusion index (HAPI). Slices of postoperative specimen were stained with haematoxylin–eosin and anti-CD34 immunohistochemistry. The slices were evaluated with emphasis on the CD34-positive neovasculature in the tumour parenchyma. Tumour microvascular density (MVD) was calculated according to the Weidner method. Pearson correlation was used to detect correlations between tumour MVD and tumour perfusion parameters.ResultTBF and HPP in the tumour area were lower than in the non-tumour area (P < 0.05). HAP and HAPI in the tumour area were higher than those of the non-tumour area (P < 0.05). TBF and HAP in the tumour area correlated with MVD in the tumour (P < 0.05), with correlation coefficients of 0.849 and 0.829, respectively.ConclusionCT perfusion imaging can quantitatively assess the blood supply and its distribution in liver cancer. TBF or HAP may be a useful parameter in assessing angiogenesis of liver cancer.

CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions

AIM To assess the accuracy and risk factors for complications of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for small (≤20 mm) pulmonary lesions. MATERIALS AND METHODS A retrospective study was undertaken comprising 169 patients who underwent CT-guided CNB for small (≤20 mm) pulmonary lesions. To assess the accuracy of the procedure, the diagnosis at biopsy was compared with the diagnosis after definitive surgery or clinical follow-up. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables. RESULTS The overall diagnostic accuracy was 93.5%. The sensitivity for malignancy and specificity for benign lesions were 90.4% and 100%, respectively. Positive and negative predictive values were 100% and 83.3%, respectively. Twenty-five patients (14.8%) had pneumothorax after CT percutaneous CNB of the lung. The significant risk factors affecting the incidence of pneumothorax were lesion-pleural distance (p = 0.008) and needle-pleural angle (p = 0.012). The highest rate of pneumothorax correlated with a lesion-pleural distance ≥21 mm (OR = 18.46; 95%CI: 2.27-149.95) and a needle-pleural angle ≥51° (OR = 8.22; 95%CI: 2.14-31.49). Bleeding occurred in 30 patients (17.8%). The only significant risk factor affecting the incidence of bleeding was lesion-pleural distance (p = 0.011). The highest bleeding rate correlated with a lesion-pleural distance ≥21 mm (OR = 7.93; 95%CI: 1.73-36.43). CONCLUSION CT-guided percutaneous CNB of small (≤20 mm) pulmonary lesions provides high diagnostic accuracy with acceptable complications. A lesion-pleural distance of ≥21 mm and needle-pleural angle of ≥51° are identified as the risk factors for highest pneumothorax rate. In addition, the needle-pleural angle is a novel predictor of pneumothorax. A lesion-pleural distance of ≥21 mm is also identified as a risk factor for the highest bleeding rate.

Factors influencing diagnostic yield of CT-guided percutaneous core needle biopsy for bone lesions

AIM To evaluate the factors influencing diagnostic yield of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for bone lesions. MATERIALS AND METHODS Between September 2005 and July 2011, 162 consecutive CT-guided CNB procedures were performed in 155 patients. The variables analysed were age, sex, lesion location, lesion type, lesion size, specimen size, biopsy needle gauge, and individual radiologist. The factors influencing diagnostic yield of CT-guided percutaneous CNB for bone lesions were determined by multivariate analysis of variables. RESULTS The diagnostic yield was 81.5%. Diagnostic yield was 89.9% for lytic bone lesions and 48.5% for sclerotic bone lesions (p < 0.001), and 89.2% for lesions ≥3 cm and 73.4% for lesions <3 cm (p = 0.010). The significant factors influencing diagnostic yield of CT-guided percutaneous CNB for bone lesions were lesion type [p < 0.001; odds ratio (OR) for a lytic lesion was approximately 12 times higher than that for a sclerotic lesion; 95% confidence interval (CI): 4.22-34.01], and lesion size (p = 0.012; OR for a lesion size ≥3 cm was about five-times higher than that for a lesion size <3 cm; 95% CI: 1.42-16.71). CONCLUSION Lesion type and lesion size are determining factors in diagnostic yield. The higher diagnostic yield is correlated with lytic lesion and lesion size ≥3 cm.

CT-guided sclerotherapy with ethanol concentration monitoring for treatment of renal cysts.

OBJECTIVE The purpose of our study was to investigate the value of ethanol concentration monitoring for efficacy of CT-guided sclerotherapy of simple renal cysts. MATERIALS AND METHODS For the experimental study, ethanol solutions with various concentrations (from 10% to 100% at 10% increments) were scanned with CT; the correlation between the CT density values and different ethanol concentrations in the ethanol solution were analyzed. For the clinical study, a total of 66 consecutive patients with simple renal cysts treated with sclerotherapy were retrospectively studied. Of the 66 patients, 45 (group A) did not have ethanol concentration monitoring, whereas 21 (group B) had ethanol concentration monitoring during the procedure. Treatment results between the two groups were compared 6 months later with follow-up ultrasound. RESULTS In the experimental study, there was a linear correlation (r =-0.981) between the CT density values and the ethanol concentration (p < 0.05). In the clinical study, for group A, 25 of 45 patients (55.5%) showed complete regression of the cysts and nine of 45 cases (20%) showed partial regression of the cysts. There was a 24.5% recurrence rate (11/45) in Group A. In group B, 17 of 21 patients (81%) exhibited complete regression of the cyst and four of 21 (19%) showed a partial regression of the cyst. There was no recurrence in Group B. CONCLUSION Our in vitro experiment showed a linear correlation between ethanol concentration and CT density values. CT density values can be used to measure ethanol concentration. Ethanol concentration monitoring during the procedure can improve the success rate in CT-guided sclerotherapy for simple renal cysts.

Computed tomography for assessing resectability of gallbladder carcinoma: a systematic review and meta-analysis

PURPOSE The purpose was to calculate the sensitivity and specificity of computed tomography (CT) in assessing the resectability of gallbladder carcinoma (GBCA) with meta-analysis. MATERIALS AND METHODS A meta-analysis of the reported sensitivity and specificity of each study with 95% confidence intervals (CI) was performed. RESULTS Pooled sensitivity was 99% (95% CI), and pooled specificity was 76% (95% CI). CONCLUSION CT can be used as an appropriate choice for the diagnosis and assessment of resectability of GBCA.

Effectiveness of CT-guided sclerotherapy with estimated ethanol concentration for treatment of symptomatic simple hepatic cysts.

BACKGROUND AND OBJECTIVE The mean Hounsfield value of 99.9% ethanol did get down to -190 Hounsfield units (HU), there was a linear correlation between ethanol concentration and Hounsfield values. We aimed to evaluate whether sclerotherapy with estimated ethanol concentration was helpful in improving the success rate for treatment of symptomatic simple hepatic cysts. METHODS Forty-five patients with 52 symptomatic simple hepatic cysts were enrolled in this study. Twenty-one patients (24 cysts, group A) were treated by sclerotherapy without estimated ethanol concentration and 24 patients (28 cysts, group B) with estimated ethanol concentration. The Chi-square test and Mann-Whitney U test were used to compare the difference in characteristics and treatment outcomes of the subjects between these two groups. RESULTS The mean cyst size before and after treatment were 8.4cm and 2.3cm, respectively, in group A, and 8.2cm and 0.8cm, respectively, in group B. There was no significant difference in the initial size of hepatic cysts between the groups. However, the final size was significantly smaller in group B (P=0.022). The mean ethanol exposure time was 18.3minutes in group B, which was less than that in group A (P<0.001). The success rate was significantly higher in group B (96.4%) than in group A (70.8%) (P=0.03). There were no major complications in either group. CONCLUSION CT-guided sclerotherapy with estimated ethanol concentration yields better results than those without estimated ethanol concentration in the treatment of symptomatic simple hepatic cysts.

A Systematic Review and Meta-Analysis of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules

Summary Background A systematic review and meta-analysis of all available publications was performed to evaluate the diagnostic accuracy of percutaneous transthoracic needle biopsy (PTNB) using a C-Arm Cone-Beam CT (CBCT) system in patients with lung nodules. Material/Methods Thedatabases of PUBMED, OVID, EBSCO, EMBASE, and China National Knowledge Infrastructure (CNKI) were systematically searched for relevant original articles on the diagnostic accuracy of CBCT-guided PTNB for the diagnosis of nodules in the lungs. Diagnostic indices including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and diagnostic score (DS) were calculated. Moreover,summary receiver operating characteristic curves (SROC) were constructed with Stata (version 13.0), Rev Man (version 5.3), and Meta-disc (version 1.4) software. Other clinical indices such as incidence of complications were also recorded. Results Eight studies met the inclusion and exclusion criteria for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, DS, and SROC with 95% confidence intervals were 0.96 (0.93–0.98), 1.00 (0.91–1.00), 711.15 (9.48–53325.89), 0.04 (0.02–0.07), 16585.29 (284.88–9.7e+05), 9.72 (5.65–13.78), and 0.99 (0.97–0.99), respectively. The incidence of pneumothorax and hemorrhage was 10–29.27% and 1.22–47.25%, respectively. Conclusions CBCT-guided PTNB has an acceptable rate of complications and is associated with a reasonable radiation exposure. Moreover, it is a highly accurate and safe technique for the diagnosis of lung nodules and can be recommended to be used in routine clinical practice.

Computed tomography-guided catheter drainage with urokinase and ozone in management of empyema

AIM To retrospectively compare the outcomes of catheter drainage, urokinase and ozone in management of empyema. METHODS Retrospective study included 209 patients (111 males and 98 females; age range 19 to 72 years) who were diagnosed with empyema. The patients were divided into 3 groups based on the therapy instituted: catheter drainage only (group I); catheter drainage and urokinase (group II); catheter drainage, urokinase and ozone (group III). Drainage was considered successful if empyema was resolved with closure of cavity, clinical symptoms were resolved, and need for any further surgical procedure was avoided. Success rate, length of stay (LOS), need for further surgery and hospital costs were compared between the three groups using the Kruskall-Wallis nonparametric test, with P < 0.05 considered significant. RESULTS Of the 209 patients with empyema, all catheters were placed successfully under CT guidance. Sixty-three patients were treated with catheters alone (group I), 64 with catheters and urokinase (group II), and 82 with catheters, urokinase and ozone (group III). Group I, group II and group III had success rates of 62%, 83% and 95% respectively (P < 0.05). Group I and group II had statistically longer LOS (P < 0.05) and higher hospital costs (P < 0.05) compared to group III. There were statistically significant differences between the three groups when comparing patients who converted into further surgery. CONCLUSION The combination of chest tube drainage, urokinase and ozone is a safe and effective therapeutic modality in thoracic empyema.

Re: CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions. A reply

Sir d My co-authors and I thank Guimaraes and Marchiori for their comments regarding our article.1 We read the comments carefully, and are well aware of the evidence that shows core needle biopsy (CNB) is superior to fine-needle aspiration biopsy (FNAB) because CNB can obtain adequate specimens for histopathology diagnosis.2 Conversely, FNAB only provides cytological features of the lesion and does not preserve the architecture of the obtained tissue. CNB specimens are more suitable for the evaluation of tissue patterns and for various ancillary diagnostic tests. Furthermore, obtaining a tumour specimen to analyse themolecular fingerprint of somatic mutation for personalized treatment will be a major trend in the future.3 Thus, we believe that CT-guided CNB will be an important technique in the personalized treatment of lung cancer. CTguided CNB deserves to be the first-line technique in lung biopsy because it is an accurate, minimally invasive, safe, and cost-effective method. In our study, CT-guided percutaneous CNB of small ( 20 mm) pulmonary lesions provided high diagnostic accuracy with acceptable complications. The overall diagnostic accuracy was 93.5%. The main complications were pneumothorax (14.8%; 25 of 169 patients), chest tube insertion (1.8%; three of 169 patients), and bleeding (17.8%;

Multiple occipital defects caused by arachnoid granulations: Emphasis on T2 mapping

A 56-year-old man presented with a 6-mo history of headache. Although neurological and laboratory examinations were normal, computed tomography (CT) scan was performed which revealed multiple occipital osteolytic lesions, which were suspected to be multiple myeloma. Subsequently nuclear magnetic resonance imaging (MRI) showed that these lesions presented with a cerebrospinal fluid (CSF)-like signal intensity, no diffusional restriction and intrinsic mass-like enhancement on conventional sequences were seen. T2 relaxation time was similar to that of CSF in the ventricles and adjacent subarachnoid space on T2-mapping. Single photon emission CT with (99m)Tc-Methyl diphosphonate was performed which revealed no increased radiotracing accumulation. Finally, these lesions were diagnosed as mutiple arachnoid granulations (AGs). The headache was treated symptomatically with medical therapy. On follow up examination after 6 mo no evidence of tumor was detected. This report aimed to illustrate the appearance and differentiation of occipital defects caused by multiple AGs on CT and MRI, with emphasis on the findings from T2 mapping.