Yan Shen

HRCT features distinguishing pre-invasive from invasive pulmonary adenocarcinomas appearing as ground-glass nodules

AbstractObjectiveTo investigate the high-resolution computed tomography (HRCT) features that distinguish lung adenocarcinomas in situ (AISs) and minimally invasive adenocarcinomas (MIAs) from invasive adenocarcinomas (IACs) appearing as ground-glass nodules (GGNs), and to select candidates for sublobar resection.MethodsTwo hundred and twenty-nine patients with 237 GGNs of less than 2 cm (139 AIS-MIA nodules and 98 IAC nodules) confirmed by surgery and pathology were retrospectively reviewed. The HRCT features of the AIS-MIAs and IACs were analysed and compared. Receiver operating characteristic (ROC) analyses were conducted to determine the cutoff values for the qualitative variables and their diagnostic performances.ResultsSignificant differences were found in the density, nodule and solid component diameters, CT values of the ground-glass and solid components, lobulated shape, spiculated margin, abnormal pulmonary vein and artery, air bronchogram, and pleural indentation of the GGNs between the two groups. Multivariate and ROC analyses revealed that larger diameter of nodules (≥12.2 mm) and solid components (≥6.7 mm), and higher CT values of the solid components (≥ -192 HU) in the GGNs with air bronchogram were significantly associated with IACs.ConclusionsHRCT can identify distinguishing morphological features between AIS-MIAs and IACs, and is helpful for selecting candidates for sublobar resection.Key Points• IACs appearing as GGNs were often ≥ 12.2 mm in diameter.n • IACs were often ≥ 6.7 mm in solid component diameter.n • The solid components of the IACs often exhibited ≥ -192 HU.n • IACs exhibited air bronchogram more frequently than AIS-MIAs.

Plasma ghrelin levels are closely associated with severity and morphology of angiographically-detected coronary atherosclerosis in Chineses patients with diabetes mellitus

Aim:Low plasma ghrelin level was found to be associated with diabetes, and ghrelin was shown to inhibit pro-atherogenic changes in experimental models of atherosclerosis. The aim of this study was to investigate the relationship between plasma ghrelin levels and coronary atherosclerotic lesions in Chinese patients with diabetes.Methods:Plasma ghrelin levels were measured using an ELISA kit. The severity of coronary artery disease (CAD) was determined via angiography. Composition of atherosclerotic plaques was detected via coronary CT angiography.Results:A total of 178 patients with diabetes were recruited. Among the patients, 70 were diagnosed with acute coronary syndrome (ACS), 82 with stable angina pectoris (SAP) and 26 without coronary angiographic finding (controls). A negative correlation was found between ghrelin levels and the severity of the CAD, as determined via the Gensini score (r=-0.2434; P=0.0217). In diabetic patients with CAD and a complex lesion, the plasma ghrelin levels were significantly lower than in those with a simple lesion (ACS group: 3.81±0.49 ng/mL vs 4.72±0.50 ng/mL, P<0.0001; SAP group: 4.21±0.52 ng/mL vs 4.76±0.59 ng/mL, P=0.0397). Angiographically-detected complex lesion was an independent factor associated with ghrelin levels (adjusted beta coefficient=-0.67, 95% CI -0.97 to -0.37, P<0.0001).Conclusion:Low plasma ghrelin level is closely related to angiographically-detected severity and the complex lesion morphology in Chinese diabetic patients with CAD.

Plasma ghrelin levels are closely associated with stenosis severity and morphology of angiographically-detected coronary atherosclerosis in patients with coronary artery disease.

angiographically-detected coronary atherosclerosis in patients with coronary artery disease Min Zhang , Weiyi Fang ⁎, Fang Yuan , Xinkai Qu , Hua Liu , Hui Chen , Yongfu Yu , Zhichun Zheng , Yan Shen c a Department of Cardiology, The Affiliated Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China b Department of Biostatistics, School of Public Health, Fudan University, 200032, China c Department of Radiology, The Affiliated Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China

Using air bronchograms on multi-detector CT to predict the invasiveness of small lung adenocarcinoma

PURPOSEnTo investigate the prevalence of multidetector CT (MDCT) air bronchograms and their value in predicting the invasiveness of lung adenocarcinomas.nnnMETHODSnMDCT scans of 606 nodules in 582 patients with a lung adenocarcinoma less than 2cm in diameter confirmed by surgery and pathology were reviewed. Air bronchograms were classified into three patterns: type I, bronchus with intact lumen; type II, bronchus with dilated or tortuous lumen; and type III, bronchus with obstructed lumen.nnnRESULTSnAir bronchograms were demonstrated on MDCT in 210 of 606 (34.7%) lung adenocarcinomas with 16.6% (35/211) preinvasive lesions (PL), 30.5% (50/164) minimally invasive adenocarcinoma (MIA), and 54.1% (125/231) invasive adenocarcinoma (IAC) (P=0.000); 18.3% (44/240) pure ground-glass nodules (GGNs), 44.2% (137/310) mixed GGNs, and 51.8% (29/56) solid nodules (P=0.000). Type I was slightly more common in MIA (36/164, 22.0%) than IAC (40/231, 17.3%) and PL (30/211, 14.2%) but without differences among them (P=0.147). Type II (PL: 5/211, 2.4%; MIA: 13/164, 7.9%; IAC: 53/231, 22.9%) and type III (PL: 0/211; MIA: 1/164, 0.6%; IAC: 32/231, 13.9%) were observed more frequently with increasing lung adenocarcinoma invasiveness (both P=0.000).nnnCONCLUSIONSnThe prevalence and patterns of air bronchograms on MDCT can predict the invasiveness of small lung adenocarcinomas.

Acute and chronic myocardial infarction in a pig model: Utility of multi-slice cardiac computed tomography in assessing myocardial viability and infarct parameters

OBJECTIVESnThe aim of this study was to determine the feasibility of multi-slice computed tomography (MSCT) biphasic imaging in assessing myocardial viability and infarct parameters in both acutely and chronically infarcted pig models.nnnMATERIALS AND METHODSnSeven pigs underwent ligation of the distal left anterior descending artery. Imaging was performed on the day of infarction and 3 months post-infarct, with contrast infusion followed by MSCT scan acquisition at different time-points. Left ventricular ejection fractions (LVEFs) were obtained by left ventriculography (LVG) after 3 months. Infarcted locations found using MSCT were compared with those obtained using SPECT. Infarcted areas were also analysed histopathologically and compared with the findings from MSCT.nnnRESULTSnChronic phase images had perfusion defects with lower CT values relative to normal myocardium (43±10HU vs. 156±13HU, p=0.001) on the early images but no residual defects on delayed images. However, we found hyperenhancing regions on delayed images (244±20HU vs. 121±25HU, p=0.001), and good correlation between MSCT- and LVG-derived LVEFs (60.56±7.56%). The areas identified by MSCT corresponded to the location of (201)Tl SPECT-/pathologic staining-derived regions in all models. Infarct size was in good agreement with MSCT and pathological analyses of chronic phase models.nnnCONCLUSIONSnNecrotic myocardium in different stages after infarction could be qualitatively and quantitatively assessed using MSCT biphasic imaging, as could the status of microcirculation formation. MSCT-measured LVEFs matched well with other modalities, and hence MSCT is a useful tool in assessing post-infarct cardiac function.

Lymph node metastasis in thymic malignancies: A Chinese multicenter prospective observational study

Objectives To study the incidence and pattern of lymph node metastases in thymic malignancies. Methods This multicenter prospective observational trial with intentional lymph node dissection was carried out by the Chinese Alliance for Research in Thymomas (ChART). Data on patients with thymic tumors without pretreatment were collected prospectively. Results from this prospective study were then compared with those from a previously reported ChART retrospective study. Results Among 275 patients, metastasis was detected in 41 nodes (3.04%) in 15 patients (5.5%). The rate of lymph node metastasis was 2.1% (5/238) in patients with thymomas, 25% (6/24) in those with thymic carcinomas, and 50% (4/8) in those with neuroendocrine tumors (P < .001). The rate of lymph node metastasis in category T1 to T4 tumors was 2.7% (6/222) in T1, 7.7% (1/13) in T2, 18.4% (7/38) in T3, and 50% (1/2) in T4 (P < .001). Nodal involvement was significantly higher compared with the ChART retrospective study (5.5% vs 2.2%; P = .002), although the 2 groups were comparable in terms of tumor stage and histology. Metastasis was found in N1 nodes in 13 patients (86.7%) and in N2 nodes in 8 patients (53.3%); 6 patients (40%) had simultaneous N1/N2 diseases and 6 (40%) had multistation involvement. Based on World Health Organization histological classification and Union for International Cancer Control T category, patients were divided into a low‐risk group (1/192; 0.5%) with T1‐2 and type A‐B2 diseases and a high‐risk group (14/83; 16.9%) of category T3 and above or histology B3 and above tumors for nodal metastasis (P < .001). On multivariate analysis, type B3/thymic carcinoma/neuroendocrine tumors, category T3 or above, and N2 dissection predicted a greater likelihood of finding nodal metastasis. Conclusions Lymph node involvement in thymic malignancies is more common than previously recognized, especially in tumors with aggressive histology and advanced T category. Intentional lymph node dissection increases the detection of nodal involvement and improves accuracy of staging. In selected high‐risk patients, systemic dissection of both N1and N2 nodes should be considered for accurate tumor staging.

Clinical significance of a single multi-slice CT assessment in patients with coronary chronic total occlusion lesions prior to revascularization.

Accurate assessment of coronary chronic total occlusion (CTO) lesion is essential to design an appropriate procedural strategy before revascularization. The present study aims to evaluate the significance of a single multislice computed tomography (MSCT) examination in patients with CTO lesion. We retrospectively analyzed the clinical data of 23 CTO lesions in twenty patients underwent computed tomography coronary angiography (CTCA) and SPECT. The CTCA was more powerful and sensitive to determine the CTO lesion length (100% v.s 47.8%) and to identify the length and location of calcification in occluded vessels compared with the coronary angiography (CAG). The LVEF measured by MSCT was comparable to that from the gated SPECT. Myocardial perfusion imaging showed that the location of the early defect region identified by MSCT was corresponded to the nuclide filling defect on the stressed 201thallium-SPECT imaging. The late hyperenhancement on MSCT was presented as incomplete nuclide filling on the 99mTc-MIBI imaging. The results suggested that a single MSCT examination in previous myocardial infarction without revascularization facilitates to provide some valuable information on the nature of the occluded lesion, myocardial perfusion and globe cardiac function, which would be helpful to design appropriate revascularization strategy in these subjects.

CT staging and preoperative assessment of resectability for thymic epithelial tumors

BACKGROUNDnThe aim of this study was to determine the computed tomography (CT) features potentially helpful for accurate staging and predicting resectability of thymic epithelial tumors (TET).nnnMETHODSnOne hundred and thirty-eight consecutive TET patients undergoing surgical resection from April 2010 to November 2011 were prospectively entered into a database. All patients were staged according to the Masaoka-Koga staging system. The relationship between CT features with tumor staging and complete resection was reviewed after surgery.nnnRESULTSnSurgico-pathological staging was stage I in 63, stage II in 32, stage III in 32, and stage IV in 11 patients. Preoperative CT staging was highly consistent with postoperative surgico-pathological staging (Kappa =0.525). Tumor shape, contour, enhancement, with or without invasion of the adjacent structures (mediastinal fat, mediastinal pleura, lung, pericardium, mediastinal vessels, phrenic nerve), and presence of pleural, pericardial effusionor intrapulmonary metastasis were correlated with Masaoka-Koga staging (P<0.05). However, tumor size, internal density or presence of calcification was not associated with staging (P>0.05). Tumor size, presence of calcification and mediastinal lymph node enlargement were not correlated with complete tumor resection (P>0.05). Tumor shape, contour, internal density, enhancement pattern, and invasion of adjacent structures were related to complete resection of the primary tumor in univariate analysis (P<0.05). However, upon multivariate logistic regression, only absence of artery systems invasion was predictive of complete resection (P<0.05).nnnCONCLUSIONSnClinical staging of TET could be accurately evaluated with CT features including tumor shape, contour, enhancement pattern, with or without invasion of adjacent structures, and presence of pleural, pericardial effusion or intrapulmonary metastasis. Absence of arterial system invasion on CT was the only predictive feature for predicting complete resection of TET.

Utility of 64-MSCT in assessing acute non-reperfused myocardial infarct size

Objective To evaluate the utility of multi-slice computed tomography (MSCT) in assessing acute non-reperfused myocardial infarct size. Methods Seven domestic pigs (mean weight 17.3 ± 1.9 kg) underwent ligation of the distal left anterior descending artery to establish a model of acute myocardial infarction (MI). MSCT and triphenyltetrazolium chloride (TTC) staining were performed two hours later. The following data were acquired and analyzed: MI volume (%), CT values of the infarcted region, left ventricular cavity and normal cardiac tissue at various scanning time-points (1, 5, 10, 15, 20 min after contrast injection). Results Using MSCT, the overall MI volume showed a time-dependent decrease, with a reduction of 28.87% after 20 min. The greatest reduction occurred at the 5 min time-point. In TTC staining, MI volume was 9.87% ± 2.44%. When MI size, as determined by MSCT, was compared with that by TTC staining in Bland-Altman plots, there was a better agreement at 5, 10, and 15 min time-points at 1 and 20 min. Conclusions The study indicates that double-phase scanning examination using MSCT is a useful tool to assess MI size, and the optimal late-phase scanning time-point set within 5–15 min of contrast injection.

Efficacy of computed tomography features in predicting stage III thymic tumors

Accurate assessment of the invasion of intrathoracic structures by stage III thymic tumors assists their appropriate management. The present study aimed to evaluate the efficacy of computed tomography (CT) features for the prediction of stage III thymoma invasion. The pre-operative CT images of 66 patients with confirmed stage III thymic tumors were reviewed retrospectively. The CT features of invasion into the mediastinal pleura, lungs, pericardium and great vessels were analyzed, and their sensitivity, specificity, positive predictive value (PPV), negative predictive value and accuracy were calculated. For mediastinal pleural and pericardial invasion, an absence of space between the tumor and the mediastinal pleura/pericardium with mediastinal pleural/pericardial thickening and pleural/pericardial effusion exhibited a specificity and PPV of 100%, respectively. For lung invasion, a multi-lobular tumor convex to the lung with adjacent lung abnormalities exhibited a specificity and PPV of 91.2 and 81.3%, respectively. For vessel invasion, the specificity and PPV were each 100% for tumors abutting ≥50% of the vessel circumference, and for tumor oppression, deformation and occlusion of the vessel. In conclusion, recognition of the appropriate CT features can serve as a guide to invasion by stage III thymic tumors, and can facilitate the selection of appropriate pre-operative treatment.