Objective To discuss the correlation between immune status and clinical characteristics in pulmonary cryptococcosis. Methods The clinical data of 32 non-AIDS patients with pulmonary cryptococcosis, diagnosed from August 2001 to October 2017 in Tianjin Medical University General Hospital, were retrospectively analyzed. The enrolled patients were divided into an immune-competent group with 13 cases and an immune-suppressed group with 19 cases. The clinical characteristics were compared between the two groups with different immune status. Results All 32 patients were treated for clinical symptoms. The main symptoms were cough, expectoration, fever, chest tightness, chest pain, and hemoptysis. There were no statistical differences between the two groups. The computed tomography of chest showed that there were 2 patients (6.3%) involving upper lung in the immune-competent group, and 5 patients (15.6%) in the immune-suppressed group. There were 9 patients (28.1%) involving lower lung in the immune-competent group, and 12 patients (37.5%) in the immune-suppressed group. There were 10 patients (31.3%) with nodular masses of lesions in the immune-competent group and none in the immune-suppressed group. There was 1 patient with infiltrating in the immune-competent group and 8 patients in the immune-suppressed group. There were 2 patients with mixed types of lesions in the immune-competent group and 11 patients in the immune-suppressed group. Five patients were complicated with cryptococcal meningitis, and 2 patients with eosinophilia. Conclusions The clinical characteristics of the patients with pulmonary cryptococcosis are not specific in difference immune status. The chest CT shows that the lesions of immune-competent patients are mainly nodular masses type, while lesions of immune-suppressed patients are mainly infiltrating shadow and mixed shadow. The treatment should be chose according to immune status.
Electrical impedance tomography (EIT) is an emerging technology for real-time monitoring based on the impedance differences of different tissues and organs in the human body. It has been initially applied in clinical research as well as disease diagnosis and treatment. Lung perfusion refers to the blood flow perfusion function of lung tissue, and the occurrence and development of many diseases are closely related to lung perfusion. Therefore, real-time monitoring of lung perfusion is particularly important. The application and development of EIT further promote the monitoring of lung perfusion, and related research has made great progress. This article reviews the principles of EIT imaging, lung perfusion imaging methods, and their clinical applications in recent years, with the aim of providing assistance to clinical and scientific researchers.
ObjectiveTo construct a map of cerebral cortex thickness in Idiopathic Generalized Epilepsy (IGE) diagnosed at the first visit, using T1-weighted brain magnetic resonance imaging and advanced image analysis software. MethodsHigh-resolution three-dimensional T1 images were obtained from 27 IGE patients diagnosed at the first visit and 29 normal controls in Shouguang People's Hospital from January 1, 2022 to December 31, 2021. The location recognition calculation system of the Freesurfer software was used to calculate the values of cortical thickness in each brain region, and the cortical thickness values were transformed into a brain atlas using the image analysis software. A differential brain atlas was generated using the two-sample t-test to analyze the difference in cortical thickness between IGE patients and normal controls. Paired t-test was used for within-group comparison to explore changes of cortical thickness laterality. ResultsIn the IGE brain atlas, the brain regions with higher cortical thickness were the right left temporal pole, the right left entorhinal cortex, the head of the right anterior cingulate gyrus, the right and left insular lobe, the right and left middle temporal gyrus, the right inferior temporal gyrus, the head of the left anterior cingulate gyrus, the left tail of the anterior cingulate gyrus, the left inferior temporal gyrus, the left and right fusiform gyrus, and the left frontal pole. The areas with lower cortical thickness were the right and left paracalcaric gyrus, the right and left cuneiform lobe, the left and right lingual gyrus, the left and right posterior central gyrus, the left lateral occipital gyrus, and the right and left superior parietal gyrus. The distribution of cortical thickness of the IGE group was comparable to the cortical thickness atlas of the normal control. Compared with normal control, the areas with changes of cortical thickness in the IGE group were bilateral superior frontal gyrus, bilateral posterior central gyrus, bilateral anterior central gyri, bilateral lingual gyri, left cuneiform lobe, bilateral entorhinal cortex and temporal pole. The brain areas with laterality of cortical thickness between hemispheres in the IGE group were the tail of anterior cingulate gyrus, cuneiform lobe, inferior parietal gyrus, lateral occipital gyrus, posterior central gyrus, head of anterior cingulate gyrus, and superior marginal gyrus. Compared with normal control, the IGE group has decreased number of brain regions with laterality of cortical thickness. ConclusionThe present study revealed the distribution and laterality of cerebral cortical thickness map in early idiopathic generalized epilepsy, which provides imaging structural basis for brain research in the future.
ObjectiveTo observe the clinical characteristics of elderly patients with demyelinating optic neuritis (DON), and preliminarily analyze the related factors affecting their visual prognosis. MethodsA observational clinical case-control study. A total of 107 patients with DON who were diagnosed and hospitalized in Beijing Tongren Hospital and its medical alliance Department of Ophthalmology, Beijing Puren Hospital from March 2019 to October 2023 were included in this study. Detailed medical histories were recorded, including time of onset, presence of ocular pain, treatment modalities, and follow-up status. All affected eyes underwent best-corrected visual acuity (BCVA) testing, orbital magnetic resonance imaging (MRI), and laboratory tests, including erythrocyte sedimentation rate (ESR), antinuclear antibodies (ANA), extractable nuclear antigens (ENA), aquaporin-4 (AQP4) antibodies, and myelin oligodendrocyte glycoprotein (MOG) antibodies in peripheral blood. Based on age, patients were categorized into the elderly DON group (≥50 years) and the young and middle-aged DON group (＜50 years), comprising 50 and 57 cases, respectively. Furthermore, the elderly DON group was subdivided by serum-specific antibody status into the AQP4 antibody-positive ON group (AQP4-ON group), the MOG antibody-positive ON group (MOG-ON group), and the double-negative ON group (DN-ON group), with 18, 10, and 22 cases respectively. The median follow-up duration was 36 months. Follow-up assessments were conducted using the same equipment, methods, and relevant examinations as those applied at baseline. Binary logistic regression analysis was performed to identify factors associated with visual prognosis in elderly DON patients. ResultsCompared with the DON group of young and middle-aged people, the incidence of binocular disease, accelerated ESR, MRI imaging score, the incidence of combined cardiovascular and cerebrovascular diseases, diabetes, tumors, and the proportion of adverse reactions of glucocorticoids in the elderly group were higher, and the proportion of ocular pain was lower. The differences were statistically significant (P＜0.05). Six months after the treatment, the number of cases with BCVA＞0.3 in the affected eyes in the elderly DON group and the young and middle-aged DON group was 28 (56.0%, 28/50) and 42 (73.7%, 42/57), respectively. The number of patients with BCVA＞0.3 in the elderly DON group was significantly lower than that in the young and middle-aged DON group, and the difference was statistically significant (P=0.034). Moreover, with the increase of age, the degree of improvement in visual acuity showed a decreasing trend. The proportion of females in the AQP4-ON group, the proportion of optic chiasm and posterior optic pathway involvement in acute MRI, and the positive rate of ANA/ENA were significantly higher than those in the MOG-ON group and the DN-ON group, and the differences were statistically significant (P＜0.05). The rate of optic disc edema in the MOG-ON group was significantly higher than that in the AQP4-ON group, and the difference was statistically significant (P=0.031). One and six months after treatment, the BCVA in the MOG-ON group was significantly better than that in the AQP4-ON group and the DN-ON group, and the difference was statistically significant (P＜0.05). The results of binary logistic regression analysis showed that at the onset of the disease, BCVA＜0.01 [odds ratio (OR) =2.60, 95% confidence interval (CI) 1.23-5.52, P=0.013] and accelerated ESR (OR=4.68, 95%CI 1.08-20.18, P=0.039) was an independent risk factor affecting the prognosis of BCVA in elderly patients with DON. ConclusionsThere are different clinical characteristics between elderly DON patients and young and middle-aged patients. The risk of combined systemic diseases and side effects of glucocorticoids is higher, and the visual prognosis is worse. There are also differences in clinical characteristics and visual prognosis among subgroups of different serological antibodies in elderly DON. Advanced age, the lowest visual acuity at onset and immune inflammatory indicators are all factors affecting the visual prognosis of DON.
ObjectiveTo investigate the clinical and CT findings in patients with coronavirus disease 2019 (COVID-19).MethodsThe epidemiological data and clinical manifestations of 83 COVID-19 patients admitted to Chongqing Public Health Medical Center from January 24, 2020 to February 4, 2020 were analyzed retrospectively. According to the clinical classification, they were divided into four groups: mild group 8 patients, common group 62 patients, severe group 10 patients, and critically severe group 3 patients. The CT characteristics and their relationship with clinical classification were analyzed.ResultsThe average age of 70 mild patients was (43.7±15.0) years, 13 severe patients was (57.4±11.8) years. The average age of mild patients was lower than that of severe patients (Z=–3.185, P=0.001). The average course of mild disease was (5.5±4.2) days, lower than that of severe disease (11.8±5.0) days (Z=–3.978, P=0.000). The clinical manifestations were fever in 72 patients, cough in 60 patients, expectoration in 34 patients, asthenia in 25 patients and shortness of breath in 19 patients. Basic diseases were complicated in 16 patients. CT findings: Both lung lobes were affected in 70 patients (93.3%), pure right lung lobe was affected in 3 patients (4.0%), pure left lung lobe was affected in 2 patients (2.7%), and there was no focus in 8 patients. The total number of affected lung segments was 203 in severe type, with an average of 15.6±5.4 and 530 in the common type, with an average of 9.6±5.3. The number of the severe type was more than that in the common type (Z=–3.456, P=0.001). The focus was mainly in the posterior part, 62 in the dorsal and 65 in the posterior basal segments, 41 in the anterior part of the upper lobe, and less in the common type (P<0.05). The main lesions were ground-glass opacities in 74 patients, patchy shadow in 72 patients, piece shadow in 46 patients, strip shadows in 51 patients and consolidation in 34 patients. Among them, the common CT showed patchy shadow in 34 patients (54.8%), less than severe patients in 12 patients (92.3%) (χ2=4.880, P=0.027). There was no significant difference between the mild CT and the severe patients (P>0.05).ConclusionsThere are some radiographic characteristics in COVID-19. Chest CT is helpful for the diagnosis and the judgement of the disease.
Objective To investigate the value of contrast-enhanced ultrasonography in detection and diagnosis of small primary liver cancer. Methods SonoVue-enhanced ultrasonography were performed on 353 patients with 378 primary liver cancer, less than 3 cm in diameter. Enhancement patterns and enhancement phases of hepatic lesions on contrast-enhanced ultrasonography were analyzed and compared with the results of histopathology. Results In all hepatic tumors, 96.6% （365/378） lesions enhanced in the arterial phase. Among them, 317 (83.9%) tumors enhanced earlier than liver parenchyma and 48 (12.7%) tumors enhanced synchronously with liver parenchyma, and 342 (90.5%) tumors showed early wash-out in the portal and late phases. With regard to the enhancement pattern, 329 (87.0%) tumors presented whole-lesion enhancement, 35 (9.3%) to be mosaic enhancement and 14 (3.7%) to be rim-like enhancement. If taking the whole-lesion enhancement and mosaic enhancement in arterial phase as diagnotic standard for primary liver cancer on contrast-enhanced ultrasonography, the sensitivity was 92.9%(351/378), and if the earlier or synchronous enhancement of the tumor compared with liver parenchyma in arterial phase and the wash-out in portal phase were regarded as the stardand, the sensitivity was 87.3%(330/378). Conclusion Contrast-enhanced ultrasonography could display real-time enhancement patterns as well as the wash-out processes both in hepatic tumors and the liver parenchyma. It might be of clinical value in diagnosis of primary liver cancer based on the hemodynamics of hepatic tumors on contrast-enhanced ultrasonography.
ObjectiveTo investigate the association between the imaging markers of ischemic cerebral small vessel disease and the occurrence of large hemispheric infarction (LHI).MethodsWe consecutively enrolled the patients with cerebral infarction in the middle cerebral artery blood supply area who admitted to the Department of Neurology, West China Hospital, Sichuan University between January 1st, 2015 and March 30th, 2016, and underwent head CT/MRI scans within one month of onset. LHI was defined as: the hypodensity was larger than 1/2 of the blood supply area of middle cerebral artery or more than 1/3 of the cerebral hemisphere within 6 hours on head CT at admission, or the infarction area was larger than 2/3 of the ipsilateral hemisphere on head MRI at admission. The basic clinical data and imaging data were collected, and the independent predictors of LHI and its independent correlation with ischemic cerebrovascular disease were explored by univariate and multivariate analyses.ResultsA total of 503 patients were included, 111 (22.1%) with LHI and 392 (77.9%) with non-LHI. Compared with the non-LHI patients, the LHI patients had a lower prevalence of white matter lesions, a lower Fazekas score, a lower prevalence of Fazekas score > 1, a lower prevalence of lacunae, a lower proportion of diabetes mellitus, a higher atrial fibrillation proportion of history, a shorter time from onset to treatment, a higher National Institute of Health Stroke Scale (NIHSS) score at admission, and a lower Glasgow Coma scale score; the distributions of TOAST types and locations of vascular stenosis were different (P<0.05). Multivariate analyses showed that white matter lesions [odds ratio (OR)=0.182, 95% confidence interval (CI) (0.050, 0.660), P=0.010], higher Fazekas score [OR=0.770, 95% CI (0.611, 0.970), P=0.027], and Fakazes score > 1 [OR=0.490, 95%CI (0.259, 0.928), P=0.029] were independent protective factors of LHI, while lacunae was not an independent factor of LHI [OR=0.583, 95% CI (0.265, 1.279), P=0.178]. Higher NIHSS score and history of atrial fibrillation were independent risk factors for LHI (P<0.001).ConclusionsThe occurrence and severity of white matter lesions (higher Fazekas score and Fazekas score > 1) are more in non-LHI group, and are independently related to the occurrence of LHI. The results suggest that ischemic preconditioning may have a protective effect on brain.
ObjectiveTo investigate and analyze the clinical manifestations and imaging features of the eyes with bullous retinal detachment. MethodsRetrospective case series study. Eleven eyes of 11 patients with bullous retinal detachment diagnosed in Department of Ophthalmology, Peking University People's Hospital from July 2015 to September 2021 were enrolled. There were 10 males and 1 female, with the mean age of (39.27±6.81) years. All patients had monocular bullous retinal detachment, with mean duration ranged from 3 months to 14 years. The basic information and medical history of all patients were collected. All patients underwent best corrected visual acuity (BCVA), indirect ophthalmoscopy, color fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan ultrasonography. BCVA was performed using a standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The clinical data and imaging features of BCVA, OCT, FFA and ICGA were retrospectively analyzed and summarized. ResultsThe mean logMAR BCVA of the 11 eyes was 0.91±0.45. Nine patients had bilateral disease, but bullous retinal detachment occurred in only 1 eye, and CSC manifestations were present in the contralateral eye. Six patients had received systemic or topical hormone therapy prior to onset. Yellowish-white material was observed in 6 eyes and retinal folds were observed in 5 eyes. OCT examination showed serous retinal detachment in the macular area with granular or patchy hyperreflective signals in the subretinal area in all eyes, and a few granular hyperreflective substances in the neuroretina in 6 eyes. Neuroretina cystoid degeneration was observed in 6 eyes, adhesion between the detached neuroretina and retinal pigment epithelial (RPE) was observed in 6 eyes, RPE tear was observed in 6 eyes, and different forms of retinal pigment epithelial detachment (PED) were observed in 6 eyes. FFA showed multiple fluorescence leakage spots in 10 eyes, and the average number of fluorescence leakage spots in all eyes was 3.82±2.44. There were multiple diffuse RPE lesions in 9 eyes. The results of ICGA examination showed that choroidal vessels were dilated and multiple hyperfluorescent leaks were observed in all eyes. B-scan ultrasonography examination of all affected eyes showed retinal detachment. Retinal reattachment can be achieved at (2.0±1.0) months after photodynamic therapy (PDT), while SRF can be completely absorbed at (2.36±0.81) months. The mean logMAR BCVA can be improved to 0.50±0.33, and no recurrence was found in the follow-up period up to 6 months. ConclusionsBullous retinal detachment is often associated with the use of hormones, while yellow-white material in the subretina and hyperreflective material in the OCT are common. It is characterized by neuroretina cystoid degeneration in the macular area, adhesion between the neuroretina and RPE, RPE tear and PED, with multiple fluorescence leakage spots and diffuse RPE lesions. PDT is an effective treatment for bullous retinal detachment.
Objective To evaluate the value of 16slice spiral computed tomography (SCT) and its threedimensional reconstruction in diagnosis of aortic dissection (AD). Methods Fortyfive cases with AD underwent 16slice SCT, performed with unenhanced, contrastenhanced scanning and threedimensional reconstructions. Emphasis was placed on the true and false lumen, intimal flap, the entry and reentry tear and the involvement of branches of AD. Eleven cases were confimed by operation. Results True and false lumen and intimal flap of AD could be shown in all 45 cases (100%), the entry and reentry tears were revealed in 44 cases (97.8%) and 33 cases (73.3%), respectively. The right common iliac arteries were most easily involved by AD, 21 cases (46.7%). The thrombi in false lumen were shown in 29 cases (64.4%). Compared with surgery, the location and size of initial entry sites of 11 cases were consistent with the former. Conclusion 16slice SCT can exactly and completely diagnose AD, and provide detailed imaging information for clinical therapy. It’s very important for the selection of treatment methods and the observation of curative effect of patients.
ObjectiveTo explore the clinical, imaging, and pathological features of patients with synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma (sdpHCC-ICC), to enhance our understanding of the disease and reduce the rate of misdiagnosis and missed diagnosis.MethodsThe clinical, imaging, and pathological data of patients who were histologically confirmed as sdpHCC-ICC in West China Hospital of Sichuan University between January 1st 2014 and December 31st 2018 were studied retrospectively.ResultsA total of 11 patients with sdpHCC-ICC were screened for the study, of which 10 were male and 1 was female. The median age of patients was 55.6 years (ranged from 47 to 73 years). Eight patients were chronically infected with hepatitis B virus. Both increased alpha-fetoprotein and carbohydrate antigen 19-9 were observed in 8 patients. Contrast enhanced CT was performed in 8 cases, color doppler ultrasound in 4 cases, enhanced MRI in 3 cases, and contrast-enhanced ultrasound in 1 case. Among them, one solitary lesion was found in 2 patients, and two or more lesions were observed in 9 patients. Most of the patients had typical imaging performance of hepatocellular carcinoma (HCC): 8 patients showed strong enhancement of HCC during the hepatic arterial phase and progressive hyper-attenuation on venous and delayed phases, 1 patient showed peripheral rim enhancement in the arterial phase of intrahepatic cholangiocarcinoma (ICC) in another lesion could be observed at the same time. None of the 11 patients with sdpHCC-ICC was diagnosed accurately before operation. All patients underwent surgical treatment. HCC lesions were distributed in all parts of the liver, while ICC lesions were located in the right lobe of the liver in 10 cases. The median diameter of HCC and ICC was 3.5 cm and 2.1 cm, respectively. All of them were confirmed by hematoxylin-eosin staining and immunohistochemistry.ConclusionsThe clinical characteristics of sdpHCC-ICC are usually atypical. It is difficult to make an accurate preoperative diagnosis. Tumor markers may be valuable to the diagnosis of sdpHCC-ICC. The definite diagnosis of sdpHCC-ICC depends on pathological examination.