摘要:目的:研究胸腺瘤與前縱隔(血管前間隙)淋巴瘤的MSCT表現,提高對二者的診斷與鑒別診斷能力。方法:回顧性分析經手術病理證實的30例胸腺瘤與18例血管前間隙淋巴瘤MSCT表現,著重觀察腫瘤的密度、形態及其與周圍結構的關系。結果:30例胸腺瘤中,24例良性胸腺瘤與鄰近大血管分界清晰,腫塊表現 “D”字或反“D”字狀,平掃CT值16~59 Hu,增強CT值20~110 Hu;6例侵襲性胸腺瘤邊界不清,呈分葉狀、不規則形,密度不均,平掃CT值23~42 Hu,增強CT值23~60 Hu。18例淋巴瘤中,單發于前上縱隔者6例,其余12例呈多結節、腫塊狀,侵入血管間隙生長,致大血管受壓,增強掃描呈輕度強化,常伴有其它部位淋巴結增大。結論:MSCT能清晰顯示胸腺瘤與前縱隔淋巴瘤的影像學表現特征,并能有效提高對二者的鑒別診斷。Abstract: Objective: To diagnosis and differentiate thymoma and malignant lymphoma in the anterior mediastinum on the basis of multislice CT (MSCT) imaging features. Methods:We retrospectively reviewed 30 cases with thymoma and 18 cases with malignant lymphoma proven by surgery and pathology.More attention was put on the density, morphology and relation with the surrounding structures of the tumors. Results: The CT manifestations of 30 cases of thymoma were shown as: For 24 cases of benign thymoma, the boundaries were clear, the shapes were “D” signs or contra“D” signs, CT attenuation value were 1659Hu and 20110Hu on unenhanced and contrastenhanced scanning. For 6 cases of malignant thymoma, the boundaries were unclear, the shapes were lobulated or irregular, the density was heterogeneous, CT attenuation value were 2342Hu and 2360Hu on unenhanced and contrastenhanced scanning. For 18 cases of malignant lymphoma, 6 cases were located at anterior mediastinum, 12 cases were nodes or multiple mass, enveloped the neighboring vessel structures, mildly enhanced on contrastenhanced scanning, and associated with enlargement of lymph nodes in other place. Conclusion: MSCT can display the imaging features of thymoma and anterior mediastinal lymphoma, and effectively differentiate thymoma and mediastinal lymphoma.
Objective To develop and validate a composite model (PAH score) based on dual-center data, integrating logistic regression and machine learning approaches, to improve the preoperative differential diagnostic efficacy for appendiceal mucinous neoplasms (AMNs). MethodsA dual-center retrospective case-control design was adopted. The study included 108 AMNs patients and 230 healthy controls from The 900th Hospital of Joint Logistics Support Force (January 2014 to November 2024) and Sanming First Hospital Affiliated to Fujian Medical University (December 2018 to December 2023) for feature screening and model construction. Additionally, 258 patients with pathologically confirmed chronic appendicitis (CA) from the same period were included as the differential validation group. Predictors were screened using leastabsolute shrinkage and selection operator combined with traditional logistic regression, and four machine learning algorithms—random forest, support vector machine, gradient boosting, and decision tree—were applied to rank feature importance. Core variables consistently identified by both approaches were integrated to construct a logistic regression model. Based on the model results, the PAH score was formulated, and its performance in distinguishing AMNs from CA was validated. An online visualization platform for AMNs risk prediction was subsequently developed.ResultsBaseline characteristics were balanced between the AMNs group and healthy control group, as well as between the AMNs group and CA group (P>0.05). Multivariate logistic regression identified prognostic nutritional index (PNI, OR=0.81), albumin-to-globulin ratio (AGR, OR=0.37), and hemoglobin to red blood cell distribution width ratio (HRR, OR=0.36) as independent predictors of AMNs (all P<0.001). All four machine learning algorithms consistently ranked PNI, AGR, and HRR as the top three important features. Based on these findings, a PAH model was constructed, and the PAH score was calculated using the standardized regression coefficient weighting method as follows: PAH score=20.8–0.21×PNI–0.99×AGR–1.01×HRR. The model demonstrated excellent discriminative ability for AMNs, with an area under the curve (AUC) of 0.918. The Hosmer-Lemeshow test indicated good calibration between predicted and observed probabilities (P=0.925). Decision curve analysis (DCA) showed significant net clinical benefit within the risk threshold range of 0.15–0.25. Bootstrap internal validation confirmed robust model performance (AUC=0.911). The median PAH score was significantly higher in the AMNs group than that of the CA group (MD=1.78, P<0.001). For distinguishing AMNs from CA, the PAH score achieved an AUC of 0.758. At the optimal cutoff value (–1.00), sensitivity was 70%, specificity was 76%, and accuracy rate was 74%. The Hosmer-Lemeshow test again confirmed good calibration (P=0.106), and Bootstrap validation indicated stable performance (AUC=0.783). DCA further demonstrated considerable net benefit within the threshold range of 0.15–0.35. ConclusionsThe PAH score developed in this study effectively predicts the risk of AMNs and accurately differentiates AMNs from CA, showing promising clinical application potential. However, as an exploratory study, further validation through multicenter, large-sample, prospective studies with diverse control groups is needed to enhance the generalizability and stability of the scoring system.
ObjectiveTo investigate misdiagnosis of primary squamous cell carcinoma of liver (PSCCL) as cholangiocarcinoma before operation and its clinical manifestations, imaging manifestations, etiology, histological origin, pathological characteristics, diagnosis and differential diagnosis, selection of treatment methods, and prognosis, so as to improve understanding and reasonable diagnosis and treatment of disease.MethodThe clinicopathologic data of a case of PSCCL misdiagnosed as cholangiocarcinoma in the West China Hospital of Sichuan University were analyzed retrospectively.ResultsThe patient was admitted to the West China Hospital of Sichuan University with the right hepatic space occupying. The preoperative imaging examination showed that the patient had the imaging characteristics of hepatic cholangiocarcinoma, then the right hemihepatectomy was performed. The postoperative pathological diagnosis was the PSCCL.ConclusionsPreoperative diagnosis of PSCCL is extremely difficult and it is difficult to differentiate it from primary liver cancer, and it is easy to overlook liver metastasis’s occurrence in other parts of the squamous cell carcinoma, which leads to liver metastasis. It is usually diagnosed by pathological diagnosis after operation, and then original lesions in other parts are excluded by various examinations. PSCCL is treated in a variety of ways, but it’s prognosis is not good. At present, there is no unified treatment principle, most of which are surgery, followed by postoperative radiotherapy and chemotherapy. In most cases, because PSCCL’s etiology is unknown and mechanism is not clear, clinicians can only implement individualized treatment according to patient’s condition.
ObjectiveTo investigate the clinical manifestations, imaging manifestations, etiology, histological origin, pathological characteristics, diagnosis and differential diagnosis, selection of treatment methods, and prognosis of primary diffuse large B cell lymphoma of livers (PDLBCLL), so as to improve understanding and reasonable diagnosis and treatment of this kind of disease.MethodThe clinicopathologic data of a case of PDLBCLL diagnosed in the West China Hospital of Sichuan University in June 2019 were analyzed retrospectively.ResultsIt was very difficult to diagnose PDLBCLL preoperatively and to distinguish PDLBCLL from primary liver cancer and other liver space occupying lesions. It was also easy to ignore the possibility of invasion of liver by lymphopoietic tissue tumor, which was often diagnosed by postoperative pathological diagnosis or puncture biopsy, and after the elimination of hematological diseases by various examinations. This patient was admitted to the hospital as a space occupying in right liver. Preoperative imaging examination considered that may be a tumor. After MDT discussion, considering that the nature of the tumor should be confirmed by surgical resection, and then go to the Department of Oncology. Irregular right hemihepatectomy + cholecystectomy + hilar lymphadenectomy + diaphragmatic repair was performed after MDT discussion. The diagnosis of PDLBCLL was confirmed by postoperative pathological examination. The operation duration was about 230 min, and the intraoperative blood loss was about 200 mL. The patient recovered well without complications and was discharged on the 10th day after operation. The patient was followed up for 9 months. The liver and kidney function, electrolytes and abdominal Doppler ultrasound examination were regularly reviewed every month. No obvious abnormality was found in these results.ConclusionsAt present, there is no unified treatment principle, most of them will undergo surgery, chemotherapy, radiotherapy or combined treatment. Due to its unknown etiology and unclear mechanism, clinicians can only implement individualized treatment according to the characteristics of patients’ conditions.
ObjectiveTo investigate the research progress of etiology, pathogenesis, diagnosis, differential diagnosis, and treatment of granulomatous lobular mastitis (GLM). MethodA comprehensive analysis was conducted by reviewing the domestic and foreign literatures on GLM and combining with clinical experience. ResultsGLM was a relatively rare chronic inflammatory disease of the breast, and the number of patients had been increasing in recent years. It mainly occured in multiparous women of childbearing age. Clinically, it was characterized by a hard breast mass with or without redness and pain, and severe cases might be accompanied by nodular erythema and arthritis. Bacterial infection, especially Corynebacterium kroppenstedtii and autoimmunity were considered to be the main causes of GLM. The diagnosis of GLM needed to combine with medical history, clinical manifestations, histopathological findings, imaging findings, and laboratory tests. A multidisciplinary team for diagnosis and treatment of GLM should be established to improve the diagnostic accuracy and reduce misdiagnosis. At present, the treatment methods for GLM were mainly conservative treatment and surgical treatment, including follow-up observation, antibiotic treatment, glucocorticoid treatment, immunosuppressive therapy, surgical treatment, traditional Chinese medicine treatment, and combined treatment. ConclusionsAt present, the incidence of GLM is on the rise, but its etiology and pathogenesis are still unclear. The diagnosis needs to combine with many aspects, and it is recommended that the multidisciplinary team could improve the accuracy of diagnosis. There is still no unified standard for the selection and timing of treatment. Clinicians’ experience and patients’ wishes should be taken into account when choosing treatment options in clinical practice. Prospective and high-quality multicenter clinical trials and evidence-based medicine practice are still needed to further improve diagnosis and treatment of GLM.
Tumor chemotherapy is a treatment method that employs chemotherapeutic drugs to eradicate cancer cells. These drugs are cytotoxic, meaning they can affect both tumor cells and normal cells. In recent years, there has been a gradual increase in chemotherapy-induced liver injury. Chemotherapy-induced parenchymal liver injury often manifests as diffuse lesions, although focal lesions can occasionally be observed. There is a diversity in the pathogenesis and pathological changes of chemotherapy-induced focal liver disease. Radiologically, there is often challenging in differentiating chemotherapy-induced focal liver disease from hepatic metastases. Therefore, early and accurate diagnosis of this condition poses a certain challenge in clinical practice. This article presents the radiological findings of a case of chemotherapy-induced focal liver disease induced by chemotherapy for gastric cancer, and summarizes the radiological features and differential diagnostic points of chemotherapy-induced focal liver disease, aiming to enhance the understanding of this type of lesion among radiologists and clinicians and reduce related missed diagnoses and misdiagnoses.
Hepatic angiomyolipoma (HAML) is a rare benign mesenchymal tumor of the liver, which has highly variable imaging appearances, often leads to missed diagnosis and misdiagnosis. The images of 2 patients with HAML confirmed by pathology were presented in this study, and the typical imaging features of the HAML, the underlying pathophysiological mechanism, and the differential diagnosis were briefly summarized so as to deepen the understanding of HAML and to improve the diagnosis and differential diagnosis abilities of HAML, then reduce the rates of missed diagnosis and misdiagnosis of the HAML.
Objective To improve accuracy of clinical diagnosis through analyzing the CT characteristics and clinical manifestations of patients with benign lung diseases whose CT manifestations initially led to a suspicion of lung cancer. Methods This study collected 2 239 patients of benign lung disease verified by postoperative pathology in the Department of Thoracic Surgery, Beijing Chao-yang Hospital from June 2006 to December 2016. Lesions of 173 patients (101 males and 72 females with a mean age of 56.0 years) were considered very likely to be malignant on preoperative contrast CT scan, which were sorted to 20 types of lung diseases, and the 20 types of diseases contained 907 patients diagnosed or misdiagnosed. Statistical analyses were performed using the CT and clinical characteristics of the 173 patients. Results Among the 907 patients with benign lung disease, the benign pathologies that were most commonly misdiagnosed by preoperative enhanced CT were pulmonary leiomyoma (100.0%), pulmonary actinomycosis (75.0%), pulmonary cryptococcosis (71.4%), sclerosing hemangioma (50.0%) and organizing pneumonia (44.2%). Among the 173 patients with benign diseases, the most common diseases were tuberculosis (29.5%), organizing pneumonia (28.9%), pulmonary hamartoma (6.4%) and pulmonary abscess (6.4%). In the 173 patients, 17.3% had fever, 56.6% coughing, 8.7% yellow sputum, 28.9% hemoptysis, 16.2% chest pain, 18.5% elevated leukocyte counts and 4.6% elevated carcinoembryonic antigen levels. Most of the CT manifestations consisted of nodular or mass shadows, 70.5% of which had foci≤3 cm and manifestations were similar to those of lung cancer, such as a spiculated margin (49.1%), lobulation (33.5%), pleural indentation (27.2%) and significant enhancement (39.3%). Furthermore, some patients had uncommon tumor signs, such as calcification (12.7%), central liquefactive necrosis (18.5%), satellite foci (9.8%) and multiple pulmonary nodules (42.2%). Moreover, 24.3% of the patients had enlarged lymph nodes of the mediastinum or hilum. Conclusion As the CT manifestations of some benign lung conditions are similar to those of lung cancer, careful differential diagnosis is necessary to identify the basic characteristics of the disease when the imaging results are ambiguous, and the diagnosis of a lung disease need incorporate the patients' clinical characteristics and a comprehensive analysis.
Objective To determine feasibility of texture analysis of CT images for the discrimination of nonhypervascular pancreatic neuroendocrine tumor (PNET) from pancreatic ductal adenocarcinoma (PDAC). Methods CT images of 15 pathologically proved as PNETs and 30 PDACs in West China Hospital of Sichuan University from January 2009 to January 2017 were retrospectively analyzed. Results Thirty best texture parameters were automatically selected by the combination of Fisher coefficient (Fisher)+classification error probability combined with average correlation coefficients (PA)+mutual information (MI). The 30 texture parameters of arterial phase (AP) CT images were distributed in co-occurrence matrix (18 parameters), run-length matrix (10 parameters), and autoregressive model (2 parameters). The distribution of parameters in portal venous phase (PVP) were co-occurrence matrix (15 parameters), run-length matrix (10 parameters), histogram (1 parameter), absolute gradient (1 parameter), and autoregressive model (3 parameters). In AP and PVP, the parameter with the highest diagnostic performance were both Teta2, and the area under curve (AUC) value was 0.829 and 0.740 (P<0.001,P=0.009), respectively. By the B11 of MaZda, the misclassification rate of raw data analysis (RDA)/K nearest neighbor classification (KNN), principal component analysis (PCA)/KNN, linear discriminant analysis (LDA)/KNN, and nonlinear discriminant analysis (NDA)/artificial neural network (ANN) was 28.89% (13/45), 28.89% (13/45), 0 (0/45), and 4.44% (2/45), respectively. In PVP, the misclassification rate of RDA/KNN, PCA/KNN, LDA/KNN, and NDA/ANN was 35.56% (16/45), 33.33% (15/45), 4.44% (2/45), and 11.11% (5/45), respectively. Conclusions CT texture analysis is feasible in the discrimination of nonhypervascular PNET and PDAC. Teta2 is the parameter with the highest diagnostic performance, and in AP, LDA/KNN modality has the lowest misclassification rate.
Objective To compare the clinicopathological features of hilar cholangiocarcinoma (HCCA) and hilar benign diseases, and then explore the value of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in the differential diagnosis between them. Methods Clinical data of 65 patients (54 patients with HCCA and 11 patients with hilar benign diseases) who were diagnosed as HCCA and received treatment from January 2011 to October 2015 in our hospital were retrospectively analyzed. Comparison of clinical data of HCCA patients and patients with hilar benign diseases in age, gender, disease duration, clinical manifestation, laboratory examination, and imaging examination was performed, and the receiver operating characteristic curve (ROC) was used to explore the value of CA19-9 and CEA in differential diagnosis between hilar benign diseases and HCCA. Results The age, levels of serum CA19-9, CEA, alanine aminotransferase (ALT), total bilirubin (BILT), and direct bilirubin (BILD) of HCCA group were significantly higher than that in benign group (P<0.05). However, the gender, disease duration, clinical manifestations (including jaundice, abdominal discomfort, fever, and weight loss), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALKP), and imaging findings (including hilar mass, intrahepatic bile duct dilatation, thickening of the bile duct wall, lymph node enlargement, vascular invasion, and gallbladder invasion) had no significant difference between the 2 groups (P>0.05). The ROC curve results showed that, when cut-off point for CA19-9 was 233.15 U/mL, the sensitivity was 56% and specificity was 91%; when cut-off point for CEA was 2.98 ng/mL, the sensitivity was 61% and specificity was 90%. Conclusions For the differential diagnosis between HCCA and hilar benign diseases, the elderly patients with high levels of serum transaminase and bilirubin were more likely to be malignant. It is more likely to be malignant when the serum CA19-9>233.15 U/mL or CEA>2.98 ng/mL.