Objective To evaluate the therapeutic effect of antituberculosis therapy in elderly patients with smear-negative pulmonary tuberculosis by low-dose computed tomography (CT).Methods Forty-seven elderly patients diagnosed as smear-negative pulmonary tuberculosis were rechecked with low-dose chest CT scan (120 kV, 20 mAs) after 1-12 months of antituberculous therapy respectively. These images were compared with common CT before treatment (120 kV, 200-280 mAs). Results In the elderly patients with smear-negative pulmonary tuberculosis, the most common CT signs before treatment were acinus consolidation (100%) and lobar or segmental consolidation (77%), but the cavity was seen less. After effective antituberculous therapy, tree-inbud was improved after one to three months, the acinus consolidation and lobular or segmental consolidations were improved after four to nine months, and the cavitations were slowly improved after six months. Conclusions Low-dose CT can provide sufficient information for the therapeutic effects of antituberculous therapy of smear-negative pulmonary tuberculosis in the elderly and could be used for rechecking.

Objective To analyze CT manifestations of chest wall Askin tumor and to illustrate its CT diagnostic and differentially diagnostic key points.Methods Eleven cases of chest wall Askin tumors were pathologically confirmed in our hospital between May 2006 and November 2014.Of them,10 cases were children and adolescents,and 9 cases had chest pain as the first symptom.All patients received plain CT scan,while 7 cases received contrast enhanced scan.CT signs of this group were retrospectively analyzed,including the location,quantity,shape,size,density,adjacent tissue invasion and distant metastasis of the tumors.Results CT examination showed a single oval mass on the chest wall in all 11 cases.The tumor was located completely within the thoracic cavity in 10 cases,while a tumor's main part was within thoracic cavity.Nine tumors had long diameters of more than 9 cm.All the tumors were heterogeneous without calcification,wherein 10 cases showed necrosis and cystic degeneration.On contrast enhanced scan,7 cases showed heterogeneously mild to moderate enhancement.All tumors invaded adjacent tissues,including 7 cases of bone damage of a single rib,and 7 cases of pleural involvement,wherein 6 cases had pleural effusion.No remote metastases were found in this group.Conclusions CT manifestations of Askin tumors of chest wall have some characteristics,and familiarity with these manifestations is conducive to diagnosis and differential diagnosis of this disease.

Purpose To investigate the diagnostic value of parameters derived from intravoxel incoherent motion (IVIM) model for benign and malignant breast lesions,and to provide reference for the identification of breast lesions.Materials and Methods 27 cases with 28 benign breast lesions and 34 cases with 35 malignant breast lesions were collected and analyzed retrospectively.All of the patients were examined with IVIM-DWI scans.GE AW 4.4 workstation was used to calculate the value of ADC,D,D* and f.The diagnostic performance of different parameters was evaluated by receiver operating characteristic curve (ROC curve).The ADC,D,D* and f value of malignant group and the benign group were compared,respectively.Results The value of ADC and D were significantly lower in malignant group than in benign group (P＜0.05),and the value of D* and fwere significantly higher in malignant group than in benign group (P＜0.05).The cutoff value of D was 0.74× 10-3 mm2/s,and the AUC were 0.907,the specificity,sensitivity in the diagnosis of malignant breast lesions was 0.86,0.95,respectively.Conclusions Parameters of IVIM-DWI are helpful in the differential diagnosis of benign and malignant breast lesions.

Objective:To investigate the high resolution computed tomography (HRCT) findings, laboratory test results and clinical manifestations of anti-melanoma differentiation-associated gene 5 (MDA5) antibody positive dermatomyositis complicated with lung interstitial lesions, and to analyze the correlation between the HRCT findings and clinical course of disease.Methods:Twenty-seven patients with anti-MDA5 antibody positive associated dermatomyositis (DM) were included and divided into two groups: acute/subacute group ( n=15) and chronic group ( n=12). HRCT images of lung were analyzed. Clinical data including gender, age, clinical manifestations and course of disease, anti-Ro52 antibody, creatine kinase (CK), antinuclear antibody (ANA), anti-Jo-1 antibody and erythrocyte sedimentation rate (ESR) were also collected. χ2 test was adopted for statistical analysis. Results:① Interstitial changes were 100%(27/27). The proportion of unilateral localized distribution was the most [48%(13/27)], followed by bilateral localized distribution [30%(8/27)], and bilateral diffuse distribution [22%(6/27)). ② Among the HRCT findings of lung interstitial changes, ground glass shadow was the most common presentations [59%(16/27)], followed by subpleural curve sign [63%(17/27)] and interlobular septal thickening [56%(15/27)], while honeycomb sign [0(0/27)] had the lowest rate of presentation. ③ Compared with the chronic progressive group, the acute/subacute progressive group presented as chest tightness (80% vs 8%, χ2=13.715, P<0.05) and dyspnea (47% vs 0, χ2=7.560, P<0.05). Acute/subacute HRCT showed ground glass opacity (87% vs 25%, χ2=10.501, P<0.05). The prominent HRCT showed interlobular septal thickening in the chronic course group (83% vs 33%, χ2=6.750, P<0.05). ④ The anti-MDA5 antibody (+++) index was significantly different (88% vs 25%, χ2=8.168, P<0.05). There was no significant difference in anti-Ro52 antibody (+), ANA(+), anti-Jo-1 antibody(+), CK elevation and ESR elevation between the two groups ( P>0.05). Conclusion:Most dermatomyositis patients with positive anti-MDA5 antibody are complicated with interstitial lung lesions, the HRCT manifestations of lung are diverse. In order to confirm the diagnosis of this disease, clinical manifestations, laboratory and pathological examinations are required.

Objective To explore CT manifestations of the lung in Castleman disease (CD) patients.Methods Totally 14 CD patients with abnormal pulmonary manifestations were enrolled,including 8 multicentric CD (MCD) and 6 unicentric CD (UCD).CT manifestations of the lung were analyzed retrospectively.Results In 3 patients of pulmonary hilar UCD,CT showed circular masses with solitary homogeneous density,obviously or markedly enhanced after contrast media administration.Bronchiolitis obliterans was found in 1 patient of retroperitoneal UCD with paraneoplastic pemphigus.Two patients of mediastinal UCD showed well defined centrilobular nodules in the lung.Eight patients of MCD mainly showed multiple small nodules,and large nodules with diameters of 1-2 cm were found in 2 of them.Four patients showed poorly defined nodules,and the rest 4 showed well-defined nodules.The nodules were mainly demonstrated as small centrilobular nodules,and a few of them located in subpleural regions in 3 patients.Other CT signs included interlobular septal thickening in 4 patients,ground glass opacity in 4 patients,streaks in 4 patients,patchy consolidation in 3 patients,cysts in 2 patients and thickening of the bronchovascular bundles in 1 patient.Conclusion CT manifestations of the lung in CD patients are complex and variable,and might be related to pathological types.

Objective ToinvestigatethevalueofDWIhyperintensityinvenoussinusindiagnosisandrecanalizationpredictionof cerebralvenoussinusthrombosis(CVST).Methods Clinicaland MRIdataof19patientswithCVST wereanalyzedretrospectively. BasedonDWIsignalcharacteristicsoftheCVST,thepatientsweredividedintoasthehyperintensegroupandthenon-hyperintense group.TheintervaltimebetweenthefirstMRIexaminationandtheonset,andtherecanalizationratewithin1 monthand3 months werecomparedbetweenthetwogroups.Results Therewere76 CVSTinthe19patients,withhyperintensein16venoussinus (21%)andin11patients(57.9%).Theintervaltimewaslongerinthehypertensegroupthanthenon-hypertensegroupbutnosta-tisticalsignificance[(12.81±11.10)daysversus(5.70±7.82)days,P=0.165].17patientsunderwentthesecond MRIexamination in1month,andtherecanalizationrateoftheobstructedsinuswaslowerinthehypertensegroupthanthenon-hypertensegroupwith nostatisticalsignificance(P=0.130).14patientsunderwenttheMRIexaminationafter3 months,andtherecanalizationrateofthe obstructedsinuswaslowerinthehypertensegroupthanthenon-hypertensegroupwithstatisticalsignificance(P=0.047).Conclu-sion ThehypertenseonDWIhashighsensitivityforthedetectionofsubacuteCVST.Thepresenceofhypertenseinoccludedsinus onDWIhasthepredictivevalueforvesselrecanalization.

Objective To investigate the atypical MRI manifestations in patients with primary central nervous system lymphoma(PCNSL). Methods The clinical and MRI manifestations of 17 patients with pathologically confirmed atypical PCNSL in the First Affiliated Hospital of Henan University of Science and Technology (from May 2011 to Dec 2016) and Nanfang Hospital (from Sep 2003 to May 2009) were analyzed retrospectively in this study. Both conventional and contrast-enhanced MR images were acquired for each patient. The MRI manifestations including the number, location, size, shape, signal intensity, enhancement patterns of lesions were evaluated by two senior radiologists.Results Of the 17 cases,8 were solitary and 9 were multiple.Two types of atypical MR findings were found:(1)Atypical location:For the 9 patients showed atypical location,7 patients had solitary masses which were located in the brainstem(n=3), the supratentorial superficial parts(n=2), the cerebellum(n=1)and the sella(n=1). Two patients had multiple lesions, showing multiple subependymal nodules and no abnormalities in the brain parenchyma. Six of the 7 solitary lesions and the 2 multiple cases showed isointense or hypointense on T1-weighted scans and isointense or hyperintense on T2-weighted scans as well as significant homogenous enhancement on contrast-enhanced T1-weighted scans.(2)Atypical signal features:Ten cases were found with atypical signal features including:①Patchy lesions were observed in 6 patients( one patient with single lesion, and five patients with multiple lesions),appearing as hyperintense spots on T2-weighted image and subtle hypointense on T1-Weighted image. Corresponding contrast-enhanced T1-weighted MR image showed multiple patchy/linear enhancement. ②Two cases showed diffuse supratentorial periventricular and infra-tentorial white matter T2hyperintensity and absence of contrast enhancement. ③Nodular lesions with inhomogeneous internal signals were found in 2 cases with calcification(n=1) and cystic necrosis (n=1, ring-like enhancement).Conclusions The atypical imaging manifestations of PCNSL could lead to misdiagnosis or delay in the diagnosis.It is important to understand its atypical imaging features and combine with clinical manifestations to improve the accuracy of differential diagnosis of intracranial lesions.

Objective:To explore the evolution of CT characteristics of the "reversed halo sign" of pulmonary tuberculosis, and to further improve the recognition of its CT signs.Methods:Clinical and CT data of 12 patients with pulmonary tuberculosis who were clinically and pathologically confirmed and accompanied with CT manifestation of "reversed halo sign" in First Affiliated Hospital of Henan University of Science and Technology from August 2013 to April 2020 were analyzed retrospectively. Pathological and imaging contrastl analysis was performed on 1 patient undergoing surgical treatment.Results:Among 12 cases with "reversed halo sign", there were 2 cases with single lesion in unilateral lung, 2 cases with multiple lesions in unilateral lung, and 8 cases with multiple lesions in bilateral lungs. Three cases showed only "reversed halo sign", 9 cases showed both halo-like sign and uniform fireworks sign. "Tree-in-bud "sign was found in all 12 patients in the outer ring of the "reversed halo sign". Eight patients received three or more CT examinations, and six of them showed reduction of density and volume of the "reversed halo sign" after standardized anti-tuberculosis treatment. Under the natural course of the disease in two cases, the overall enlargement of the lesion was observed in 1 case, and the overall density of the lesion was reduced and the outer ring wall of the "reversed halo sign" was thinned in 1 case. The pathology of one case after surgical lobectomy showed granulomatous inflammatory nodules of varying sizes containing Langerhans nodule giant cells in the lung parenchyma. The typical caseous necrotic granulomatous nodules were rare here. The "reversed halo sign" showed dense Langerhans nodules in the outer ring, sparse central areas with fibrous hyperplasia and alveolar wall thickening.Conclusions:The outer ring of "reversed halo sign" of pulmonary tuberculosis shows as "tree-in-bud" sign, and its center shows as the fine reticulation pattern. After effective anti-tuberculosis treatment, both the overall density of "reversed halo sign" and the lesion size reduced. Finally, the lesions mostly present as as fine grid shadows for a long time.

This study reported a family of mitochondrial diabetes mellitus complicated with chronic hereditary pancreatitis. A 18-year-old woman presented with self-reported hyperglycemia and chronic epigastric pain was admitted to our hospital. Clinical data and family history were collected. Mitochondrial gene sequencing and whole exon gene sequencing showed that the proband carried mutation of mt.3243A>G and heterozygous mutation of SPINK1 c. 194+ 2T>C, which was considered as mitochondrial diabetes mellitus with chronic pancreatitis.