Objective To assess diagnostic value of Wells and Geneva seales in patients with suspected pulmonary embolism(PE).Methods Clinical data of 958 consecutive cases of suspected PE admitted to Shanghai Pulmonary Hospital form January 1,1995 to January 1,2009,were analyzed retrospectively,and all patients were assessed with Wells and Geneva scales,respectively for likelihood of PE,as compared to those diagnosed by lung imaging Results Three hundred and forty-seven patients with PE were diagnosed with lung imaging as gold standard,sensitivity,specificity,and positive and negative predictive values for Wells scale and Geneva scale in diagnosis for PE were 82.4%,58.1%,52.8%and 85.3%.and 88.8%,55.3%,53.1%and 89.7%,respectively,with positive and negative likelihood ratios.Youden index and crude agreement of 1.97,0.30,0.41 and 0.21,and 1.99,0.20,0.44 and 0.25.respectively.Area under the receiver operating characteristic(ROC) curve of Geneva scale(0.79)was significantly more than that of Wells scale(0.73)(Z=2.25,P＜0.05).As compared to Wells scale,sensitivity and specificity for Geneva scale in diagnosis for PE was significantly higher(χ2=7.12 and 6.84,respectively,P＜0.05).Conclusions Although there is a considerable gap in accuracy between clinical scales and lung imaging in diagnosis for PE.both Wells and Geneva scales can be used in clinical screening for PE to save unnecessary cost.however,Geneva scale is more practical and accurate than Wells scale,worthwhile to be popularized clinically.

Objective To evaluate the MR imaging features of chondrnblastoma. Methods MRI examinations of 20 patients with histological proven chondroblastoma were reviewed retrospectively. The MRI findings of chondroblastoma including the signal intensity, the shape, the growth patterns, and the surrounding bone marrow edema and the adjacent soft tissue edema, the periosteal reaction, the adjacent joint effusion were analyzed . Results All 20 cases demonstrated heterogeneous MR signal intensity on T1WI and T2WI images and showed Iobular margins. Sixteen cases demonstrated expansive growth patterns. Surrounding bone marrow edema was found in 18 cases and adjacent soft tissue edema in 14 cases. Periosteal reaction was identified in 6 cases. In 7 cases the tumor extended to adjacent soft tissue. Adjacent joint effusion was visible on MRI in 6 cases. Conclusion Heterogeneous signal intensity, lobular margins and expansive growth pattern, adjacent bone marrow and soft tissue edema were the common features of chondroblastoma on MRI.

Objective:To investigate the feasibility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)parameters in differentiating musculoskeletal tumors with different behaviours of pathological findings before therapy.Methods:A total of 34 subjects of musculoskeletal tumors were in-volved in this retrospective analysis.DCE-MRI was performed using a fat-saturated 3 D VIBE (volumetric interpolated breath-hold exam)imaging sequence with following parameters:FA,10 degree;TR/TE, 5.6/2.4 ms;slice thickness,4.0 mm with no intersection gap;field of view,310 mm ×213 mm;ma-trix,256 ×178;voxel size,1 .2 mm ×1 .2 mm ×4.0 mm;parallel imaging acceleration factor.The ac-tuation time for the DCE-MRI sequence was 255 s with a temporal resolution of 5 s and 40 image vo-lumes.Using pathological results as a gold standard,tumors were divided into benign,borderline and malignant tumors.Toft’s model was used for calculation of Ktrans (volume transfer constant),Ve (extra-vascular extracellular space distribute volume per unit tissue volume)and Kep(microvascular permeability reflux constant).Those parameters were compared between the lesions and the control tissues using paired t-tests.The one-way analysis of variance was used to assess the difference among benign,border-line and malignant tumors.P values <0.05 difference was statistically significant.Results:Based on the WHO Classification of Tumours of Soft Tissue and Bone(2012)criteria,34 patients were divided into three groups:1 1 for benign tumors,12 for borderline tumors,and 1 1 for malignancies.Compared with control tissues,Ktrans and Kepshowed no difference,but Ve was increased in benign tumors,Kep showed no diffe-rence,butKtransandVewereincreasedinborderlinetumors, Ktrans,KepandVewereincreasedin malignant tumors.Ktrans(P<0.001 )and Kep (P<0.01 )were significantly higher in malignant tumors than in benign and borderline tumors,but did not show any difference between benign tumors and border-line tumors.Ve was significantly higher in malignant tumors than in benign (P<0.05),but did not show any difference between malignant and borderline tumors,benign tumors and borderline tumors (P >0.05 ).Conclusion:DCE-MRI technique is useful to evaluate the pathological behaviour of musculoske-letal tumors.The quantitative analysis of DCE parameters in conjunction with conventional MR images can improve the accuracy of musculoskeletal tumor qualitative analysis.

Objective To study the value of Geneva score assessment combined with simplified rapid plasma D-dimer assay(SRPDDA)for early diagnosis of pulmonary embolism(PE).Methods Clinical data of 658 suspected cases of PE hospitalized at Shanghai Pulmonary Hospital during January 1,1995 to November 30,2007 were retrospectively analyzed.The patients were divided into three categories based on their Geneva score assessment,highly suspected with equal to or greater than 9 scores,intermediately suspected with 5-8 scores and mildly suspected with equal to or less than 4 scores,respectively.Clinical diagnosis for PE of the patients was made based on their probability Geneva score developed by Wicki,SRPDDA,and both Geneva score assessment and SRPDDA,respectively,and compared with results of lung imaging.Results Finally,PE diagnosis was established in 267 cases.Sensitivity for Geneva score and SRPDDA to diagnose PE was 88.4%and 90.3%,with negative predictive value(NPV)of 88.9%and 90.2%and Youden Index(YI)of 51.7%and 51.4%,respectively.And,sensitivity of both Geneva score assessment combined with SRPDDA wag 97.8%,with NPV and YI of 97.3%and 53.8%,respectively,with a likelihood ratio(LR)for both positive test results of 2.62 and a LB for both negative test results of 0.04,respectively.Conclusions As a routine and non-invasive diagnostic test,Geneva score assessment,as well as SRPDDA,play a screening role in early diagnosis for PE,which can help to save unnecessary cost of imping,and complement each other so to improve accuracy of diagnosis and reduce misdiagnosis.

To retrospectively analyze the clinical data of 48 patients with allergic bronchopulmonary aspergillosis (ABPA) at Shanghai Pulmonary Hospital.There were 23 males and 25 females with a mean age of (36 ± 15) years.Their clinical manifestations included wheeze,cough,sputum production,sputum plugs,fever,hemoptysis,weight loss,chest pain,weakness and night sweats.They had a high peripheral blood eosinophilia,a higher serum total IgE,a higher level of aspergillosis fumigatus-specific IgE and positive immediate skin-prick test to aspergillus fumigatus.Aspergillus species were detected in sputum samples of 26 patients.Chest computed tomography (CT) was performed in 48 patients.There were patchy infiltrations (n =45),transient infiltrations (n =40),central bronchiectasis (n =35) and mucoid impaction (n =18).Obstructive ventilation dysfunction was confirmed by lung function test.

Objective To study the Gadolinium-enhanced MRI and diffusion weighted imaging (DWI) characteristics of the chondroid matrix-forming sarcomas.Methods Contrast-enhanced MRI and DWI were performed in 14 eases of chondroid matrix-forming sarcomas (10 chondrosarcomas,4 chondroblastic esteosarcomas) and 13 cases of other types of osteosarcomas.DWI was obtained with a single-shot echo-planar imaging (EPI) sequence using a 1.5 T MR imager with two different b values of 0 and 700 s/mm2.The apparent diffusion coefficient (ADC) values were obtained in GE Functiontool software.The contrast-enhancement pattern was evaluated and the ADC values of ehondroid matrix-forming sarcomas was compared with that of other types of asteosarcoma.Independent sample t-test was performed to evaluate the difference of ADC values between the group of chondroid matrix-forming sarcoma and the group of other types of osteosarcoma.In addition, nonparametrie test was used to assess the difference of ADC values between the chondrosareoma and the chondroblastic osteosarcoma.P value less than 0.05 was considered to represent a statistical significance.Results For 14 eases of ehondroid matrix-forming sarcomas, peripheral enhancement was found in all cases, septonodular enhancement was identified in 12 cases.While 13 eases of other types of osteosarcowas demonstrated heterogeneous enhancement.The mean ADC value of chondroid matrix-forming sarcomas [(2.56 ±0.35) × 10 -3 mm2/s] was significantly higher than that of other types of osteosarcoma [( 1.16±0.20) × 10-3 mm2/s] (t = 12.704,P <0.O1 ).There was no significant difference in the ADC value between the chondrosarcoma and the chondroblastie osteesarcama(Z =0.507 ,P =0.959).Conclusion Contrast-enhanced MRI and DWI can improve differentiation between chondroid matrix-forming sarcomas and other types of osteosarcomas.

Objective To analyze the CT and magnetic resonance imaging (MRI) manifestations of the pelvic osteosarcoma. Methods The CT and MRI manifestations of 15 cases with pelvic osteosarcoma from January, 2013 to December, 2015 proved by histology were ret-rospectively analyzed. Results There were 10 males and 5 females in them. The median age was 27.0 years. Ilium was involved in 11 cases. A mixed lytic/sclerotic pattern of bone destruction was found in 11 cases, and the sclerotic type in 2 cases, the osteolytic type in 2 cases. Ra-dial periosteal reaction was found in 5 cases and immature bone formation in 8 cases. Soft tissue masses were seen in 13 cases. MRI showed enhancement in 15 cases and the CT showed no enhancement in 2 cases with sclerotic type. Conclusion The typical imaging manifestations of pelvic osteosarcomainclude mixed lytic/sclerotic appearance, radial periosteal reaction, soft tissue masses and immature bone formation.

Objective To evaluate the magnetic resonance imaging (MRI) monitoring for osteonecrosis of the knee joints in recovered patients with severe acute respiratory syndrome (SARS) after the administration of glucocorticoids and its characteristics. Methods One hundred and ninety-eight knee joints in 99 recovered SARS patients after administration of glucocorticoids,22 males and 77 females,were examined by MRI and interpreted independently by four senior radiologists for determining osteonecosis. Results Osteonecrosis were found in 56 knee joints (28%,56/198) in 31 of 99 patients (31%,31/99),25 with bilateral lesions (81%,25/31) and six unilateral ones (19%,6/31). The lesions were symmetric (100%,25/25) in all the patients with bilateral osteonecosis,involving weight-bearing zone in 27,non-weight-bearing zone in 29 and subchondral zone in 47 knee joints (84%,47/56). The anterior zone of the medial femoral condyle was involved in 14 (8%) lesions,the posterior zone of the medial femoral condyle in 27 (16%) ,the anterior zone of the lateral femoral condyle in 29 (17%),the posterior of the lateral condyle in 44 (27%),the metaphysis of femur in 18 (11%),the anterior zone of the medial tibial plateau in three (2%),the posterior zone of the medial tibial plateaus in 13 (8%),the anterior zone of the lateral tibial plateaus in two (1%),the posterior zone of the lateral tibial plateau in seven (4%),the metaphsis of the tibia in nine (5%),and no lesion was found in the patella. Conclusions MRI can preferably be used to reveal changes of ischemia and necrosis in the knee joints. So,MRI for the knee joints should be earlier performed in the patients with glucocorticoids for diagnosis and therapy for them.

Objective To evaluate the MRI findings and its diagnostic value in gluteal muscle contracture (GMC). Methods Eleven clinic or operation confirmed GMC patients were examined by plain X-ray and MRI. Conventional T 1WI and T 2WI MR imaging were performed and FFE-T 2WI (fast field echo-T 2WI) was also scanned. CT scan was conducted in 5 cases. Results 11 GMC patients were all diagnosed by MRI. Conventional T 1WI and T 2WI could only show the atrophy of gluteal muscles, while FFE-T 2WI could directly show the fibrous band of gluteal muscle and its fascia, and the fibrous band appeared as low signal intensity on FFE-T 2WI sequence. Conclusions MRI is the efficient modality in imaging the fibrous band for GMC patients, and FFE-T 2WI is the most valuable sequence. MRI is very helpful in the diagnosis and treatment of GMC.

Objective To explore the inflammatory mechanisms of pulmonary embolism ( PTE ) and/or deep venous thrombosis ( DVT ) in elders secondary to chronic obstructive pulmonary disease ( COPD) exacerbation.Methods A total of 26 elders with acute exacerbation of high-risk COPD secondary PTE and/or DVT and 26 patients with low-risk COPD during stable phase diagnosed during the period of January 2008 to December 2012 were enrolled.The relevant parameters of routine blood examination , blood viscosity, D-dimer, fibrinogen ( FIB), arterial blood gas, blood cytokine, erythrocyte sedimentation rate ( ESR ) and C-reactive protein ( CRP ) were retrospectively analyzed.Results The major nonspecific symptoms were cough, sputum and dyspnea.The mean of neutrophile percentage (N%), D-dimer, FIB, interleukin-6 (IL-6), tumor necrosis factor (TNF), C-reactive protein (CRP), low and high shear blood viscosity in blood samples of patients with acute exacerbation of high-risk COPD secondary PTE and ( or ) DVT were higher than those of the control group ( t =3.339, 2.700, 2.207, 2.431, 2.257, 2.143, 2.223, 2.797, all P<0.05).However arterial partial pressure of oxygen ( PaO2 ) was lower than that of lower-risk COPD patients (t=4.312, P<0.05).IL-6 in blood of patients with acute exacerbation of high-risk COPD secondary PTE and ( or) DVT was positively correlated with low-shear blood viscosity , D-dimer and FIB (r=0.437, 0.624, 0.429, all P<0.05).TNF in blood of patients with acute exacerbation of high-risk COPD secondary PTE and ( or ) DVT was positively correlated to FIB , low and high cut blood viscosity ( r =0.624, 0.519, 0.513, all P <0.05 ).Plasma CRP in blood of patients with acute exacerbation of high-risk COPD secondary PTE and/or DVT was positively correlated with D-dimer, FIB, IL-6 and TNF ( r=0.478, 0.541, 0.533, 0.491, all P<0.05).Conclusions Inflammation may exist in elders with acute exacerbation of high-risk COPD secondary thrombotic disease.IL-6 and TNF may promote thrombosis secondary to acute exacerbation of COPD disease.Early screening and/or prophylactic anticoagulation are necessary for prevention.