Objective To investigate the combination of multiple CT signs in diagnosis and differential diagnosis of nodular goiters (NGs).Methods The CT images of 242 pathologically confirmed lesions (＞ 10 mm in diameter) from 188 patients with nodular goiters were retrospectively reviewed.The CT signs,including regular shape,cystic degeneration,clearer enhancement margin,strong enhancement of nodular goiters were compared with those of 236 pathologically confirmed lesions (＞ 10 mm in diameter)from 225 patients with papillary thyroid carcinomas (PTCs).The sensitivity,specificity and accuracy of different CT signs or their combination in diagnosis and differential diagnosis of NGs were analyzed.Results Regular shape was present in 208 of 242 NGs (86.0％) and in 35 of 236 PTCs (14.8％) (x2 =241.804,P =0.000).Cystic degeneration was present in 143 of 242 NGs (59.1％) and 7 of 236 PTCs (3.0％)(x2 =174.783,P =0.000).Clearer enhancement margin was present in 192 of 242 NGs (79.3 ％) and in 51 of 236 PTCs (21.6％) (x2 =159.318,P =0.000).Strong enhancement was present in 41 of 242 NGs(16.9％) and in 3 of 236 PTCs (1.3％) (x2 =35.108,P =0.000).Regular shape showed the highest sensitivity and accuracy for diagnosis of NGs (86.0％ and 85.6％),while strong enhancement showed the highest specificity (98.7％).The combination of regular shape and clearer enhancement margin showed the highest sensitivity and accuracy of 67.4％ and 80.5％,respectively.The combination of strong enhancement with any of other signs showed the highest specificity of 100.0％.The combination of regular shape,cystic degeneration and clearer enhancement margin showed the highest sensitivity,specificity and accuracy of 45.5％,99.6％ and 72.2％ respectively.The combing of 4 signs showed a sensitivity,specificity,and accuracy of 2.9％,100.0％ and 50.8％.Conclusion CT scan is effective for diagnosis of NGs,and the combination of different CT signs can significantly improve the specificity and reduce the incidence of misdiagnosis to avoid unnecessary surgery.

Objective To investigate the differential diagnostic value of CT scan minimum attenuation values (minAVsCT) in adrenal adenomas and non-adenomas.Methods CT scan data of 89 cases of clinical and pathologically confirmed adrenal adenomas were subjected to retrospective analysis and compared with data of 46 cases involving 50 non-adenomas (25 metastases,20 pheochromocytomas,3 lymphomas,and 2 cortical carcinomas).The distributions of mean attenuation values (meanAVs) ￥ 10 Hu and minAVs ￥0 Hu and CT histogram analysis with ≥ 10％ negative pixels were observed in adrenal adenomas and non-adenomas,and the diagnostic sensitivity and specificity of these 3 methods for adenomas were calculated.Results The distributions of unenhanced meanAVs ￥ 10 Hu,minAVs ￥0 Hu,and CT histogram analysis with ≥ 10％ negative pixels among cases of adenoma and non-adenoma were 62.9％ (56/89) and 0％ (0/50) (x2=52.687,P=0.000),84.3％ (75/89) and 2％ (1/50) （x2=83.917,P=0.000),and 77.5％ (69/89) and 0％ (0/50) (x2=83.917,P=0.000),respectively.The respective diagnostic sensitivities,specificities,false negative rate (FNR),false positive rate (FPR),positive pre dictive value (PPV),negative predictive value (NPV) and accuracy of these 3 methods for adenomas were 62.9％vs 84.3％ vs 77.5％,100％ vs 98.0％ vs 100％,37.1％ vs 15.7％ vs 22.5％,0 vs 2％ vs 0,100％ vs 98.7％ vs 100％,60.2％ vs 77.8％ vs 71.4％,and 76.3％ vs 89.2％ vs 85.6％.Conclusion Although the specificity and PPV of minAVs≤0Hu is slightly less than meanAVs≤10Hu and CT histogram analysis with ≥ 10％ negative pixels,it exhibits the best sensitivity and accuracy with a simple operation,and is thus suitable for clinical application.

Objective:To investigate the clinical, imaging and endoscopic characteristics of idiopathic mesenteric phlebosclerosis (IMP).Methods:From January 2010 to December 2020, 14 patients with IMP diagnosed and treated at the Quzhou Hospital Affiliated to Wenzhou Medical University (Quzhou People′s Hospital) were enrolled. All patients underwent abdominal X-ray, contrast enhanced computed tomography (CT) and endoscopy. Three cases accepted double-contrast barium enema and 11 cases underwent endoscopic biopsy. Three of the 14 IMP patients underwent surgery and pathological examination because of intestinal perforation or intestinal obstruction that failed conservative treatment. The general data (such as gender, drinking history, etc.), clinical symptoms, complications, imaging (abdominal X-ray, CT, double-contrast barium enema) and endoscopic features were retrospectively analyzed. Descriptive method was used for statistical analysis.Results:Among the 14 IMP patients, 13 cases were male and one case was female. All the 13 male cases had long history of drinking Chinese herbal medicine wine, among them, 8 patients consumed acanthopanax bark wine. Complications occurred in 7 cases, including 5 cases of intestinal obstruction and 2 cases of intestinal perforation. The clinical symptoms of 14 IMP patients were nonspecific, mostly manifested as abdominal pain (11 cases), abdominal distension (6 cases), diarrhea (6 cases), nausea and vomiting (4 cases), and constipation (2 cases). Abdominal X-ray images mainly showed multiple irregular calcifications along involved colon. The images of 3 patients received double-contrast barium enema demonstrated shallowness or disappearance of semilunar folds, rigid colonic wall, narrowed lumen and " thumb printing". The typical CT images indicated edema and thickening of the involved intestinal wall, blurred mesenteric fat space, spot, thread-like, and curved calcification of mesenteric vein and colonic wall. Typical endoscopic findings included dark-purple colored mucosa, congestion, edema, erosion and ulceration, and focal nodular surface and visible varicose veins.Conclusions:IMP has typical imaging and endoscopic characteristics, and the combination of them can diagnose and evaluate IMP more accurately.