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The aim of the study was to investigate the preoperative factors affecting the survival of patients with resectable peripheral non-small cell lung cancer (NSCLC) to improve the management of NSCLC.One hundred ninety-nine patients with peripheral NSCLC diagnosed clinically without lymph node metastasis were enrolled. The preoperative computed tomography characteristics of the tumors were retrospectively analyzed and the preoperative clinical data were collected. The size of the solid components for lung adenocarcinomas containing ground-glass opacity (GGO) component were measured. Kaplan-Meier method with log-rank test was used to compare overall survival (OS) between groups. Univariate and multivariate cox regression analyses were used to identify prognostic factors.Survival analysis showed that the OS of the group with a tumor of 3 cm or less was longer than that of the group with a tumor greater than 3 cm, the OS of the group with GGO component was superior to that of the group without GGO component, and the OS of the group with elevated carcinoembryonic antigen (CEA) levels was inferior to that of the group with normal CEA levels. Multivariate Cox regression analysis showed that tumor size, density, and preoperative CEA level were independent factors affecting OS, with hazard ratios of 2.401, 0.457, and 1.948, respectively. The analysis of lung adenocarcinomas with GGO component demonstrated that the mean size of the solid component in the nonsurviving group was significantly larger than that in the surviving group (mean, 23 ± 6.4 vs 8.6 ± 7.0 mm). The area under the receiver operating characteristic curve of the solid component size of lung cancer containing GGO component to predict postoperative death was 0.932.Tumor size, density, and preoperative CEA level were independent prognostic factors of patients with resectable peripheral NSCLCs. Preoperative computed tomography findings can be valuable for predicting the prognosis of patients with NSCLC after surgery.

To investigate the value of an intravoxel incoherent motion (IVIM) diffusion model for discriminating malignant versus benign mediastinal lymph nodes (MLN). Thirty-five subjects with enlarged MLN were scanned at 1.5 Tesla. Diffusion-weighted imaging was performed with eight b-values. IVIM parameters D, D*, and f, as well as apparent diffusion coefficient (ADC) from a mono-exponential model were obtained. 91 nodes (49 malignant and 42 benign) were analysed with pathologic (n=90) or radiologic (n=1) confirmations. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance. The mean values of D, ADC, and f for the malignant group were significantly lower than those for the benign group (p

Background The aim of this study was to explore whether spectral computed tomography (CT) imaging parameters are associated with PD‐L1 expression of lung adenocarcinoma. Methods Spectral CT imaging parameters (iodine concentrations [IC] of lesion in arterial phase [ICLa] and venous phase [ICLv], normalized IC [NICa/NICv]‐normalized to the IC in the aorta, slope of the spectral HU curve [λHUa/λHUv] and enhanced monochromatic CT number [CT40keVa/v, CT70keVa/v] on 40 and 70 keV images) were analyzed in 34 prospectively enrolled lung adenocarcinoma patients with common molecular pathological markers including PD‐L1 expression detected with immunohistochemistry. Patients were divided into two groups: positive PD‐L1 expression and negative PD‐L1 expression groups. Two‐sample Mann‐Whitney U test was used to test the difference of spectral CT imaging parameters between the two groups. Results The CT40keVa (127.03 ± 37.92 vs. −54.69 ± 262.04), CT40keVv (124.39 ± 34.71 vs. −45.73 ± 238.97), CT70keVa (49.56 ± 11.76 vs. −136.51 ± 237.08) and CT70keVv (46.13 ± 15.81 vs. −133.10 ± 230.72) parameters in the positive PD‐L1 expression group of lung adenocarcinoma were significantly higher than the negative PD‐L1 expression group (all P 0.05). Conclusion CT40keVa, CT40keVv, CT70keVa and CT70keVv were increased in positive PD‐L1 expression. These parameters may be used to distinguish the PD‐L1 expression state of lung adenocarcinoma.

Background This study quantitatively assessed the efficacy of spectral computed tomography (CT) imaging parameters for differentiating the malignancy and benignity of solitary pulmonary nodules (SPNs) manifesting as ground glass nodules (GGNs) and solid nodules (SNs). Methods The study included 114 patients with SPNs (61 GGNs, and 53 SNs) who underwent CT plain and enhanced scans in the arterial (a) and venous (v) phases using the spectral imaging mode. The spectral CT imaging parameters included: iodine concentrations (IC) of lesions in the arterial (ICLa) and venous (ICLv) phases; normalized IC (NICa/NICv, normalized to the IC in the aorta); the slope of the spectral Hounsfield unit (HU) curve (λHUa/λHUv); and monochromatic CT number (CT40keVa/v, CT70keVa/v) enhancement on 40 and 70 keV images. The two‐sample Mann–Whitney U test was used to compare quantitative parameters between malignant and benign SPNs, SNs, and GGNs. Results Pathology revealed 75 lung cancer cases, 3 metastatic nodules, 14 benign nodules, and 22 inflammatory nodules. Among the 53 SNs there were 37 malignant and 16 benign nodules. Among the 61 GGNs there were 41 malignant and 20 benign nodules. Overall, the CT40keVa, λHUa, CT40keVv, λHUv, and ICLv of benign SPNs were all greater than those of malignant SPNs (all P < 0.05). For GGNs, CT40keVa/v, CT70keVa/v, λHUa/λHUv, and ICLv of malignant GGNs were all lower than those of benign GGNs. Conclusion Spectral CT imaging is a more promising method for distinguishing malignant from benign nodules, especially in nodules manifesting as GGNs in contrast‐enhanced scanning.

ABCA1 -565C/T gene promoter variants have been associated with the severity of coronary artery disease in Western populations. The purpose of our study was to investigate the association between the -565C/T gene polymorphism and coronary artery disease severity and cholesterol efflux in the Chinese Han population.A cohort of 298 acute coronary syndrome (ACS) patients and 541 healthy controls was genotyped using the highly sensitive ligase detection reaction. ABCA1 -565C/T genotype was correlated with the clinical features of 164 acute myocardial infarction (AMI) patients. Monocytes from patients with various -565C/T gene polymorphisms were isolated and differentiated into foam cells by coincubation with [(3)H]-labeled acetyl-low-density lipoprotein cholesterol. ABCA1 mRNA and protein expression levels were evaluated, as well as cellular cholesterol efflux.The frequency of the TT genotype in the -565C/T polymorphism of ACS patients was significantly increased when compared with controls (0.211 vs. 0.162, p0.05). The TT genotype, but not the CT or CC genotypes, in the -565C/T gene polymorphism correlated with the severity of the coronary lesion observed in AMI patients. Patients with the TT homozygote genotype also exhibited significantly lower cellular cholesterol efflux (TT [6.37%±0.554%]) levels than controls and also had the lowest levels of ABCA1 mRNA and protein expression among the group of variants. In contrast, cholesterol efflux levels in AMI patients with CT [11.35%±3.975%] and CC ([15.32%±6.293%]) genotypes were not significantly different from controls.Impaired ABCA1-mediated cholesterol efflux in macrophages may be associated with the severity of the coronary lesions in AMI patients with the TT genotype at the -565C/T gene polymorphism.

OBJECTIVE The aim of this study was to comprehensively analyze computed tomography features to improve the diagnostic accuracy of visceral pleural invasion of peripheral non-small cell lung cancer. METHODS The computed tomography features of 205 non-small cell lung cancer patients were retrospectively studied. The lesion's relation to the pleura was classified into 5 grades. A multivariate logistic regression analysis was conducted to identify independent factors predicting pleural invasion. RESULTS The multivariate logistic regression analysis showed that sex (odds ratio [OR], 1.822; P = 0.080), pleural indentation (OR, 4.111; P < 0.001), tumor density (OR, 2.735; P = 0.008), and distance between the lesion and pleura (OR, 1.981; P = 0.048) were independent predictors of pleural invasion. A patient with a score of 10.6 had an 80% risk of pleural invasion, whereas a score lower than 2 was associated with a lower (20%) risk of pleural invasion. CONCLUSIONS Comprehensive consideration of these factors of pleural indentation, sex, tumor density, and distance between the lesion and pleura might improve the diagnosis of pleural invasion.

The purpose of this article is to investigate whether apparent diffusion coefficient (ADC) might be used as a universal biomarker for response evaluation in different tumors.Twenty-one patients with lung cancer, 12 patients with esophageal cancer, 19 patients with liver metastases, 24 patients with gastric cancer, and 26 patients with rectal cancer were recruited to the study. Percentage changes in the ADC and changes in the size of responding and nonresponding lesions of different tumors after treatment were analyzed using repeated measures analysis of variance.There was no significant difference among the percentage ADC changes of different tumors (F = 1.57; p = 0.192). Clear differences were seen in the percentage ADC changes between responding and nonresponding tumors (F = 21.62; p0.001), which were significant at every time point after the start of treatment (early time point, F = 19.75 and p0.001; middle time point, F = 11.23 and p = 0.001; and later time point, F = 15.98 and p0.001). The percentage size changes after treatment between responding and nonresponding tumors were significantly different (F = 19.38; p0.001). However, at the early time point after treatment, the difference was not statistically significant (F = 0.02; p = 0.894).The ADC changes correlated with treatment response in five types of body tumor but were independent of the tumor's location. Early increases in ADC during treatment indicate good response to treatment. ADC change is a promising biomarker for detecting therapeutic responses at an early stage that could be widely used.

The usefulness of diffusion-weighted magnetic resonance (MR) imaging (DWI) for differentiating central lung cancer from postobstructive lobar collapse (POC) was investigated. Thirty-three cases suspected of lung cancer and POC on chest bolus computed tomography (CT) underwent thoracic MR imaging examinations. MR examinations were performed using a 1.5-T clinical scanner. Scanning sequences were T1-weighted imaging, T2-weighted imaging (T2WI) and DWI with b=0, 500 s/mm(2), four excitations and segmented breath-holding. The densities and signals of cancer and postobstructive collapsed lung were compared on bolus-enhanced CT, T2W and DW images. Statistical analyses were performed with chi-square test, paired t-test, non-parameter test and kappa statistics. Differentiation between cancer and POC was possible on bolus CT, T2W and DW images in 14, 21 and 26 patients, respectively. Eight cases that were impossible to differentiate on T2W images were distinguishable on DWI, demonstrating that DWI is complementary to T2WI. Using a combination of T2W and DW images, 88% (29/33) of cases were differentiated on MR imaging. Thus, a combination of T2W and DW imaging is superior to bolus-CT or T2WI alone. The contrast-to-noise ratio of DWI was significantly higher than that of T2WI. Agreement between two independent observers on the differential ability of lung cancer and POC was higher for DWI (kappa=0.474) than for T2WI (kappa=0.339). The degree of consolidation around the cancer was negatively correlated with the degree of artifact and degree of deformation. It is feasible to use DWI to differentiate lung cancer from POC. DWI played a role in confirming and providing complementary information to that obtained from T2WI. Our data indicate that using a combination of the two scanned sequences was the best means of distinguishing between lung cancer and POC.

The aim of this study was to investigate the performance of monochromatic images of spectral computed tomographic (CT) in the visualization of the pancreatic arteries compared with polychromatic CT images. We conducted a case–control study in a group of 26 consecutive patients with monochromatic CT and contrasted the results against a control group of 26 consecutive patients with polychromatic CT. The CNR (contrast-to-noise ratio), SIR (signal intensity ratio), SNR (signal to noise ratio), and image noise were measured. A 5-score classification system was used to evaluate the branch order of pancreatic arteries. The course of pancreatic arteries was compared. Compared with polychromatic images, the CNR, SIR, and SNR obtained by monochromatic images were increased by 64.74%, 23.99%, and 39.50%. Branch visualization of PSPDA (posterior superior pancreaticoduodenal artery), ASPDA (anterior superior pancreaticoduodenal artery), and DPA (dorsal pancreatic artery) was better at monochromatic images than at polychromatic images. The display rate was significantly better in monochromatic images for the second and third segments of PSPDA, total course of ASPDA, and artery of uncinate process. Compared with polychromatic images, monochromatic images can improve the visualization of pancreatic arteries.

The objective of this study was to compare the image quality and radiation dose of chest CT images reconstructed with a blend of adaptive statistical iterative reconstruction (ASIR) and filtered back-projection (FBP) with images generated using conventional FBP.Patients with chest CT re-examinations were alternately assigned to two scanners with different reconstruction techniques. The study groups included noise index (NI) 11 with 30% ASIR (A30), NI 13 with 40% ASIR (A40), NI 15 with 50% ASIR (A50) and NI 17 with 60% ASIR (A60), sequentially changed every 2 months. The control images were obtained using FBP and NI 11. All acquisitions were performed with automatic dose modulation. Paired t-test and non-parameter test were applied to compare the difference.The radiation doses were significantly lower in the examinations that used ASIR (p0.001). The mean dose reduction rate was 27.7%, 45.2%, 57.1% and 71.8% for Groups A30, A40, A50 and A60, respectively. The image quality of Groups A30-A50 was not inferior to that of the control examinations. The image noise of Group A60 was greater and subjective image quality was inferior to that of the control.ASIR enabled the use of a higher NI with automatic dose modulation. With 50% ASIR and a NI of 15, the effective radiation dose was reduced by 57%, without compromising image quality.

To prospectively investigate the use of the apparent diffusion coefficient (ADC) as an early response indicator in patients with gastrointestinal stromal tumors (GISTs) treated with imatinib mesylate.This study was approved by the institutional review board and written informed consent was obtained from all patients. Diffusion-weighted magnetic resonance (MR) imaging was performed in 32 patients with GISTs before and 1, 4, and 12 weeks after treatment with a tyrosine kinase inhibitor, imatinib mesylate. The measurable lesions were classified as having responded well or poorly according to size alterations at clinical evaluation following the first round of treatment (3 months). A linear mixed-effects model was applied to analyze changes in the ADCs of tumors during treatment and to compare the variation and slopes of the time-dependent ADC curves between the good- and poor-response groups.There were 56 lesions in the good-response group and 35 in the poor-response group. An early (1 week after therapy) noticeable and statistically significant (P.001) increase in the ADC was observed in the good-response group (median ADC increase, 44.8%) but not in the poor-response group (median ADC increase, 1.5%). The time-dependent ADC variation was significantly different between the good- and poor-response groups, with a sharper median ADC increase displayed in the former (week 1: 44.8% vs 1.5%; week 4: 80.4% vs 7.8%; week 12: 89.6% vs 16.7%; F = 25.78, P.001). The largest difference in the weekly percentage increase in ADC between the good- and poor-response groups was observed at 1 week after therapy (week 0-1: 44.8% vs 1.5%; week 1-4: 7.0% vs 2.8%; week 4-12: 1.6% vs 0.7%). The pretherapy mean ADC (± standard deviation) of lesions in the good-response group (1.06 [×10(-3) mm(2)/sec] ± 0.27) was significantly lower than that in the poor-response group (1.24 [×10(-3) mm(2)/sec] ± 0.32) (F = 8.34, P = .005).Comparatively low pretherapy ADC and marked ADC increase at 1 week after therapy is associated with good response to imatinib mesylate in patients with GISTs.

Objective In this study, we examine the association of single nucleotide polymorphisms (SNPs) of the human ATP binding cassette transporter G1 (ABCG1) gene with atherosclerotic coronary artery disease (CAD) in a Chinese Han population. Methods 1021 patients with CAD and 1013 unaffected control subjects were enrolled. PCR-based ligation detection reaction (PCR-LDR) method was used to genotype four SNPs of ABCG1, three (rs2234714, rs2234715 and rs57137919) in the promoter region and one (rs1044317) in the 3′-untranslated region (UTR). Results The human ABCG1 −367G>A polymorphism (rs57137919) showed a significantly decreased risk for CAD and myocardial infarction (MI) in a dominant model (adjusted OR=0.73, p =0.033 for CAD, and adjusted OR=0.65, p =0.014 for MI, respectively). The rs57137919 also showed an association with angiographic severity of CAD (multi-vessel vs. single-vessel CAD, adjusted OR=0.40, p =0.005). The findings were further supported by luciferase reporter assay, in which the polymorphism impaired reporter gene expression. The ABCG1 −768G>A polymorphism (rs2234714) showed an association with CAD in a recessive model (adjusted OR=0.64, p =0.015), but did not demonstrate a functional influence on reporter gene expression in the luciferase reporter assay. Conclusions The SNP rs57137919 in the ABCG1 promoter region is functionally associated with a reduced risk of CAD in a Chinese Han population.

To investigate the association between CT image changes and the prognosis in gastrointestinal stromal tumors (GIST) after targeted therapy.A total of 35 patients with GIST were treated by imatinib mesylate from April 2003 to June 2008. The longest diameter (LD) and mean enhanced CT values (HU) of tumors were measured on axial images. The CT classifying (number, location, liver metastasis, hemorrhage,cystic degeneration) and quantitative indices (pre- and 2-6 months post-treatment LD, HU, and their change rate) were compared between those with and without progress in two years.During follow-up (median:285 months) 13 cases had tumor progress. The progress rate was higher in the group with extensive tumor involvement (or = 5 lesions andor = 2 parts), and that without hemorrhage demonstrated. The mean change rate was -14.29% (range, -67%, 11%) for LD and -12.25% (range, -55%, 39%) for HU in non-progressive group, while the mean change rate was 15.09%(range, -45%, 191%) for LD and 9.91% (-27%, 135%) for HU in progressive group. The differences were significantly different (P0.01). The accuracies of predicting 2-year progress by LD and HU change rates were moderate, with area under ROC curve being 0.790 and 0.797, respectively.The 2-year progress rate of GIST after targeted therapy is higher in extensively involved tumors. Higher decrease rates of LD and HU predict less 2-year progress, which possess moderate prediction accuracy and can be used as valuable indicators in the evaluation of targeted therapy for GIST.

Test ocular surface electromyography signal waves and characteristic parameters to provide effective data for the diagnosis and treatment of ocular myopathy.Surface electromyography signals tests were performed in 140 normal volunteers and 30 patients with ophthalmoplegia. Surface electrodes were attached to medial canthi, lateral canthi and the middle of frontal bone. Then some alternate flashing red lamps were installed on perimeter to reduce the movement of eyeball. The computer hardware, software, and A/D adapter (12 Bit) were used. Sampling frequency could be selected within 40 kHz, frequency of amplifier was 2 kHz, and input short circuit noise was less than 3 microV.For normal volunteers, the ocular surface electromyography signals were regular, and the electric waves were similar between different sex groups and age groups. While for patients with ophthalmoplegia, the wave amplitude of ocular surface electromyography signals were declined or disappeared in the dyskinesia direction. The wave amplitude was related with the degree of pathological process. The characteristic parameters of patients with ophthalmoplegia were higher than normal volunteers.The figures of ocular surface electromyogram obtained from normal volunteers were obviously different with that from patients with ophthalmoplegia. This test can provide reliable quantized data for the diagnosis and treatment of ocular myopathy.

To investigate the clinical characteristics and related pathogenetic factors in systemic lupus erythematosus (SLE) patients with myocardial involvement.Clinic data and myocardial involvements were analyzed in 2494 SLE patients who admitted to our hospital from 1997 to 2007.Myocardial involvements were seen in 13 out of 2494 SLE patients (0.52%). Dyspnea of various degrees and left ventricular systolic dysfunction are frequently found in these patients with myocardial involvements. Glucocorticoid therapy significantly increased left ventricular ejection fraction (LVEF, 37.7% +/- 5.8% vs. 40.9% +/- 7.1%, P = 0.002). Significant associations were found between anti-rRNP antibody and LVEF (r = 0.843, P = 0.001) as well as between cardiac troponin I (cTnI) and left ventricular end diastolic diameter (LVEDD) (r = 0.656, P = 0.036).Myocardium is rarely affected in patients with SLE in this cohort. Echocardiography is a valuable method for detecting cardiac abnormalities in patients with SLE. Glucocorticoid therapy could improve cardiac function in SLE patients with cardiac involvement and serological factors are related to cardiac functions.

This study was designed to investigate the clinical characteristics of systemic vasculitis with cardiac involvement.Clinical information of 10 patients with systemic vasculitis complicated by myocardial vasculitis, selected from 181 small vessel vasculitis patients and 114 systemic vasculitis patients were analyzed.The clinical manifestations were varied significantly dependent on the etiology of small vessel vasculitis. It is usually difficult to make the diagnosis because of the insidious onset, varied etiology and the undifferentiated manifestations of heart involvement. Echocardiography is commonly used in detecting and monitoring cardiac involvement. Glucocorticoid therapy can improve left ventricular systolic function dramatically when used properly.The cardiac involvement of systemic vasculitis is quite rare. Dyspnea of various degrees and left ventricular systolic dysfunction are the most common clinical findings. The earlier the establishment of diagnosis and institution of appropriate treatment, the better the prognosis.