Radiology of Infectious Diseases最新文献

Objective

Chest CT is useful in assessing the disease course of coronavirus disease-19 (COVID-19). This study aims to identify the characteristics of patients in whom imaging progression occurred while clinical symptoms were relieved and to guide radiological reexamination.

Methods

This retrospective study included 73 patients with reverse transcription-polymerase chain reaction (RT-PCR) confirmed severe acute respiratory syndrome-2 (SARS-CoV-2) infection. All patients received CT reexaminations within 24 h after symptomatic remission. We divided patients into two groups according to the matching degree between clinical and imaging outcomes.

Results

21 patients displayed imaging progression while symptoms relieved. Patients with imaging progression were prone to be advanced in age [years: 60 (46–65) v 47 (37–60.75), P = 0.030]; lymphopenia (66.7% v 40.4%, P = 0.042) and low level of C-reactive protein [mg/L: 5.7 (1.9–20.2) v 18.9 (6.7–38.9), P = 0.038]. An age over 50 was an independent risk factor for imaging progression (OR = 3.41, 95%CI 1.14–10.20, P = 0.028). In CT images, they were inclined to present lesions with clear border (94.7% v 64.7%, P = 0.012), pure peripheral distribution (89.5% v 39.2%, P < 0.001), without bilateral lungs involved (57.9% v 29.4%, P = 0.028) especially with left lung involved only (42.1% v 17.6%, P = 0.034).

Conclusion

In order to improve the therapeutic effect, the interval before radiological follow-up should be shortened appropriately especially in patients over the age of 50. It is essential to proceed to CT reexamination before symptomatic remission.

Objective

To elucidate the spectrum of findings on neuroimaging in leprosy with special reference to magnetic resonance imaging (MRI).

Methods

We retrospectively reviewed the neuroimaging findings on MRI in thirty-two patients with leprosy where dedicated plexus, brain and spine imaging had been performed.

Results

Twenty-two patients had positive findings on imaging. Six patients showed involvement of the peripheral nerves as thickening and formation of micro or macroabscesses. The brachial plexus showed thickening and hyperintensity in ten patients, with associated involvement of the lumbosacral plexus in one patient. Four patients showed spinal cord involvement as discrete T2 hyperintense lesions with postcontrast enhancement. Intracranial lesions involving the nucleus ambiguus and facial colliculus were seen in two patients.

Conclusion

Neuroimaging in Hansen's disease has brought several new findings to the fore front. Besides peripheral nerves, involvement of the centrally located plexuses, spinal cord and brain has also been seen which thus expands the imaging spectrum of the disease.

The purpose of this article was to review the literature on hepatobiliary anatomy evaluation using different imaging modalities and opt for the best suitable imaging technique to show a specified part of the hepatobiliary system. For this article, the best suitable literature was searched using PubMed database and reviewed. This article describes major aspects of liver segmentation and the most popular classification of the hepatic segments and the vascular and biliary variants in the liver. And the evaluation of the hepatobiliary system using imaging techniques such as ① computed tomography (CT) and magnetic resonance imaging (MRI) for liver, ② computed tomography angiography (CTA) and magnetic resonance angiography (MRA) for the hepatic vasculature including the hepatic arteries, hepatic veins and the portal vein, and ③ magnetic resonance cholangiopancreatography (MRCP) for bile duct. These imaging techniques have provided us with better procedures to depict the liver and biliary architecture, which will help us differentiate normal anatomy from variants and abnormal findings, even benefit in differential diagnosis and devising surgical planning/mapping for preoperative evaluation and post-operative care in conditions of the liver sucha as hepatocellular carcinoma and parasitic cysts.

Melioidosis is a potentially life-threatening infection caused by the Gram-negative bacterium Burkholderia pseudomallei. Diagnosis of melioidosis is difficult due to its diverse clinical manifestations and ability to mimic many other diseases. We report a case of pulmonary melioidosis in a diabetic patient with the air crescent sign evident on a thoracic computed tomography. B. pseudomallei was cultured from the patient's sputum and pleural fluid samples. The infection fully resolved following antimicrobial treatment for melioidosis. This case report highlights the importance of recognizing the air crescent sign as a radiological manifestation of melioidosis to facilitate the prompt administration of appropriate antibiotic treatment, thus reducing morbidity and mortality.

Pulmonary ground glass opacity (GGO) is increasingly detected through the advances made in diagnostic technology, in particular computed tomography (CT). There are those who fear GGO because some patients with GGO are diagnosed with lung cancer. There is indeed some connection between GGO and lung cancer, but GGO does not necessarily deteriorate into tumors. There are many causes of GGO, such as hemorrhage, inflammation or tumors, and GGO with different pathological types also have different CT characteristics. Diagnosis of GGO affects clinical treatment decisions, whether these GGO should be surgically resected or require regular follow-up. This article introduces the differential diagnosis of GGO from the perspective of high-resolution CT (HRCT) imaging and histopathology characteristics.

Objective

To assess the diagnostic efficacy of magnetic resonance imaging (MRI) in the differential diagnosis between well-differentiated hepatocellular carcinomas (WD-HCCs) and high-grade dysplastic nodules (HGDNs) in cirrhotic liver.

Methods

From January 2012 to April 2018, we retrospectively analyzed 91 cirrhotic nodules (HGDN, n = 31, WD-HCC, n = 60) which were confirmed by surgery or pathology. Each patient underwent gadobenate dimeglumine-enhanced hepatic MRI. The MRI characteristics and enhancement effects were calculated and analyzed.

Results

Hyperintensity on diffusion-weighted imaging (DWI), the typical enhancement pattern and hypo-intensity on T1-Weighted imaging (T1WI)were showed with statistically significant difference between WD-HCCs and HGDNs in cirrhotic live (P = 0.002, 0.008, 0.002, respectively). And high signal intensity (SI) on DWI (sensitivity, 66.7%, specificity, 67.7%) was the most specific feature to differentiated WD-HCCs from HGDNs. The combination of DWI and the dynamic enhancement pattern improved the differentiation of WD-HCCs from HGDNs(specificity 83.9%).

Conclusion

DWI is the most specific technique to differentiate WD-HCCs from HGDNs. The combination of DWI and the typical dynamic enhancement pattern can improve the differentiation of WD-HCCs from HGDNs. Pre-enhanced T1WI, as well as a capsule, provides additional diagnostic values.

Salmonella enterica subsp. enterica serovar Dublin (S. Dublin) is a cattle host-adapted serotype, and often causes bacteremia in human. Focal abscess caused by this pathogen is very rare, especially in those who are immunocompromised. Here, we report for the first time a case of chronic chest wall abscess caused by S. Dublin in a 51-year-old HIV-infected woman who was admitted to hospital due to chest pain which had persisted for nine months. The patient had very low CD4 count and a very high virus load. However, S. Dublin had not invaded her blood. After surgical drainage and antimicrobial treatment, the patient was discharged and did not complain chest pain at her 12-month follow up. This case suggests that S. Dublin infection should be considered in the differential diagnosis in HIV-infected patients with chronic subcutaneous abscess.

We describe a case of simian immunodeficiency virus (SIV) infected rhesus monkey with irregular antiretroviral (ARV) therapy that was finally diagnosed as pulmonary toxoplasmosis. So far, there are still rare reports on pulmonary toxoplasmosis for its non-specific clinical and radiological abnormalities.

A Chinese origin rhesus monkey started to row loose stools on the 148th day after SIV-mac239 inoculation with irregular ARV therapy, and improved after expectant treatment for five days. However, when the treatment was stopped, loose stools reappeared with inappetence. On the 157th day after inoculation, it became worse with reduced autonomous activity. Before its death, Computed tomography (CT) scan results showed a bilateral pulmonary multiple lesion, characterized by ground-glass opacities, increase of lung markings, the affected lung segments and the obscure lung lobe. Lung autopsy study validated the infection of toxoplasma gandii.

In this case, we verified the infection of toxoplasma gandii in SIV-mac239 rhesus monkey pathologically, which reflects the pathological basis of infection imaging in return. We also found that pulmonary toxoplasmosis should be taken into consideration in HIV/AIDS patients with a poor adherence or failure to ARV and with fever, loose stools and reduced autonomous activity.

Infectious diseases of the liver are major causal factors leading to acute or chronic liver failure and end-stage liver failure necessitating Liver transplantation (LT). Parasitic infections (Alveolar echinococcosis) and viral hepatitis (HBV and HCV) in particular are prominent infectious diseases in China which carry substantial morbidity rate. Chronic infections of HBV and HCV have a high potential to develop Hepatocellular cancer (HCC). At the end stage or acute liver failure due to these infectious diseases, LT places itself as an effective treatment option. It is a complex procedure requiring the collaborative planning of a radiologist, transplant surgeon, oncologist, and hepatologist. The criteria required for liver transplantation are constantly being optimized with an aim of decreasing the risks involved and increasing the post-transplant survival rate. Role of imaging is crucial in differentiating the normal from abnormal anatomy of the liver, anatomical variants of the vasculature and biliary tree. It helps the transplant surgeon in deciding the technique which benefits both the donor and recipient, putting the graft to optimal use. In this article, we review the literature on infectious diseases (viral and parasitic) of the liver, their impact on the necessity to undergo hepatic transplantation while highlighting the role of imaging evaluation during pre-transplantation stage.

Objectives

To evaluate the value of Xpert MTB/RIF in the diagnosis of pulmonary tuberculosis (PTB) in general hospitals, which are usually where patients first visit.

Materials and methods

Presumptive PTB patients, based on imaging results, in a general hospital in China, were enrolled from August 2015 to April 2017. The sensitivity and specificity of four tuberculosis (TB) detection methods, including sputum smear, Xpert MTB/RIF, T-SPOT.TB and TB-DNA were studied. To predict the effectiveness of the methods, different combinations were assessed using the receiver operating characteristic (ROC) curve.

Results

283 PTB suspect patients were enrolled, 81 of which were diagnosed as TB infections based on the golden standard. The TB detection rate for sputum smear was 11.7% (33/283). The respective sensitivity and specificity of Xpert MTB/RIF were 87.8% (71/81) and 99.5% (201/202). For the smear negative TB patients, the sensitivity of Xpert MTB/RIF was 79.2% (38/48). Combined with several methods, the Xpert MTB/RIF assay had the highest area under curve (AUC) value (0.913).

Conclusions

Xpert MTB/RIF showed tremendous promise for early, rapid and accurate diagnosis of TB. Multicentre evaluation and adoption of Xpert MTB/RIF in general hospitals in China should be embraced and promoted in order to establish an effective TB identification system.