ISSN 1004-4140
CN 11-3017/P

2022 Vol. 31, No. 4

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2022, 31(4): 417-530.
Current Situation and Future of Medical Imaging in the Diagnosis of Lymphatic Diseases
WANG Rengui
2022, 31(4): 417-424. doi: 10.15953/j.ctta.2022.154
Pediatric Diffuse Pulmonary Lymphangiomatosis: CT Characteristics
GAO Jun, YU Tong, DUAN Xiaomin, ZHANG Xiaoyan, PENG Yun
2022, 31(4): 425-432. doi: 10.15953/j.ctta.2022.103
Objective: To explore the typical CT features of diffuse pulmonary lymphangiomatosis in children and improve the diagnostic accuracy. Methods: The radiologic data of 13 children with diffuse pulmonary lymphangiomatosis confirmed by clinical, imaging and pathological biopsy were reviewed retrospectively, including 6 girls and 7 boys, with an average age of 5.8 years. All the 13 cases underwent CT plain scan and enhanced examination. Results: The characteristic CT findings of diffuse pulmonary lymphangiomatosis in this group were as follows: (1) Mediastinum and hilum, peribronchovascular, interlobular septa were involved; (2) The thickening of soft tissue in mediastinum continued with the thickening of soft tissue around hilum and bronchovascular; (3) The soft tissue density in the mediastinum was low, no enhancement was observed under contrast, and there was no compression or shift in the brachiocephalic great vessels; (4) Hilar thickening, smooth thickening of soft tissue around bronchovascular and interlobular septa, most of which involved both sides of the lung, and a few involved one side at the same time; (5) Pleural thickening or pleural effusion; (6) Spleen involvement is common; (7) Cervical and or axillary lymph node enlargement and density reduction; (8) The density of several or single vertebrae wasreduced. Laboratory examination with thrombocytopenia and/or DIC was considered Kaposiform lymphangiomatosis. Conclusion: CT findings of diffuse pulmonary lymphangioma lymphangiomatosis in children show high specificity, when combined with the age of onset and clinical laboratory examinations, can significantly improve the diagnostic coincidence rate of the disease.
CT and CT Lymphangiography Findings of Congenital Pulmonary Lymphangiectasis
GUO Jia, ZHANG Yan, LIU Mengke, LI Xingpeng, HAO Qi, WANG Rengui
2022, 31(4): 433-440. doi: 10.15953/j.ctta.2022.116
Objective: To investigate the diagnostic value of chest CT and CT lymphangiography (CTL) in congenital pulmonary lymphangiectasia (CPL). Materials and methods: The clinical and imaging datas of 41 patients with CPL diagnosed by clinical and imaging from August 2012 to July 2021 were retrospectively analyzed. All patients underwent chest CT examination before direct lymphangiography (DLG) and CTL after DLG. The CT and CTL imaging manifestations were analyzed and statistically described using the composition ratio in the categorical variable data. Results: Among the 41 patients, CT showed thickening of bronchovascular bundles in 33 cases, interlobular septal thickening in 32 cases, intralobular interstitial thickening in 4 cases, and ground-glass opacity in 26 cases, 5 cases of lung consolidation, 14 cases of atelectasis, 24 cases of pleural effusion. CTL lipiodol was abnormally deposited at the end of the thoracic duct in 35 cases, bronchovascular bundles in 31 cases, hilum in 32 cases, pleura in 17 cases, mediastinum in 36 cases, pericardium in 17 cases, diaphragm in 3 cases, intraperitoneal in 10 cases, and retroperitoneal in 10 cases , 20 cases of pelvis and perineum. Conclusion: CT and CTL can show the extent and distribution of Lymphangiectasia, and provide imaging basis for the diagnosis and treatment of CPL.
Application of CT Lymphangiography in the Diagnosiis of Primary Pulmonary Lymphedema
ZHANG Yan, HAO Qi, LIU Mengke, LI Xingpeng, SUN Xiaoli, WANG Rengui
2022, 31(4): 441-447. doi: 10.15953/j.ctta.2022.096
Objective: To explore the clinical value of CT lymphangiography in diagnosing primary pulmonary lymphedema. Methods: 52 patients who were diagnosed by clinical, imaging and pathology as primary pulmonary lymphedema were analyzed retrospectively. All patients underwent CT lymphangiography. Two experienced radiologists carried out double-blind film reading of the CT lymphangiography manifestations, and observed the abnormal perfomance of lymphatic vessels in the chest as well as CT signs of other chest diseases.Results: CT lymphangiography showed contrast agent abnormity deposited in all 52 patients: the end of thoracic duct was found in 38 cases (73.1%), mediastinum in 34 cases (65.4%), hilar in 22 cases (42.3%), pleura in 18 cases (34.6%), pericardium in 15 cases (28.8%), diaphragm in 5 cases (9.6%), hepatic hilum in 9 cases (17.3%), pancreas in 5 cases (9.6%), retroperitoneum in 12 cases (23.1%). Abnormal CT changes including: (1) alveolar nodule-like ground glass opacity in 19 cases (36.5%), patchy ground glass opacity in 23 cases (44.2%), atelectasis in 11 cases (21.2%), pulmonary nodules in 3 cases (5.8%). (2) the thickening of bronchovascular bundle in 43 cases (82.7%), the thickening of interlobular septum in 43 cases (82.7%), the thickening of intralobular interstitium in 4 cases (7.7%), frog-spawn sign in 7 cases (13.5%). (3) abnormal mediastinum changes in 34 cases (65.4%). (4) other chest CT abnormalities including: the crazy-paving sign in 2 cases (3.8%), pleural effusion in 18 cases (34.6%), pericardial effusion in 18 case (34.6%). Conclusion: CT lymphangiography can indirectly predict the abnormality of lymphatics and the presence or absence of lymphatic reflux by showing the abnormal deposition and distribution of contrast agents, and thus can provide valuable imaging basis for the diagnosis and treatment of primary pulmonary lymphedema.
Analysis of Spiral CT Phenotypes and Features of Primary Intestinal Lymphoma
YU Ming, HU Jiayuan, SONG Yan, LI Saying
2022, 31(4): 449-458. doi: 10.15953/j.ctta.2022.090
Objective: To investigate the CT manifestations of primary intestinal lymphoma (PIL) so as to improve the diagnosis and differential diagnosis. Methods: 21 patients with PIL confirmed pathologically in our hospital from March 2013 to February 2022 were enrolled in this study, their CT phenotypes and features were analyzed. Results: All 21 cases of PIL were non-Hodgkin's lymphoma (NHL), 12 cases were diffuse large B-cell lymphoma (DLBCL), 3 cases were follicular lymphoma, 2 cases were NK/T-cell lymphoma, 2 cases were T-cell lymphoma, mucosa-associated lymphoid tissue lymphoma (MALT) and mantle cell lymphoma (MCL) were identified 1 case each. The lesions were located in the colon in 7 cases, ileum in 5 cases, small intestine mesentery in 4 cases, ileocecum in 2 cases, jejunum in 1 case, rectum in 1 case, and both right hemicolon and ileocecum in 1 case. CT findings showed intestinal wall infiltration in 3 cases, intestinal wall thickening in 3cases, mass in 4 cases, aneurysmal dilation in 7 cases and mesenteric multiple nodules in 4 cases. CT enhancement mostly showed homogeneous mild/moderate enhancement. Among the 21 patients, 2 case was complicated by by intestinal perforation, and 2 cases were complicated by intestinal obstruction. Conclusion: The characteristic imaging features of CT in PIL include multifocal involvement of the intestines, marked mural thickening in a focal or diffuse manner, aneurysmal dilatation of lumen, eccentric intestinal mass of uniform density and mesenteric "sandwich sign". Recognition of these signs is of diagnostic value for primary intestinal lymphoma.
The Application Value of CT Lymphangiography in Diagnosis and Grading in Patients with Primary Chyluria
HAO Qi, ZHANG Yan, LI Xingpeng, LIU Mengke, SUN Xiaoli, WANG Rengui
2022, 31(4): 459-468. doi: 10.15953/j.ctta.2022.106
Objective: To investigate the application value of CT lymphangiography in diagnosis and grading in patients with primary chyluria. Methods: Clinical and CTL imaging data of 79 patients diagnosed with primary chyluria were collected retrospectively. For CTL, the indexs were (1) Involved kidney and distribution of abnormal lymphatic vessels in the kidney: unilateral or bilateral kidney,renal sinus, renal parenchymal, suprahilar area and subhilar area; (2) Distribution of perirenal and retroperitoneal abnormal lymphatic vessels: retroperitoneal area,lumbar trunk area, renal perivascular area, fatty capsule area, adrenal area, etc; (3) Distribution of dilated lymphatic vessels and lymphatic reflux in chest, abdomen and pelvis; (4) Other abnormal manifestations: lymphatic-related abnormal changes in the chest, abdomen, pelvic cavity and bone; (5) Imaging grading: the imaging grading was carried out according to the range of retroperitoneal involvement, and the retroperitoneal area was divided into 10 areas, including left and right suprahilar area, subhilar area, perirenal area, renal perivascular area and lumbar trunk area, involvement of five or fewer areas were graded as mild, while involvement of six or more were graded as severe. In addition, clinical grading was carried out according to clinical manifestations. The clinical characteristics and CTL signs of patients with primary chyluria were statistically described by the composition ratio of classification variables, and the consistency of imaging grade and clinical grade of patients with primary chyluria was evaluated by Kappa test. Results: CTL showed abnormal lipiodol deposition in kidney in 74 cases (93.7%), unilateral kidney in 55 cases (69.6%), bilateral kidneys in 19 cases (24.1%), renal sinus in 74 cases (93.7%), renal parenchyma in 37 cases (46.8%); suprahilar area in 61 cases (77.2%), 52 cases (65.8%) were unilateral and 9 cases (11.4%) were bilateral; subhilar area in 61 cases (77.2%), 47 cases (59.5%) were unilateral and 14 cases (17.7%) were bilateral; retroperitoneal area in 78 cases (98.7%); lumbar trunk area in 76 cases (96.2%), 20 cases (25.3%) were unilateral and 56 cases (70.9%) were bilateral; perivascular area in 72 cases (91.1%), 45 cases (57.0%) were unilateral and 27 cases (34.2%) were bilateral; fatty capsule in 14 cases (17.7%), 13 cases (16.5%) were unilateral and 1 case (1.3%) was bilateral; adrenal area in 12 cases (15.2%); bladder in 31 cases (39.2%), perivesical area in 12 cases (15.2%), iliac perivascular area in 73 cases (92.4%), abdominal and pelvic wall in 14 cases (17.7%), perineal area in 12 cases (15.2%), perirectal area in 14 cases (17.7%), mesentery in 26 cases (32.9%), intestinal wall in 11 cases (13.9%), intestinal canal in 5 cases (6.3%), peripancreatic area in 15 cases (18.9%), perisplenic area in 2 cases (2.5%), perihepatic area in 7 cases (8.8%), hilus of the lung in 1 case (1.3%), mediastinum in 14 cases (17.7%), pericardium in 1 case (1.3%), extrapleural area in 25 cases (31.6%), chest wall in 2 cases (2.5%), skeleton in 2 cases (2.5%), end of thoracic duct in 70 cases (88.6%). Among the 79 patients with primary chyluria, according to clinical classification, 27 cases were mild and 52 cases were severe; according to imaging classification, 40 cases were mild and 39 cases were severe. The consistency of the two grades was moderate. Conclusion: CTL can evaluate the distribution and range of intrarenal, perirenal and retroperitoneal dilated lymphatic vessels accurately, and evaluate the abnormal lymphatic vessels in the chest, abdomen and pelvis and thoracic duct in patients with primary chyluria.It can provide image basis for the diagnosis, grading and treatment of primary chyluria.
CT Lymphangiography (CTL) in Different Type of Primary Intestinal Lymphangiectasia (PIL): A Comparative Study
DONG Jian, XIN Jianfeng, YUAN Guangxiao, ZHANG Chunyan, GUAN Xiaojiao, GUO Jia, LI Xingpeng, ZHANG yan, HAO Qi, SHEN Wenbin, WANG Rengui
2022, 31(4): 469-477. doi: 10.15953/j.ctta.2022.115
Objective: To explore the clinical and imaging characteristics and application value CT lymphangiography (CTL) in patients with different types of primary intestinal lymphangiectasia (PIL). Methods: Patients diagnosed as PIL in our center were recruited in this retrospective study from January 2016 to December 2019, All CTL data were blindly reviewed by two radiologists separately, and the evaluation indicators included: sex, onset age, symptoms and signs, serum albumin, wall thickening, serous cavity effusion, abnormal distribution of lymphatics, lymph reflux, lymph nodes, fistula and abnormal lymphatics around neck area. Based on the abnormal lymphatics in intestinal wall and/or mesentery, PIL was classified into type Ⅰ (positive type) and type Ⅱ (negative type). The clinical and imaging features were compared between the two groups. Results: 34 PIL patients were recruited in this study, including 15 cases of Ⅰ and 19 cases of Ⅱ. Type I showed older age of first onset (15.3±9.4 vs. 8.3±3.8), higher rate of diarrhea, and lower rate of limb and/or facial edema than type Ⅱ, with no statistical difference in sex and serum albumin. For imaging features comparisons, type Ⅰ demonstrated higher rate of abnormal dilated lymphatics and fistula, lower rate of increased attenuation of mesentery and lymph nodes, while no statistical difference was found between wall thickening, serous cavity effusion, lymph reflux and abnormal dilated lymphatics around neck area. Conclusion: CTL demonstrated capability of evaluation in detection of location, distribution and range of abnormal lymphatics in PIL. Based on CTL, the imaging classification of PIL was proposed. Different types of PIL showed different clinical and imaging features, which was useful for therapeutic adoptions.
Study on the Staging of Primary Lower Extremity Lymphedema Based on Calf Soft-tissue Thickness Measurement by MRI
LIU Mengke, LI Xingpeng, ZHANG Yan, HAO Qi, SUN Xiaoli, LI Bin, WANG Rengui
2022, 31(4): 479-487. doi: 10.15953/j.ctta.2022.100
Objective: To investigate the value of MRI-based measurement of calf soft-tissue thickness in assessing the clinical staging of primary lower extremity lymphedema (PLEL). Methods: The clinical and MR imaging data of 90 patients diagnosed with PLEL in our hospital were retrospectively collected, and all patients underwent bilateral lower limb MR examinations. Short Time Inversion Recovery (STIR) sequence was used to measure the total soft tissue thickness (T), musculoskeletal thickness (M) and subcutaneous soft tissue thickness (S) of bilateral lower legs, and the difference between T and S of bilateral lower legs (DT, DS) was calculated respectively. Patients were classified into stages Ⅰ, Ⅱ and Ⅲ with reference to the clinical staging criteria of the International Lymphatic Association 2020 and our lymphatic surgery department for lower limb lymphedema, excluding stage 0. One-way ANOVA was used to compare calf soft tissue thickness among different clinical stages, Spearman correlation was used to analyze the correlation between calf soft tissue thickness and clinical stage, and ROC curves were used to evaluate the efficacy of calf soft tissue thickness in discriminating clinical stage. Results: The differences among T, S, DT and DS of the three stages were statistically significant, while there was no statistical difference among M; when comparing two by two in each subperiod, T, S, DT and DS were statistically different between stage Ⅰ and Ⅱ and stage Ⅰ and Ⅲ, while there was no statistical difference between stage II and III. The correlation between DT (r=0.750) and DS (r=0.772) and clinical stage was significantly greater than that between T (r=0.669) and S (r=0.734), with DS showing the highest correlation with clinical stage; there was no significant correlation between M and clinical stage. ROC curves showed that the AUC values for each parameter to identify stage Ⅰ and Ⅱ were greater than those to identify stage Ⅱ and Ⅲ. The AUC value of DS (AUC=0.945) demonstrated the highest area under the curve (AUC) among all parameters to identify stage Ⅰ and stage Ⅱ. Conclusion: MRI soft-tissue thickness measurement of calf can be used as a quantitative adjunct in the clinical staging of unilateral PLEL, and for patients with unilateral PLEL, we recommend DS as the best thickness index to differentiate stage Ⅰ from Ⅱ lymphedema.
Neck-chest-abdomen-pelvis Combined Enhanced CT in Breast Cancer Patients: Comparison between Dual-energy and Conventional Scanning Mode
WANG Hong, LI Ling, LU Yao, YU Kezhen, WANG Guoxuan, JIANG Lei, LI Saying
2022, 31(4): 489-498. doi: 10.15953/j.ctta.2022.094
Objective: To investigate the application value of dual-energy scanning scheme in neck-chest-abdomen-pelvis combined enhanced CT in patients with breast cancer patients by comparing with the conventional scanning scheme. Methods: A retrospective analysis was performed on 40 female patients with breast cancer who underwent neck-chest-abdomen-pelvis combined enhanced CT in Beijing hospital, including 20 patients scanned by conventional protocol and 20 patients scanned by dual-energy protocol. The radiation doses in arterial phase and delayed phase were compared between the two modes. The image qualities were evaluated by measuring signal-to-noise ratio (SNR), contrast noise ratio (CNR) and subjective scoring. Results: The radiation doses in arterial phase and delayed phase of conventional and dual-energy protocol were statistically different, and the radiation dose of dual-energy protocol was lower. There was no significant difference between the two modes in SNR and CNR of cervical arterial lymph nodes. There was significant difference between conventional and dual-energy mode in SNR and CNR value of axillary lymph nodes in thoracic artery phase. There was no significant difference in the subjective scores of conventional and dual-energy protocol of cervical lymph nodes. However, there was significant difference in the subjective scores of conventional and dual-energy protocol of axillary lymph nodes. The subjective score of dual-energy protocol was higher and the consistency of subjective score was better with Kappa value of 0.916. Conclusion: Compared with conventional scanning scheme, dual-energy scanning scheme for neck-chest-abdomen-pelvis combined enhanced CT shows lower radiation dose, simpler scanning process, higher patient cooperation degree, clearer display of axillary lymph nodes, which has important clinical application and promotion value.
Technical Points and Imaging Parameters of CT Lymphangiography
FAN Wei, DUAN Yongli, FU Yan, LIANG Ziyi, ZHANG Chunyan, WANG Rengui
2022, 31(4): 499-504. doi: 10.15953/j.ctta.2022.156
CT lymphangiography (CTL) is a multimodal imaging method combining direct lymphangiography (DLG) and MSCT. It is an important imaging technology for the diagnosis of lymphatic reflux disorders. In order to better popularize and improve the utilization and success rate of this technology in clinic, this paper reviews the imaging technology and scanning parameters, indications or advantages and disadvantages of CTL, as well as its clinical application value in the diagnosis of lymphatic diseases. The purpose is to enable clinical physicians and radiologist to further understand and to realize the effective development and accurate diagnosis of this technology.
Imaging Features of Lymphatic Malformation in Children
ZHANG Qifeng, HONG Tianyu, DUAN Xiaomin, YU Tong, WANG Yan
2022, 31(4): 505-515. doi: 10.15953/j.ctta.2022.105
Lymphangiodysplasia is a common vascular disease in children. This paper summarizes the imaging characteristics, anatomical basis and pathophysiological mechanism of lymphatic reflux disorder, lymphangiodilation, lymphangiopathy and lymphangiomatosis through different imaging techniques and methods, so as to intuitively display the characteristic imaging changes of lymphatic dysplasia. It provides accurate and appropriate diagnosis and treatment information, as well as the means of monitoring curative effect for clinical diagnosis and treatment of lymphatic diseases.
EBV Infection Associated Neoplastic Lesions and Imaging Characteristics
YU Tong, WANG Yan, HONG Tianyu, ZHANG Hong, DUAN Xiaomin
2022, 31(4): 517-530. doi: 10.15953/j.ctta.2022.104
Epstein-Barr virus (EBV), also known as a gamma herpesviru, has the characteristics of lymphophilic tissue. EBV is one of the most common human viruses of the human cold virus group and the first human tumor virus found. Infection with EBV occurs by the oral transfer of saliva and respiratory secretions. Human B-lymphocytes and epithelial cells are EBV-susceptible host cells. First EBV infection often occurs in infancy and in childhood. EBV-associated diseases include infectious mononucleosis, EB virus associated hemophagocytic lymphoproliferative disorder (EBV-HLH), chronic active EBV Infection, EBV infection-associated autoimmune disease. EBV infection can also cause the proliferative diseases of the infected cells, such as various non-malignant lymphoproliferative diseases, lymphomatoid granulomatosis, EBV associated with many more malignant diseases including Burkitt′s lymphoma, Hodgkin′s lymphoma, Diffuse Large B-Cell Lymphoma, NK/T cell lymphoma, nasopharyngeal carcinoma, a subset of gastric carcinomas, and many more. This paper mainly focuses on EBV associated lymphoproliferative diseases and imaging characteristics in children.