Combined antiviral therapy has extended the life span of people living with HIV,but it has not reduced the incidence rate of neurocognitive impairment.After entering old age,individuals with HIV experience greater cognitive impairment,leading to a decline in the quality of life and an increased social burden.At present,it is widely believed that early neurocognitive impairment is reversible,so the early detection of HIV-related neurocognitive impairment is of great significance.In recent years,resting-state functional magnetic resonance imaging has been widely used in the field of neurological and psychiatric disorders,including HIV infection-related cognitive impairment,and it has been shown to have potential significance for the early diagnosis of HIV-induced neurocognitive impairment.
Veina cava filters(VCF)are used as an alternative to anticoagulation therapy in patients with thrombo-embolic events.Some mechanical complications are commonly described.Such complications are,most of the time,asymptomatic and noninfectious.A 70-year-old woman presented with pulmonary embolism with a contraindication to anticoagulants,leading to a VCF implantation.Eight months later,she complained of mechanical back pain associated with Staphylococcus epidermidis bacteremia,leading to diagnose VCF infection associated with spondylodiscitis.Filter retrieval and long-duration antibiotic therapy allowed recovery.Patients with an endovascular prosthesis may benefit from a positron emission tomography-computed tomography in case of fever or growing blood cultures without a designed source.
We present two cases of acute aortitis identified by positron emission tomography-computed tomography imaging that are of infectious origin,notably the Streptococcus pyogenes and Fusarium species.Management of infectious aortitis,both medically and surgically,is imperative as infectious etiologies can be potentially fatal.
BACKGROUND:Sepsis is a life-threatening condition caused by the body's severe response to infection,leading to widespread inflammation and organ failure.Ulinastatin,a glycoprotein hydrolase inhibitor from human urine,has anti-inflammatory properties and has shown potential in improving the outcomes in sepsis patients. OBJECTIVE:To systematically review the efficacy and safety of ulinastatin to clarify its clinical benefits in the treatment of sepsis. METHODS:Through searches of PubMed,Embase,Cochrane Library,and four Chinese databases(SINOMED,CNKI,VIP,and WANFANG data),we searched for published randomized controlled trials from January 1,2004,to November 30,2023.Stata 16.0 software was used to perform the meta-analysis. RESULTS:A total of 39 articles were included(37 in Chinese and 2 in English),involving a total of 2,911 patients.The results of meta-analysis show that the treatment of ulinastatin could reduce mortality(risk ratio[RR]=0.52,95%confidence interval[CI][0.43,0.63],P<0.05),multiple organ dysfunction syndrome(RR=0.30,95%CI[0.18,0.49],P<0.05),length of intensive care unit stay(mean difference[MD]=-5.42,95%CI[-8.13,-2.71],P<0.05),time on mechanical ventilation(MD=-5.84,95%CI[-7.60,-4.07],P<0.05),and length of hospital stay(MD=-12.40,95%CI[-15.03,-9.77],P<0.05).Nine articles reported adverse reactions,of which 1 article reported no obvious adverse reactions. CONCLUSIONS:The results of this meta-analysis show that ulinastatin reduces sepsis case-fatality rate and improves other related outcomes,suggest that ulinastatin is effective in the treatment of sepsis.
INTRODUCTION:In the era of modern antiretroviral therapy,the incidence of AIDS-related opportunistic infections decreased dramatically.However,pulmonary infection still remains an important cause of morbidity and even mortality.In this study,we aimed to present the chest computed tomography(CT)findings of people living with HIV(PLWH)who were followed up in our institution because of opportunistic pneumonia. MATERIALS AND METHODS:The data of PLWH who received the diagnosis of acute pneumonia in our hospital between November 2016 and April 2024 were evaluated retrospectively.Patient data including chest CT images were collected from the hospital database. RESULTS:There were five eligible cases in the determined study period.Mycobacterium tuberculosis,nontuberculosis mycobacteria,Pneumocystis carinii,SARS-CoV-2,and Respiratory syncytial virus were detected as the causative agents of opportunistic pneumonia in our case series. CONCLUSION:Undiagnosed HIV/acquired immunodeficiency syndrome patients may present with serious pneumonia.Hence,patients having pneumonia with an unexpected serious course should be tested for underlying HIV infection.
Coronavirus disease 2019(COVID-19)is a newly emerged acute respiratory infectious disease that is rapidly spreading worldwide,becoming a significant global public health concern.Imaging assessment is the primary and commonly utilized method for clinical diagnosis,differential diagnosis,treatment monitoring,and follow-up.To achieve early detection,reporting,isolation,and treatment of COVID-19,and ultimately improve the cure rate and reduce mortality,it is crucial to establish imaging diagnostic criteria for COVID-19.
Microvascular invasion(MVI)is an independent risk factor for the recurrence of hepatocellular carcinoma(HCC)and affects the formulation of treatment plans.The mechanism of MVI in HCC may involve two ways:Mediated by the vascular pattern surrounding the tumor tissue and invasive-mediated metastasis.At present,imaging techniques have been used to explore the preoperative prediction of MVI,including semantic imaging features,radiomics,deep learning,and other methods.However,there are problems such as poor model robustness,moderate predictive performance,and insufficient interpretability.Further exploration and research are needed to achieve clinical translational applications.
BACKGROUND: Herein, we explored the clinical and computed tomography (CT) features, disease differentiation, diagnosis, and treatment of pulmonary histoplasmosis (PH). METHODS: Clinical and imaging data of 11 patients diagnosed with PH with the same travel history, who were admitted to our hospital from November 2018 to December 2018, were analyzed. The diagnosis was confirmed using chest CT, histopathology, and alveolar lavage. The patient’s travel history, imaging, and pathological characteristics were analyzed. The pathogenesis, differential diagnosis, and disease treatment plan were also analyzed and summarized. RESULTS: The lesions in all 11 patients were diffusely distributed in both lungs and were mainly small solid nodules with round-like shapes and clear margins (2–15 mm). Halo signs were observed around the nodules. The first patient’s CT scan showed a slight enhancement of the solid components. Histopathological examination showed a small amount of lung tissue with chronic granulomatous inflammation. Diagnosing PH requires a combination of relevant epidemiological history, imaging, pathology, culture, and metagenomic sequencing. The prognosis of PH is generally good. CONCLUSIONS: Its clinical symptoms are atypical. Physicians should consider the possibility of PH if the chest CT shows diffuse, high-density solid nodules of varying sizes in both lungs, with clear margins, halo signs, and an absence of burrs and lobulation. A history of outdoor cave exploration, during which patients may have close contact with bat and bird feces, should also be considered. Itraconazole can be used as an empirical treatment to control disease progression.
Human immunodeficiency virus(HIV)causes structural and functional changes in the brain and is often accompanied by HIV-associated neurocognitive disorders.Diffusion tensor imaging(DTI)is sensitive to microstructural changes of white matter(WM)in the brain,which can explore the changes of WM in HIV-infected people.In this article,the research progress of DTI imaging on microstructural changes in WM in HIV-infected patients will be reviewed.
OBJECTIVE:This study aims to explore the value of magnetic resonance native T1 mapping technology in diagnosing fulminant myocarditis(FM),as there is currently a lack of reliable imaging features for identifying this condition in clinical practice. METHODS:A total of 112 patients clinically diagnosed with myocarditis and who underwent cardiac MRI scans from June 2019 to June 2022 were included in the study.The patients were divided into two groups based on the diagnostic criteria of FM:the FM group(n=38)and the non-FM group(n=74).In addition,a control group(n=38)consisting of healthy volunteers matching the age and gender of the study group was also collected.Cardiac magnetic resonance(CMR)results and relevant clinical data were collected from patients.Analysis of variance and rank sum tests were used to examine the correlation between different groups.The results showed a statistically significant difference(P＜0.001)in the native T1 mapping values between the two groups.The receiver operating characteristic curve analysis indicated good diagnostic efficacy(area under the curve=0.872),with a cutoff value＞1315.0 ms.The sensitivity and specificity were 81.6％and 87.8％,respectively.There was no statistically significant difference in EDV,end-diastolic volume index,end-systolic volume(ESV),stroke volume,stroke volume index,cardiac output,cardiac index,and left ventricular mass(LVM)index between the two groups.However,there was a statistically significant difference in ESV index and LVM(P＜0.001). CONCLUSION:The utilization of native T1 mapping in CMR imaging can be a valuable tool for differentiating between FM and non-FM.This technology can also aid in the early clinical diagnosis of FM,providing important insights for medical professionals.
OBJECTIVE:This study aimed to perform a systematic review and meta-analysis to evaluate the diagnostic efficacy and establish thresholds of magnetic resonance elastography(MRE)for assessing different stages of liver fibrosis in individuals with chronic hepatitis B(CHB). MATERIALS AND METHODS:The study was performed in PubMed,Web of Science,Embase,CNKI,WANFANG,and SinoMed until April 2024.Two authors independently screened and assessed the methodological quality of studies and extracted data.QUADAS-2 tool was used to evaluate the risk of bias.A meta-analysis was conducted to calculate the pooled effect size using a fixed-effect model or a random-effects model by RStudio. RESULTS:Thirteen studies were included in the analysis.MRE for liver fibrosis staging in CHB patients demonstrated an accuracy of 0.97(95%confidence interval[CI]=0.96-0.99),sensitivity of 0.98(95%CI=0.95-1.00),and specificity of 0.96(95%CI=0.92-1.00).Moreover,for CHB patients at stage F2 of liver fibrosis,there was a statistically significant difference in MRE thresholds between 1.5 T and 3 T(P<0.05). CONCLUSIONS:MRE has high accuracy in the early detection and staging of CHB-induced liver fibrosis.The threshold of MRE based on field strengths should be further discussed and determined to improve the clinical applicability of MRE in the staging diagnosis of liver fibrosis caused by CHB.
A 60-year-old immunocompetent woman was diagnosed with meningococcemia and presumed meningitis after presenting with altered consciousness,headache,neck stiffness,and a purpuric rash.She had some atypical features for meningitis including nystagmus and dizziness,which persisted beyond a standard course of 7 days of intravenous ceftriaxone.Computed tomography brain and fundoscopy were normal.Magnetic resonance imaging(MRI)brain revealed pyogenic ventriculitis and ependymal enhancement.Antimicrobials were not extended due to clinical and biochemical improvement.The patient had close neurological monitoring as an inpatient and following discharge until recovery.Follow-up MRI brain after 3 months was normal.Pyogenic ventriculitis is described rarely in the literature as a complication of bacterial meningitis in adults,particularly secondary to Neisseria meningitidis.Optimal antibiotic regimen and duration are not well-established.It should be considered in patients not improving as per expected trajectory,including those with atypical neurology.If not recognized early,it can lead to hydrocephalus and death.
OBJECTIVE:The objective of this study was to investigate the clinical characteristics,imaging manifestations,and prognosis of patients with acquired immunodeficiency syndrome(AIDS)-related non-Hodgkin's lymphoma(NHL). PATIENTS AND METHODS:This retrospective study included 92 patients with AIDS-related NHL(ARL),who were treated at the Central South Hospital of Wuhan University between January 2005 and March 2022.Patients were divided into three groups according to their pathological type:diffuse large B-cell lymphoma(DLBCL),Burkitt lymphoma(BL),and plasmablastic lymphoma(PBL).Their clinical characteristics and imaging data were compared.In addition,some computed tomography(CT)features of the tumors were analyzed and summarized.SPSS 26.0 was used for statistical analysis.The prognostic factors were analyzed using the Kaplan-Meier method,Cox proportional risk regression model,and receiver operating characteristic curve. RESULTS:Among the 92 cases,68 were DLBCL,19 were BL,and five were PBL.BL patients had a higher risk profile than DLBCL and PBL patients.Most of the tumors had unclear borders,uneven densities on plain and enhanced CT scans,and signs of fusion and necrosis.The analyses indicated that the International Prognostic Index(IPI)score(odd ratio[OR]=15.699,95％confidence interval[CI]=1.828-134.829,P=0.012)and Eastern Cooperative Oncology Group(ECOG)score(OR=28.869,95％CI=3.015-276.395,P=0.004)were independent prognostic indicators of the overall survival. CONCLUSIONS:ARL is a heterogeneous and aggressive disease with a poor prognosis.Compared with DLBCL or PBL patients,BL patients have higher risk features.IPI and ECOG scores can effectively predict the prognosis of ARL.
Acquired immunodeficiency syndrome (AIDS)-related cerebral toxoplasmosis has a high mortality rate and is a serious complication affecting the survival and prognosis of patients with AIDS. Diagnostic imaging plays an important role in assessing early diagnoses and responses, and standardized applications of imaging techniques and thorough knowledge of the radiological features of AIDS-related cerebral toxoplasmosis are essential. Although the imaging findings for AIDS-related cerebral toxoplasmosis vary, some characteristic features are common. Currently, no consensus exists regarding the diagnostic imaging for AIDS-related cerebral toxoplasmosis. Based on recent research, the Grading of Recommendations, Assessment, Development, and Evaluations system, and our clinical expertise and experience, we developed this consensus paper to guide clinical decision-making, facilitate early diagnoses, and guide rational use of medications and other treatments.
Taenia solium is a parasitic tape worm that causes neurocysticercosis(NCC),which is classically characterized by scattered,intraparenchymal brain lesions.However,in very rare cases,a solitary,lateral ventricle lesion may be all that is present,which can make diagnosis difficult.Herein,we report the case of a 34-year-old female from Western Europe who presented with 12 days of intractable headaches.Magnetic resonance imaging revealed a single,heterogeneous appearing intraventricular mass with mild enhancement located in the left lateral ventricle near the foramen of Monro.Using a minimally invasive image-guided tubular retractor system for surgical biopsy and resection,NCC was identified on histological analysis.The patient tolerated the procedure well,and her headaches improved.Although NCC is associated with exposure to raw pork and/or prior residence in an endemic location,these are not always present.This case highlights the unusual radiographic findings and benign clinical history providers may encounter with NCC.
Tuberculosis continues to have a significant impact on public health.Radiology plays an important role in the clinical diagnosis of pulmonary tuberculosis,especially active pulmonary tuberculosis(APTB),as well as the treatment of the disease.This review summarizes the relevant literature on the radiological diagnosis of APTB,the imaging characteristics,and progress in research,from radiography,computed tomography,magnetic resonance imaging,nuclear medicine imaging,and computer-aided diagnostic studies.
BACKGROUND: Non-Hodgkin’s lymphoma (NHL) has a poor prognosis and serious risk of mortality. Furthermore, the clinical and imaging characteristics differ between human immunodeficiency virus (HIV)-positive and HIV-negative NHL. We aimed to create a nomogram based on imaging, clinical, and laboratory indicators to predict the mortality risk of patients with HIV-positive NHL. MATERIALS AND METHODS: A total of 306 patients were enrolled. The training cohort comprised 194 patients with HIV-positive NHL treated at four Chinese medical centers between April 2012 and October 2020. A series of statistical methods were used to screen potential predictive factors for inclusion in a prognostic nomogram. The performance of the nomogram was assessed by internal validation, external validation, and clinical utility. The independent external verification cohort comprised 112 patients treated between January 2013 and November 2020. RESULTS: After investigating 39 potentially predictive factors, a nomogram containing eight factors (three imaging factors, four clinical factors, and one HIV-infection special factor) was developed. Internal and external validation revealed good discrimination (concordance index: 0.837 vs. 0.817; 95% confidence interval, 0.826–0.848 vs. 0.798–0.836) and excellent calibration. Regarding the clinical utility, our nomogram was more accurate in predicting survival than the International Prognostic Index (area under the curve, 0.9217 vs. 0.8150; sensitivity, 0.85 vs. 0.67; and specificity, 0.89 vs. 0.87). The nomogram identified low-risk, intermediate-risk, and high-risk groups with 1-year survival rates of 95%, 59%, and 2%, respectively. CONCLUSION: The nomogram model based on imaging, clinical, and laboratory indicators may be useful in predicting the treatment efficacy and long-term mortality risk of patients with HIV-positive NHL. This may provide a new scientific basis for clinical decision-making.
Multiple lesions commonly appear in the liver of patients with hepatocellular carcinoma (HCC), and the prognosis is associated with the subtype. However, simultaneous occurrence of scirrhous HCC (SHCC) and primary clear cell carcinoma of the liver (PCCCL) has not been reported to date. The diagnosis of SHCC and PCCCL is uncommon using the traditional imaging examination methods such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging. We herein summarize the imaging features of SHCC and PCCCL to provide a reference for accurate preoperative diagnosis and appropriate treatment. A 55-year-old male was diagnosed with two hepatic tumors by the US examination. On the 2 nd day after the US examination, he was diagnosed with HCC with intrahepatic metastasis by enhanced CT examination. His alpha-fetoprotein level was 3272 ng/mL (reference range, 0–7 ng/mL). Two weeks after enhanced CT examination, the patient underwent hepatectomy and cholecystectomy. Pathological examination showed that the tumor in liver segments 2 and 3 was SHCC and that the tumor in liver segment 4 was PCCCL. One year postoperatively, digital subtraction angiography showed no obvious tumor staining. Five years postoperatively, enhanced CT examination showed no recurrence or metastasis. Radiologists usually diagnose multiple tumors in the liver as malignant tumors with intrahepatic metastasis. Simultaneous occurrence of SHCC and PCCCL in the liver is occasionally found. The US imaging features, CT enhancement types, and location of the tumors can help radiologists to accurately diagnose SHCC and PCCCL, allowing clinicians to choose appropriate treatment.
OBJECTIVE:The objective of the study was to investigate magnetic resonance imaging(MRI)findings of the upper respiratory tract(URT;a main harbor site for infection)in patients with coronavirus disease 2019(COVID-19),and their association with pneumonia severity. MATERIALS AND METHODS:URT MRI of 128 patients with confirmed COVID-19 was evaluated.URT lymphoid tissue hyperplasia as an overall score of adenoid mass,tonsil enlargement,and cervical adenopathy was analyzed,along with quantitative pneumonia data on chest computed tomography(CT). RESULTS:Effusion of the posterior laryngopharyngeal wall(98％)was the most common,followed by the nasopharyngeal(80％)and the posterior oropharyngeal(70％)walls.There was also evidence of(Ⅰ)swelling of the epiglottis(99％)and vocal cord(58％),(Ⅱ)mild or no(15％),moderate(42％),and severe(37％)nasopharyngeal roof thickness,(Ⅲ)mild(50％),moderate(21％),and severe(3％)tonsil enlargement,and(Ⅳ)mild(22％),moderate(54％),and severe(20％)cervical lymph node enlargement.Ethmoid sinusitis was the most common(98％),which was followed by maxillary sinusitis(81％).Mastoiditis was present in 32％of patients.At follow-up(n=22),nasopharyngeal wall thickening was improved in four patients.Chest CT images showed pneumonia in 57％of patients.There were also more focal adenoid masses,and tonsil and cervical lymph node enlargement.Furthermore,the URT lymphoid tissue hyperplasia scores were higher in patients without pneumonia than in those with pneumonia,while the four indexes were negatively correlated with CT pneumonia quantification at the peak time(r=-0.26 to-0.49,P＜0.001). CONCLUSIONS:URT lymphoid tissue hyperplasia assessed by MRI may be a protective factor against COVID-19 pneumonia.
Advanced non-small cell lung cancer(NSCLC)negative for driver genes is a medical oncology treatment challenge.The increasingly widespread application of immunotherapy,especially programmed death-1(PD-1)/programmed death-ligand 1 inhibitors,has changed the treatment pattern of patients with advanced NSCLC.In clinical practice,many patients with immune checkpoint inhibitor(ICI)discontinue treatment for a variety of reasons,and it is known as"immunotherapy rechallenge"to try ICI treatment again following discontinuation.We report an 82-year-old patient with advanced lung adenocarcinoma who was cured after 16 cycles(7.5 months)of PD-1 monoclonal antibody(mab)followed by 4 cycles of bevacizumab and PD-1 mab.Relapse occurred 21 months after treatment had been discontinued.After 10 cycles of immunotherapy,a partial response was achieved,with a 54-month survival and ongoing treatment.This study examines the diagnosis and treatment process,as well as provides a literature review of immunotherapy rechallenge.
