Objective To investigate the value of multislice spiral CT （MSCT） findings in the diagnosis of hepatic tuberculosis. Methods MSCT imaging data, including both plain and contrast-enhanced CT scan, of 14 patients with hepatic tuberculosis confirmed by surgery (5 patients), aspiration biopsy (4 patients), or clinic follow-up (5 patients) were collected for the study. MSCT findings were analyzed with correlation of pathological changes. Results Hepatic tuberculosis was classified into 2 types. ①The parenchymal type (12 patients), which was further divided into 4 subtypes: Miliary subtype (2 patients) showed multiple tiny hypodense dots with faint border and had no enhancement; Nodular subtype (5 patients) showed blurring border on plain CT scan, 2 patients had no enhancement, 2 had peripheral rim-like enhancement, and peripheral rim enhancement mixed with no enhancement in 1 patient; Abscess subtype (4 patients) showed central hypodense area with peripheral zone-like enhancement in 2 patients, or patchy like slight enhancement in 2 patients; Fabric and calcific subtype (1 patient) depicted enplaque calcification. ②The serohepatic type (2 patients) showed thickened hepatic capsule, sub-capsule nodules with slight enhancement, and local subcapsular fluid collection. Other signs included hepatomegaly, tuberculous lymphadenopathy, splenic tuberculosis, and tuberculosis of pancreas, adrenal glands, intestine and thorax. Conclusion MSCT plays an important role in diagnosis of hepatic tuberculosis, by reflecting underlying pathological changes.
ObjectiveTo explore the clinical value of low-dose contrast agnet in CT angiography (CTA) for head and neck by SOMATOM Definition Flash CT.MethodsSixty consecutive patients with head and neck vessel diseases examined by CTA in the head and neck were chosen from West China Hospital of Sichuan University from March to July 2015, and then were randomly divided into two groups (the experimental group: n=30, 30 mL contrast medium; the control group: n=30, 50 mL contrast medium). Imaging post processing techniques included curved plannar reconstruction, volume rendering, and maximal intensity projection. CT values of the different level of carotid arteries (aortic arch, carotid bifuracation, and M1 segment of middle cerebral artery) were measured. The artifact of the remaining contract in the jugular vein and overall quality of the image were observed by two senior doctors using double blind method.ResultsAll the patients in the two groups completed CTA for head and neck successfully. The image qualities of the two groups satisfid clinical diagnostic requirements, and there was no difference in the image qualities between the two groups (P>0.05). The evaluation of venous pollution in the experimental group was lighter than that in the control group (P<0.05). The CT values of aortic arch, carotid bifuracation, and M1 segment of middle cerebral artery in the experimental group [(341.3±89.5), (391.0±103.7), (305.0±62.0) HU] were slightly lower than those in the control group [(437.3±83.7), (532.5±113.3), (396.6±93.1) HU], which were statistically significant (P<0.05).ConclusionLow-dose contrast in CTA for head and neck by SOMATOM Definition Flash CT can satisfy the clinical diagnostic requirements, and reduce the dose of contrast agent and venous pollution, with a good clinical value.
ObjectiveTo assess the value of multi-slice spiral CT (MSCT) in the diagnosis and resectability judgement of hepatic alveolar echinococcosis (HAE). MethodsThe CT findings of 28 patients who were confirmed HAE by surgical pathological examination were retrospectively analyzed. Comparative analysis were made between the CT findings and surgical pathology. ResultsAltogether 45 lesions in hepatic were detected. Lesions mainly revealed an infiltrating tumor-like hepatic mass with irregular margins and heterogeneous contents with varied attenuation, including scattered hyper-attenuating calcifications and hypo-attenuating areas corresponding to necrosis, no substantial enhancement, however, the fibro-inflammatory component surrounding the parasitic tissue was enhanced faintly in the delayed phase, and clearly demarcated from surrounding parenchyma. MSCT angiography (CTA) depicted signs of infiltration of hepatic vessels such as pushed, compression, displacement, stenosis, encasement and interruption. Compared with findings of operation, the sensitivity and specificity value of MSCT for evaluating the hepatic artery system disorders were 67%, 97%; and for portal venous system were 83%, 93%; and for hepatic venous system were 84%, 91%; while for inferior vena cava were 85%, 100%. Twelve cases which were evaluated as resectable by MSCT were in accordance with surgical findings. In the rest 16 patients which were judged as non-resectable by MSCT, only 2 patients were radical treatment through partial excision, repair and reconstruction for the involvement of large vessels and bile ducts. ConclusionMSCT is accuracy in the diagnosis and assessment of vessels complication of HAE. It has an important value to evaluate the resectability of HAE and the planning of treatment.
ObjectiveTo evaluate the diagnostic accuracy and efficacy of X-ray for evaluating the tip position of umbilical venous catheterization (UVC). MethodsThe PubMed, Embase, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect diagnostic tests for UVC tip localisation from inception to 1 May 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality of the studies using the QUADAS-2 tool. Then, meta-analysis was performed by using Stata 16.0 software. Results Twelve articles involving 1 055 patients were included. The sensitivity and specificity of Negar Yazdani’s study were both 100%. The results of the meta-analysis (the remaining eleven articles, n=951) indicated a pooled sensitivity of 0.7 (95%CI 0.6 to 0.8), a pooled specificity of 0.8 (95%CI 0.7 to 0.9), a positive likelihood ratio of 4.0 (95%CI 2.0 to 8.1), a negative likelihood ratio of 0.4 (95%CI 0.2 to 0.6) and a diagnostic odds ratio of 11 (95%CI 3 to 36) with an area under the cumulative receiver operating characteristic curve of 0.8 (95%CI 0.8 to 0.9). A subgroup analysis was performed according to the different methods of judging X, the 8th–9th thoracic, the 9th–10th thoracic and combined judgement of the diaphragmatic plane + the vertebral body + the heart shadow. The sensitivities of the 3 groups were 0.8 (95%CI 0.5 to 0.9), 0.5 (95%CI 0.4 to 0.7) and 0.8 (95%CI 0.6 to 0.9); the specificities of the 3 groups were 0.8 (95%CI 0.6 to 0.9), 0.76 (95%CI 0.6 to 0.9) and 0.91 (95%CI 0.79 to 0.96). The areas under the cumulative receiver operating characteristic curve were 0.9 (95%CI 0.8 to 0.9), 0.7 (95%CI 0.6 to 0.7) and 0.92 (95%CI 0.89 to 0.94). ConclusionSome error is present when determining the catheter tip position by X-ray, in which the evaluation of the umbilical vein catheter tip position through a comprehensive evaluation of the diaphragmatic plane, the heart margin and the vertebral body is more powerful than the evaluation of the vertebral body alone.
Objective To investigate differential points of clinical symptoms and pathology of solid-pseudopapillary tumor of the pancreas (SPTP) and islet cell tumor (ICT). Methods Fifteen cases of SPTP and twelve cases of ICT were studied in this retrospective research. Clinical symptom, pathologic feature and computed tomography (CT) image of patients with both tumors were analyzed, and the imaging features were compared with pathological results. Results The mean age of SPTP patients was 22.4 year-old. Twelve patients with SPTP presented a palpable abdominal mass as the initial symptom. It was observed that the tumor cells were located in a pseudopapillary pattern with a fibro-vascular core histologically. On the CT images, a mixture of solid and cystic structures could be seen in all the tumors. After taking enhanced CT scan, the solid portion was slightly enhanced in the arterial phase and the contrast intensity increased in the portal venous phase. On the other hand, the mean age of ICT patients was 39.3 year-old. The major symptom was due to the function of islet cell tumor, which was typical in 8 patients, presenting as Whipple triad. Histologically, cells demonstrated in trabecular, massive, acinar or solid patterns, and the blood supply of the tumor was abundant. On the CT images, most small tumors were difficulty to be detected. ICT could be markedly enhanced in the arterial phase and slightly enhanced in the portal venous phase on post-contrast CT scan. Conclusion Clinical symptom, pathologic feature and CT scanning are helpful to differentiate SPTP from ICT.
【Abstract】Objective To investigate the imaging features of malignant invasion of major intrahepatic ductal structures (the portal and hepatic venous vasculature, the bilie duct) by primary hepatocellular carcinoma (HCC) using multidetector-row spiral CT (MDCT). Methods We retrospectively analyzed 68 documented HCC patients with tumorous invasion of the major intrahepatic ductal structures who had undergone contrast-enhanced dual-phase MDCT scanning of the upper abdomen.The morphological changes of the portal and hepatic venous vasculature, the bile duct, and the liver parenchyma at both the hepatic arterial phase and portal venous phase images were carefully observed and recorded. Results Among the 68 patients, 47 patients had malignant invasion of the intrahepatic portal venous vessels with secondary tumor thrombus formation; 12 patients had tumor involvement of the hepatic veins and intraheptic segment of the inferior vena cava; Tumor invasion of the bile duct was seen in 9 patents. The direct CT signs of tumor invasion of intrahepatic venous vessels included: ①dilatation or enlargement of the involved vein with intraluminal softtissue “filling defect”； ②enhancement of the tumor thrombus at hepatic arterial phase, the so-called “venous arterialization” phenomenon. The indirect CT signs included: ①arterial-venous shunt, ②early and heterogeneous enhancement of the hepatic parenchyma adjacent to HCC focus, ③cavernous transformation of the portal vein. The CT signs suggesting tumor invasion of the bile duct included: ①dilation of the bile ducts near or proximal to HCC lesion, ②soft-tissue nodule or mass inside the bile ducts. Conclusion Invasion of major intrahepatic ductal structures by HCC will present corresponding CT imaging features. Contrast-enhanced MDCT dualphase scanning combined with appropriate image postprocessing techniques can better evaluate the malignant invasion of major intrahepatic ductal structures.
【Abstract】ObjectiveBy using multidetector row spiral CT (MDCT) to investigate the CT imaging findings of gallbladder abnormalities caused by hepatic parenchymal diseases and those of inflammatory cholecystitis. MethodsCT and clinical data of 80 patients with gallbladder abnormalities were retrospectively reviewed. Fifty patients were in hepatic disease group, including 20 chronic hepatitis, 25 liver cirrhosis, and 5 cirrhosis with hepatocellular carcinoma. Thirty patients were in inflammatory group, including 19 chronic cholecystitis, 6 acute cholecystitis, 3 cholecystitis with acute pancreatitis, 1 gangrenous cholecystitis, and 1 xanthogranulomatous cholecystitis. All patients underwent MDCT plain scan and contrastenhanced dualphase scanning of upper abdomen. ResultsIn hepatic disease group, 48 cases had evenly thickened gallbladder wall (96%) with mean thickness of (3.67±0.49) mm; 38 cases had clear gallbladder outlines (76%); 38 cases had gallbladder wall enhancement of various degree (76%); 14 cases had gallbladder bed edema and localized nondependant pericholecystic fluid collection (28%). In inflammatory cholecystitis group, 28 cases had obscuring gallbladder outlines (93%) ; 26 cases had gallbladder wall evenly thickened (87%), 4 cases showed unevenly thicked wall (13%), the mean thickness being (4.54±1.14) mm; 30 cases had inhomogenous enhancement of the gallbladder wall (100%); 9 cases had highattenuation bile (30%); 4 cases had dependant pericholecystic fluid collection (13%); 5 cases had transient enhancement of adjacent hepatic bed in arterial phase (17%); microabscess and gas in the gallbladder wall was observed in 1 case respectively. ConclusionMDCT can offer imaging findings useful for differentiating abnormal gallbladder changes caused by hepatic parenchymal diseases from those due to inflammatory cholecystitis.
ObjectiveTo compare the X-ray projection doses during leadless pacemaker implantation and conventional single chamber ventricular pacemaker (VVI) implantation. MethodsThis study included all patients who underwent leadless pacemaker implantation and VVI pacemaker implantation performed by the same principal investigator team using the same digital subtraction angiography (DSA) machine in the West China Hospital of Sichuan University from August 3rd, 2018 to February 18th, 2020. Among the enrolled patients, 27 who underwent leadless pacemaker implantation were included in the case group, whereas 38 who underwent conventional VVI implantation were included in the control group. Data regarding the intraoperative dose area product (DAP), air kerma (AK), duration of X-ray fluoroscopy, number of exposed sequences on the film, total number of frames on the film, operation time, and BMI were collected to investigate the causes of the differences. ResultsThe case group received a higher X-ray projection dose than the control group, and there were statistically significant differences between the two groups in terms of DAP, AK, duration of X-ray fluoroscopy, the number of exposed sequences on the film, the total number of frames on the film, and operation time (P<0.05). ConclusionPatients who underwent leadless pacemaker implantation are exposed to more radiation than those who underwent conventional VVI implantation.
Objective To investigate the effects of X-ray dose on the expressions of microRNA-221 （miR-221） and phosphatase and a tensin homolog deleted from chromosome10 （PTEN） in human colorectal carcinoma （CRC） cells. Methods Human CRC-derived cell line， Caco2， was cultured conventionally. The cells were divided into five groups and exposed to different doses of X-ray （0， 2， 4， 6， and 8 Gy） respectively. The total RNA and protein of the Caco2 cells were extracted after irradiation， and the miR-221 and PTEN mRNA expressions were detected by real-time RT-PCR.Moreover， the protein alteration of PTEN in Caco2 cells was detected by Western-blot analysis. Results The radiation dose of X-ray significantly affected the expressions of miR-221 and PTEN protein in human Caco2 cells in a dose-depen-dent manner. Moreover， the miR-221 expression level was up-regulated gradually with the increase of irradiation dose， on the contrary， the PTEN protein expression level was down-regulated gradually （P＜0.01）. Conclusion The radiation dose can affect the miR-221 and PTEN protein expression pattern in CRC cells.
Objective To assess value and limitations of non-invasive methods in assessing liver fibrosis．Methods By summarized current situation and advancement of serum fibrotic markers, ultrasound, CT and MRI in assessing liver fibrosis, we investigated their value and limitations. Results In addition to diagnosis, non-invasive methods of assessing liver fibrosis assess severity of liver fibrosis. For liver fibrosis, however, non-invasive methods can not monitor effectively reaction to therapy and progression. Conclusion Non-invasive methods play important roles in diagnosis and assessing severity of liver fibrosis, and reduce the need of liver biopsy.