OBJECTIVE: To study the effect of color doppler flow imaging(CDFI) technique in the design of axial pattern flap. METHODS: From April 1996 to June 1999, 10 patients with residual wound were adopted in this study. Among them, there were seven males and three females, the area of wounds ranged from 6 cm x 8 cm to 15 cm x 20 cm. Before operation, the axial pattern flaps were designed by traditional method, then CDFI technique with high frequency(5.0-7.5 MHz) was used for examining the major supply artery of the flap. At last, the modified flaps were transferred to cover the wounds. RESULTS: All the patients except one case completed the operation successfully. The cosmetic and function of the flaps were excellent. CONCLUSION: CDFI is a simple, direct and accurate method for detecting the supply artery of axial pattern flap. This technique should be popularized to avoid the blindness of flap design.
Objective To clarify relationship between signal heterogeneity on hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI and prognosis of hepatocellular carcinoma (HCC). Methods From January 2014 to January 2017 in the First Affiliated Hospital of Chongqing Medical University, a total of 77 patients with the pathologically proved HCC underwent Gd-EOB-DTPA-enhanced MRI prior to surgery were included in this study. On the basis of the signal heterogeneity in the hepatobiliary phase, the included patients were designed to homogeneous hypointensity group and heterogeneous hyperintensity group. The disease-free survival time were compared between the 2 groups and it’s influencing factors were analyzed. Results Seventy-seven patients with HCC were included, including 45 cases of homogeneous hypointensity and 32 cases of heterogeneous hyperintensity. There were no significant differences in the age, gender, etiology, liver function, alpha-fetoprotein, differentiated degree, Child-Pugh grade, lesion diameter, lesion border, and number of lesions between the 2 groups (P>0.05). However, the HCC patients with heterogeneous hyperintensity had a later BCLC staging (P=0.001). The disease-free survival time of the patients with homogeneous hypointensity and heterogeneous hyperintensity was (17.0±9.8) months and (12.4±10.4)months, respectively. The Kaplan-Meier survival curve showed that the disease-free survival time in the patients with homogeneous hypointensity was significantly better than that in the patients with heterogeneous hyperintensity (P=0.020). The results of univariate analysis showed that the other confounding factors had no effect on the disease-free survival time of patients with hepatocellular carcinoma (P>0.05) except for the signal of hepatobiliary phase (P<0.05). Furthermore, the hepatobiliary phase signal, BCLC stage, and degree of differentiation, which might be clinically considered as potentially influencing for the prognosis of patients with HCC, were included in the Cox multivariate proportional hazard regression model and found that the heterogeneous hyperintensity was still the risk factor of the disease-free survival rate in patients with HCC (P=0.047). Conclusion Signal heterogeneity on hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI is related to prognosis of patients with HCC, heterogeneous hyperintensity may indicate a lower disease-free survival rate.
【Abstract】Objective To study the surgical therapy and staging investigation about stage Ⅳ breast carcinoma. Methods The clinical data of 38 patients with stage Ⅳ breast carcinoma were summarized, and the patients were followed up. Results The stage Ⅳ patients who had isolated metastasis and removable primary tumor were treated by radical surgery with good effect. On the other hand, the stage Ⅳ patients who had extensive metastasis and primary tumor unresectable were treated by palliative operation with the living quality of patients becoming better and chemotherapy load cutting down. Conclusion The stage Ⅳ patients should be divided into stage Ⅳa and stage Ⅳb. And the stage Ⅳa patients should be treated by radical operation, and the stage Ⅳb by palliative operation.
Objective To explore the intraoperative imaging to monitor the prosthetic fixation for the total hip arthroplasty (THA) and to increasethe accuracy of the primary THA prosthetic fixation. Methods From April 2000 to August 2005, 69 patients (75 hips) underwent THA monitored by the imaging (the imaged THA group, Group I), and 72 patients (78 hips) underwent THA with the standard method (the standard THA group, Group S). There were 32 males and 37 females in Group S. The mean ages of the patients in Group I and Group S were 62.3 years and 60.5 years respectively, ranging 46-75 years in Group I and 43-75 years in Group S. Preoperative diagnoses were femoral neck fracture (Garden Ⅲ,Ⅳ) in 23 patients (23 hips) in Group I and 25 patients (25 hips) in Group S, acetabular dysplasia (Campbell Ⅰ, Ⅱ) in 9 patients (10 hips) in Group I and 11 patients (13 hips) in Grouop S, osteoarthritis in 16 patients (17 hips)in Group I and 15 patients (15 hips) in Group S, femoral head osteonecrosis (Ficat Ⅲ,Ⅳ) 15 patients (16 hips) in Group I and 17 patients (17 hips) in Group S, and rheumatoid arthritis in 6 patients (9 hips) in Group I and 4 patients (8 hips) in Group S. There were 21 hips of cement prostheses in Group I and 22 hips in Group S, 12 hips of cementless prostheses in Group I and 11 hips in Group S, 42 hips of cement and cementless prostheses in Group I and 45 hips in Group S. Group I used the standard THA and the intraoperative X-ray monitoring the prosthetic fixation in the numerical measure of abduction angle, anteversion angle, femoralneck length, and femoral offset distance. The items compared betweem Group I and Group S included incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, infection, postoperative functional recovery, and prostheric position of postoperative X-ray imaging. Results The follow-up on 62 patients in Group I and 64 patients in Group S for 6-64 months averaged 42 months revealed that there were statistically significant differences in incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, postoperative functional recovery, prosthetic position of postoperative X-ray imaging, and the Harris score between Group I and Group S one year after operation. The results of Group I were significatly better than those of Group S. Conclusion The intraoperative X-ray imaging can increase the accuracy of the THA prosthetic fixation and reduce the incidence of THA maloperation by The X-ray imaging can also be used in county hospitals if Carm fluoroscopy can be provided.
Objective To study the characteristics of optic al coherence tomography (OCT) in idiopathic macular epiretinal membranes (IMEM) and the relationship between the thickness of fovea and the vision of affected eyes. Methods Total of 67 cases (73 eyes) with clinica l diagnosis of IMEM by direct, indirect ophthalmoscopy, three mirror contact len s, fundus color photography or fundus fluorescein angiography(FFA）were examined with OCT. Results Epiretinal membranes(ERMs) with macular edema were found in 32 eyes, proliferative ERMs in 20 eyes, ERMs with macular pseudoholes in 14 eyes and ERMs with laminar macular holes in 7 eyes. Based on OCT, the ERMs were clearly and partially seperated from the retina (27 eyes, 38.36%), the retinal thickness of the fovea was the thickest in proliferative ERMs and the thinnest in ERMs with laminar macular holes. The statistical an alysis showed there was a negative correlation between the thickness of fovea an d visual acuity (r=－0.454, P= 0.000 ). Conclusion There were four types of image of OCT in IMEM: ERMs with macularedema, proliferative ERMs, ERMs with macular pseudohole and ERMs with laminar macular hole；and the thicker the fovea under the OCT, the poorer th e visual acnity in the affected eyes with ERMs. (Chin J Ocul Fundus Dis, 2001,17:115-118)
Objective To introduce the imaging modalities used for the evaluation of postoperative complications of orthotopic liver transplantation (OLT) and to present the imaging findings of these complications. Methods The literatures related to the imaging methods and imaging manifestations of OLT complications were reviewed. Results Ultrasound was the initial imaging technique used for the detection of complications in the early postoperative period. Spiral CT and MRI yielded more accurate and comprehensive evaluation of postoperative complications in later stage. So far, there had been no specific imaging findings to suggest rejection reaction. The spectrum of imaging manifestations of OLT complications, such as vascular complications, biliary complications, liver parenchymal complications, and so on, were summarized and illustrated. Conclusion Imaging examination (especially ultrasound, spiral CT and MRI ) plays an important role in the evaluation of postoperative complications of OLT.
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.
Hepatic angiomyolipoma (HAML) is a rare benign mesenchymal tumor of the liver, which has highly variable imaging appearances, often leads to missed diagnosis and misdiagnosis. The images of 2 patients with HAML confirmed by pathology were presented in this study, and the typical imaging features of the HAML, the underlying pathophysiological mechanism, and the differential diagnosis were briefly summarized so as to deepen the understanding of HAML and to improve the diagnosis and differential diagnosis abilities of HAML, then reduce the rates of missed diagnosis and misdiagnosis of the HAML.
Objective To investigate application of medical digital imaging systems and computer technologies in orthpedics. Methods The main computer-assisted surgery systems comprise the four following subcategories. Results ①A collection and recording process for digital data on each patient, including preoperative images (CT scans, MRI, standard X-rays), intraoperative visualization (fluoroscopy, ultrasound), and intraoperative position and orientation of surgical instruments or bone sections (using 3D localisers). Data merging based on the matching of preoperative imaging (CT scans, MRI, standard X-rays) and intraoperative visualization (anatomical landmarks, or bone surfaces digitized intraoperatively via 3D localiser; intraoperative ultrasound images processed for delineationof bone contours). ②In cases where only intraoperative images are used for computer-assisted surgical navigation, the calibration of the intraoperative imaging system replaces the merged data system, which is then no longer necessary. ③A system that provides aid in decisionmaking, so that the surgical approach is planned on basis of multimodal information: the interactive positioning of surgical instruments or bone sections transmitted via pre- or intraoperative images, display of elements to guide surgicalnavigation (direction, axis, orientation, length and diameter of a surgical instrument, impingement, etc.). And ④ A system that monitors the surgical procedure, thereby ensuring that the optimal strategy defined at the preoperative stage is taken into account. Conclusion It is possible that computer-assisted orthopedic surgery systems will enable surgeons to better assess the accuracy and reliability of the various operative techniques, an indispensable stage in the optimization of surgery.
Objective To explore the value of virtual touch tissue quantification(VTQ) of acoustic radiation force impulse (ARFI) in the differential diagnosis between benign and malignant thyroid nodules. Methods The ultrasound (US), elastography imaging(EI), and VTQ of ARFI were performed to determine the characteristics and features of 63 thyroid nodules. The pathological diagnosis was the gold standard. According to the receiver operating characteristic curve (ROC) of US, EI, and VTQ, the critical points and diagnostic values of US, EI, and VTQ in diag-nosis of malignant thyroid nodules were achieved. Results Of the 63 nodules, 45 were benign and 18 were malignant. The area under curves of US, EI, and shear wave velocity(SWV) were 0.837(95% CI:0.712-0.962), 0.863(95% CI:0.751-0.974), and 0.900 (95% CI:0.810-0.990) respectively, and all the 3 kinds of technique had diagnostic value(P=0.001), but there were no significant difference among the 3 kinds of technique on the area under curve(P > 0.05). According to the receiver operating characteristic(ROC) curve, the critical point of US in distinguishing benign nodules with malignant nodules was 3 conventional ultrasonography, which displayed a sensitivity of 83.3%, a specificity of 86.7%, and a accuracy of 85.7%. The critical point of EI grades in distinguishing benign nodules with malignant nodules was gradeⅣ, which displayed a sensitivity of 94.1%, a specificity of 82.6%, and a accuracy of 87.3%. The critical value of SWV in distinguishing benign nodules with malignant nodules was 3.39 m/s, which displayed a sensiti-vity of 88.9%, a specificity of 91.1%, and a accuracy of 90.5%. Conclusion US, EI, and VTQ techniques all have diagnostic values in the differential diagnosis between benign and malignant thyroid nodules, and we should make combination with all of the 3 kinds of technique when performing differential diagnosis.