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Imaging Evaluation of Portosystemic Collateral Vessels of Liver Cirrhosis by MultiDetector Row Spiral CT Portal Venography

ObjectiveTo introduce the technique of threedimensional portal venography of multidetector row spiral CT and its clinical application in the evaluation of the portosystemic collateral shunts of liver cirrhosis. MethodsAll relevant literatures were retrospectively reviewed on the application of twodimensional and threedimensional reconstruction techniques such as MIP, SSD, VRT of multidetector row spiral CT to demonstrate the collateral vessels of liver cirrhosis.ResultsThe distribution, pathway and anatomy of portosystemic collateral vessels were well shown by multidetector row spiral CT portal venography. Conclusion Multidetector row spiral CT portal venography provides excellent depiction of the anatomic characteristics of the collateral shunts and enables the continuous tracing of vascular structures, thus it is very helpful in the imaging evaluation of the collateral vessels of liver cirrhosis.

Nodular Lesions of Cirrhotic Liver: Imaging Manifestations with Pathologic Correlation

ObjectiveTo introduce the new nomenclature scheme of the International Working Group (1995) on hepatic nodules, and summarize the imaging features of various hepatic nodules in light of their pathological characteristics, and evaluate the diagnostic values of various imaging facilities.MethodsUltrasound, computed tomography(CT), magnetic resonance imaging(MRI), and angiographic CT were reviewed and introduced.ResultsMany of these types of hepatic nodules play a role in the de novo and stepwise carcinogenesis of hepatocellular carcinoma(HCC) in the following steps: regenerative nodule, lowgrade dysplastic nodule, highgrade dysplastic nodule, small HCC, and large HCC. Accompanying such transformations, there are significant alterations in the blood supply and perfusion of these hepatic nodules.ConclusionModern stateoftheart medical imaging facilities can not only delineate and depict these hepatic nodules, but also provide important clues for the characterization of focal hepatic lesions in most cases, thus facilitating the early detection, diagnosis and management of HCC in its early stage.

Applications of New Imaging Techniques in Digestive System

Differentiation of Chronic Mass-Forming Type Pancreatitis from Pancreatic Carcinoma by Functional Magnetic Resonance Imaging

Objective　To summarize the principle and application of functional MR imaging of pancreatic carcinoma and chronic mass-forming type pancreatitis. Methods　Articles about diffusion-weighted imaging (DWI), magnetic resonance spectrum imaging (MRSI) and dynamic contrast-enhanced MR imaging of pancreatic carcinoma and chronic pancreatitis were reviewed and analyzed. Results　Functional MR imaging could reflected the differences in molecules diffusion, metabolism and tissue perfusion between pancreatic carcinoma and chronic pancreatitis. Conclusion　 As a non-invasive protocol, functional MR imaging can provide useful information in differential diagnosis between chronic mass-forming type pancreatitis and pancreatic carcinoma.

Bowel Wall Thickening——CT Findings and Diagnostic Values

肠道是人体容易发生疾病的部位之一，肠外局部或全身性疾病也易累及肠道。无论肠道原发疾病还是肠外疾病累及肠道，肠壁增厚都是一种常见而重要的病理改变。钡餐、钡灌肠和纤维内镜是常用的检查手段，但它们只能显示肠腔内及黏膜面的情况； 灰阶超声和多普勒超声可发现肠壁及肠外异常，但敏感性和准确率低，且受操作者经验影响较大。随着影像检查技术的不断进步，CT用于肠道疾病的诊断已日益普遍，多层螺旋CT快速薄层扫描和强大的图像后处理能力使其成为显示肠壁及相关肠外病变的主要手段［1］。虽然很多疾病可造成肠壁增厚，但正确认识肠壁增厚的CT表现特征，包括部位、范围、程度、密度、强化方式和相关肠外异常征象有助于疾病的诊断和鉴别诊断［2，3］。现通过复习肠壁增厚的相关文献，介绍肠壁增厚的基本CT征象，归纳引起肠壁增厚的常见疾病及其表现，并提出CT在诊断肠壁增厚中存在的问题……

Clinical Applications of Hepatic 31P-MR Spectrocscopy

【Abstract】Objective To summarize the principle and clinical applications of 31phosphorus MR spectroscopy（31pMRS）. Methods Literatures about 31PMRS in liver were reviewed and analyzed. Results Abnormalities of 31PMRS were found in patients of hepatitis, liver cirrhosis, liver tumor，obstructive jaundice and patients after liver transplantation. Evaluation of 31PMRS is important in diagnosis and treatment of many hepatic diseases. Conclusion As a noninvasive protocol for analyzing the energetic metabolism and biomedical changes in cellular level of living liver, 31PMRS has a wide clinical application.

Collateral Venous Pathways in Pancreatogenic Splenic Vein Occlusion： Spiral CT Manifestations

Objective To investigate the spiral CT manifestations of the collateral circulation pathways resulting from splenic vein occlusion (SVO) duo to pancreatic diseases. Methods The CT imaging and clinical data of 33 cases of pancreatic disease with SVO, including 28 cases of pancreatic carcinoma, 3 cases of acute pancreatitis and 2 cases of chronic pancreatitis, were retrospectively analyzed.Results Tortuous and dilated vessels were observed in the areas between splenic hilum and gastric fundus and/or along the gastric greater curvature in all 33 cases. In isolated SVO cases, the short gastric vein (SGV, 86%)，coronary vein (CV, 79%)，gastroepiploic vein (GEV, 79%) and gastrocolic trunk (GCT, 57%) were varicose and dilated. While in nonisolated SVO，other collateral veins such as the right superior colic vein (RSCV, 37%），middle colic vein (MCV, 37%） and posterior superior pancreaticoduodenal vein (PSPDV, 21%） were seen as well. Conclusion The two predominant collateral pathways of SVO are ①SGV→gastric fundal veins→CV， and ②GEV→GCT→SMV. They have characteristic imaging features on spiral CT and are of clinical significance in both preoperative staging of pancreatic carcinoma and the evaluation of pancreatogenic segmental portal hypertension.

Analysis of Signal Intensity and Enhancement Patterns of Early Arterial Phase of Small Hepatic Nodular Lesions on MRI

　Objective　To retrospectively assess the importance and imaging appearance of the signal intensity， the signal noise ratio (SNR), the contrast noise ratio (CNR) and enhancement patterns of early arterial phase in diagnosis and differential diagnosis of small hepatic nodular lesions on MRI. 　Methods　Conventional spin-echo T2W, 2D GRE T1W plain scan and Gd-enhanced 3D-VIBE multi-phasic (early arterial, late arterial and portal venous phase) acquisitions were performed for 68 consecutive patients with 102 lesions on MRI. Native T2W and 2D GRE T1W were acquired first, then 3D-VIBE fast scanning at early arterial, late arterial and portal venous phase respectively. The SNR, CNR, signal intensity and enhanced pattern of the nodular lesions appearances on plain scan and eariy arterial phase were carefully observed. 　Results　There were hyperintense in 102 (100%) lesions in T2W and hypointense in 95 (93.1%) lesions in T1W in plain scan. There were differences among the SNR, CNR of hepatic cyst, cavernous hemangioma, neoplasm metastasis and small hepatocellular carcinoma in T2W (P＜0.05)，the highest SNR and CNR of lesions were hepatic cyst. The SNR of small hepatocellular carcinoma and the CNR of hepatic cyst were highest in all the type diseases in T1W, there was significantly difference as compared with the other type diseases (P＜0.05). The enhancement rate of small hepatic nodular lesions was 76.5% in early arterial phase. The enhancement rate of small hepatocellular carcinoma and hepatic metastasis were 100% and 87.9% respectively. The non-enhancement rate of hepatic cyst were 100%. The common enhancement patterns of early arterial phase were peripheral enhancement which were 36 lesions (35.3%). The even enhancement and uneven enhancement were 22 lesions (21.6%) and 20 lesions (19.6%) respectively. 　Conclusion　Qualitative and quantitative evaluation of MR signal intensity combined with the enhancement patterns of early arterial phase will help for qualitation and differential diagnosis of small hepatic nodular lesions on MRI.

Value of MR Diffusion-Weighted Imaging for Differentiating Pancreatic Carcinoma from Chronic Focal Pancreatitis on 3.0 T MR System

Objective　To investigate the value of MR diffusion-weighted imaging (DWI) in differentiating pancreatic carcinoma from chronic focal pancreatitis on 3.0 T MR system. Methods　Thirteen patients with proved pancreatic carcinoma, 7 patients with confirmed chronic focal pancreatitis, and 14 healthy volunteers, were included in this study. MR examination including the routine abdomen scanning protocol and DWI was performed for both patients and volunteers. The SE-EPI sequence and ASSET technique were used for DWI. The b values of 400, 600, 800 and 1 000 s/mm2 were selected to acquire the DWI. The corresponding apparent diffusion coefficient (ADC) values were measured in each designated region of interest and statistically analyzed. Results　①DWI of the healthy volunteers showed intermediate signals of pancreas. ②DWI of pancreatic tumor masses showed homogenous high signal intensity relative to the surrounding pancreatic tissue with clear boundary. Under different b values, the tumor ADC values were (1.63±0.235)×10-3 mm2/s, (1.42±0.126)×10-3mm2 /s, (1.36±0.170)×10-3 mm2 /s and (1.26±0.178)×10-3 mm2 /s respectively, which were significantly lower than those of non-tumor region 〔(2.11±0.444)×10-3 mm2 /s, (1.83±0.230)×10-3 mm2 /s, (1.81±0.426)×10-3 mm2 /s, (1.60±0.230)×10-3 mm2 /s〕 and of the normal pancreas 〔(1.85±0.350)×10-3 mm2 /s, (1.69±0.290)×10-3 mm2 /s, (1.67±0.268)×10-3 mm2 /s, (1.42±0.221)×10-3 mm2 /s〕， P＜0.05. ③DWI of chronic focal pancreatitis showed inhomogeneous slightly hyper-intense signal with blurring borders. Under different b values, the ADC values of the inflammatory masses of chronic pancreatitis were (169±0.150)×10-3 mm2 /s, (1.56±0.119)×10-3 mm2 /s, (1.59±0.172)×10-3 mm2/s and (1.35±0.080)×10-3 mm2 /s respectively, which were higher than those of pancreatic carcinoma. When b value was set to 800 s/mm2 , the difference in ADC values between pancreatic carcinoma and chronic focal pancreatitis was statistically significant (P＜0.05). Conclusion　MR DWI can clearly depict the tumor mass of pancreatic carcinoma. In addition, the measurement of ADC values can provide useful information for the differential diagnosis between pancreatic carcinoma and chronic focal pancreatitis.

Diagnostic Value of CT and MRI on Acute Cholecystitis

Objective　 To investigate the diagnostic value of CT scanning and MR imaging on acute cholecystitis. Methods　The　CT or MR imaging data of 21 patients with proved acute cholecystitis were retrospectively reviewed. Eleven patients were examined with contrast-enhanced multi-detector-row spiral CT scanning and other 10 cases underwent contrast-enhanced MR imaging. Results　Nineteen patients showed obscure gallbladder outlines （90.5%）. The gallbladder wall demonstrated even thickening in 15 patients （71.4%） and irregular thickening in 6 cases （28.6%）. All patients showed inhomogeneous enhancement of the gallbladder wall （100%）. The bile was hyper-dense or hyper-intense on T1W image in 11 cases （52.4%）. Ten cases had free peri-cholecystic effusion （47.6%）, and 16 cases had peri-cholecystic adhesive changes or fat swelling （76.2%）. Patchy or linear-like transient enhancement of the adjacent hepatic bed in the arterial phase was seen in 16 cases （76.2%）. Twelve patients developed pleural effusion, or ascites, or both （57.1%）. Gallbladder perforation complicated with peritonitis was seen in one case, micro-abscess formation and pneumocholecystitis was observed in another case, and one case had gallbladder diverticulum. Conclusion　Wall blurring, pericholecystic adhesion or fat edema, and transient enhancement of adjacent hepatic bed in the arterial phase are the imaging findings specifically associated with acute cholecystitis, which are readily appreciated on contrast-enhanced multi-phasic CT and MR scanning.