【Abstract】ObjectiveBy using multidetectorrow spiral CT (MDCT), to investigate the CT imaging features of inflammatory diseases in retroperitoneal space with correlation of radiological anatomy.MethodsThe clinical and laboratory dada of 30 patients with proven inflammatory diseases of retroperitoneal space were collected. All patients underwent MDCT plain scanning and portal venous acquisition. CT imaging data generated at portal venous phase were processed with coronal, sagittal and oblique multiplanar reformation (MPR) technique.ResultsAcute pancreatitis and various types of renal infection were the two main sources of retroperitoneal inflammation. Depending on the specific anatomic locations, retroperitoneal inflammation of different subspaces demonstrated characteristic imaging features. Spreading of inflammatory process across subspaces was also quite common.ConclusionMDCT is the imaging method of choice to depict comprehensively and clearly the inflammatory diseases of various retroperitoneal spaces.
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, lowgrade dysplastic nodule, highgrade 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 stateoftheart 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.
Objective We sought a good understanding of the current role of computed tomography (CT) in the diagnosis of small bowel obstruction (SBO).Methods We looked for the best evidence on computed tomography for diagnosing small bowel obstruction by searching MEDLINE/PubMed (1978-April, 2006), SUMsearch (1978-April, 2006), CNKI (1978-April, 2006) and critically appraised the evidence. Results There was powerful evidence supporting the efficacy of computed tomography in the diagnosis of small bowel obstruction. Given the current evidence together with our clinical experience and considering the patient and his family members, values and preferences, computed tomography was done. We confirmed the diagnosis of strangulating small bowel obstruction, which needed immediate operation. Conclusions Computed tomography is a very useful tool for the diagnosis of small bowel obstruction with high sensibility and specificity.
目的 探讨急性重症胰腺炎不同时期的治疗方式，观察治疗效果以及治疗前后的临床表现。 方法 回顾性分析2006年1月-2009年1月收治的34例急性重症胰腺炎患者的临床资料，患者给予内科规范化治疗，并对比治疗前、后的APACHEⅡ评分、主要的实验室检查指标以及CT检查表现。 结果 31例治愈，2例中途转外科治疗，1例死亡。所有患者治疗后APACHEⅡ评分较治疗前减小（Plt;0.01），治疗后血清淀粉酶和白细胞计数较治疗前明显降低（Plt;0.05），而治疗后短期内CT检查表现无明显变化。 结论 内科规范化治疗能有效地治疗急性重症胰腺炎，适当的肠内外营养和预防性使用抗生素可有效地减少急性重症胰腺炎并发症的发生。APACHE-Ⅱ评分可作为判断急性重症胰腺炎患者预后的指标。
【摘要】 目的 探讨利用术前CT多平面重建（MPR）图像上钉道设计与术中确定枢椎峡部中心，指导后路寰枢经关节螺钉内固定徒手置钉的价值。 方法 选取成人头颈尸体标本9具，及寰枢关节不稳患者5例，螺旋CT扫描，取后路寰枢经关节螺钉内固定的理想钉道（经枢椎峡部中心点）所在平面重建并设计个体化钉道，确定安全的置钉范围。参考术前钉道设计与术中确定枢椎峡部中心，徒手行后路寰枢经关节螺钉固定。术后对实际钉道CT多平面重建，分析徒手实际置钉情况。 结果 后路寰枢经关节螺钉固定共28侧，术中徒手操作顺利，无重要血管神经损伤。手术实际钉道均在术前设计钉道的安全范围内。5例患者寰枢椎间术后较术前存在相对位移变化。 结论 根据螺旋CT MPR图像设计的个体化后路寰枢经关节螺钉内固定钉道，结合术中枢椎峡部中心显露，可指导临床安全地徒手置钉。【Abstract】 Objective To explore the clinical value of the free-hand technique on making the screw path of posterior atlantoaxial transarticular screw fixation, which guided in accordance with the preoperative design of the screw trajectory in spiral CT multilevel reconstruction (MPR) imaging and intra-operative exposure of the center of C2 isthmus. Methods The cervical spine segments of 9 human cadavers and 5 patients with atlantoaxial instability were scanned with spiral computed tomography. Then the CT MPR images of ideal screw trajectory of posterior atalanto-axial transarticular screw reconstructed through the central point of C2 isthmus were used for plotting individual safe screw trajectory. According to preoperative designing of the individual screw trajectory and intraoperative exposure of the center of C2 isthmus, free-hand operation made the transarticular screw path of posterior atlantoaxial screw fixation. Postoperative CT MPR image was used to analyze the actual screw trajectory in atlantoaxial complex, as well. Results The transarticular screws were inserted atlantoaxial joints in 28 sides. The free-hand operation of screw placement was successful, and no screw misplacement or major neurovascular injury was found. There was relative displacement between the atlas and axial vertebrae in 5 patients. Conclusion The free-hand technique of posterior atlantoaxial transarticular screw placement is reliable and safe which refers the preoperative individual screw trajectory designed by CT MPR image and intraoperative exposure of the center of C2 isthmus.
Objective To evaluate the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to identify the different causes of acute cholecystitis. Methods In January 2009 to December 2012， 169 patients diagnosed with acute cholecystitis caused by various pathologic conditions were performed MDCT scans， the images of portal venous phase and clinical data were retrospectively reviewed by two blinded radiologists. There were 146 cases in non-hepatopathy cholecystitis group and 23 cases in hepatopathy cholecystitis group. The other 5 normal gallbladder cases diagnosed by MDCT scans were retrospectively reviewed as contrast group. Using five patterns according to the enhancement pattern of flat gallbladder wall thickening on MDCT. The study cases were then divided into five patterns and the thickness of the mucous membrane were measured. The occurrence rate of each pattern and the thickness of the mucous membrane between the groups were compared respectively. Results In the non-hepatopathy cholecystitis group， there were typeⅡin 102 cases （69.9%）， typeⅢin 5 cases （3.4%）， typeⅣ in 30 cases （20.5%）， and typeⅤ in 9 cases （6.2%）. In the hepatopathy cholecystitis group， there were typeⅡin 2 cases （8.7%）， typeⅢ in 11 cases （47.9%）， typeⅣin 5 cases （21.7%）， and typeⅤin 5 cases （21.7%）. The occurrence rate of typeⅡin the non-hepatopathy cholecystitis group was significialtly higher than that in the hepatopathy cholecystitis group （P＜0.005）. The occurrence rate of typeⅢ and typeⅤ in the hepatopathy cholecystitis group were significialtly higher than those in the non-hepatopathy cholecystitis group（P＜0.005， P＜0.05）. The occurrence rate of type Ⅳ between the two groups had no significant difference （P＞0.05）. TypeⅠonly present in the contrast group. The non-hepatopathy group’s mean mucous membrane thickness was （2.61±1.30） mm ， which was thicker than the hepatopathy group’s （2.02±0.52） mm（t=2.22， P＜0.05）. Conclusion Analyzing the enhancement pattern of a thickened gallbladder wall on MDCT is helpful in identifying the causes of acute cholecystitis， and the gallbladder perforation or not.
ObjectiveTo investigate the imaging findings of carcinoma of body and tail of the pancreas. MethodsTotally twentythree patients with carcinoma of body and tail of the pancreas were studied. The diagnosis was proven by surgery and pathological findings. The imaging features of twentythree cases were reviewed including the location, size, shape, texture, and enhancement patterns of the tumor masses. Five cases underwent enhanced MRI examination, 18 cases underwent enhanced spiral CT examination. ResultsThe tumors located in the pancreatic body in 5 cases, located in the tail in 7 cases, and located in the body and tail of pancreas in 11 cases. The tumor masses were irregular in shape and heterogeneously hypointense from CT scan. From MR, the masses were slightly hypointense on T1WI, and slightly or mixed hyperintense on T2WI. Nineteen cases showed heterogeneous slight enhancement and four cases had no enhancement. The tumors were well demarcated in five cases, while those were poorly defined in the other 18 cases. Metastatic lymphadenopathy was shown in 16 cases, vascular invasion in 8 cases, and metastatic lesions of other organs in 3 cases. ConclusionThe carcinoma of body and tail of the pancreas shows certain characteristic imaging. CT and MRI examination can reflect the morphologic features, the hemodynamic alterations, and the involvement of adjacent structures and organs.
Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computed tomography (MSCT) with serum amyloid A protein (SAA) or C-reactive protein (CRP) on the selection of operative procedures of rectal cancer under the multi-disciplinary team. Methods Prospectively enrolled patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to August 2009 were randomly assigned into two groups. In one group named MSCT+SAA group, both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT+CRP group, both MSCT and CRP combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed. Results All 165 patients were randomly assigned into MSCT+SAA group (n=83) and MSCT+CRP group (n=82). The baseline characteristics of two groups were statistically similar (Pgt;0.05). For MSCT+SAA group, the accuracies of preoperative staging T, N, M and TNM were 74.7%， 68.7%, 100% and 66.3%, respectively. For MSCT+CRP group, the accuracies of preoperative staging T, N, M and TNM were 72.0%, 86.6%, 100% and 81.7%, respectively. There were statistically significant differences in the accuracies of N staging and TNM staging between two groups (P＜0.05). However, there was no statistically significant difference of the accuracy of prediction to operative procedures between two groups (90.4% vs. 95.1%, Pgt;0.05). The pathological T staging (P＜0.001), N staging (P＜0.001), TNM staging (P＜0.001), preoperative serum level of SAA (P=0.010), serum level of CRP (P=0.042), and distance of tumor to the dentate line (P=0.011) were associated with the operative procedures. Conclusion Combinative assessment of MSCT+CRP could improve the accuracy of preoperative staging and operative procedures prediction, which may be superior to MSCT+SAA.
Objective To determine the influence of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA ) on the selection of operative procedures in lower rectal cancer.MethodsProspectively enrolled 130 patients diagnosed definitely as lower rectal cancer (distance of tumor to the dentate line ≤7 cm) at West China Hospital of Sichuan University from July 2007 to September 2008 were randomly assigned into two groups with 65 participants, respectively. In one group named MSCT+SAAgroup, both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT group, only the preoperative MSCT was made. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation program, respectively.ResultsAccording to the criteria, 119 patients with colorectal cancer were actually included into MSCT+SAA group (n=58) and MSCT group (n=61). The baselines characteristics of two groups were basically identical. For MSCT+SAAgroup, the accuracies of preoperative staging T, N, M and TNM were 89.66%, 79.31%, 100% and 77.59%, respectively; For MSCT group, the corresponding rates were 86.89%, 70.49%, 100% and 65.57%, respectively. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups (93.10% vs. 80.33%, P=0.041). The clinical staging (P=0.001), preoperative T staging (P=0.000), M staging (P=0.016), TNM staging (P=0.013) and serum level of SAA (P=0.029) were related to the selection of operative procedures when analyzing the relationship between the operative procedures and multiple clinicopathologic factors in lower rectal cancer. ConclusionCombinative assessment of 64 MSCT and SAA could improve the accuracy of preoperative staging, thus provide higher predictive coincidence rate to operative procedures for surgeon.
Objective To determine the role of multimodal preoperative evaluation (MPE) system of transrectal ultrasound (TRUS), 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in assessment of preoperative staging and selection of operative procedures of the lower and middle rectal cancer in multi-disciplinary team. Methods Prospectively enrolled 150 patients, who were diagnosed definitely as lower and middle rectal cancer (distance of tumor to the dentate line ≤10 cm) at West China Hospital of Sichuan University from November 2008 to March 2009, randomly assigned into two groups. In one group named MPE group, MPE consisting of TRUS, MSCT and SAA were made for the preoperative evaluation. In another group named MSCT+SAA group, both MSCT and SAA were made preoperatively. Then, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively. Furthermore, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathological factors. Results According to the criteria, 146 patients with lower and middle rectal cancer were randomly assigned into MPE group (n=74) and MSCT+SAA group (n=72). The baselines characteristics of two groups were statistically identical. For MPE group the accuracy of preoperative staging T, N, M and TNM were 94.6% (70/74), 85.1% (63/74), 100% （74/74） and 82.4% (61/74), respectively; For MSCT+SAA group the corresponding rates were 77.8% (56/72), 84.7% (61/72), 100% （72/72） and 81.9% (59/72), respectively. The analysis showed a statistically difference in the accuracy of preoperative T staging between two groups (P=0.003) while there was no statistically significant difference of the accuracies of preoperative N, M and TNM staging between two groups (Pgt;0.05). There wasn’t a statistically significant increasing of the accuracy of prediction to operative procedures in MPE group compared with MSCT+SAA group 〔95.9% (71/74) vs.88.9% (64/72), P=0.106〕. When analyzing the relationship between multiple clinicopathologic factors and the operative procedures of lower and middle rectal cancer, there were statistical correlations between the pathological T staging (r=0.216， P=0.009), N staging (r=0.264， P=0.001), TNM staging (r=0.281， P=0.001), serum level of SAA before operation (r=0.252， P=0.002) or the distance of tumor to the dentate line (r=－0.261， P=0.001) and the operative procedures. Conclusion MPE system could display the accurate preoperative staging for lower and middle rectal cancer, on which the prediction of operative procedures can rest convincingly.