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.
Objective To investigate the diagnostic value of a double action MR contrast agent——gadobenate dimeglumine （Gd-BOPTA） for focal liver lesion and biliary system disease. Methods Articles about Gd-BOPTA in CNKI and PubMed for the past few years were searched and the value of Gd-BOPTA in the diagnosis of focal liver lesion and biliary system disease was summarized. Results For focal liver lesion, Gd-BOPTA not only can reveal blood supply of the lesion, but also reveal the hepatocellular functional status in the lesion. For biliary system, biliary excretion of Gd-BOPTA can be used to evaluate the anatomic structure of bile duct， function of gallbladder and biliary system disease. Conclusions Gd-BOPTA has an important value in the diagnosis of focal liver lesion and biliary system disease. Gd-BOPTA may have wider applications in the future.
摘要:目的:探讨16层螺旋CT图像后处理技术对青少年特发性脊柱侧凸的胸椎旋转和椎弓根径线变化特点及临床价值。 方法:收集经临床诊治的青少年特发性脊柱侧凸20例,运用16层螺旋CT扫描及图像后处理技术,进行相关CT数据测量统计。结果:(1)脊柱胸椎侧凸的顶椎及邻近椎体均向凸侧旋转、后份向凹侧旋转,以顶椎旋转最重,且凹侧椎弓根径线小于凸侧,与侧凸程度及方向具有相关性。(2)上、下终椎椎体旋转及椎弓根径线变化则较复杂,其椎体无旋转或向相反方向旋转,椎弓根径线可凸侧小于凹侧,以上终椎明显。结论:16层螺旋CT及图像后处理技术,对显示青少年特发性脊柱侧凸胸椎旋转及椎弓根径线变化特征,可提供临床拟订手术方案的重要影像学依据。
ObjectiveTo investigate the diagnostic value of spectral saturation inversion recovery, gradient-echo chemical shift MRI， and proton magnetic resonance spectroscopy in quantifying hepatic fat content. MethodsConventional T1-weighted and T2-weighted scanning (without fat saturation and with fat saturation)， gradient-echo T1W in-phase （IP） and opposedphase （OP） images and 1H-MRS were performed in 31 healthy volunteers and 22 patients who were candidates for liver surgery. Signal intensities of T1WI amp; T1WIFS (SInonfat1, SIfat1), T2WI amp; T2WI-FS (SInonfat2, SIfat2), and IP amp; OP (SIin, SIout) were measured respectively, the relative signal intensity one (RSI1), relative signal intensity two (RSI2)， and fat index (FI) were calculated. Peak values and the area under peak of 1H-MRS were measured, and the relative lipid content of liver cells (RLC ) were calculated. Twenty-two patients accepted liver resection and histological examination after MRI scanning, the proportion of fatty degenerative cells were calculated by image analysis software. Results①Hepatic steatosis group showed higher average values of RSI1, FI， and RLC to non-hepatic steatosis group (Plt;0.05), while there was no significant difference in RSI2 between two groups (Pgt;0.05). ②There was a statistical significant difference in RLC among different histopathological grades of hepatic steatosis, and RLC increased in parallel with histopathological grade (Plt;0.05).There was no significant difference in RSI2, RSI1, and FI among different histopathological grades, although the latter two had a tendency of increasing concomitant with histopathological grade (Pgt;0.05). ③The values of FI and RLC were positively correlated with the PFDC （r=0468, P=0.027； r＝0771， Plt;0.000 1）, while they were not in RSI1 and RSI2 (r=0.411, P=0.057； r=0.191, P=0.392). ConclusionsSPIR, Gradient-echo chemical shift MRI and 1H-MRS can help to differentiate patients with hepatic steatosis from normal persons, the latter also can help to classify hepatic steatosis. In quantifying hepatic fat content, 1H-MRS is superior to gradient-echo chemical shift MRI, while SPIR’s role is limited.
Objective To introduce the current value of multi-detector row CT (MDCT) and magnetic resonance imaging (MRI) techniques on evaluation of diffuse hepatic parenchymal diseases.Methods By literature review, the application and recent advances of various kinds of MDCT and MR imaging techniques in evaluating diffuse hepatic parenchymal diseases were summarized. Results There were three kinds of diffuse liver parenchyma diseases, which were the diseases of storage, vascular and inflammatory. The morphology changes of diffuse liver parenchyma diseases could be demonstrated well by MDCT. MRI, especially MR functional imaging could reflect the morphology changes, and cellular metabolic activity of the liver, which provided qualitative and quantitative information for the diagnosis and evaluation of therapeutic effect on diffuse liver parenchyma diseases. Conclusion MR imaging techniques, especially those functional techniques, developed rapidly and had practical value in both the diagnosis and severity assessment of hepatic fibrosis.
Objective To probe CT grading criteria of vascular invasion in pancreatic cancer. Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years. Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer. There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels, on the degree of circumferential contiguity of tumor to vessel, on the degree of lumen stenosis, and on the degree of contiguity between tumor and vessels combined vascular caliber. Conclusion CT grading criteria are not uniform, each one has defects.
Objective To determine the frequencies and patterns of gastrointestinal wall thickening at muti-slice computed tomography (MSCT) in patients with hepatic cirrhosis. Methods One hundred and nine patients with cirrhosis and 130 patients without cirrhosis for gastrointestinal wall thickening were retrospectively analyzed by the abdominal MSCT scans. The frequencies of wall thickening were determined in the cirrhosis patients and in those without cirrhosis. The segmental distribution, symmetry and enhancement pattern were evaluated in all patients with cirrhosis for gastrointestinal wall thickening. Results Gastrointestinal wall thickening was seen in 72 cases (66%) with cirrhosis patients and in 12 cases (9%) without cirrhosis patients (Plt;0.005). The jejunum and ascending colon were the most common sites of gastrointestinal wall thickening, which was involved in 32 and 31 patients respectively. The scans of 46 (64%) patients with gastrointestinal wall thickening showed multisegmental distribution. Gastrointestinal wall thickening was concentric and homogeneous in all patients with cirrhosis. Conclusion Gastrointestinal wall thickening is common in patients with hepatic cirrhosis. It frequently involves multiple segments. The jejunum and ascending colon are the most common sites of involvement. MSCT plays an invaluable role in diagnostic evaluation of bowel wall thickening in patients with hepatic cirrhosis.
Objective To discuss the CT appearances and clinicopathologic features of gastrointestinal neuroendocrine neoplasms (GI-NENs). Method The clinical and CT materials of 33 cases of GI-NENs who treated in our hospital from Jan. 2013 to Dec. 2015 were retrospectively analyzed. Results Of the 33 cases, 25 males and 8 females were enrolled. The median age was 62-year old (27–78 years), and the age at diagnosis mainly focused in the 50–70 years period. GI-NENs situation: 12 cases in the stomach, 11 cases in the rectum, 3 cases in the esophagus and colon respectively, 2 cases in the duodenum and appendix respectively. The main clinical symptoms included: abdominal pain in 13 cases, dysphagia and obstruction in 9 cases, hematemesis and hematochezia in 8 cases, abdominal distention in 5 cases, stool and bowel habits change in 5 cases, subxyphoid pain in 3 cases, belching in 2 cases, diarrhea in 1 case, protrusion of the neoplasm when defecation in 1 case, obstructive jaundice in 1 case. Seven cases of G1 grade, 6 cases of G2 grade, 15 cases of G3 grade, and 5 cases of mixed adenoneuroendocrine carcinomas were found according to pathologic grading. The immunohistochemical marker: synaptophsin was positive in 31 cases, cytokeratin A was positive in 23 cases, and cytokeratin was positive in 9 cases. The CT appearances of GI-NENs were mainly thickening of the walls and formation of nodules or masses in local area. Moderately homogeneous enhancement (in 20 cases) and irregularly heterogeneous enhancement (in 13 cases) were both commonly seen. In addition, 13 cases of lymphadenophathy, 6 cases of liver metastasis, and 3 cases of lung metastasis were also detected by CT. Conclusions GI-NENs have a preference for elderly male. The most common site of onset is the stomach. Its clinical symptoms and CT appearances are nonspecific, however, the enhancement pattern of the tumors has a certain characteristic.
Objective The purpose of this study is to compare the differences of opened collateral circulation status between hepatic portal hypertension (HPH) and pancreatogenic portal hypertension (PPH), to guide the clinical treatment. Methods From Nov. 2015 to Oct. 2017, data of 119 cases of computed tomography portography (CTP) from the Department of Radiology of Sichuan Provincial People’s Hospital and Department of Radiology of West China Hospital of Sichuan University were retrospective analyzed, and the patients were divided into 2 groups, namely the HPH group (77 patients) and PPH group (42 patients) according to different causes. The diameter of portal vein system (including trunk of portal vein, left gastric vein, splenic vein, superior mesenteric vein, and gastroepiploic vein) and the incidences of varicose veins (lower esophageal vein, gastric fundal vein, gastric body vein, Retzius vein varix, umbilical vein open, and splenorenal shunt), as well as the degree of varicose of lower esophageal vein, gastric fundal, and gastric body vein were compared. Results The diameter of portal vein in the HPH group was larger than that of the PPH group, but the diameter of gastroepiploic vein was smaller than that of the PPH group, and the differences were statistically significant (P<0.05). There was no significant difference in left gastric vein, splenic vein, and superior mesenteric vein between the 2 groups (P>0.05). Significant differences were found in varicose veins incidence of gastric and lower esophageal vein (P<0.05), the varicose veins incidence of gastric was lower and varicose veins incidence of lower esophageal vein was higher in the HPH group. Statistically significant differences were also found in the incidence of umbilical vein open, Retzius varicose veins and splenorenal shunt between the 2 groups (P<0.05), and the incidences were all higher in the HPH group. Conclusions There are differences in collateral circulation status between the HPH and PPH. Gastric fundal and lower esophageal vein varices are easy to appear simultaneously in HPH, while gastric fundal and body vien varices are mostly only occurred in PPH. Compared with HPH, the degree of gastric fundal and lower esophageal vein varices is more mild in PPH.
Objective To investigate the imaging features of idiopathic hepatic arteriovenous malformation（IHAVM） on multi-detector row spiral CT (MDCT) and magnetic resonance imaging (MRI). Methods Nineteen patients with IHAVM between January 2009 and June 2010 were included for retrospective analysis of the imaging findings on MDCT (n=9) and MRI (n=10), especially the imaging features of IHAVM on contrast-enhanced dynamic scans. Results All IHAVM lesions in 9 patients were isodense in plain scan of MDCT, and showed marked small nodular or linear enhancement with similar intensity to vascular enhancement in arterial phase, and the enhancement continued to persist to portal phase but with reduced enhancement degree. Early visualization of venous tributaries in arterial phase was present in 4 cases, and wedge-shaped or lamellar transient hepatic parenchyma enhancement in arterial phase in the edge of the lesion was observed in 6 cases. In 10 patients with MRI scan, the enhancement patterns of IHAVM were quite similar to the findings on MDCT, with early visualization of venous tributaries in arterial phase in 5 cases and wedge-shaped transient hepatic parenchyma enhancement in arterial phase in the edge of the IHAVM lesion in 7 cases. Conclusion Contrast-enhanced multi-phase MDCT and MRI scans can depict the morphologic and hemodynamic characteristics of IHAVM, thus they are very valuable for the diagnosis of IHAVM.