Objective To study the clinical significance of multi-slice spiral CT in portal vein imaging. Methods One hundred and thirty seven cases underwent enhanced scan with GE Light SpeedQX/i4 CT scanner were collected, including 41 cases of liver cancer, 20 cases of hepatic cirrhosis, 21 cases of cavernous hemangioma of liver, 9 cases of hepatic abscess, 6 cases of carcinoma of gallbladder, 14 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 5 cases in normal. The results of portal vein images were reconstructed with three-dimensional software and analyzed. Results In 109 cases, portal vein, cranial mesenteric vein, and splenic vein were demonstrated successfully in the stage of portal vein: volume rendering images were clear in 84 cases, and maximum intensity projection images and multiplanar reconstruction images were clear in 109 cases. Forty-five cases of portal hypertension, 18 cases of opened collateral circulation, 15 cases of portal vein tumor thrombus, 1 case of splenic vein tumor thrombus, and 6 cases of large cavernous hemangioma were demonstrated successfully. Conclusion The portal vein imaging with multi-slice spiral CT can show the dissection and lesions of portal vein and its branches clearly, and can provide the clinical evidence for clinicians to formulate a treatment plan correctly.
ObjectiveTo explore the value of multi-slice CT angiography (MSCTA) in peripancreatic vascular invasion of pancreatic carcinoma. MethodsThirty-eight patients with pancreatic carcinoma were detected by MSCTA technology before operation. The peripancreatic vascular invasion of pancreatic carcinoma was evaluated by multi-planar reconstruction (MPR) and maximum intensity projection (MIP) combined with axial image, and compared with the surgical results. ResultsThe MSCTA results showed that there were 12 patients (31.6%) with vascular invasion in 38 patients with pancreatic carcinoma, and the surgical results showed that there were 16 patients (42.1%) with vascular invasion. There was a b fit goodness of two results (kappa=0.665, P=0.000). The sensibility and specificity of MSCTA was 68.8% (11/16) and 95.5% (21/22), respectively. ConclusionsMSCTA technology has a high correct rate in evaluation of peripancreatic vessel encroached by pancreatic carcinoma, the MSCTA result has a b consistency to the surgical result. It has a value of clinical application in evaluation of peripancreatic vessel encroached by pancreatic carcinoma.
ObjectiveTo explore the effect of snapshot freeze (SSF) on the image quality of coronary artery in 64 multislice spiral CT for patients with high heart rate. MethodsWe retrospectively analyzed the clinical data of 98 patients with an mean heart rate of ≥ 70 beats/min who underwent coronary CT angiography examination between August 2013 and February 2014. According to the inclusion criteria, 60 patients were included in our study. The image quality of standard reconstruction (STD) and motion-corrected (MC) reconstruction based on SSF platform were analyzed. The image quality was classified into 4 grades, and the image quality of coronary segments named according to AHA standard was evaluated. Then, we compared the image quality between the two different reconstruction methods. ResultsAltogether 180 coronary arteries and 795 coronary segments were evaluated. Before MC reconstruction, there were 133 (73.89%) arteries and 287 (36.10%) segments had pseudomorph, while after MC reconstruction, those two numbers were 89 (49.44%) and 150 (18.87%) (P<0.05). The right coronary artery (RCA) had a higher rate of pseudomorph and a lower image quality score[91.67% (55/60), 3.32±0.40] than left anterior descending artery[60.00% (36/60), 3.69±0.42] and left circumflex artery[70.00% (42/60), 3.44±0.55], especially the S2[90.00% (54/60), 2.45±0.85]. Overall image quality was higher with the use of MC reconstruction on per-artery level (P<0.05) and most of the per-segment level (P<0.05) compared with STD, especially for RCA and its segments (P<0.05). ConclusionSSF improves image quality of coronary artery in patients with high heart rate, especially for RCA.
ObjectiveTo investigate the value of head boneless CT angiography (CTA) for surface shaded display (SSD) (hereinafter referred to as the SSD-CTA technology) and volume computed tomographic digital subtraction angiography (VCTDSA) in diagnosing intracranial aneurysms. MethodsWe collected the clinical data of 35 patients diagnosed to have intracranial aneurysm by VCTDSA between April 2013 and November 2014 from the First Affiliated Hospital of Chongqing Medical University. The original data were imported into the CT workstation of the First People's Hospital of Chengdu. Then, SSD-CTA technology was performed for bone reconstruction. We compared the results of these two technologies. In addition, we selected another 27 patients diagnosed with intracranial aneurysm by SSDCTA and DSA examination at the same time between June 2012 and November 2014 in the First People's Hospital of Chengdu for comparison. ResultsThe quality score of SSD-CTA reconstructed image was lower than that of VCTDSA, but the diagnosis of the two technologies for intracranial aneurysm was not statistically different (P>0.05). Compared with DSA, the sensitivity and specificity of the diagnosis for intracranial aneurysms by SSD-CTA were both 100%. ConclusionSSD-CTA is valuable in diagnosing intracranial aneurysms.
ObjectiveTo explore the feasibil ity to repair defect on the neck and chest with the rectus abdominis flap which pedicle is lengthened by measuring the width, thickness, and the intercostal space of the inferior costicartilage using CT angiography (CTA). MethodsThirty cases receiving CTA and three-dimensional reconstruction between July and December 2013 were included in the study. Of 30 cases, 17 were male and 13 were female, aged 44-70 years (mean, 56 years). The width and thickness of the 3rd to 7th costicartilages and the distance of the 3rd to 6th intercostal spaces were measured, and the lengthened pedicle was calculated after the 4th to 7th costicartilage was cut off. Between July 2012 and November 2013, the lengthened pedicle of the rectus abdominis flap was cl inically used to repair the defect on the neck and chest in 4 cases. ResultsThe pedicle of the rectus abdominis flap was about 6 cm in length. When the left 7th, 6th, 5th, and 4th costicartilages were cut off, the average pedicle was lengthened by 4.07, 7.99, 12.50, and 17.48 cm respectively; when the right 7th, 6th, 5th, and 4th costicartilages were cut off, the average pedicle was lengthened by 4.63, 10.82, 16.64, and 22.05 cm respectively. In 4 flaps which were cl inically used to repair defects, 3 flap completely survived, 1 flap had partial necrosis. Three patients were followed up 6 months, and the appearance and texture of the flap were satisfactory; 1 patient failed to be followed up. ConclusionResecting the inferior costicartilage can prolong the pedicle of the rectus abdominis flap, therefore it can be used to repair defect on the upper chest and the neck.
ObjectiveTo study the value of CT angiography (CTA) in the surgical treatment of bone tumors with the temporary balloon blocking technique. MethodsA retrospective analysis was made on the clinical data of 36 bone tumor patients between April 2008 and October 2013. There were 22 males and 14 females, aged from 25 to 83 years (mean, 46 years). The tumor located at the sacrococcygeal region in 17 cases, at the ilium in 12 cases, at the pubis in 5 cases, and at the proximal femur in 2 cases. Before surgery, CTA was performed to measure the external diameter of aortaventralis and arteria iliac communis, and the distance between the low renal artery and the abdominal aortic bifurcation as well as mark the anatomical relationship between the low renal artery, the abdominal aortic bifurcation and bony landmarks of vertebral body. According to these data, suitable balloon was chosen and the balloon positioning was guided in the surgery to completely excise tumor assisted by balloon blocking technique. ResultsThe CTA results showed that the external diameter of aortaventralis and arteria iliaca communis was (1.545±0.248) cm and (1.060±0.205) cm respectively, and the distance between the low renal artery and the abdominal aortic bifurcation was (10.818±1.165) cm. The three-dimensional reconstruction showed that the opening of the low renal artery was mainly located at L1 (16/36, 44.4%) and the abdominal aortic bifurcation mainly located at L4 (22/36, 61.1%). Effective block of abdomial aorta was performed; the blood pressure obviously increased in 3 cases after balloon inflation, and pulse of the left dorsal artery of the foot decreased in 1 case after removal of balloon, which were relieved after expectant treatment. The operation time was 118-311 minutes; the intraoperative blood loss was 200-1 800 mL, 21 patients were given blood transfusion, and the amount of blood transfusion was 400-1200 mL; and the aortic clamping time was 40-136 minutes. All patients were followed up 5-44 months (mean, 21 months). According to Enneking standard, the results were excellent in 9 cases, good in 20 cases, fair in 5 cases, and poor in 2 cases at 3 months after operation. There were 10 cases of dysfunction of urination and defecation, 2 cases of tumor recurrence, and 3 cases of death after surgery. ConclusionCTA and three-dimensional reconstructions technique can accurately measure the external diameter of aortaventralis and arteria iliaca communis and the distance between low renal artery and abdominal aortic bifurcation and offer great help to choose appropriate balloon and locate the balloon during surgery. The balloon blocking technique under the assistance of CTA can obviously reduce intraoperative blood loss and tumor recurrence, supply a clear view in surgery and shorten the operation time.
ObjectiveTo explore the feasibility of three-dimensional (3-D) visualization reconstruction of the medial sural artery perforator flap based on digital technology. MethodsA series of Dicom images were obtained from three healthy adult volunteers by dual source CT angiography. Then the Mimics software was used to construct the medial sural artery model and measure the indexes, including the starting position of medial sural artery, external diameters of vascular pedicle, the number of perforators, location perforated deep fascia, and the maximum pedicle length of perforators based on medial sural artery perforator flap. ResultsThe 3-D visualization reconstruction models were successfully finished with Mimics software, which can clearly display the distribution, travel, and perforating point. Thirteen perforators were found in 6 legs, which started at the popliteal artery with a mean external diameter of 2.3 mm (range, 1.9-2.7 mm). Each specimen had 1-3 perforators, which located at the site of 6.2-15.0 cm distal to popliteal crease and 2.5-4.2 cm from posterior midline. The maximum pedicle length of medial sural artery perforator flap was 10.2-13.8 cm (mean, 11.8 cm). ConclusionThe 3-D visualization reconstruction models based on digital technology can provide dynamic visualization of the anatomy of the medial sural artery for individualized design of the medial sural artery perforator flap.
ObjectiveTo study the digital anatomy and application value of the thoracic dorsal artery based on CT angiography (CTA). MethodsBetween September 2012 and June 2014, aorta CTA images were chosen from 10 cases (20 sides) undergoing aorta CTA. By using Mimics 17.0 software for three dimensional (3D) reconstruction of image post-processing, the digital vascular anatomical information were obtained after observing and measuring the origin of the thoracic dorsal artery, the number of perforators, type, inner diameter, and pedicle length; and the body surface location of perforator vessel was determined, and then the thoracic dorsal artery perforators tissue flap harvesting was simulated. Results3D reconstruction images showed that the thoracic dorsal artery originated from subscapular artery, 76 perforator vessels were found, including 32 perforators (42.1%) from the medial branch of the thoracic dorsal artery and 44 perforators (57.9%) from the lateral branch of the thoracic dorsal artery, of which 69 were intramuscular perforators (90.8%) and 7 were direct skin artery (9.2%). The inner diameter of the thoracic dorsal artery was (1.69±0.23) mm, and its pedicle length was (2.12±0.64) cm. The first lateral perforator of the thoracic dorsal artery located at (1.65±0.42) cm above the horizontal line of the inferior angle of scapula and at (1.68±0.31) cm lateral to vertical line of the inferior angle of scapula. The first medial perforator located at (1.43 ±0.28) cm above the horizontal line of the inferior angle of scapula and at (1.41±0.28) cm lateral to vertical line of the inferior angle of scapula. The thoracic dorsal artery perforators flap harvesting was successfully simulated. ConclusionCTA is a more intuitive method to study the thoracic dorsal artery in vivo, it can clearly display 3D information of the main blood supply artery course and distribution after flap reconstruction, so it can effectively and accurately guide the design of the flap.
ObjectiveTo investigate the effectiveness of digital technology in repairing wounds of the hand and foot with anterolateral thigh flap. MethodsBetween September 2013 and September 2014, 16 cases of wounds of the hand and foot were treated with the anterolateral thigh flap. There were 10 males and 6 females, with an average age of 31 years (range, 20-52 years). The causes included traffic accident injury in 8 cases, crushing injury by machine in 6 cases, burning injury in 1 case, and animal biting injury in 1 case. The locations of soft tissue defect were the dorsum of the foot in 5 cases, the ankle in 4 cases, the planta pedis in 1 case, and the hand and forearm in 6 cases. The time was 2 hours to 45 days from injury to hospitalization (mean, 14.3 days). All defects were associated with exposure of bone and tendon. The size of wound was from 9.0 cm×4.0 cm to 29.0 cm×8.5 cm. CT angiography (CTA) was performed before operation, and the appropriate perforator as well as the donor site was selected. Then the Mimics15.0 software was used to reconstruct the data of CTA so as to locate the main perforators, design the three-dimensional models of the anterolateral thigh flap, and simulate operation. The flap was obtained according to preoperative plan during operation. The size of flaps varied from 11 cm×5 cm to 31 cm×10 cm. The donor sites were sutured directly in 14 cases and were repaired by free skin graft in 2 cases. ResultsThe lateral femoral circumflex artery identified by Mimics15.0 software before operation, as well as the starting position of its descending branch, the blood vessel diameter at start site, vascular distribution, the maximum cutting length of the vascular pedicle were consistent with the actual observation during operation. All flaps were harvested and were used to repair defect smoothly. Vascular crisis occurred in 1 flap after operation, and the other flaps survived successfully. The wounds and the incisions obtained healing by first intention, and grafted skin survived completely. All cases were followed up 6-17 months (mean, 9 months). Fifteen flaps had good shape;but a second-stage operation was performed to make the flap thinner in 1 case. At last follow-up, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case according to total active motion (TAM) in 6 cases of hand and forearm injury;the results were excellent in 5 cases, good in 3 cases, and fair in 2 cases according to American Orthopaedic Foot and Ankle Society (AOFAS) in 10 cases of foot injury. The total excellent and good rate was 81.25%. ConclusionThe preoperative individualization design of the flap can be realized through CTA digital technology and Mimics15.0 software;it can reduce the operation risk.
Objective To investigate the effectiveness of the digital technology in repairing tiny hand wounds with superficial lateral sural artery perforator flap. Methods Between August 2013 and October 2016, 10 cases of tiny hand wounds were treated with the superficial lateral sural artery perforator flap. There were 6 males and 4 females, aged 19 to 47 years (mean, 31.2 years). The causes included crushing injury by machine in 6 cases, traffic accident injury in 3 cases, and electric burning injury in 1 case. The location of the soft tissue defect was the first web in 2 cases, the thumb pulp in 3 cases, the index finger pulp in 1 case, the dorsal palms in 3 cases, and the dorsum of finger in 1 case. The time from injury to hospitalization was 4 hours to 10 days (mean, 3.5 days). The size of wound was from 4 cm×3 cm to 8 cm×7 cm. All defects were associated with exposure of tendon and bone. CT angiography (CTA) from aortaventralis to bilateral anterior and posterior tibial arteries was performed before operation, and the appropriate donor site as well as perforator was selected. Then the CTA data were imported into the Mimics15.0 software to reconstruct the three dimensional structure of the perforator artery, bone, and skin; according to flap size, the flap design and harvesting process were simulated. The flap was obtained on the basis of preoperative design during operation. The size of flaps varied from 5 cm×4 cm to 10 cm×8 cm. The donor site was sutured directly in 9 cases and repaired with skin grafting in 1 case. Results Superficial medial sural artery peforator was cut in 3 patients whose superficial lateral sural artery was too narrow, and the flaps were obtained to repair defects smoothly in the others. Venous crisis occurred in 1 flap, which survived after exploration of the vessel, thrombus extraction, and thrombolysis; the other flaps survived successfully. All wounds and incisions healed by first intention. All cases were followed up 3-18 months (mean, 10 months). The flaps had good shape. At last follow-up, the results were excellent in 6 cases, good in 3 cases, and fair in 1 case according to total active motion (TAM). Conclusion The preoperative individualized design of the superficial lateral artery perforator flap can realize through CTA digital technology and Mimics15.0 software; it can reduce the operation risk and is one of better ways to repair the tiny hand wounds.