Objective To investigate the imaging features of intestinal volvulus on multi-detector row spiral CT (MDCT). MethodsThirty-one patients with surgically confirmed intestinal volvulus were included in this study. Nine patients received MDCT plain scan, 22 received contrast enhanced MDCT scan and 5 of them had additional CT angiography. Two abdominal radiologists analyzed the MDCT imaging features of intestinal volvulus observed, such as the location, direction of rotation, degree of volvulus, appearance rate of the “whirl sign” and the “beak sign”, bowel wall thickening and ascites and the possible causes of volvulus, which were recorded with review of surgical findings. Results The location of volvulus included duodenum (1 case), jejunum (23 cases), ileum (3 cases), entire small intestine (2 cases) and sigmoid colon (2 cases). The location of volvulus was correctly diagnosed based on MDCT findings in 27 patients (27/31; 87.0%). The direction of volvulus was correctly diagnosed for all patients based on MDCT findings (clockwise in 11 cases and counterclockwise in 20 cases). The degrees of volvulus assessed on MDCT findings were respectively 180° in 13 cases, 360° in 12 cases, 540° in 2 cases, 720° in 2 cases and 900° in 2 cases, as compared with surgical findings of 180° in 17 cases, 360° in 10 cases, 540° in 1 case, and 720° in 3 cases. The diagnostic accuracy of MDCT for assessing the degree of volvulus was 74.2%. The “whirl sign” and “beak sign” appeared in 18 and 20 patients, respectively. Bowel wall thickening and ascites were showed in 9 patients. In 5 patients with reconstructed images, the images obtained by maximum intensity projection (MIP) and volume rendering (VR) techniques showed the abnormality of mesenteric vessels in all patients, and the multi-planar reconstruction (MPR) image of one patient showed the “whirl sign” and the “beak sign”. The causes of intestinal volvulus were identified on MDCT in 10 patients. Conclusion The “whirl sign” and the “beak sign” are the characteristic images of intestinal volvulus on MDCT. Bowel wall thickening and ascites may indicate the hemody-namic images impairment of volvulus. MDCT plays valuable role in the diagnosis of intestinal volvulus.
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 investigate the value of CT grading diagnosis in clinical therapy of acute pancreatitis. Methods CT scanning was carried out in patients with acute pancreatitis between 2003 and 2009, and Enhancement CT scanning was carried out in patients without contraindications of contrast medium. Two radiologists analyzed the images and made CT grading diagnose. Contrast study was made between CT grading diagnose and clinical scale as well as prognosis. Results In 518 cases, the CT grading was as the following: grade A 9 cases, grade B 66 cases, grade C 105 cases, grade D 147 cases, and grade E 191 cases. Patients with grade A and B were fully recovered after conservation and supportive treatment. In cases of grade C, only 2 patients had recurred pancreatitis after conservation treatment, and others were fully healing. Ninety-four patients who needed operation and 23 patients who died were all occurred in grade D and E. Conclusion CT grading diagnosis of acute pancreatitis can reflect the range, extent, and course of disease, and it has good dependablity with clinical grading.
Objective To investigate multi-slice spiral CT (MSCT) and MRI features of stasis cirrhosis and the diagnostic value of MSCT and MRI. Methods MSCT and MRI findings of 35 patients with stasis cirrhosis were studied. The size of liver and spleen, the diameter of hepatic vein (HV), enhancement pattern of liver parenchyma, contrast medium reflux in inferior vena cava (IVC) and (or) HV, ascites, number of varices and correlated abnormalities were reviewed. Results The volume index of liver and spleen of 35 patients was 4434.95 cm3 and 621.92 cm3 respectively. The mean diameter of HV of 27 patients (77.1%) was 3.61 cm and HV of other 8 patients (22.9%) were too small to show. Number of patients showed waves of borderline, inhomogeneous pattern of parenchymal contrast enhancement, contrast medium reflux in IVC and (or) HV, varices and ascites was 5 (14.3%), 29 (82.9%), 20 (57.1%), 16 (45.7%), and 6 (17.1%), respectively. Correlated abnormalities included cardiac enlargement 〔4 cases (11.4%)〕, pericardium thickening 〔11 cases (31.4%)〕, and pericardial effusion 〔2 cases (5.7%)〕. Conclusions Stasis cirrhosis mainly demonstrate liver enlargement, inhomogeneous pattern of parenchymal contrast enhancement, contrast medium reflux in IVC and (or) HV, and slight portal hypertension. MSCT and MRI play invaluable roles in diagnosis, differential diagnosis and etiological diagnosis of stasis cirrhosis.
Objective To investigate the value of multislice spiral CT （MSCT） findings in the diagnosis of hepatic tuberculosis. Methods MSCT imaging data, including both plain and contrast-enhanced CT scan, of 14 patients with hepatic tuberculosis confirmed by surgery (5 patients), aspiration biopsy (4 patients), or clinic follow-up (5 patients) were collected for the study. MSCT findings were analyzed with correlation of pathological changes. Results Hepatic tuberculosis was classified into 2 types. ①The parenchymal type (12 patients), which was further divided into 4 subtypes: Miliary subtype (2 patients) showed multiple tiny hypodense dots with faint border and had no enhancement; Nodular subtype (5 patients) showed blurring border on plain CT scan, 2 patients had no enhancement, 2 had peripheral rim-like enhancement, and peripheral rim enhancement mixed with no enhancement in 1 patient; Abscess subtype (4 patients) showed central hypodense area with peripheral zone-like enhancement in 2 patients, or patchy like slight enhancement in 2 patients; Fabric and calcific subtype (1 patient) depicted enplaque calcification. ②The serohepatic type (2 patients) showed thickened hepatic capsule, sub-capsule nodules with slight enhancement, and local subcapsular fluid collection. Other signs included hepatomegaly, tuberculous lymphadenopathy, splenic tuberculosis, and tuberculosis of pancreas, adrenal glands, intestine and thorax. Conclusion MSCT plays an important role in diagnosis of hepatic tuberculosis, by reflecting underlying pathological changes.
Objective?To evaluate the value of various CT features in differentiating renal angiomyolipoma (RAML) with minimal fat and renal cell carcinoma (RCC). Methods?The Cochrane Library, PubMed, MEDLINE (OVID), EMBase, and the Chinese Periodical Wed (CNKI, CBM, VIP) were searched. They were searched from Jan 2001 to Nov 2008. Trials screening, quality assessment, and data extraction was conducted according to the inclusion criteria recommended by the Cochrane Collaboration. The SROC curve and meta-analyses were performed by Meta-disc 1.4. Results?Seven trials, involving 482 patients and 513 tumors, were included. The studies were highly homogonous. It was considered that 8 features including single or multiple lesions, scanning density, calcification, angle with cortex, levering-cortex-up sign, lesions pro-trusion, homogeneous enhancement, and prolonged enhancement, played certain roles in differentiating RAML with minimal fat and RCC. Among these features, interface with the cortex was the most important, and the features of homogeneous enhancement and prolonged enhancement were the second most important. Conclusion?Besides measuring lipoid tissue in the tumor, there are another 8 features which are valuable to the differentiation of RAML with minimal fat and RCC.
【Abstract】Objective To investigate the appropriate reconstruction techniques of multidetectorrow spiral CT angiography (MDCTA) to depict the collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC). Methods MDCTA scanning was performed during the portal venous phase after intravenous contrast materials in 18 HCC patients with CTPV induced by tumor thrombosis. Raw data were reconstructed with thin slice thickness followed by 2D and 3D angiographic reconstruction methods, including maximum intensity projection(MIP), shade surface display （SSD） and volume rendering technique(VRT). Results MDCTA with MIP reconstruction accurately depicted both the tumor thrombus within the portal vein and the collateral vessels of CTPV including the biliary (cystic vein and pericholedochal veinous plexus) and the gastric (left and right gastric veins) branches. However, VRT and SSD methods did poorly in showing the tumor thrombus and the collateral vessels. Conclusion MDCTA with MIP reconstruction is the method of choice to evaluate the collateral vessels of CTPV.
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 evaluate the predictive value of pancreatic duct diameter and pancreatic gland thickness measured using preoperative CT imaging on pancreatic fistula(PF)following pancreaticoduodenectomy (PD). MethodsOne hundred and fifty-one patients who underwent PD consecutively from January 2013 to April 2014 were reviewed retrospectively. Associations between the gender, age and the pancreatic duct diameter and pancreatic gland thickness from preoperative CT imaging and PF were analyzed. The diagnostic values of the pancreatic duct diameter and pancreatic gland thickness in patients with PF were evaluate by receiver operating characteristic (ROC) analysis. The reliability analysis was done for the pancreatic duct diameter and pancreatic gland thickness by using the intraclass correlation coefficient (ICC). The Spearman rank correlation analysis was done between the pancreatic duct diameter and pancreatic gland thickness. Results①PF occurred in 46 cases (30.1%).②The gender and age were not associated with PF (Gender: χ2=1.698, P=0.193; Age: χ2=0.016, P=0.900). The pancreatic duct diameter and pancreatic gland thickness were associated with PF (Pancreatic duct diameter: OR=0.275, 95% CI 0.164-0.461, P=0.000; Pancreatic gland thickness: OR=1.319, 95% CI 1.163-1.496, P=0.000).③There was no correlation between the pancreatic duct diameter and the pancreatic gland thickness (rs=-0.120, P=0.145).④The area under curve of ROC was 0.814 (95% CI 0.745-0.883, P < 0.001) for the pancreatic duct diameter in predicting the PF, the sensitivity and specificity was 68.6% and 78.3% respectively when the best critical value was 3.5 mm. The area under curve of ROC was 0.762 (95% CI 0.674-0.849, P < 0.001) for the pancreatic gland thickness in predicting PF, the sensitivity and specificity was 63.0% and 85.7% respectively when the best critical value was 31 mm.⑤The ICC of the pancreatic duct diameter and pancreatic gland thickness was 0.984 and 0.992 respectively by two medical diagnostic measurement. ConclusionPancreatic duct diameter and pancreatic gland thickness measured using preoperative CT imaging might be useful in predicting PF following PD.
Objective To analyze the ability of spectral CT imaging in displaying breast cancer lesions and explore the value of spectral CT imaging in detecting breast cancer. Methods The spectral CT images with different parameters of sixty-eight breast cancer lesions confirmed by pathology between July 2013 and February 2016 were retrospectively analyzed. The contrast noise ratio (CNR) and signal to noise ratio (SNR) as well as the ability in detecting breast cancer of the images with different parameters were compared. Results Fat-water material decomposition images showed breast cancer lesions best. Iodine-water material decomposition images had the lowest CNR. 70 keV monochromatic images and the monochromatic of best CNR images had better SNR. Fat-water material decomposition images detected all of the breast cancer lesions. Conventional CT plain scan detected least lesions. Conclusion Spectral CT imaging, especially fat-water material decomposition images, can show breast cancer lesions well, which has the potential application for detection of breast cancer lesions.