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 summarize the methods and applications for quantitative measurement of iron in human.Methods The methods and applications for quantitative measurement of iron in human were analyzed retrospectively via reviewing the literatures domesticly and abroad， and summarized the advantages and disadvantages respectively. Results The methods for quantitative measurement of iron included laboratory tests， pathology examinations， CT， superconducting quantum interference device investigation （SQUID）， and MRI. Conclusions Laboratory test is the most simple and economic method for quantitative measurement of iron in human. Percutaneous liver biopsy is the gold standardmethod. Radiologic examinations， especially MRI， may be main methods of measuring liver iron content in future.
Hepatoid adenocarcinoma is a rare extrahepatic malignant tumor with pathological characteristics similar to hepatocellular carcinoma. It is more common in the gastrointestinal tract and patients often have a history of hepatitis and elevated serum alpha fetoprotein (AFP). In clinical practice, patients may seek medical treatment due to liver lesions or elevated AFP, while primary gastrointestinal lesions are easily ignored. The author presents imaging findings of two patients who were diagnosed with hepatoid adenocarcinoma of stomach (HAS) due to elevated AFP in our hospital. By summarizing their clinical imaging characteristics and sorting out various clinical conditions that may cause elevated serum AFP, in order to improve the recognition and differential diagnosis of HAS.
Liver cancer is a highly prevalent malignancy of the digestive system in China. Hepatic imaging examinations, including CT and MRI, play a critical role in the screening, diagnosis, and therapeutic evaluation of liver cancer. To standardize terminology, reduce variability in imaging interpretation, and improve diagnostic consistency and accuracy, the Department of Radiology of West China Hospital of Sichuan University has developed a CT/MRI structured reporting specifically designed for high-risk populations of primary liver cancer, which is based on the 2018 version of the Liver Imaging Reporting and Data System published by the American College of Radiology. We introduce the design background, core elements, and practical application experience of the CT/MRI structured reporting developed by West China Hospital of Sichuan University, aiming to promote the standardization and uniformity of hepatic imaging evaluation for high-risk populations of liver cancer.
Objective To determine feasibility of texture analysis of non-enhanced CT scan for differential diagnosis of liver cancer and hepatic hemangioma. Methods Fifty-six patients with liver cancer or hepatic hemangioma confirmed by pathology were enrolled in this retrospective study. After exclusion of images of 4 patients with artifacts and lesion diameter less than 1.0 cm, images of 52 patients (57 lesions) were available to further analyze. Texture features derived from the gray-level histogram, co-occurrence and run-length matrix, absolute gradient, autoregressive model, and wavelet transform were calculated. Fisher, probability of classification error and average correlation (POE+ACC), and mutual information coefficients (MI) were used to extract 10 optimized texture features. The texture characteristics were analyzed by using linear discriminant analysis (LDA) and nonlinear discriminant analysis (NDA) provided by B11 module in the Mazda software, the minimum error probability of differential diagnosis of liver cancer and hepatic hemangioma was calculated. Most discriminating features (MDF) of LDA was applied to K nearest neighbor classification (KNN); NDA to extract the data used in artificial neural network (ANN) for differential diagnosis. Results The NDA/ANN-POE+ACC was the best for identifying liver cancer and hepatic hemangioma, and the minimum error probability was the lowest as compared with the LDA/KNN-Fisher, LDA/KNN-POE+ACC, LDA/KNN-MI, NDA/ANN-Fisher, and NDA/ANN-MI respectively, the differences were statistically significant (χ2=4.56, 4.26, 3.14, 3.14, 3.33;P=0.020, 0.018, 0.026, 0.026, 0.022). Conclusions The minimum error probability is low for different texture feature selection methods and different analysis methods of Mazda texture analysis software in identifying liver cancer and hepatic hemangioma, and NDA/ANN-POE+ACC method is best. So it is feasible to use texture analysis of non-enhanced CT images to identify liver cancer and hepatic hemangioma.
【摘要】 目的 通過觀察單肺通氣患者術中氧合指數（oxygenation index，OI）、呼吸指數（respiratory index，RI）及動態肺順應性（dynamic lung compliance，Cdyn）的變化，探討高滲氯化鈉溶液對術中單肺通氣患者的肺保護作用。 方法 選擇2009年12月-2011年2月完成的美國麻醉師協會分級為Ⅰ~Ⅲ級，心肺功能篩查、血常規、肝腎功能及凝血功能無明顯異常，擬在全麻雙腔氣管插管下行開胸手術，術中需行單肺通氣患者60例，隨機分為高滲氯化鈉組（A組）和對照組（B組），每組30例。A組在開始單肺通氣后30 min快速輸注7.5%高滲氯化鈉溶液2 mL/kg，15 min內輸注完畢，B組輸注等量生理鹽水，分別記錄輸注前（T1）、輸注完畢時（T2）、輸注后30 min（T3）、輸注后1 h（T4）的OI、RI及Cdyn變化，并比較兩組各時間點生命體征變化。 結果 兩組患者OI、RI及Cdyn在T1、T2時差異無統計學意義（Pgt;0.05）；兩組患者不同時間點平均動脈壓、心率、脈搏血氧飽和度、中心靜脈壓、呼氣末CO2分壓比較差異無統計學意義（Pgt;0.05）；A組患者在T3、T4時的OI和Cdyn較B組明顯升高，RI明顯降低（Plt;0.05）；且A組患者在T3、T4時的OI和Cdyn較T1時明顯增高，RI明顯降低（Plt;0.05）。 結論 高滲氯化鈉溶液能改善術中單肺通氣患者的OI、RI及Cdyn，對肺功能有一定的保護作用。【Abstract】 Objective To observe the oxygenation index (OI), respiratory index (RI) and dynamic lung compliance (Cdyn) changes of the patients with one-lung ventilation, in order to determine if hypertonic saline has lung protective effects. Methods Sixty ASA Ⅰ-Ⅲ patients who needed one-lung ventilation during thoracotomy under general anesthesia with double-lunmen endotracheal tubes were chosen to be the study subjects. No obvious abnormalities were detected by cardiopulmonary function screening, blood test, hepatorenal function and blood coagulation examinations in these patients. They were randomly divided into hypertonic saline group (group A) and control group (group B) with 30 patients in each group. For patients in group A, 30 minutes after one-lung ventilation, infusion of 7.5% hypertonic saline solution at 2 mL/kg was carried out and completed in 15 minutes. For patients in group B, the same amount of saline solution was infused. We recorded OI, RI and Cdyn changes before the infusion (T1), on the completion of the infusion (T2), 30 minutes after the infusion (T3), and 1 hour after the infusion (T4). The changes of vital signs in patients of the two groups were compared. Results OI, RI and Cdyn were not significant different between the two groups at T1 and T2 (Pgt;0.05). Mean arterial pressure (MAP), heart rate (HR), SpO2, central venous pressure (CVP), and PetCO2 were not significant different between the two groups at all time points (Pgt;0.05). OI and Cdyn of group A patients were significantly higher than those of group B, while RI was significantly lower at T3 and T4 (Plt;0.05). Cdyn and OI of group A patients at T3 and T4 were significantly higher when compared with T1, and RI was significantly lower (Plt;0.05). Conclusion Hypertonic saline has the lung protection effect in patients with one-lung ventilation by improving OI, RI and Cdyn.
Objective To summarize the research progress of magnetic resonance quantitative technique in the iron overload of the abdominal parenchyma organ. Methods By reviewing the related literatures domesticly and abroad, the present status and progress of abdominal magnetic resonance quantitative technique and other examinations in the study of iron overload were analyzed. Results MRI multi-sequence examination technique had changed the research model of iron overload in different organs, and had important clinical significance in imaging diagnosis of abdominal parenchyma organ damage. so far, many techniques of MRI had been used in detection of iron overload, which included signal intensity measurements(including signal intensity ratio and signal intensity difference of positive and negative phases), T2/R2 measurements, T2*/R2* measurements, Dixon and its derivatization, ultrashort echo time technique and susceptibility weighted imaging (including conventional susceptibility weighted imaging and quantitative magnetic sensitive imaging). Conclusion Magnetic resonance quantitative examination technique is expected to be the first choice for detection of hepatic iron overload, and can improve the early detection rate of iron overload pancreatic damage.
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.
Objective To investigate the imaging features of Budd-Chiari syndrome (BCS) on 64 slice spiral computed tomography (64SCT) and the diagnostic value of 64SCT for BCS. Methods Twenty-nine patients diagnosed as BCS by 64SCT were retrospectively included into this study and all the patients were researched by digital substraction angiography (DSA). Two abdominal radiologists analyzed the CT imaging features of BCS, paying attention to the vascular lesion, the morphology abnormality of the liver and the degree of portal hypertension, with review of DSA findings. Results ①The accuracy of 64SCT for BCS was 93.1% (27/29), and there were 2 false positive cases and no false negative case. The accuracy of 64SCT for those patients with thrombosis of inferior vena cava (IVC) and (or) hepatic vein (HV) was high as compared to those with stenosis of IVC and (or) HV. ②The morphology abnormality of the liver included hepatomegaly (24 cases), low attenuation (27 cases) and inhomogeneous pattern of parenchymal contrast enhancement (5 patients in arterial phase and 19 patients in portal vein phase). ③The images of all the patients showed the features of portal hypertension. Conclusion The accuracy of 64SCT for BCS is satisfactory and the false negative is seldom. The 64SCT could accurately display the morphology abnormality of the liver and the compensatory circulation in BCS patients. For those patients with stenosis of IVC and (or) HV, however, the diagnostic power of 64SCT is limited.
To investigate the computed tomography (CT) characteristics and differential diagnosis of high altitude pulmonary edema (HAPE) and COVID-19, CT findings of 52 cases of HAPE confirmed in Medical Station of Sanshili Barracks, PLA 950 Hospital from May 1, 2020 to May 30, 2020 were collected retrospectively. The size, number, location, distribution, density and morphology of the pulmonary lesions of these CT data were analyzed and compared with some already existed COVID-19 CT images which come from two files, “Radiological diagnosis of COVID-19: expert recommendation from the Chinese Society of Radiology (First edition)” and “A rapid advice guideline for the diagnosis and treatment of 2019 novel corona-virus (2019-nCoV) infected pneumonia (standard version)”. The simple or multiple ground-glass opacity (GGO) lesions are located both in the HAPE and COVID-19 at the early stage, but only the thickening of interlobular septa, called “crazy paving pattern” belongs to COVID-19. At the next period, some increased cloudy shadows are located in HAPE, while lesions of COVID-19 are more likely to develop parallel to the direction of the pleura, and some of the lesions show the bronchial inflation. At the most serious stage, both the shadows in HAPE and COVID-19 become white, but the lesions of HAPE in the right lung are more serious than that of left lung. In summary, some cloudy shadows are the feature of HAPE CT image, and “crazy paving pattern” and “pleural parallel sign” belong to the COVID-19 CT, which can be used for differential diagnosis.