目的:研究多層螺旋CT多平面圖像重組技術(multiplanar reformation,MPR)對肺部病變定位診斷的價值。方法:398例患者行胸部多層螺旋CT薄層掃描后,采用MPR技術將橫斷面圖像重組,分別獲得矢狀和冠狀位的MPR圖像。三位高年資醫師分別在橫斷和矢冠狀重組圖像上確定病變部位,兩位或兩位以上均診斷為同一位置者確定為病變部位,納入統計分析。所有資料用χ2檢驗。結果:398例中,矢冠狀重組圖像組無定位診斷錯誤,橫斷圖像組有22例定位診斷錯誤。兩者間差異無統計學意義(Pgt;005)。結論:多層螺旋CT MPR圖像定位準確性較高,對少數橫斷圖像難以定位的病變可加作MPR重組圖像。
ObjectiveTo evaluate the predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with multislice computed tomography (MSCT) in the evaluation of neoadjuvant chemotherapy (NACT) for breast cancer. MethodsThe clinical, imaging, and pathological data of breast cancer patients who received NACT in the Affiliated Hospital of Southwest Medical University from February 2019 to August 2021 were retrospectively collected. Based on the results of postoperative pathological examination, the patients were assigned into significant remission (Miller-Payne grade Ⅰ–Ⅲ) and non-significant remission (Miller-Payne grade Ⅳ–Ⅴ). The variables with statistical significance by univariate analysis or factors with clinical significance judged based on professional knowledge were included to conduct the logistic regression multivariate analysis to screen the risk factors affecting the degree of pathological remission after NACT. Then, the screened risk factors were used to establish a prediction model for the degree of pathological remission of breast cancer after NACT, and the efficacy of this model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) curve. ResultsAccording to the inclusion and exclusion criteria, a total of 211 breast cancer patients who received NACT were collected, including 116 patients with significant remission and 95 patients with non-significant remission. Logistic regression multivariate analysis results showed that the human epidermal growth factor receptor 2 positive, lower early enhancement rate after NACT, lower arterial stage net increment after NACT, and lower CT value of arterial phase of lesions would increase the probability of significant remission in patients with breast cancer after NACT (P<0.05). The area under the ROC curve of the model for predicting the degree of pathological remission of breast cancer after NACT was 0.984, the specificity was 93.7%, and the sensitivity was 95.7%. The calibration curve showed that the model result fit well with the actual result, and the DCA result showed that it had a high clinical net benefit value. ConclusionFrom the results of this study, DCE-MRI combined with MSCT enhanced scanning has a good predictive value for pathological remission degree after NACT for breast cancer, which can provide clinical guidance for further treatment.
ObjectiveTo study the application value of multi-slice CT portography (MSCTP) in the diagnosis and evaluation of esophageal and gastric varices (EGV) caused by cirrhosis. MethodsPatients with cirrhosis diagnosed between September 2009 and December 2012 were screened in this study. And the consistency of MSCTP and digestive endoscopy in the diagnosis, classification and grading of EGV in cirrhosis were evaluated. ResultsA total of 78 patients were included in this study, and there were 55 patients with EGV diagnosed by endoscopy, including 35, 16 and 4 patients with GOV1, GOV2 and IGV1 respectively by Satin type standards; and the number of patients with mild, moderate and severe EGV by general grading standards was 2, 15, and 37, respectively. In this cohort, the findings of MSCTP examination also showed that 58 patients had EGV, including 36, 17, 4 and 1 patients with GOV1, GOV2, IGV1 and IGV2 by Satin type standards; and the number of patients with grade I,Ⅱ andⅢ EGV by Kim grading standards was 5, 16 and 37, respectively. Statistical analysis showed that there was a high consistency between endoscopy and MSCTP in the diagnosis (Kappa=0.712, P=0.000), typing (Kappa=0.732, P=0.000) or grading (Kappa=0.863, P=0.000) of EGV. ConclusionMSCTP has a high application value in the diagnosis and severity evaluation of EGV in patients with cirrhosis.
摘要:目的:研究胸腺瘤與前縱隔(血管前間隙)淋巴瘤的MSCT表現,提高對二者的診斷與鑒別診斷能力。方法:回顧性分析經手術病理證實的30例胸腺瘤與18例血管前間隙淋巴瘤MSCT表現,著重觀察腫瘤的密度、形態及其與周圍結構的關系。結果:30例胸腺瘤中,24例良性胸腺瘤與鄰近大血管分界清晰,腫塊表現 “D”字或反“D”字狀,平掃CT值16~59 Hu,增強CT值20~110 Hu;6例侵襲性胸腺瘤邊界不清,呈分葉狀、不規則形,密度不均,平掃CT值23~42 Hu,增強CT值23~60 Hu。18例淋巴瘤中,單發于前上縱隔者6例,其余12例呈多結節、腫塊狀,侵入血管間隙生長,致大血管受壓,增強掃描呈輕度強化,常伴有其它部位淋巴結增大。結論:MSCT能清晰顯示胸腺瘤與前縱隔淋巴瘤的影像學表現特征,并能有效提高對二者的鑒別診斷。Abstract: Objective: To diagnosis and differentiate thymoma and malignant lymphoma in the anterior mediastinum on the basis of multislice CT (MSCT) imaging features. Methods:We retrospectively reviewed 30 cases with thymoma and 18 cases with malignant lymphoma proven by surgery and pathology.More attention was put on the density, morphology and relation with the surrounding structures of the tumors. Results: The CT manifestations of 30 cases of thymoma were shown as: For 24 cases of benign thymoma, the boundaries were clear, the shapes were “D” signs or contra“D” signs, CT attenuation value were 1659Hu and 20110Hu on unenhanced and contrastenhanced scanning. For 6 cases of malignant thymoma, the boundaries were unclear, the shapes were lobulated or irregular, the density was heterogeneous, CT attenuation value were 2342Hu and 2360Hu on unenhanced and contrastenhanced scanning. For 18 cases of malignant lymphoma, 6 cases were located at anterior mediastinum, 12 cases were nodes or multiple mass, enveloped the neighboring vessel structures, mildly enhanced on contrastenhanced scanning, and associated with enlargement of lymph nodes in other place. Conclusion: MSCT can display the imaging features of thymoma and anterior mediastinal lymphoma, and effectively differentiate thymoma and mediastinal lymphoma.
ObjectiveTo investigate the vaules of multi-slice spiral CT (MSCT) in diagnosing metastatic lymph nodes and judging N stage of resectable gastric cancer. MethodsFifty-nine patients with gastric cancer performed preoperative MSCT plain scan and triple enhanced scans from February 2019 to March 2021 in the First People’s Hospital of Wuhu City were collected. The results of postoperative pathology were taken as the gold standard, the short diameter, long diameter, short to long diameter ratio, CT values of triple enhanced scans and lymphatic hilar blur were compared between the metastatic lymph nodes and the non-metastatic lymph nodes. ResultsThe preoperative MSCT showed that there were 50 cases of metastatic lymph nodes and 9 cases of non-metastatic lymph nodes in 59 patients with gastric cancer. A total of 1 467 lymph nodes were harvested, including 562 metastatic lymph nodes and 905 non-metastatic lymph nodes. The short diameter, long diameter, short to long diameter ratio, and the CT values of plain scan, arterial phase, portal vein phase, and delayed phase of metastatic lymph nodes were higher than those of non-metastatic lymph nodes (P<0.05), and the incidence of lymphatic hilar blur was also higher than that of non-metastatic lymph nodes (P<0.05). Referring to the results of postoperative pathological examination, the accuracies of MSCT in judging of N0, N1, N2, N3a, and N3b stages were 88.9% (8/9), 83.3% (5/6), 85.7% (12/14), 92.3% (12/13), 88.2% (15/17), respectively, and the total accuracy was 88.1% (52/59), the specificity was 96.6% (57/59), and the sensitivity was 91.2% (52/57). ConclusionAccording to this study results, preoperative MSCT has higher specificity, sensitivity, and accuracy in diagnosing metastatic lymph nodes and judging N stage of resectable gastric cancer.
ObjectiveTo explore the differences and similarities of the featurs of lymph node metatasis of abdominal esophageal carcinoma and cardiac cancer. MethodsPreoperative CT images of abdominal esophageal carcinomas and cardiac cancers were reviewed and analysed on lymph node size and preponderant distribution. ResultsShort diameter ≥10 mm of lymph node at CT was adopted as metastasis criterion. The detection rates of abdominal esophageal carcinomas and cardiac cancers were 73.5%（144/196） and 83.7% （170/203）, respectively. Thoracic lymph node metastasis rate of abdominal esophageal carcinomas was 11.1% （4/36） in 7 area, 27.8% （10/36） in 8 area, 8.3% （3/36） in 9 area, while celiac lymph node metastasis rate was 36.1% (13/36 ） in No.7 group, 19.4% （7/36） in No.1 group, and 11.1% （4/36） in No.2 group primarily. Lymph node metastasis rate of cardiac cancers was 17.9% （5/28） in No.1 group, 28.6% （8/28） in No.2 group, 39.3% （11/28 ） in No.3 group, and 25.0% （7/28） in No.4 group for the first stop lymph nodes, and 35.7% （10/28 ） in No.7 group for the second stop primarily. ConclusionAs metastasis criterion, short diameter ≥10 mm of lymph node at CT is feasible, but there exist certain falsepositive rate. Thoracic lymph node metastasis of abdominal esophageal carcinomas is mainly in the 7, 8, and 9 area, while celiac metastasis is mainly in No.7, No.1, and No.2 groups. Lymph node metastasis of cardiac cancers is in No.1, No.2, No.3, No.4, and No.7 group primarily.
目的:探討螺旋CT對腹壁疝的診斷價值和臨床意義。方法: 收集被手術證實的腹壁疝86例,術前均進行螺旋CT檢查。觀察腹壁疝的部位、數目、疝囊大小、疝內容物及并發癥。結果: 86例腹壁疝中,腹股溝斜疝38例(雙側7例),腹股溝直疝8例,腹壁切口疝19例,造瘺口疝6例,閉孔疝3例,臍疝8例,白線疝2例,雙側腹股溝斜疝伴右下腹壁切口疝1例,雙測腹股溝斜疝伴左下腹壁造瘺口疝1例。疝囊直徑在5cm以下者45例, 6~10cm者38例, 10cm以上者3例,腹壁疝伴小腸不全梗阻者21例,切口疝伴感染1例。螺旋CT可以顯示腹壁疝的種類、數目、疝囊大小、疝內容物類型及存在的并發癥.結論: 螺旋CT是腹壁疝的一種非常有效的檢查方法,可以為外科綜合評價患者病情及進行有效手術治療提供重要依據。
ObjectiveTo analyze the multidetector computed tomography (MDCT) findings of normal appendices and appendices of acute appendicitis in old patients, and to explore the clinical value of MDCT in assessing acute appendicitis in old patients. MethodsSixty-six cases of acute appendicitis confirmed by surgery in 24 hours after MDCT scan from Jun. to Oct. 2016 (acute appendicitis group), and 40 cases underwent MDCT scan for non-abdominal pain causes without appendiceal lesions from Sep. to Oct. 2016 (normal appendices group), were included, and the MDCT images of both 2 groups were retrospectively analyzed. Observation items included:location, diameter, mural thickness, intra-luminal contents, and changes of surrounding structures. Results① Rate of appendices visualization. In total of 95.5% (63/66) appendices were visualized on MDCT in acute appendicitis group, while 95.0% (38/40) appendices were visualized on MDCT in normal appendices group (P > 0.05). ② Locations of appendices. Acute appendicitis group:appendices were found to be located at pelvic cavity in 22 cases, in front of ileum in 2 cases, behind ileum in 10 cases, below cecum in 25 cases, and behind cecum in 4 cases. Normal appendices group:appendices were found to be located at pelvic cavity in 15 cases, in front of ileum in 3 cases, behind ileum in 7 cases, below cecum in 5 cases, and behind cecum in 8 cases. There was significant difference between 2 groups in terms of location of appendices (P < 0.05). The appendices in acute appendicitis group located mainly at pelvic cavity and below cecum, while the appendices in normal appendices group located mainly at pelvic cavity. ③ The diameter and thickness of appendices. The appendiceal diameter and thickness in acute appendicitis group were (11.4±4.2) mm (6.2-21.9) mm and (4.3±2.2) mm (1.1-8.6) mm, respectively, while those in normal appendices group were (6.1±1.4) mm (3.7-8.6) mm and (1.7±0.8) mm (0.5-3.2) mm, respectively. The diameter and thickness of appendices in acute appendicitis group were significantly greater than those in normal appendices group, respectively (P < 0.05). ④ Contents of appendices. Acute appendices group:there was effusion with air in 14 cases in appendiceal cavity, full of effusion in 36 cases, and appendicolith combined with effusion in 13 cases. Normal appendices group:there was full of air in 15 cases in appendiceal cavity, air with a little faeces of higher density in 13 cases, and nothing in 10 cases. Effusion was more common in appendiceal cavity in acute appendicitis group, while air was more common in normal appendices group. ⑤ Around appendices. Fat stranding was seen in 57 cases, adjacent parietal peritoneum thickening was seen in 56 cases, focal effusion was seen in 18 cases, abscess was seen in 2 cases, free air in peritoneal cavity was seen in 8 cases, and lymphadenopathy was seen in 35 cases. None of these imaging features were seen in normal appendices group. ConclusionsMDCT can demonstrate features of normal appendices and acute appendicitis in old patients. MDCT yield high diagnostic accuracy in acute appendicitis in old patients, and can provide useful information before surgery.
【Abstract】ObjectiveTo study the CT features of bare area involvement in gastric carcinoma and their anatomicpathological basis, and to evaluate the role of multi-detector CT in the diagnosis of bare area involvement. Methods In 196 consecutive gastric carcinoma cases, 56 were found bare area involvement and divided into proximal gastric carcinoma (PGC) group and distal gastric carcinoma (DGC) group according to anatomic position of primary tumor. CT images and incidence of gastric bare area (GBA) involvement in the PGC group were observed and compared with those of DGC group. Results The lesion appeared as nodule or mass in bare area in 46 cases and as metastatic lymphadenopathy in 10 cases. CT features of GBA involvement included: ① widening of gastric bare area and blurring or obliteration of the thin fat strip between gastric wall and diaphragm; ② irregular mass with heterogeneous enhancement or round lymph nodes in GBA; ③ irregular thickening of left diaphragmatic crus or gastrophrenic ligament with blurring border to the mass; ④ other metastatic lymph nodes in subphrenic extroperitoneal space. The incidence of GBA involvement in PGC group was 70.0%(42/60), significantly difference from those in DGC group (10.3%,14/136) ,P=0.025. Conclusion The incidence of GBA involvement in PGC group is significantly higher than those in DGC group. Multidetector CT is very useful for preoperative imaging evaluation of bare area involvement and lymphatic spread.
Objective To compare the bronchial arteriography through multidetector-row CT (MDCT) with the digital subtraction angiography (DSA) via femoral artery, and evaluate the application value of bronchial arteriography through MDCT in the diagnosis and treatment of hemoptysis. Methods 133 cases complained of hemoptysis were examined by MDCT and DSA via femoral artery respectively to perform bronchial arteriography, and the differences of image results by two methods were compared. Results 129 cases with abnormal bronchial arteries were confirmed by DSA via femoral artery, 117 cases were checked by MDCT [ the positive rate was 90.7% (117/129 ) ] . 117 cases with abnormal bronchial arteries were confirmed by both MDCT and DSA via femoral artery and 4 cases did not detected any abnormal arteries by both methods. The coincidence rate of two methods was 91.0% (121 /133) . MDCT and DSA via femoral artery showed the similar origins of abnormal bronchial arteries. The coincidence rate of two methods was 100% . Conclusions There is a high coincidence rate betweenMDCT and DSA in detecting bronchial artery abnormalities. MDCT shows the origins of abnormal vessels clearly which could be a fist-choice of routine imagination for interventive operation.