Objective To investigate the CT manifestation and clinical significance of the gastrointestinal tract involvement in acute pancreatitis (AP). Methods Two hundreds CT scans in 131 patients with acute pancreatitis between Jan. 1, 2009 and Jun. 30, 2009 were included into the study. Two radiologists analyzed the images retrospectively, paying attention to the CT features of the gastrointestinal tract involvement, such as the style, distribution, and so on. The correlation between gastrointestinal tract involvement and CT severity index, clinical severity grading, and turnover of acute pancreatitis were studied using a SPSS 14.0 for windows statistics software. Results The CT images in 109 (83.2%) patients showed gastrointestinal tract involvement, which distributing mainly stomach, duodenum, jejunum, and transverse colon, and showing mainly the gastrointestinal tract wall thickening and distension. The gastrointestinal tract involvement had positive correlation with CT severity index, clinical severity grading, and turnover of acute pancreatitis (r=0.689， P=0.000; r=0.584， P=0.000; r=0.346， P=0.000). Conclusions The gastrointestinal tract involvement is common complication in acute pancreatitis and concerns with severity and prognosis of the disease. As other extrapancreatic organs involvement, the gastrointestinal tract involvement has important value for severity assessment, prognosis evaluation, and therapeutic effect monitoring of acute pancreatitis.
ObjectiveTo investigate the value of rectumaerated MSCT examination in diagnosis of mesorectal infiltration of rectal cancer and lymph node metastasis staging. MethodsFrom January 2010 to July 2010, the data of 68 patients with rectal cancer confirmed by pathology were analyzed in the First Affiliated Hospital of Liaoning Medical University. All the patients underwent rectumaerated MSCT preoperatively and postoperative pathology was taken as the gold standard for evaluation of the accuracy, sensitivity, specificity, positive or negative predictive values of MSCT in diagnosis of mesorectal infiltration and lymph node metastasis.ResultsIn rectum-aerated MSCT scanning, rectum and sigmoid colon was fully expanded, perirectal fat space was clear between perirectal fat space and relatively high density rectal wall and very low density enteric cavity. For mesorectal infiltration of degree Ⅰ, Ⅱ, and Ⅲ, the accuracies were 92.6%（63/68）, 91.1%(62/68), and 95.6%(65/68), respectively; sensitivities were 91.2%(31/34), 85.0%(17/20), and 92.9%(13/14), respectively; specificities were 94.1%(32/34), 93.8%(45/48), and 96.3%(52/54), respectively; positive predictive values were 93.9%(31/33), 85.0%(17/20), and 86.7%(13/15), respectively; negative predictive values were 91.4%(32/35), 93.8%(45/48), and 98.1%(52/53), respectively. For lymph node metastasis in N0, N1, and N2, the accuracies were 92.6%(63/68）,85.3%(58/68）, and 92.6%(63/68）, respectively; sensitivities were 86.2%(25/29), 90.0%(27/30), and 66.7%(6/9), respectively; specificities were 97.4%(38/39), 81.6%(31/38), and 96.6%(57/59), respectively; positive predictive values were 96.2%(25/26), 79.4%(27/34), and 75.0%(6/8), respectively; negative predictive values were 90.5%(38/42), 92.1%(35/38), and 95.0%(57/60), respectively. ConclusionsRectumaerated MSCT scaning can clearly show the depth of rectal carcinoma infiltration in the mesorectum, and N staging of mesorectal lymph node metastasis of MSCT has a higher consistency with that of pathological staging. Rectumaerated MSCT scanning is an important referenced method for clinical preoperative staging and individualized chemotherapy regimen.
【Abstract】Objective To investigate the imaging features of malignant invasion of major intrahepatic ductal structures (the portal and hepatic venous vasculature, the bilie duct) by primary hepatocellular carcinoma (HCC) using multidetector-row spiral CT (MDCT). Methods We retrospectively analyzed 68 documented HCC patients with tumorous invasion of the major intrahepatic ductal structures who had undergone contrast-enhanced dual-phase MDCT scanning of the upper abdomen.The morphological changes of the portal and hepatic venous vasculature, the bile duct, and the liver parenchyma at both the hepatic arterial phase and portal venous phase images were carefully observed and recorded. Results Among the 68 patients, 47 patients had malignant invasion of the intrahepatic portal venous vessels with secondary tumor thrombus formation; 12 patients had tumor involvement of the hepatic veins and intraheptic segment of the inferior vena cava; Tumor invasion of the bile duct was seen in 9 patents. The direct CT signs of tumor invasion of intrahepatic venous vessels included: ①dilatation or enlargement of the involved vein with intraluminal softtissue “filling defect”； ②enhancement of the tumor thrombus at hepatic arterial phase, the so-called “venous arterialization” phenomenon. The indirect CT signs included: ①arterial-venous shunt, ②early and heterogeneous enhancement of the hepatic parenchyma adjacent to HCC focus, ③cavernous transformation of the portal vein. The CT signs suggesting tumor invasion of the bile duct included: ①dilation of the bile ducts near or proximal to HCC lesion, ②soft-tissue nodule or mass inside the bile ducts. Conclusion Invasion of major intrahepatic ductal structures by HCC will present corresponding CT imaging features. Contrast-enhanced MDCT dualphase scanning combined with appropriate image postprocessing techniques can better evaluate the malignant invasion of major intrahepatic ductal structures.
【Abstract】ObjectiveTo study the spiral CT features of gastrointestinal invasion by carcinoma of gallbladder. MethodsEight patients with surgical-pathologically documented gastrointestinal invasion by carcinoma of gallbladder were analyzed retrospectively. All patients underwent plain and contrast-enhanced dual-phase scanning of the abdomen. Oral contrast medium (1.2% Angiografin) was used to fill the gastrointestinal tract before CT scanning. ResultsThere were 2 cases of gastric antrum invasion, 6 duodenal invasion and 3 colonic invasion according to the surgical and pathological findings. Spiral CT correctly diagnosed 2 gastric invasion and 4 duodenal invasion based on several imaging features, like blurring of fat plane, focal wall thickening and luminal narrowing of involved gastrointestinal segments, and mass formation. However CT was unable to diagnose the 3 cases of hepatic flexure of colon invasion. ConclusionCT is valuable for diagnosing upper gastrointestinal tract invasion by carcinoma of gallbladder, yet the diagnosis of hepatic flexure of colon invasion is still difficult.
【Abstract】Objective To study the CT features of peritoneal Metastasis in postoperative patients of ovarian carcinomas. Methods CT appearance of peritoneal metastasis of ovarian carcinomas proved by surgery and pathology in 33 postoperative patients were reviewed. The CT features of the foci were recorded and analyzed, especially on the location, quantity, density and size.Results In the peritoneal cavity, 186 implant foci and 10 recurrent foci were found. metastasis often occurred in the right upper abdomen, especially the right subphrenic spaces. The most frequent locations were the right suprahepatic and subhepatic spaces, the small bowel mesentery, the gastrocolic ligament and the omentum. The density of the foci was most of solid. The size was ranged from 0.5~13 cm. Conclusion Peritoneal metastasis is the most frequent route of metastases for ovarian carcinomas. It is frequently found in upper abdomen, especially in the subphrenic spaces. Localized ascites in the peritoneal cavity is another important sign suggesting peritoneal implants. CT scan from the diaphragm to the pelvic floor will be helpful to diagnose peritoneal implants in cases of postoperative ovarian carcinomas.
【Abstract】Objective To investigate the CT imaging features of metastatic hepatic adenocarcinomas from the digestive tract by using multidetectorrow helical CT (MDCT) with pathological correlation. Methods CT and clinical data of 36 patients with pathologically proven metastatic hepatic adenocarcinomas from the digestive tract were retrospectively reviewed. The primary tumors included 10 cases of gastric cancer, 1 duodenal cancer, 18 colonic carcinoma, 7 rectal cancer. All patients underwent MDCT plain scan and contrastenhanced dualphase scanning of upper or whole abdomen. The appearances of hepatic metastatic lesions on MDCT images at various enhancement phases were carefully observed. Results On plain CT scan 32 cases （88.9%） presented multiple nodules of low density at different sizes, 3 cases （8.3%） showed a single low-density nodule, and 1 case presented with a cystic mass. On contrast-enhanced scan, 4 cases (11.1%) showed faintly enhanced rim around the nodules on arterial phase; on portal venous phase 29 cases (80.6%) presented slight ringlike enhancement at the periphery of the nodule while the nodule core was markedly hypodense with intermediate soft tissue density area in between, giving rise to the typical appearance of “bull’seye” sign. Three cases (8.3%) showed no enhancement on either phase images. Conclusion The ring-like enhancement and the appearance of “bull’s-eye” on portal venous phase was characteristic CT features of metastatic hepatic adenocarcinoma from digestive tract.
ObjectiveTo investigate the radiological appearances of postoperative complications after living donor liver transplantation for patients with hepatocellular carcinoma under multi-detector row spiral computed tomography (MDCT) and magnetic resonance imaging (MRI) examination. MethodsThirty-nine imaging data in 20 patients with hepatocellular carcinoma after living donor liver transplantation from January 2008 to June 2010 in the West China Hospital were included and analyzed by two radiologists respectively. The relations between the types of complications and radiological appearances were especially recorded. ResultsAll the cases experienced complications to different extent. Common surgical complications occured in 20 cases, including pertitoneal fluid collection (14 cases), pneumoperitoneum (2 cases), swelling of peritoneum, omentum, and mesentery (1 case), abdominal wall swelling (2 cases), pleural effusion (9 cases), and pericardial fluid collection (2 cases). Hepatic vascular complications involved hepatic artery in 3 cases, portal vein in 5 cases. Biliary complications presented in 7 cases, including anastomotic stenosis of biliary duct (6 cases) and bile leak (1 case). Graft parenchymal complications included intrahepatic lymph retention (11 cases), infarction (3 cases), and infection (2 cases). Intrahepatic recurrence in 5 cases, intraperitoneal metastasis in 3 csses and pulmonary metastasis in 2 cases. ConclusionMDCT and MRI have important diagnostic values for postoperative complications after living donor liver transplantation for patients with hepatocellular carcinoma.
Objective To investigate the value of the multi-detector row spiral CT (MDCT) and 3-dimensional reconstruction technique for adult intussusception. Methods Twenty-one patients with surgically and clinical following-up confirmed intussusception were retrospectively included into this study. Three patients had plain MDCT scan, 18 received contrast enhanced MDCT scan. The original images were reconstructed with multi-planar reconstruction (MPR) technique and all the images of 21 patients were divided into original image group and original image add MPR image group. Two abdominal radiologists analyzed the MDCT imaging and recorded respectively the accuracy rate and the confidence index of the doctor about following indexes: whether or not having intussusception, the location of intussusception, finding reason caused intussusception, whether or not having bowel wall ischemia and whether or not having bowel obstruction. The accuracy rate and the confidence index of the doctor were compared using a SPSS statistics software. Results The accuracy rates about above indexes between original image group and original image add MPR image group were 90.5% (19/21) vs. 100% (21/21), 81.0% (17/21) vs. 95.2% (20/21), 85.7% (18/21) vs. 90.5% (19/21), 90.9% (10/11) vs. 90.9% (10/11) and 100% (11/11) vs. 100% (11/11) respectively, and there was no significant difference between original image group and original image add MPR image group (Pgt;0.05). For following indexes: whether or not having intussusception, the location of intussusception, finding reason caused intussusception, the confidence index of the doctor between original image add MPR image group and original image group had significant difference (5.00 vs. 4.24, 4.76 vs. 4.29, 4.29 vs. 3.71), and the confidence index of the doctor of original image add MPR image group exceeded that of original image group (Plt;0.05). Conclusions MDCT plays a valuable role in diagnosis and location of intussusception, finding the reason caused intussusception and evaluation the hemodynamic impairment of being involved in bowel wall. Compared to simple axial image, axial image combine 3-dimensional reconstructed image can increase the diagnostic confidence of the doctor.
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.
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.