Objective To evaluate the directional significance of SurgiCase software in free fibula mandibular reconstruction. Methods Between September 2010 and March 2012, 10 patients with mandibular defect underwent free fibula mandibular reconstruction. There were 7 males and 3 females, with an age range of 19-43 years (mean, 27 years). The extent of lesions was 7 cm × 5 cm to 16 cm × 8 cm. In each case, three-dimensional spiral CT scan of the maxilla, mandible, and fibula was obtained before surgery. The CT data were imported into the SurgiCase software and the virtual surgery planning was performed. After that, the mandibular rapid prototyping was made according to customized design. The reconstruction surgery was then carried out using these preoperative data. During actual surgery, the extent of mandibular defect was from 6 cm × 3 cm to 16 cm × 5 cm; the length of fibula which was used to reconstruct mandible was 6-17 cm; and the area of flap was from 6 cm × 5 cm to 16 cm × 6 cm. Results Preoperative data could not be applied because the intraoperative size of tumor was larger than preoperative design in 1 case of mandibular ameloblastoma, and the fibula was shaped according to the actual osteotomy location; operations were performed successfully according to preoperative design in the other 9 patients. The operation time was 5-7 hours (mean, 6 hours). Primary healing of incision was obtained, without early complications. Ten patients were followed up 1 year. At last follow-up, 8 patients were satisfactory with the appearance and 2 patients complained with unsatisfied wide facial pattern. The panoramic radiograghs showed good bone healing. The range of mouth opening was 2.5-3.5 cm. Conclusion SurgiCase software can provide precise data for free fibula mandibular reconstruction during surgery. It can be applied widely in clinic.
Objective To study the feasibil ity and rel iabil ity of the multi-plannar reformation (MPR) of multispiral CT (MSCT) in measuring the kyphosis angle (KA) after thoracolumbar fracture. Methods From December 2007 to December 2009, 45 thoracolumbar fracture patients who underwent computed radiology (CR) and MSCT were recruited. There were 32 males and 13 females with a mean age of 48 years (range, 24-63 years), including 36 simple compression fractures and 9 burst fractures. The fracture locations were T11 in 6 cases , T12 in 11 cases, L1 in 20 cases, and L2 in 8 cases. Fracture was caused by trafffic accident in 25 cases, by fall ing from height in 12 cases, and by others in 8 cases. The imaging examination was performed after 2 hours to 7 days of injury in 22 cases and after more than 7 days in 23 cases. The KA was measured on the lateral X-ray films of CR and MPR by two observers, then the measurements were done again after three weeks. The data were statistically analyzed. Results The average KA values on CR by two observers were (20.75 ± 8.31)° and (22.49 ± 9.07)°, respectively; showing significant difference (P lt; 0.05), and the correlation was good (r=0.882, P lt; 0.05). The average KA values on MPR by two observers were (16.65 ± 8.62)° and (17.08 ± 7.88)°, respectively, showing no significant difference (P gt; 0.05), the correlation was excellent (r=0.976, P lt; 0.05). The average KA values on CR and MPR were (21.61 ± 8.43)° and (16.87 ± 8.20)°, respectively; showing significant difference (P lt; 0.05), the correlation was good (r=0.852, P lt; 0.05). Conclusion It is more feasible and rel iable in measuring the KA on MRP of MSCT than CR, but the value is larger on CR.
Objective To evaluate the accuracy of pedicle guide device for the placement of the pedicle screws. Methods Pedicle guide device was designed and made for the anatomical trait of pedicle. The 3-Danatomical data of the thoracic pedicles were measured by multislice spiral CT in two embalmed human cadaveric thoracic pedicles spine(T1 -T10). Depending on transverse section angle(TSA) and sagittal section angle(SSA) of pedicle axis, the degree of horizontal dial and sagittal dial were adjusted in the guide device. The screws wereinserted bilaterally in the thoracic pedicles by using the device. After pulling the screws out, the pathways were filled with contrast media. The TSA and SSA of developed pathways were measured. Results Analysis of the difference between pedicle axis and developed pathway was of no statistical significance(P＞0.05). Conclusion The guide device could be easilyoperated and guarantee high accuracy of the pathways of screws and the incidence of pedicle penetration could be significantly reduced.
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 summarize controversy and progress of multi-slice spiral CT in efficacy evaluation of transformation therapy for advanced gastric cancer.MethodThe recent studies published at home and abroad on the spiral CT in evaluating the therapeutic effect of transformation therapy for the advanced gastric cancer were reviewed and analyzed.ResultsIn recent years, though the energy spectrum and dual-energy CT examinations had appeared, the most common tool in evaluating of the efficacy of transformation therapy for the advanced gastric cancer was the spiral CT. The most common evaluation standard was still the RECIST standard.ConclusionsSpiral CT has its outstanding diagnostic significance in therapeutic evaluation of transformation therapy for advanced gastric cancer. Although there is some controversy, with advancements of a large number of studies, it will greatly help diagnosis and treatment of advanced gastric cancer.
Objective To compare diagnosis values of computed tomography (CT) and magnetic resonance imaging (MRI) in preoperative staging of rectal carcinoma. Methods The imaging data of 81 patients with rectal carcinoma from January 2013 to January 2017 in the Hefei Second People’s Hospital were retrospectively analyzed. Based on the postoperative pathological results, the diagnostic accordance rates of CT and MRI on the T staging and N staging were calculated. Results The sensitivities of the CT and MRI on the preoperative T staging of rectal carcinoma were 69.1% (56/81) and 82.5% (52/63), the difference was not statistically significant (χ2=3.396, P=0.065), the Kappa values was 0.521 and 0.371, respectively, the MRI on the T staging was in a good agreement with the pathological diagnosis. The sensitivitie of the T1-2, T3, and T4 stagings with CT was 70.0%, 66.7%, and 72.0%, respectively, with MRI was 83.3%, 83.3%, and 81.0%, respectively, which had no significant difference respectively between the CT and the MRI. The areas under the receiver operating characteristic curve of the T1-2, T3, and T4 stagings with the CT and MRI were 0.809, 0.689, 0.798 and 0.897, 0.826, 0.869, respectively. The sensitivities of the CT and MRI on the preoperative N staging of rectal carcinoma were 59.3% (48/81) and 65.1% (41/63), the difference was not statistically significant (χ2=0.509, P=0.476), the Kappa values were 0.371 and 0.463, respectively. The sensitivities of the N0, N1, N2 stagings with CT were 64.7%, 45.5%, 64.0%, with MRI were 70.3%, 63.2%, 72.5%, which had no significant difference respectively between the CT and the MRI. Conclusions Results of in this study show that MRI is superior to CT for judgment of tumor infiltration. Neither CT nor MRI is able to provide satisfactory assessment of lymph node metastasis.
ObjectiveTo explore the correlation between coronary artery plaque composition and the gender via 128-slice spiral CT coronary angiography (128-SCTCA). MethodsBetween January and December 2012, 143 patients with coronary artery plaque diagnosed by 128-SCTCA were selected. The patients were divided into group A (no more than 50 years old, n=37) and group B (over 50 years old, n=106). ResultsThere were 29 male patients in group A, with 70 plaques including 30 fibrous plaques, 17 mixed plaques, 11 soft plaques, 12 calcified plaques; and the other 8 female patients had 13 plaques including 7 fibrous plaques, 2 mixed plaques, 2 soft plaques, and 2 calcified plaques. In group B, 56 male patients had 116 plaques, including 48 mixed plaques, 40 fibrous plaques, 14 soft plaques and 14 calcified plaques; the other 50 female patients had 90 plaques, including 36 mixed plaques, 22 fibrous plaques, and 16 soft plaques and calcified plaques. The differences of the plaque composition between males and females were not significant both in group A (χ2=0.664, P>0.05) and group B (χ2=3.708, P>0.05). ConclusionThere is no obvious correlation between gender and coronary plaque composition.
Objective To explore the manifestations and features of multi-slice spiral CT （MSCT） in the diagnosisof papillary thyroid carcinoma （PTC）. Methods Preoperative MSCT data of 35 cases of PTC proved by operation and pathology in our hospital form May. to Jun. in 2013 were observed retrospectively， to analyze the manifestations and characteristics of MSCT for it. Results Of 35 patients with PTC， MSCT totally showed 48 lesions， 68.6% （24/35） of patients with single lesion， 31.4% （11/35） of patients with 2-3 lesions， and 62.9% （22/35） of patients with lymph node metastasis. Of the 48 lesions， 29.2% （14/48） of lesions located in the left lobe， 70.8% （34/48） of lesions located in the right lobe；the lesions’ maximum diameter were 0.4-5.8cm， with the average maximum diameter of 1.3cm. There were 39.6% （19/48） of lesions with uneven density， 25.0% （12/48） of lesions with irregular shape， 47.9% （23/48） of lesions with blurred edges， 18.8% （9/48） of lesions had papillary enhanced tumor nodules， 10.4% （5/48） of lesions had peritumoral incomplete enhanced ring sign， 22.9% （11/48） of lesions invaded surrounding tissue or organs. There were 35.4% （17/48） of lesions had calcification， in which 76.4% （13/17） of lesions were fine granular calcification， 11.8% （2/17） of lesions were mixed calcification， and 11.8% （2/17） of lesions were coarse calcification. Conclusion MSCT manifestations of PTC have certain characteristics， which can provide imaging basis for clinical treatment options.
【Abstract】ObjectiveTo describe the imaging manifestations of acute necrotizing pancreatitis (ANP) on multidetectorrow spiral CT (MDCT). To investigate the relationship between pancreatic glandular necrosis and retroperitoneal inflammatory spreading and the clinical severity of ANP. MethodsA 16detector row spiral CT was used to perform contrastenhanced abdominal scanning in 90 patients diagnosed as ANP， who were prospectively enrolled into this study. Scoring of the extent of pancreatic glandular necrosis and Balthazar grading based on retroperitoneal inflammatory spreading were done at the same time. For 44 patients who met the criteria of Ranson scoring, both scoring by CT severity index (CTSI) and Ranson criteria. Multiplanar reformation technique was used for image postprocessing. Results①In 40 out of 90 patients, the pancreatic glandular necrosis was less than 30%, in 23 the necrosis was between 30%-50%, and in 27 the necrosis was more than 50%. Peripancreatic fat swelling and thickening of anterior renal fascia were observed in all cases of ANP; Peripancreatic and retroperitoneal phlegmonous fluid collection occurred in 78 patients (86.7%); 12 had fluid collection in lesser sac (13.3%); Thickening and swelling of posterior gastric wall in 71 patients (78.9%); 87 developed intestinal ileus (96.7%) and 35 patients had peritoneal effusion (38.9%); Splenic infarction in 4 patients (4.4%); 82 had pleural effusion (91.1%). ②Twelve patients were classified as Balthazar grade C， 42 as grade D and 36 as grade E. There was a statistically significant positive correlation between the extent of pancreatic glandular necrosis and Balthazar CT grade. ③In 44 ANP patients suitable for Ranson criteria, 12 cases were classified as mild (27.3%), 23 as moderate (52.3%), 9 as severe (20.5%). CTSI grading of these patients was as follows： Mild cases 0, moderate cases 25 (56.8%), severe cases 19 (43.2%). Correlation between the CTSI grades and the clinical severity of ANP was of statistical significance. ConclusionANP can demonstrate a series of imaging manifestations on MDCT. To some extent, the degree of pancreatic glandular necrosis and the extent of retroperitoneal spreading is positively correlated, and CTSI grading based on MDCT imaging features is also positively correlated with the clinical severity of ANP.
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.