ObjectiveTo evaluate roles and advantages of magnetic resonance imaging (MRI) and compute.tomography (CT) in preoperative assessment for hepatic alveolar echinococcosis. MethodMRI and CT scan imaging data of 60 patients with hepatic alveolar echinococcosis underwent radical surgery were retrospectively analyzed. ResultsMRI scanning could accurately identify the peripheral zone and marginal zone of hepatic alveolar echinococcosis lesions, and CT could not accurately show the above structures. In assessment of anatomic relation between vascular and lesions, MRI findings of 52 cases were in full compliance with corresponding intraoperative findings, and 8 cases were partial compliant. However, CT findings of 35 cases were in full compliance with corresponding intraoperative findings, 13 cases were partial compliant, and 12 cases were not compliant at all. In assessment of anatomic relation between biliary and lesions, MRCP could clearly show the bile duct, bile duct stenosis location and degree; CT scanning could only show widened bile duct, but could not accurately judge bile duct dilatation. ConclusionsMRI exerts some obvious advantages in preoperative evaluation of hepatic alveolar echinococcosis, and could accurately find relation between lesions and vascular or biliary system. MRI should be used as routine examination for patients with hepatic alveolar echinococcosis.
Objective To summarize the progress in diagnosis and treatment of hilar cholangiocarcinoma at present. Methods The literatures about diagnosis and treatment of hilar cholangiocarcinoma at home and aboard were collected to make an review. Results The diagnosis of hilar cholangiocarcinoma mainly depended on serum tumor molecular markers and imaging examinations. Preoperative excision and prognostic evaluation were required, including tumor classification and staging, preoperative yellow reduction, residual liver volume assessment, and so on. Radical resection was the first choice, as well as liver transplantation, radiotherapy, chemotherapy, and photodynamic therapy could be selected according to the patient’s condition. Conclusions The appearance of new diagnosis and treatment technology promotes the clinical development of hilar cholangiocarcinoma. The integrated diagnosis and treatment mode, which is based on surgery, will become the inevitable direction of the development of hilar cholangiocarcinoma.
Objective To evaluate the diagnostic value and utility of flexible bronchoscopy in the preoperative assessment in patients with solitary pulmonary nodules (SPNs). Methods A total of 111 patients with SPNs of unknown origin treated between January and June 2016 were retrospectively enrolled. The clinical characteristics, bronchoscopy findings and surgical strategies were collected. Results In the total 111 cases, malignant and benign SPNs were 79 and 32 cases, respectively. The mean diameter of malignant SPNs was larger than that of benign SPNs [(2.04±0.58) vs. (1.70±0.75) cm, P<0.05]. Bronchoscopy identified 9 cases (8.1%) unsuspected findings. Surgeries were modified or cancelled in 3 patients (2.7%) because of bronchoscopy findings. Transbronchoscopy biopsies were performed in 26 patients, 9 of whom were diagnosed lung cancer preoperatively, with a sensitivity of 45% (9/20) and a specificity of 100% (6/6). Conclusions Flexible bronchoscopy can be contributed to diagnosis of SPN before surgery and determination of surgical strategies. It is suggested that flexible bronchoscopy could be included in the routine preoperative work-up of SPN.
A 55-year-old male patient was admitted to the hospital due to "recurrent chest pain for 8 months, with worsening symptoms for 2 weeks". After admission, comprehensive relevant examinations led to the consideration of a giant chronic left ventricular pseudoaneurysm caused by myocardial infarction with non-obstructive coronary arteries. Surgical treatment was performed at our hospital. We discuss the diagnosis and treatment of this patient.
ObjectiveTo explore potential value of three-dimensional reconstruction technique for preoperative evaluation of hepatic alveolar echinococcosis. MethodsTwenty-one cases of hepatic alveolar echinococcosis proved by postoperative pathological examination in Affiliated Hospital of Qinghai University from October 2013 to March 2014 were analyzed retrospectively. The three periods of patients’ liver dynamic thin layerCTscan images were collected and imported in three-dimensional reconstruction software by DICOM format. The volume of the virtual resected liver tissue was calculated by software, and then was compared with the actual resected liver tissue volume. ResultsThe resected liver volume was (761.94±505.77) mL and (756.19±501.78) mL in the virtual surgery and in the veritable surgery, respectively. The proportion of resected liver in the total liver was (39.27±18.75)% and (38.95±16.99)% in the virtual surgery and in the veritable surgery, respectively. The resected liver volume had no significant difference between the virtual surgery and veritable surgery (P>0.05), which a positive relation (r=0.989, P<0.001). ConclusionThe limited preliminary data in this study show that three-dimensional reconstruction technique and virtual planning system for surgery could accurately guide resection of lesion and provide preoperative guidance of accurate liver resection for hepatic alveolar echinococcosis.
Objective To establish the optimal morphological criteria combined with fibrinogen level for evaluation of lymph node metastasis in colorectal cancer. Methods A consecutive series of 690 patients who underwent curative surgery for colorectal cancer, were examined by abdominopelvic enhanced multi-slice spiral computed tomography (MSCT) scan. If regional lymph nodes appeared, the maximal long-axis diameter (MLAD), maximal short-axis diameter (MSAD), and axial ratio (MSAD/MLAD) were recorded. At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover, preoperative plasma level of fibrinogen was retrospectively examined to identify metastatic or inflammatory lymph node combined with MSCT image. Both modalities, MSCT plus fibrinogen and MSCT alone, were compared based on the pathologic findings. Results The study population consisted of 100 patients with regional lymph nodes show. No significant difference was found between metastatic and inflammatory lymph nodes in imaging characteristics (Pgt;0.05). The best cut-off value of MSAD was 6 mm for lymph node metastasis with the sensitivity of 46.8%, specificity of 68.4%, accuracy of 55.0%, PPV of 70.7% and NPV of 44.1%. The best cut-off value of MLAD was 8 mm with the sensitivity of 43.5%, specificity of 63.2%, accuracy of 51.0%, PPV of 65.9% and NPV of 40.7%. Using hyperfibrinogenemia (FIB ≥3.5 g/L) to identify small metastatic lymph node, of which MSAD lt;6 mm or MLAD lt;8 mm, showed statistical diagnostic value (Kappa=0.256, P=0.047). Compared with MSAD (6 mm) alone, MSAD (6 mm) combined with hyperfibrinogenemia had a higher sensitivity (79.0% vs. 46.8%, Plt;0.001), but a similar accuracy (66.0% vs. 55.0%, Pgt;0.05) and a lower specificity (44.7% vs. 68.4%, P=0.037). MLAD (8 mm) combined with hyperfibrinogenemia led to a greater diagnostic value in sensitivity (80.6% vs. 43.5%, Plt;0.001) and accuracy (66.0% vs. 51.0%, P=0.031) than MLAD (8 mm) alone, with a no-significantly decreasing specificity (42.1% vs. 63.2%, Pgt;0.05). Conclusions This present study recommend MSAD ≥6 mm or MLAD ≥8 mm as the optimal criteria for preoperative N staging in colorectal cancer. Moreover, the sensitivity and even accuracy could be improved by combining hyperfibrinogenemia for lymph node metastasis identification.
Objective To determine the relationship between preoperative prognostic inflammatory and nutritional index (PINI) value and short-term prognosis in colorectal cancer. Methods Patients with colorectal cancer verified by pathologically examine were prospectively enrolled from April 2009 to June 2009. Serum alpha-1-acid glycoprotein, C-reactive protein, albumin and prealbumin were examined on day 3 before operation, and the value of preoperative PINI was calculated. The relationships between preoperative PINI and patho-TNM stage, complications, quality of life, and recurrence and metastasis after operation were analyzed. Results Total 38 patients with colorectal cancer underwent radical surgery were enrolled. Preoperative PINI value was 2.17±1.27. Preoperative PINI value was correlated with TMN stage and M stage: PINI value in patients of Ⅳ stage or M1 stage, were significantly higher than those in ones of Ⅰ, Ⅱ and Ⅲ stage （P＜0.001） or M0 stage （P＜0.001）. There was no significant correlation between preoperative PINI value and preoperative complications （Pgt;0.05）. Preoperative PINI value was correlated with postoperative diet, anorexia and overall quality of life: preoperative PINI value in patients with abnormal diet, anorexia or poor quality of life, were significantly higher than those in ones with normal diet (P=0.020), no-anorexia (P=0.020) or moderate (P=0.025) and well (P=0.020) quality of life. Conclusion Preoperative PINI value is an effective index to assess the short-term prognosis of colorectal cancer.
Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) with serum amyloid A protein (SAA) or fibrinogen (FIB) on the selection of operative procedures of rectal cancer under the multidisciplinary team. Methods Prospectively enrolled 240 patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to June 2009 were randomly assigned into two groups. In one group named MSCT+SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT+FIB group, both MSCT and FIB combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed. Results According to the criteria, 234 patients were actually included into MSCT+SAA group (n=118) and MSCT+FIB group (n=116). The baseline characteristics of two groups were statistically similar (Pgt;0.05). For MSCT+SAA group, the accuracies of preoperative staging T, N, M and TNM were 72.9%, 83.1%, 100% and 80.1%, respectively. For MSCT+FIB group, the accuracies of preoperative staging T, N, M and TNM were 68.1%, 75.0%, 100% and 74.1%, respectively, and there was not a statistically significant difference (Pgt;0.05). There was also not a statistically significant difference of the accuracy of prediction to operative procedures in two groups (99.6% vs. 96.6%, Pgt;0.05). The preoperative T staging (P＜0.001), N staging (P＜0.001), TNM staging (P＜0.001), serum level of SAA (P＜0.001), serum level of FIB (Plt;0.001) and distance of tumor to the dentate line (P＜0.05) were associated to the operative procedures. Conclusions Combinative assessment of MSCT and FIB could improve the accuracy of preoperative staging and operative procedures prediction, however, it may be not superior to MSCT plus SAA.