Objective To discuss the value of 64-slice spiral CT （MSCT） in diagnosis of gastric stromal tumor （GST）. Methods Thirty-two patients proved GST by surgery and pathology from May 2010 to August 2011 in West China Hospital, Sichuan University were classified by Fletcher malignancy degree classification，the CT features including the location，size，boundary，shape，density，growth pattern，metastases，and enhancement and its relationships to GST malignancy degree were analyzed retrospectively. Results All 32 cases were single lesion，the accuracy of CT in localization was 100%. Nine cases were intra-luminal，10 were extra-luminal，and 13 were both intra- and extra-luminal growth. Nine cases were in low degree group，with diameter＜5cm，round or oval in shape，clear border, homogenous density and enhancement （7/9）；Twenty-three cases were in high degree group，with diameter ≥5cm in 19 cases，irregular in shape and indistinct bourdry （18/23），heterogeneous density （20/23） with necrosis，ulcer was seen in 6 cases. Three cases in high malignance degree group showed pancreas and spleen involvements，2 cases of left diaphragm involvement，1 of omentum metastasis，2 of liver metastases，and 1 of lymph node metastasis. Conclusions MSCT is the optimal method to exam GST，there is correlation between the CT features and malignancy degree，MSCT is helpful for analyzing malignancy degree preoperation.
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.
ObjectiveTo evaluate the CT features of coronary artery aneurysm by coronary artery imaging on 128 slice CT and dual source CT (CTCA). MethodsA total of 1 108 cases were prospectively examined using CTCA between March 2011 and April 2014. With volume rendering, maximum intensity projection, multiplanar reconstruction and surface reconstruction, we observed the coronary artery morphology and vascular wall condition. ResultsThree cases of coronary artery aneurysm were found. In case one, the anterior descending branch (LAD) had grape-like prominency segmentally; in case two, LAD and left coronary circumflex branch (LCX) and right coronary artery (RCA) had diffuse dilation with local shuttle expansion; in case three, left main, LAD and LCX and RCA had diffuse expansion. ConclusionCTCA is a noninvasive, simple and effective method for the diagnosis of coronary artery aneurysm, and it can be the first choice for the high risk population with coronary artery aneurysm.
【Abstract】Objective To investigate the CT manifestations of chronic virus hepatitis B. Methods According to the inclusion and exclusion criteria, the clinical data and laboratory information of 120 patients with chronic virus hepatitis B were reviewed retrospectively. All patients underwent standardized contrast-enhanced spiral CT dual-phase scanning of the upper abdomen. The changes of the liver, bile duct, spleen, portal venous system, lymph node of the upper abdomen, peritoneal cavity and pleural cavity were observed and noted. Results CT manifestations of chronic virus hepatitis B were as follows: ①changes of the configuration and shape of the liver, ② changes of the density of the liver, ③intrahepatic perivascular lucency, ④thickening of gallbladder wall and edema of the gallbladder fossa, ⑤splenomegaly, ⑥enlargement of abdominal lymph nodes, ⑦ascites, ⑧abnormalities related to portal hypertension (collateral circulation), and ⑨secondary thoracic changes (pleural and pericardial effusion). Conclusion Chronic virus hepatitis B can demonstrate several abnormal findings involving the liver, gallbladder, lymph nodes, spleen, etc on contrast-enhanced CT scanning.
ObjectiveTo analyze the CT features of immune checkpoint inhibitor-related pneumonia (CIP) and improve the diagnostic accuracy of CIP. MethodsAmong patients with malignant tumor treated with immune checkpoint inhibitors, those who developed pneumonia and rule out other causes of disease were identified. Chest CT Imaging were reviewed to assess special signs, distribution characteristics, severity of pneumonia and radiographic patterns of CIP. ResultsA total of 28 patients were enrolled, including 26 males and 2 females. CT features include ground-glass opacity, centrilobular nodularity, reticular opacity, consolidation, traction bronchiectasis, honeycomb, etc. The lesions predominant involved peripheral lung zone (17/28), lower lung zone (18/28) and posterior lung zone (18/28), with a diffuse distribution (23/28). In most cases the disease involved both lungs (23/28), and a few involved unilateral or single lobe. The most common affected lobes were the lower lobe of the right lung (25/28) and the lower lobe of the left lung (20/28), followed by the upper lobe of the right lung (18/28). Mean pneumonia severity score was 5.5, standard deviation was 3.8, and range was 1 - 15. The most common radiographic patterns of CIP were nonspecific interstitial pneumonia (11/28) and hypersensitivity pneumonia (10/28). The second was organizing pneumonia (6/28). ConclusionsThe CT manifestations of CIP have certain specificity. Combined with the history of drug treatment and clinical symptoms of patients, the early and correct diagnosis can be obtained.
Objective?To evaluate the value of various CT features in differentiating renal angiomyolipoma (RAML) with minimal fat and renal cell carcinoma (RCC). Methods?The Cochrane Library, PubMed, MEDLINE (OVID), EMBase, and the Chinese Periodical Wed (CNKI, CBM, VIP) were searched. They were searched from Jan 2001 to Nov 2008. Trials screening, quality assessment, and data extraction was conducted according to the inclusion criteria recommended by the Cochrane Collaboration. The SROC curve and meta-analyses were performed by Meta-disc 1.4. Results?Seven trials, involving 482 patients and 513 tumors, were included. The studies were highly homogonous. It was considered that 8 features including single or multiple lesions, scanning density, calcification, angle with cortex, levering-cortex-up sign, lesions pro-trusion, homogeneous enhancement, and prolonged enhancement, played certain roles in differentiating RAML with minimal fat and RCC. Among these features, interface with the cortex was the most important, and the features of homogeneous enhancement and prolonged enhancement were the second most important. Conclusion?Besides measuring lipoid tissue in the tumor, there are another 8 features which are valuable to the differentiation of RAML with minimal fat and RCC.
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 differential points of clinical symptoms and pathology of solid-pseudopapillary tumor of the pancreas (SPTP) and islet cell tumor (ICT). Methods Fifteen cases of SPTP and twelve cases of ICT were studied in this retrospective research. Clinical symptom, pathologic feature and computed tomography (CT) image of patients with both tumors were analyzed, and the imaging features were compared with pathological results. Results The mean age of SPTP patients was 22.4 year-old. Twelve patients with SPTP presented a palpable abdominal mass as the initial symptom. It was observed that the tumor cells were located in a pseudopapillary pattern with a fibro-vascular core histologically. On the CT images, a mixture of solid and cystic structures could be seen in all the tumors. After taking enhanced CT scan, the solid portion was slightly enhanced in the arterial phase and the contrast intensity increased in the portal venous phase. On the other hand, the mean age of ICT patients was 39.3 year-old. The major symptom was due to the function of islet cell tumor, which was typical in 8 patients, presenting as Whipple triad. Histologically, cells demonstrated in trabecular, massive, acinar or solid patterns, and the blood supply of the tumor was abundant. On the CT images, most small tumors were difficulty to be detected. ICT could be markedly enhanced in the arterial phase and slightly enhanced in the portal venous phase on post-contrast CT scan. Conclusion Clinical symptom, pathologic feature and CT scanning are helpful to differentiate SPTP from ICT.
ObjectiveTo investigate the imaging findings of carcinoma of body and tail of the pancreas. MethodsTotally twentythree patients with carcinoma of body and tail of the pancreas were studied. The diagnosis was proven by surgery and pathological findings. The imaging features of twentythree cases were reviewed including the location, size, shape, texture, and enhancement patterns of the tumor masses. Five cases underwent enhanced MRI examination, 18 cases underwent enhanced spiral CT examination. ResultsThe tumors located in the pancreatic body in 5 cases, located in the tail in 7 cases, and located in the body and tail of pancreas in 11 cases. The tumor masses were irregular in shape and heterogeneously hypointense from CT scan. From MR, the masses were slightly hypointense on T1WI, and slightly or mixed hyperintense on T2WI. Nineteen cases showed heterogeneous slight enhancement and four cases had no enhancement. The tumors were well demarcated in five cases, while those were poorly defined in the other 18 cases. Metastatic lymphadenopathy was shown in 16 cases, vascular invasion in 8 cases, and metastatic lesions of other organs in 3 cases. ConclusionThe carcinoma of body and tail of the pancreas shows certain characteristic imaging. CT and MRI examination can reflect the morphologic features, the hemodynamic alterations, and the involvement of adjacent structures and organs.