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.
With the development of radiologic intervention, the treatments of aortic dissection are getting more and more diversified. In recent years, Debakey Ⅲ and DebakeyⅠaortic dissection has been usually treated with endovascular graft exclusion, or combined surgical and endovascular treatment. It is therefore more important to evaluate the aorta and its complications after interventional treatments. Because multidetector-row computed tomography (MDCT) has advantages, such as short examination time, high spatial resolution, and simple operation, this modality has become a first choice of non-invasive methods for the follow-up of aortic diseases after the intervention. Now the MDCT presentations and their anatomic-pathologic features of aortic dissection after endovascular graft exclusion or combined surgical and endovascular treatment are reviewed in this article.
ObjectiveTo analyze the CT features of parotid tuberculosis, in order to increase the cognition and diagnostic level of the disease. MethodsNine cases of parotid tuberculosis confirmed by pathology and laboratory examinations between August 2009 and December 2012 were collected retrospectively, and we analyzed their CT features which were then compared with pathological findings. ResultsAll the 9 cases involved unilateral parotid, among which 7 were on the left side and 2 on the right side. Eight cases were parotid lymph node tuberculosis located in parotid superficial lobe, including 3 cases of single lesion and 5 cases of multiple lesions. There were 30 lesions in total with diameters ranging from 0.5 cm to 4.5 cm, presenting slightly lower density on CT scan. Twenty-five lesions were moderate homogeneous enhancement; four lesions were ring-like enhancement; and one lesion was lace-like enhancement. Six cases of parotid lymph node tuberculosis had thickened platysma, and subcutaneous fat and skin were at different levels. Six cases in the group were accompanied with enlargement of cervical lymph nodes. One case of parotid gland essence tuberculosis involved its superficial and deep lobe diffusely presenting heterogeneous slightly low density, in which we could see some patchy low density and nodular calcification. All the parotid gland essence presented diffuse enhancement with irregular liquefactive necrosis, mildly swelling of adjacent platysma and fat, without enlargement of cervical lymph node. ConclusionCT signs of parotid tuberculosis are closely related to its pathologic changes. For the lesions in unilateral parotid superficial lobe, we should consider the diagnosis of parotid lymph node tuberculosis with the signs of homogeneous enhancement, thickness of close platysma, subcutaneous fat and skin, and enlargement of cervical lymph node.
Objective To clarify the thin-layer 16-slice spiral CT features of coal worker’s pneumoconiosis and the superior distribution of comorbidities in their staging and lobes and lung field anatomy. Methods Sixty-six patients with coal worker's pneumoconiosis diagnosed by the pneumoconiosis diagnosis and identification group from October 2014 to March 2015 were enrolled. All patients underwent 16-slice spiral CT and thin-layer CT reconstruction with a thickness of 1.5 mm. The thin-slice CT signs and comorbidities of coal workers’ pneumoconiosis were observed, and the superior distribution of CT signs in patients at different stage and different lobes and lung field anatomy were evaluated. Results There were 16 cases of irregular small nodules in the lungs, 22 cases of large shadow fusion, 18 cases of intraocular shadow calcification, 41 cases of emphysema, 21 cases of pulmonary bullae, 21 cases of pulmonary hypertension, and 31 cases of enlarged lymph nodes in the mediastinum and calcified. The above signs were mostly distributed in stage Ⅲ pneumoconiosis (P<0.05). There were 32 cases of regular small nodules, which were mostly distributed in stage Ⅰ pneumoconiosis. In the 16 cases of irregular small nodules, the advantage was distributed in the middle and outer lobes of the double lungs. In the 22 cases of large shadow fusion, the advantage was distributed in the upper and lower lobe of the lungs. In the 16 cases of tuberculosis, the advantage was distributed in the upper lobe of the lungs. In the 21 cases of bullous bullae, the advantage was distributed in the upper lobe of the two lungs, mostly in the right upper lung. Conclusion The thin 16-slice spiral CT signs of coal worker’s pneumoconiosis can reflect the pathological changes, and have a certain correlation with the stage of pneumoconiosis, and have obvious characteristics in the anatomical distribution of lung and lung fields.
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.
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.
【Abstract】ObjectiveTo evaluate the main CT features, the morbidity of CT signs and the anatomic-pathologic bases of secondary pyogenic peritonitis (SPP). MethodsTwentyfour patients of the SPP were retrospectively studied. Emphasis was placed on the spiral CT manifestations of the SPP correlating with their anatomic-pathologic bases and the occurrence as well as the signs of primary lesions which resulted in the SPP. ResultsThe main CT manifestations of SPP revealed as follows: the thickened peritoneum, 16 in 24 cases (66.7%), of which 14 cases were smooth and 2 cases were irregular; the ascites, 15 in 24 cases (62.5%); the free air within peritoneal cavity, 9 in 24 cases (37.5%); the edema and thickening involved in the greater omentum, 8 in 24 cases (33.3%); the small bowel mesentery, 5 in 24 cases (20.8%); and the bowels’ wall, 5 in 24 cases (20.8%); the adhesions of bowels, 6 in 24 cases (25.0%). The CT manifestation of the promary lesions, which caused SPP, and the complications were shown as follows: the signs of primary lesion, 13 cases (54.2%); the inflammatory changes in retroperitoneal cavity 13 cases (54.2%); the involvements of chest 13 cases (54.2%); and the abscess in peritoneal and pelvic cavity 6 cases (25.0%). ConclusionThe main significant CT signs of SPP could be concluded as follows: thickened peritoneum, ascites, free air within peritoneal cavity, edematous and thickened greater omentum, the small bowel mesentery, and the bowels’ wall, as well as the adhesions of bowels. So, the CT scan can present plenty of CT signs, which are significant and very helpful for making an appropriate diagnosis of SPP.
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.
【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.
Objective To analyze the ability of spectral CT imaging in displaying breast cancer lesions and explore the value of spectral CT imaging in detecting breast cancer. Methods The spectral CT images with different parameters of sixty-eight breast cancer lesions confirmed by pathology between July 2013 and February 2016 were retrospectively analyzed. The contrast noise ratio (CNR) and signal to noise ratio (SNR) as well as the ability in detecting breast cancer of the images with different parameters were compared. Results Fat-water material decomposition images showed breast cancer lesions best. Iodine-water material decomposition images had the lowest CNR. 70 keV monochromatic images and the monochromatic of best CNR images had better SNR. Fat-water material decomposition images detected all of the breast cancer lesions. Conventional CT plain scan detected least lesions. Conclusion Spectral CT imaging, especially fat-water material decomposition images, can show breast cancer lesions well, which has the potential application for detection of breast cancer lesions.