Computerized tomography-guided therapeutic percutaneous puncture catheter drainage-combined with somatostatin for severe acute pancreatitis: An analysis of efficacy and safety

BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to improve treatment efficacy.AIM To evaluate the efficacy and safety of computerized tomography-guided the-rapeutic percutaneous puncture catheter drainage(CT-TPPCD)combined with somatostatin(SS)in the treatment of SAP.METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected.On the basis of routine treatment,20 patients received SS therapy(control group)and 22 patients were given CT-TPPCD plus SS intervention(research group).The efficacy,safety(pancreatic fistula,intra-abdominal hemorrhage,sepsis,and organ dysfunction syndrome),abdominal bloating and pain relief time,bowel recovery time,hospital stay,inflammatory indicators(C-reactive protein,interleukin-6,and pro-calcitonin),and Acute Physiology and Chronic Health Evaluation(APACHE)II score of both groups were evaluated for comparison.RESULTS Compared with the control group,the research group had a markedly higher total effective rate,faster abdominal bloating and pain relief and bowel recovery,INTRODUCTION Pancreatitis,an inflammatory disease occurring in the pancreatic tissue,is classified as either acute or chronic and is associated with high morbidity and mortality,imposing a socioeconomic burden[1,2].The pathogenesis of this disease involves early protease activation,activation of nuclear factor kappa-B-related inflammatory reactions,and infiltration of immune cells[3].Severe acute pancreatitis(SAP)is a serious condition involving systemic injury and subsequent possible organ failure,accounting for 20%of all acute pancreatitis cases[4].SAP is also characterized by rapid onset,critical illness and unsatisfactory prognosis and is correlated with serious adverse events such as systemic inflammatory response syn-drome and acute lung injury,threatening the health of patients[5,6].Therefore,timely and effective therapeutic inter-ventions are of great significance for improving patient prognosis and ensuring therapeutic effects.Somatostatin(SS),a peptide hormone that can be secreted by endocrine cells and the central nervous system,is in-volved in the regulatory mechanism of glucagon and insulin synthesis in the pancreas[7].It has complex and pleiotropic effects on the gastrointestinal tract,which can inhibit the release of gastrointestinal hormones and negatively modulate the exocrine function of the stomach,pancreas and bile,while exerting a certain influence on the absorption of the di-gestive system[8,9].SS has shown certain clinical effectiveness when applied to SAP patients and can regulate the severity of SAP and immune inflammatory responses,and this regulation is related to its influence on leukocyte apoptosis and adhesion[10,11].Computerized tomography-guided therapeutic percutaneous puncture catheter drainage(CT-TPPCD)is a surgical procedure to collect lesion fluid and pus samples from necrotic lesions and perform puncture and drainage by means of CT image examination and precise positioning[12].In the research of Liu et al[13],CT-TPPCD applied to pa-tients undergoing pancreatic surgery contributes to not only good curative effects but also a low surgical risk.Baudin et al[14]also reported that CT-TPPCD has a clinical success rate of 64.6%in patients with acute infectious necrotizing pan-creatitis,with nonfatal surgery-related complications found in only two cases,suggesting that this procedure is clinically effective and safe in the treatment of the disease.In light of the limited studies on the efficacy and safety of SS plus CT-TPPCD in SAP treatment,this study performed a relevant analysis to improve clinical outcomes in SAP patients.

Study on sex differences and potential clinical value of threedimensional computerized tomography pelvimetry in rectal cancer patients

BACKGROUND Laparoscopic rectal cancer radical surgery is a complex procedure affected by various factors.However,the existing literature lacks standardized parameters for the pelvic region and soft tissues,which hampers the establishment of consistent conclusions.AIM To comprehensively assess 16 pelvic and 7 soft tissue parameters through computerized tomography(CT)-based three-dimensional(3D)reconstruction,providing a strong theoretical basis to address challenges in laparoscopic rectal cancer radical surgery.METHODS We analyzed data from 218 patients who underwent radical laparoscopic surgery for rectal cancer,and utilized CT data for 3D pelvic reconstruction.Specific anatomical points were carefully marked and measured using advanced 3D modeling software.To analyze the pelvic and soft tissue parameters,we emp-loyed statistical methods including paired sample t-tests,Wilcoxon rank-sum tests,and correlation analysis.RESULTS The investigation highlighted significant sex disparities in 14 pelvic bone parameters and 3 soft tissue parameters.Males demonstrated larger measurements in pelvic depth and overall curvature,smaller measurements in pelvic width,a larger mesorectal fat area,and a larger anterior-posterior abdominal diameter.By contrast,females exhibited wider pelvises,shallower depth,smaller overall curvature,and an increased amount of subcutaneous fat tissue.However,there were no significant sex differences observed in certain parameters such as sacral curvature height,superior pubococcygeal diameter,rectal area,visceral fat area,waist circumference,and transverse abdominal diameter.CONCLUSION The reconstruction of 3D CT data enabled accurate pelvic measurements,revealing significant sex differences in both pelvic and soft tissue parameters.This study design offer potential in predicting surgical difficulties and creating personalized surgical plans for male rectal cancer patients with a potentially“difficult pelvis”,ultimately improving surgical outcomes.Further research and utilization of these parameters could lead to enhanced surgical methods and patient care in laparoscopic rectal cancer radical surgery.

Positron emission tomography/computerized tomography in the evaluation of primary non-Hodgkin's lymphoma of prostate

Primary malignant lymphoma of the prostate is exceedingly rare.Here we report a case of a 65-year-old man who presented with increased urinary frequency,urinary urgency,and urinary incontinence for two years.Benign prostatic hypertrophy was suspected at primary impression.Ultrasound revealed a hypoechoic lesion of the prostate.The total serum prostate-specific antigen was within normal range.Positron emission tomography/computerized tomography(PET/CT)showed a hypermetabolic prostatic lesion.Prostate biopsy was consistent with a non-germinal center diffuse large B cell lymphoma.There was complete remission of the prostatic lesion following six cycles of chemotherapy as shown on the second PET/CT imaging.18F-fluoro-deoxy glucose PET/CT is not only a complement to conventional imaging,but also plays a significant role in the diagnosis and evaluation of treatment response of prostatic lymphoma.

Application of Proton Magnetic Resonance Spectroscopy and Computerized Tomography in the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease

In order to investigate the application of proton magnetic resonance spectroscopy （ill-MRS） and computerized tomography （CT） in the quantitative diagnosis of nonalcoholic fatty liver disease （NAFLD） and evaluation of therapeutic effects, 22 patients with NAFLD were selected according to the Chinese Medical Association＇s （CMA） standard of the NAFLD in comparison with 20 healthy volunteers （as control group）. Blood samples for biochemistry were collected. The severity of hepatosteatosis was evaluated by ^1H-MRS scan and CT scan of liver. The intrahepatic content of lipid （IHCL） and CT value ratio of liver to spleen were calculated. The patients in NAFLD group were treated with Ganzhixiao Capsule for 8 weeks. The changes in IHCL and CT value ratio of liver to spleen were observed before and after treatment. In NAFLD group serum ALT, TG, IHCL calculated by ^1HMRS were increased and CT value ratio of liver to spleen decreased significantly as compared with control group. After treatment for 8 weeks serum ALT, TG, IHCL were decreased significantly, while CT value ratio of liver to spleen increased significantly in NAFLD group. It was suggested that IHCL could be measured precisely by ^1HMRS. NAFLD was treated effectively by Ganzhixiao capsule.

Pore structure of ore granular media by computerized tomography image processing

The pore structure images of ore particles located at different heights of leaching column were scanned with X-ray computerized tomography (CT) scanner, the porosity and pore size distribution were calculated and the geometrical shape and connectivity of pores were analyzed based on image process method, and the three dimensional reconstruction of pore structure images was realized. The results show that the porosity of ore particles bed in leaching column is 42.92%, 41.72%, 39.34% at top, middle and bottom zone, respectively. Obviously it has spatial variability and decreases appreciably along the height of the column. The overall average porosity obtained by image processing is 41.33% while the porosity gotten from general measurement method in laboratory is 42.77% showing the results of both methods are consistent well. The pore structure of ore granular media is characterized as a dynamical space network composed of interconnected pore bodies and pore throats. The ratio of throats with equivalent diameter less than 1.91 mm to the total pores is 29.31%, and that of the large pores with equivalent diameter more than 5.73 mm is 2.90%.

Effects of Irregular Respiratory Motion on the Positioning Accuracy of Moving Target with Free Breathing Cone-Beam Computerized Tomography

For positioning a moving target, a maximum intensity projection (MIP) or average intensity projection (AIP) image derived from 4DCT is often used as the reference image which is matched to free breathing cone-beam CT (FBCBCT) before treatment. This method can be highly accurate if the respiratory motion of the patient is stable. However, a patient’s breathing pattern is often irregular. The purpose of this study is to investigate the effects of irregular respiration on positioning accuracy for a moving target aligned with FBCBCT. Nine patients’ respiratory motion curves were selected to drive a Quasar motion phantom with one embedded cubic and two spherical targets. A 4DCT of the phantom was acquired on a CT scanner (Philips Brilliance 16) equipped with a Varian RPM system. The phase binned 4DCT images and the corresponding MIP and AIP images were transferred into Eclipse for analysis. FBCBCTs of the phantom driven by the same respiratory curves were also acquired on a Varian TrueBeam and fused such that both CBCT and MIP/AIP images share the same target zero positions. The sphere and cube volumes and centroid differences (alignment error) determined by MIP, AIP and FBCBCT images were calculated, respectively. Compared to the volume determined by MIP, the volumes of the cube, large sphere, and small sphere in AIP and FBCBCT images were smaller. The alignment errors for the cube, large sphere and small sphere with center to center matches between MIP and FBCBCT were 2.5 ± 1.8 mm, 2.4 ± 2.1 mm, and 3.8 ± 2.8 mm, and the alignment errors between AIP and FBCBCT were 0.5 ± 1.1 mm, 0.3 ± 0.8 mm, and 1.8 ± 2.0 mm, respectively. AIP images appear to be superior reference images to MIP images. However, irregular respiratory pattern could compromise the positioning accuracy, especially for smaller targets.

Application value of high-pressure-resistant peripherally inserted central catheters in enhanced computer tomography of diabetic patients with malignant tumors

BACKGROUND Individuals with diabetes mellitus have a higher risk of developing malignant tumors,and diagnosing these tumors can be challenging.AIM To confirm the benefits of using peripherally inserted central catheters(PICCs)in contrast-enhanced computerized tomography(CECT)for diagnostic imaging in diabetic patients with malignant tumors and to provide a research basis for follow-up research.METHODS This retrospective study analyzed 204 diabetic patients with malignancies treated at The Second Affiliated Hospital,Jiangxi Medical College,Nanchang University,from January 2024 to June 2024.The patients were divided into two groups:A control group(n=102)with indwelling peripheral intravenous catheters and a research group(n=102)with high-pressure-resistant PICC.The study compared baseline data,the incidence of iodine contrast extravasation during CECT,the incidence of adverse events(discomfort,redness and swelling at the puncture site,and blood oozing),imaging quality,nursing time,intubation success rate,number of venipuncture attempts,and catheter maintenance cost.RESULTS Male patients accounted for 51.96%in the control group and 55.88%in the research group;the average age was(59.68±11.82)years in the control group and(61.41±12.92)years in the research group;the proportions of lung cancer,colorectal cancer,and gastric cancer patients in the control group were 42.16%,38.24%,and 19.61%,respectively,while those in the research group were 34.31%,37.25%,and 28.43%,respectively.Except for the gender distribution,age,and cancer type mentioned above,other general information such as underlying diseases,puncture location,and long-term chemotherapy shows no significant differences as tested(P>0.05).The results showed that the research group had significantly reduced incidence of iodine contrast extravasation(7 vs 1,P=0.031),similar incidence of adverse events(11 vs 7,P=0.324),reduced nursing time[(18.50±2.68)minutes vs(13.26±3.00)minutes,P=0.000],fewer venipuncture attempts[(2.21±0.78)times vs(1.49±0.58)times,P=0.000],lower catheter maintenance cost[(1251.79±205.47)China yuan(CNY)vs(1019.25±117.28)CNY,P=0.000],increased intubation success rate(16.67%vs 58.82%,P=0.000),and better imaging quality(85.29%vs 94.12%,P=0.038).CONCLUSION High-pressure-resistant PICCs can lessen the physical burden of diabetic patients during nursing,reduce treatment costs,and improve the efficiency and quality of imaging for diagnosis malignant tumors.

Comments on the article about correlation between computerized tomography and surgery in acute pancreatitis

We read with great interest the article by Vege et al published in issue 34 of World J Gastroenterol 2010. The article evaluates the ability of contrast-enhanced computerized tomography (CECT) to characterize the nature of peripancreatic collections found at surgery. The results of their study indicate that most of the peripancreatic collections seen on CECT in patients with severe acute pancreatitis who require operative intervention contain necrotic tissue and CECT has a limited role in differentiating various types of collections. However, there are some points that need to be addressed, including data about the stage of acute pancreatitis in which CECT was done and the time span between CECT examination and surgery.

The Differences of Interstitial Lung Diseases in High-Resolution Computerized Tomography and Pulmonary Function Test among Different Connective Tissue Diseases, and the Correlated Factors

Objective. To study the difference of interstitial lung diseases (ILDs) in high-resolution computerized tomography and pulmonary function test among different connective tissue diseases (CTDs). Methods. 209 patients with different CTDs were recruited and underwent lung HRCT and PFT. Eerythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum ferritin (SF), anti-SSA, and so on were tested. Based on HRCT, a patient was classified into ILD group (CTD+ILD) or non-ILD group (CTD-ILD). HRCT, PFT, and laboratory markers were compared according to CTDs and CTD-associated ILDs. Results. The incidences of ILD were 79.6%, 82.0%, 89.7%, and 97.1% respectively for Rheumatoid arthritis (RA), primary Sjogren’s symptom (pSS), dermatomyositis/polymyositis (DM/PM), and systemic sclerosis (SSc) groups. RA and pSS patients exhibited more nodules, patching, ground-glass opacity, and cord shadow foci in HRCT, DM/PM and SSc patients exhibited more reticular opacity and honeycombing foci. RA and pSS patients exhibited more obstructive ventilatory disorder, small airway dysfunction and emphysema in PFT, and DM/PM and SSc patients exhibited more restrictive ventilatory disorder, mixed ventilatory disorder. ESR, CRP and SF were significantly higher in total CTD+ILD group than in total CTD-ILD group (P = 0.047, 0.006, 0.004, respectively), and higher in different CTD+ ILD groups than in comparable CTD-ILD groups (P = 0.049, 0.048, and 0.023, pSS+ILD, SSc+ILD and RA+ILD compared to pSS-ILD, SSc-ILD and RA-ILD, respectively for ESR, CRP, SF). The positive rate of anti-SSA was significantly higher in DM/PM+ILD group than in DM/PM-ILD group (P = 0.025). Conclusions. The manifestations and incidences of ILDs differ among different CTDs in HRCT and PFT, and inflammation and anti-SSA are positively correlated with ILDs in different CTDs, which provide important evidences for judging disease condition and prognosis.

Screening for lung cancer with chest computerized tomography: Is it cost efficient?

Despite lung cancer(LC) screening by low-dose computerized tomography(LDCT) gaining many proponents worldwide, for many years it was not recognized as a life-prolonging and cost-effective procedure, until recently. Prospective observational studies had not been able to prove that this screening prolongs survival, but they helped to specify the inclusion and exclusion criteria. Long-awaited results of a prospective, randomized trial finally provided the evidence that LC screening with LDCT can prolong survival of the screened population. Several costeffectiveness analyses were performed to justify mass introduction of this screening. Results of these analyses are equivocal, although conclusions highly depend upon inclusion and exclusion criteria, methods of analysis and prices of medical procedures which differ between countries as well as the incidence of other pulmonary nodules, especially tuberculosis. Therefore, costeffectiveness analysis should be performed separately for every country. Cost-effectiveness depends especially upon the rate of false-positive results and the rate of unnecessary diagnostic, screening and treatment procedures. To ensure high cost-effectiveness, LC screening should be performed in accordance with screening protocol, in dedicated screening centers equipped with nodule volume change analysis, or as a prospective non-randomized trial, to ensure compliance with the inclusion and exclusion criteria. To ensure high cost-effectiveness of LC screening, future research should concentrate on determination of highrisk groups and further specifying the inclusion and exclusion criteria.

The possible value of ~18F-FDG positron emission tomography/computerized tomography imaging in detection of atherosclerotic plaque

Objective：To evaluate the clinical value with positron emission tomography/computerized tomography（PET/CT） imaging for the detection of vulnerable plaque in atherosclerotic lesions. Methods：Sixty people with a age of over 60[mean age （69.2 ± 7.1）years] underwent three dimension（3D） whole-body fluorine-18-2-fluoro-2-deoxy-D-glucose（^18F-FDG） PET/CT imaging and were evaluated retrospectively, including 6 cases assessed as normal and 54 cases with active atherosclerotic plaque. Fifty-four cases with SUVs and CT values in the aortic wall of high-FDG-uptake were measured retrospectively. These high-FDG-uptake cases in the aortic wall were divided into three groups according their CT value. Cases in group 1 had high uptake in atherosclerotic lesions of the aortic wall with CT value of less than 60 Hu（soft plaque）. Cases in group 2 had high uptake with CT value between 60-100 Hu （intermediate plaque）, Cases in group 3 had high uptake with CT value more than 100 Hu（calcified plaque）, Group 4 was normal. Results： In group 1, there were 42 high-FDG-uptake sites （average SUV 1.553 ± 0.486）. In group 2, there were 30 high-FDG-uptake sites（average SUV 1.393 ± 0.296）. In group 3, there were 36 high-FDG-uptake sites（average SUV 1.354 ± 0.189）. In group 4, there were 33 normal-FDG-uptake sites （average SUV was 1.102 ± 0.141）, The SUVs showed significant difference among the four groups（F = 678.909, P = 0.000）. There were also significant difference found between the normal-FDG-uptake group and the high-FDG-uptake groups（P = 0.000, 0.000, 0.001, respectively）. Conclusion：Different degrees of ^18F-FDG uptake in active large atherosclerotic plaque were shown in different stages of atherosclerotic plaque formation. The soft plaque had the highest FDG uptake in this study. This suggested that ^18F- FDG PET/CT imaging may be of great potential value in early diagnosis and monitoring of vulnerable soft plaque in atherosclerotic lesions.

Multi-slice computerized tomography critical role in transcatheter aortic valve implantation plan: Review of current literature

Transcatheter aortic valve implantation(TAVI) has been shown in improve outcome of severe aortic stenosis(AS) patients, deemed surgical high-risk or inoperable, and has grown popular in the past decade. The procedure requires accurate prior planning, and demands an integration of a "Heart Team" consisted from cardiac surgeons, interventional cardiologists, and imaging experts. The role of cardiac imaging and especially multi-slice computerized tomography(MSCT) has been a mainstay of pre-evaluation of severe AS patients that allows to accurately depict and size the cardiac and vascular structures, and has become the primary tool for procedural planning. This article is aimed to evaluate current uses of MSCT in severe AS patients undergoing TAVI, delineate the various measurements derived from this modality and review current literature regarding it's advantages over other techniques.

Validations of new cut-offs for surgical drains management and use of computerized tomography scan after pancreatoduodenectomy:The DALCUT trial

BACKGROUND Postoperative pancreatic fistula(POPF)is the most fearful complication after pancreatic surgery and can lead to severe postoperative complications such as surgical site infections,sepsis and bleeding.A previous study which identified cut-offs of drains amylase levels(DALs)determined on postoperative day(POD)1 and POD3,was able to significantly predict POPF,abdominal collections and biliary fistulas,when related to specific findings detected at the abdominal computerized tomography(CT)scan routinely performed on POD3.AIM To validate the cut-offs of DALs in POD1 and POD3,established during the previous study,to assess the risk of clinically relevant POPF and confirm the usefulness of abdominal CT scan on POD3 in patients at increased risk of abdominal collection.METHODS The DALCUT trial is an interventional prospective study.All patients who will undergo pancreatoduodenectomy(PD)for periampullary neoplasms will be considered eligible.All patients will receive clinical staging and,if eligible for surgery,will undergo routine preoperative evaluation.After the PD,daily DALs will be evaluated from POD1.Drains removal and possible requirement of abdominal CT scans in POD3 will be managed on the basis of the outcome of DALs in the first three postoperative days.RESULTS This prospective study could validate the role of DALs in the management of surgical drains and in assessing the risk or relevant complications after PD.Drains could be removed in POD3 in case of POD1 DALs<666 U/L and POD3 DALs<207 U/L.In case of POD3 DALs≥252,abdominal CT scan will be performed in POD3 to identify abdominal collections≥5 cm.In this latter category of patients,drains could be maintained beyond POD3.CONCLUSION The results of this trial will contribute to a better knowledge of POPF and management of surgical drains.

Detection of tracheal branching with computerized tomography:The relationship between the angles and age-gender

BACKGROUND The data obtained on the anatomical knowledge of the tracheobronchial system can be used for diagnosis,treatment and interventional interventions in areas such as anesthesia,thoracic surgery,pulmonary physiology.AIM To determine the tracheobronchial branching angles in pediatric and adult populations by using the multislice computed tomography(CT)and minimum intensity projection(MinIP)technique,which is a non-invasive method.METHODS Our study was carried out retrospectively.Patients who underwent contrast and non-contrast CT examination,whose anatomically and pathophysiologically good tracheobronchial system and lung parenchyma images were obtained,were included in the study.Measurements were made in the coronal plane of the lung parenchyma.In the coronal plane,right main bronchus-left main bronchus angle,right upper lobe bronchus-intermedius bronchus angle,right middle lobe bronchus-right lower lobe bronchus angle,left upper lobe bronchus-left lower lobe bronchus angle were measured.RESULTS The study population consisted of 1511 patients,753 pediatric(mean age:13.4±4.3;range:1-18 years)and 758 adults(mean age:54.3±17.3;range:19-94 years).In our study,tracheal bifurcation angle was found to be 73.3°±13.7°(59.6°-87°)in the whole population.In the pediatric group,the right-left main coronal level was found to be higher in boys compared to girls(74.6°±12.9°vs 71.2°±13.9°,P=0.001).In the adult group,the right-left main coronal level was found to be lower in males compared to females(71.9°±12.9°vs 75.8°±14.7°,P<0.001).CONCLUSIONS Our study,with the number of 1511 patients,is the first study in the literature with the largest number of patient populations including pediatric and adult demographic data,measuring the angle values of the tracheobronchial system using multislice CT and MinIP technique.Study data will not only be a guide during invasive procedures,but it can also guide studies to be done with imaging methods.

The Spleen and Sickle Cell Anemia: A Contrast Enhanced Computerized Tomography Based Study

The spleen is one of the most frequently affected organs in sickle cell anemia (SCA). This study aims to characterize the spleen in sickle cell anemia patients using contrast enhanced computerized tomography scanning (CECT). 67 patients with SCA from different Saudi Arabian areas were enrolled;ages are ranged from 10 months to 28 years old. The spleen was assessed with CT for abdominal pain and/or unexplained fever. The evaluation was done at different contrast enhancement scanning phases. The study showed that the least number of affected patients was from Eastern Saudi Arabia (1.5%) followed by Asseer (16.4%) then Gazan representing 82.1%. The most common type of SCA affected the Saudi children is Hemoglobin SS Disease (Hb SS) constituting 41 (61.2%). The spleen size, lymph nodes size, spleen Hounsfield (HU), splenic vein diameter and the correlation with the associated findings were evaluated for all of the patients. In children affected with SCA: 26 (38.8%) have splenomegaly, 18 (26.9%) have atrophied spleen and 2 (3.0%) are with very small tissue like structure. Lesions found in the spleen were abscess, infarction, cyst, and calcifications. At the spleen hilum region;dilated splenic vein, presence of multiple collaterals, and thrombus were also been detected. Significantly correlations were noticed between lesions type, child age, enlargement of spleen and splenic lymph nodes at P ≤ 0.033, P ≤ 0.010 and P ≤ 0.012 respectively and showed an evidence that the reduction of the HU and advanced age have significant relation with changing of the spleen size at P ≤ 0.004 and P ≤ 0.000 respectively. Spleen lesions’ enhancement pattern is well emerged in both venous and delay phase and it was significantly related with the scanning phase at P ≤ 0.000 and with different types of SCA at P ≤ 0.037, and P ≤ 0.055 in venous and delay phase in respectively. CECT offers a number of morphological criteria that can be applied to differentiate hypodense lesions of the spleen in SCA. CT characterization criteria of hypodense splenic lesions are acknowledged to aid interpretation during evaluation of abdominal CT images of the spleen in symptomatic patients with sickle cell anemia.

Diagnostic Evaluation of Pulmonary Embolism: A Computerized Tomography Based Study

Pulmonary embolism (PE) is potentially life threatening condition which requires adequate diagnosis. Since computerized tomography pulmonary angiography (CTPA) described the presence of a clot subjectively, an objective and quantification method to characterize plural parenchymal abnormality, pulmonary vessels and heart is needed (in order to diagnose PE). This study was directed to investigate whether the presence of plural parenchymal findings correlates with the PE and as well, it was designed to answer two basic questions based on CTPA findings done for clinical suspicion of PE: firstly, what are the plural parenchymal abnormalities associated with PE;secondly, correlation of PE with the presence of heart changes and pulmonary vessels measurements. CTPA scans were acquired for 55 patients suspected of having PE and another 50 subjects who were considered as control. The clinical signs and pleuroparenchymal abnormalities, pulmonary artery tree measurements, right ventricle and atrium diameters, Inter ventricular septum width as well as the myocardium thickening were characterized and correlated with PE. The results showed that the PE patients group has more dilated measurements than the normal control subjects. The right ventricle diameter changes were found to be significantly related to the presence of PE at p ≤ 0.001. Significant changes at p ≤ 0.005 were also noticed in the pulmonary trunk diameter as well as the right and left main pulmonary arteries with no significant changes detected in the distal portion of both pulmonary arteries diameters. The common complaints from PE patients were chest pain, shortness of breathing, lower limb swelling, tachycardia and syncope. Consolidation, ground glass opacifications, mosaic, right ventricle morphological changes and pleural effusion were present in the majority of patients undergoing CTPA for the clinical suspicion of PE. CTPA is considered as the diagnostic modality of choice in characterization of pulmonary vessels, atrium and ventricle changes as well as pleura parenchymal abnormalities in patients with or without PE.

The Clinical Application of Computerized Three-Dimensional Mimic Operation for Maxillofacial Bone Tumor

Facial bone, as the frame to support maxillofacial region and with several sinuses and cavities, is structurally complicated and the maxillofacial tumors,benign or malignant, in this region usually grows into the deep tissues, sinus-cav-ities and orbit and destroys the bone. In this study, the maxillofacial tumors were subjected to a mimic operation on a computer following CT scanning and 3-dimen-sional reconstruction. The data similar to those of real operation were obtained,which could be used for developing operative plans. As compared with data on the basis of conditions in the real operation, computerized mimic operation reflected the real conditions during operation. Computerized mimic operation is valuable for the preoperative planning and the prediction of probable intraoperative events.

Pancreatic volume change using three dimensional-computed tomography volumetry and its relationships with diabetes on longterm follow-up in autoimmune pancreatitis

BACKGROUND Several studies found that early pancreatic atrophy detected by computed tomo-graphy(CT)within 6 months was associated with a high incidence of diabetes in patients with type-1 autoimmune pancreatitis(AIP)receiving steroid therapy;however,no long-term follow-up studies have been performed.AIM To investigate pancreatic volume(PV)changes using three dimensional(3D)-CT volumetry and their relationship with IgG4 and diabetes in patients with AIP.METHODS This retrospective study included 33 patients with type-1 AIP receiving steroid therapy.Patients were divided into diffuse(D-type)and mass-forming type(M-type)AIP.PV was determined by semi-automated 3D-CT volumetry,and changes between initial and follow-up values were calculated.The relationship between PV and serum IgG4 levels was analyzed by Spearman’s rank correlation.The PV atrophy ratio compared with the presumed normal PV at the time of last follow-up CT and its relationship with diabetes were investigated.RESULTS There were 16 D-type and 17 M-type patients with long-term follow-up(mean,95.8 months).The regression curve of mean relative PV change reduced exponentially and rapidly during the first 25 months and then more slowly in both groups.The overall cumulative pancreas re-enlargement rates at 1,3,5,7 and 10 years were 6.1%,12.2%,29.2%,47.5%and 55.0%,respectively.There was a moderate-to-very strong positive correlation(ρ≥0.4)between PV and serum IgG4 levels in nine(9/13,69.2%)patients.All 33 patients showed pancreatic atrophy(mean 59.3%)after long-term follow-up.Patients with D-type AIP had a significantly higher atrophy rate and higher incidence of diabetes than M-type patients(P<0.05).CONCLUSION PV change initially reduced exponentially and then more slowly and is considered an important factor associated with diabetes.Serum IgG4 levels were positively correlated with PV during follow-up.

Use of the vertebrae and iliac bone as references for localizing the appendix vermiformis in computed tomography

BACKGROUND The appendix vermiformis is a part of the gastrointestinal tract,situated in the lower right quadrant of the abdomen.Acute appendicitis,acute inflammation of the appendix vermiformis,is the most common cause of acute abdomen requiring surgical intervention.Although computed tomography(CT)offers high diagnostic efficacy in assessing the appendix across various anatomical positions,it also involves radiation exposure.Reducing exposure factors and narrowing the field of view(FOV)are ways to decrease the radiation dose to the patient.To narrow the FOV,appendix locations within the population must be defined using metric markers.AIM To determine the location of the appendix vermiformis on CT using the vertebrae and the right iliac bone as anatomical landmarks.METHODS This retrospective study examined 470 patients presenting with abdominal pain who underwent abdominal CT scans between January 01,2015 and January 01,2018.Forty-three patients were excluded due to various reasons.The most superior and inferior points and the origin of the appendix were measured separately in relation to the vertebrae and right iliac bone for localization.The population was divided into normal and acute appendicitis groups,and the relationship between appendix location and anthropometric parameters relationship was examined.P values below 0.05 were considered statistically significant.RESULTS The final analysis included 427 adult patients(206 females and 221 males)with a mean age of 42.1±19.5 years.An ascending appendix course was the most common(90.4%).The appendix ranged from the L2 vertebral body level to the coccygeal vertebral level relative to the vertebrae.The appendix ranged between(−)140.5 mm and(+)87.4 mm relative to the right iliac bone.A negative correlation was found between patient age,height,body mass index,and the highest and lowest points of the appendix in regard to the vertebrae.CONCLUSION The study’s findings unveiled the locations of the appendix in the population in relation to the bony anatomical landmarks.These data can be used as the basis for future research aimed at reducing patient exposure to ionizing radiation.

Accurate quantification of the algebraic,multiplicative algebraic,and simultaneous iterative reconstruction techniques in ionosphere rebuilding based on the TIEGCM assessment

The algebraic reconstruction technique(ART),multiplicative algebraic reconstruction technique(MART),and simultaneous iterative reconstruction technique(SIRT)are computational methodologies extensively utilized within the field of computerized ionospheric tomography(CIT)to facilitate three-dimensional reconstruction of the ionospheric morphology.However,reconstruction accuracy elicits recurrent disputes over its practical application,and people usually attribute this issue to incomplete and uneven coverage of the measurements.The Thermosphere Ionosphere Electrodynamics General Circulation Model(TIEGCM)offers a reasonable physics-based ionospheric background and is widely utilized in ionospheric research.We use the TIEGCM simulations as the targeted ionosphere because the current measurements are far from able to realistically reproduce the ionosphere in detail.Optimized designations of satellite measurements are conducted to investigate the limiting performance of CIT methods in ionospheric reconstruction.Similar to common practice,electron density distributions from outputs of the International Reference Ionosphere(IRI)model are used as the iterative initial value in CIT applications.The outcomes suggest that despite data coverage,iterative initial conditions also play an essential role in ionospheric reconstruction.In particular,in the longitudinal sectors where the iterative initial height of the F2-layer peak electron density(hmF2)differs substantially from the background densities,none of the three CIT methods can reproduce the exact background profile.When hmF2 is close but the ionospheric F2-layer peak density(NmF2)is different between the targeted background and initial conditions,the MART performs better than the ART and SIRT,as evidenced by the correlation coefficients of MART being above 0.97 and those of ART and SIRT being below 0.85.In summary,this investigation reveals the potential uncertainties in traditional CIT reconstruction,particularly when realistic hmF2 or NmF2 values differ substantially from the initial CIT conditions.