Effectiveness of magnetic resonance imaging and spiral computed tomography in the staging and treatment prognosis of colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a prevalent cancer type in clinical settings;its early signs can be difficult to detect,which often results in late-stage diagnoses in many patients.The early detection and diagnosis of CRC are crucial for improving treatment success and patient survival rates.Recently,imaging techniques have been hypothesized to be essential in managing CRC,with magnetic resonance imaging(MRI)and spiral computed tomography(SCT)playing a significant role in enhancing diagnostic and treatment approaches.AIM To explore the effectiveness of MRI and SCT in the preoperative staging of CRC and the prognosis of laparoscopic treatment.METHODS Ninety-five individuals admitted to Zhongshan Hospital Xiamen University underwent MRI and SCT and were diagnosed with CRC.The precision of MRI and SCT for the presurgical classification of CRC was assessed,and pathological staging was used as a reference.Receiver operating characteristic curves were used to evaluate the diagnostic efficacy of blood volume,blood flow,time to peak,permeability surface,blood reflux constant,volume transfer constant,and extracellular extravascular space volume fraction on the prognosis of patients with CRC.RESULTS Pathological biopsies confirmed the following CRC stages:23,23,32,and 17 at T1,T2,T3,and T4,respectively.There were 39 cases at the N0 stage,22 at N1,34 at N2,44 at M0 stage,and 51 at M1.Using pathological findings as the benchmark,the combined use of MRI and SCT for preoperative TNM staging in patients with CRC demonstrated superior sensitivity,specificity,and accuracy compared with either modality alone,with a statistically significant difference in accuracy(P<0.05).Receiver operating characteristic curve analysis revealed the predictive values for laparoscopic treatment prognosis,as indicated by the areas under the curve for blood volume,blood flow,time to peak,and permeability surface,blood reflux constant,volume transfer constant,and extracellular extravascular space volume fraction were 0.750,0.683,0.772,0.761,0.709,0.719,and 0.910,respectively.The corresponding sensitivity and specificity values were also obtained(P<0.05).CONCLUSION MRI with SCT is effective in the clinical diagnosis of patients with CRC and is worthy of clinical promotion.

Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection

BACKGROUND Recurrence is the major challenge facing endoscopic submucosal dissection(ESD)-based treatment therapies for early gastric cancer(EGC).Urgent development of simple and easy surveillance approaches will enhance clinical treatment of the disease.AIM To explore the role of computed tomography(CT)recurrence in evaluating EGC after ESD treatment.METHODS We retrospectively recruited patients from our endoscopy department,between January 2002 and December 2015,and analyzed their basic characteristics,including symptoms,CT results,and results of endoscopy with biopsy,among others.RESULTS Among a total of 2150 patients EGC patients surveyed,1362 met our inclusion and exclusion criteria and were therefore enrolled in our study.The cohort’s sensitivity of CT for recurrent GC and specificity were 44.22%and 43.86%,respectively,with negative and positive predictive values of 40.15%(275/685)and 48.01%(325/677),respectively.The area under the curve of arterial and venous CT values for recurrent EGC were 0.545,and 0.604,respectively.Receiver operating characteristic curve revealed no statistically significant differences between arterial and venous CT values for recurrent EGC.CONCLUSION Enhanced CT has superior diagnostic efficacy,but less accuracy,compared to gold standard techniques in patients with recurrent EGC.

Portal vein computed tomography imaging characteristics and their relationship with bleeding risk in patients with liver cirrhosis undergoing interventional therapy

BACKGROUND This study aimed to analyze the predictive value of multi-slice spiral computed tomography(CT)perfusion imaging for upper gastrointestinal bleeding in patients with cirrhotic portal hypertension.A total of 62 patients with cirrhotic portal hypertension and 28 healthy individuals were included.The results showed that multi-slice spiral CT perfusion imaging had a significant predictive value for upper gastrointestinal bleeding in patients with cirrhotic portal hypertension.The vascular area,number of vascular cross-sections,and gastric coronary vein diameter(GCVD)showed high predictive values,with the vascular area having the best predictive value.AIM To investigate the predictive accuracy of multi-slice spiral CT perfusion imaging for upper gastrointestinal bleeding in patients with cirrhosis and portal hypertension.METHODS This study included 62 patients with cirrhotic portal hypertension(disease group)and 28 healthy individuals(control group).The disease group was further divided into two subgroups:Group A(n=27,bleeding)and group B(n=35,no bleeding).All patients underwent multi-slice spiral CT perfusion imaging at our hospital,and we compared various parameters such as liver blood flow,vein size,number of blood vessels,and blood vessel area between the two groups.We employed statistical analysis to identify factors associated with upper gastrointestinal bleeding and created a graph comparing the predictive value of different factors for bleeding.RESULTS We found no difference in hepatic artery(HAP)levels among the three groups(all P>0.05).The portal vein levels in groups A and B were much lower than in the control group;group A was much lower than group B(all P<0.05).The HAP perfusion index levels in groups A and B were much higher than in the control group;group A was much higher than group B(all P<0.05).The portal vein diameter,splenic vein diameter,and GCVD levels in groups A and B were much higher than in the control group;those in group A were much higher than those in group B(all P<0.05).The number of blood vessels and blood vessel area in groups A and B were much higher than in the control group;those in group A were much higher than those in group B(all P<0.05).The statistical method showed a strong link between GCVD,number of blood vessels,blood vessel area,and upper gastrointestinal bleeding(odds ratio=1.275,1.346,1.397,P<0.05).The graph showed that GCVD,number of blood vessels,and blood vessel area could predict bleeding well,with blood vessel area having the best prediction power.CONCLUSION That multi-slice spiral CT perfusion imaging can predict upper gastrointestinal bleeding well in patients with cirrhosis and high blood pressure in the portal vein.GCVD,number of blood vessels,and blood vessel area had high prediction power.The blood vessel area had the best prediction power,with an area under the curve of 0.831.

Segmental radiofrequency ablation of pulmonary vein ostia for patients with refractory paroxysmal atrial fibrillation using multi-slice spiral computed tomography guidance

Objective： To evaluate the safety and clinical efficacy of segmental radiofrequency ablation of pulmonary vein （PV） ostia for patients with refractory paroxysmal atrial fibrillation （AF） under multi-slice spiral computed tomography （MSCT） guidance before the procedure. Methods： A series of 58 consecutive patients with refractory paroxysmal AF were enrolled to undergo segmental radiofrequency ablation ofPV ostia. The 36 male and 22 female patients with mean age of （57.4±9.5） （32-79） years and no obvious organic heart disease. Before ablation, patients received MSCT to generate 3-dimentional image of the left atrium （LA） and proximal PVs. Patients then underwent segmental radiofrequency ablation ofPV ostia using PV circular mapping catheter manipulated several times to ensure complete isolation between PVs and LA. Results： No complications occurred during the procedure. One patient developed delayed cardiac tamponade, which was drained percutaneously. The mean follow-up time was （17.1±9.3） months. Forty-one patients （95%） experienced improved quality of life one month after the procedure. Thirty-six patients （83%） showed stable sinus rhythm, while 10 patients （23%） required additional anti-arrhythmic drugs. AF returned≥1 time in 6 （14%） patients who underwent anti-arrhythmic drug therapy, but the number of episodes was less than that before the procedure. However, one patient experienced recurrent episodes of atrial flutter. Conclusion： It is safe and effective to perform segmental radiofrequency ablation of PV ostia for patients with refractory paroxysmal AF using MSCT guidance mappening.

Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization

BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.

Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps,and gastric stromal tumor risk stratification assessment

BACKGROUND The biological characteristics of gastric stromal tumors are complex,and their incidence has increased in recent years.Gastric stromal tumors(GST)have potential malignant tendencies,and the probability of transformation into malignant tumors is as high as 20%-30%.AIM To investigate the value of multi-slice spiral computed tomography(MSCT)in the differential diagnosis of GST and benign gastric polyps,and GST risk stratification assessment.METHODS We included 64 patients with GST(GST group)and 60 with benign gastric polyps(control group),confirmed by pathological examination after surgery in PLA General Hospital,from January 2016 to June 2021.The differences in the MSCT imaging characteristic parameters and enhanced CT values between the two groups before surgery were compared.According to the National Institutes of Health’s standard,GST is divided into low-and high-risk groups for MSCT imaging characteristic parameters and enhanced CT values.RESULTS The incidences of extraluminal growth,blurred boundaries,and ulceration in the GST group were significantly higher than those in the control group(P<0.05).The CT values and enhanced peak CT values in the arterial phase in the CST group were higher than those in the control group(P<0.05).The MSCT differential diagnosis of GST and gastric polyp sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and areas under the curve(AUCs)were 73.44%,83.33%,26.56%,16.67%,0.784,respectively.The receiver operating characteristic curves were plotted with the arterial CT value and enhanced peak CT value,with a statistical difference.The results showed that the sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and AUC value of arterial CT in the differential diagnosis of GST and gastric polyps were 80.18%,62.20%,19.82%,37.80%,and 0.710,respectively.The sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and AUC value of the enhanced peak CT value in the differential diagnosis of GST and gastric polyps were 67.63%,60.40%,32.37%,39.60%,and 0.710,respectively.The incidence of blurred lesion boundaries and ulceration in the high-risk group was significantly higher than that in the low-risk group(P<0.05).The arterial phase and enhanced peak CT values in the high-risk group were significantly higher than those in the low-risk group(P<0.05).CONCLUSION Presurgical MSCT examination has important value in the differential diagnosis of GST and gastric benign polyps and can effectively evaluate the risk grade of GST patients.

3D Reconstruction with Spiral Computed Tomography in Choroidal Osteoma

Choroidal osteoma (CO) is a rare, ossifying benign tumor originated in the choroid that typically occurs in otherwise healthy young women (1,2). It is characterized by a yellowish, well demarcated lesion in the juxtapapillary or macular area. The diagnosis is clinical and can be confirmed with the use of fluorescein or indocyanine angiography, optical coherence tomography, computed tomography or magnetic resonance imaging. Choroidal neovascularization or subretinal fluid, the main causes for vision loss, can be treated with laser therapy, photodynamic therapy or intravitreal antivascular endothelial growth factor therapy. We present a case of choroidal osteoma, showing the role of the high resolution 3D spiral computed tomography.

Observation of the effect of targeted therapy of 64-slice spiral CT combined with cryoablation for liver cancer

AIM to observe the effect of targeted therapy with 64-slice spiral computed tomography (CT) combined with cryoablation for liver cancer. METHODS A total of 124 patients ( 142 tumors) were enrolled into this study. According to the use of dual-slice spiral CT or 64-slice spiral CT as a guide technology, patients were divided into two groups: dual-slice group (n = 56, 65 tumors) and 64-slice group (n = 8, 77 tumors). All patients were accepted and received targeted therapy by an argon-helium superconducting surgery system. The guided scan times of the two groups was recorded and compared. In the two groups, the lesion ice coverage in diameter of >= 3 cm and < 3 cm were recorded, and freezing effective rate was compared. Hepatic perfusion values [ hepatic artery perfusion (HAP), portal vein perfusion (PVP), and the hepatic arterial perfusion index (HAPI)] of tumor tissues, adjacent tissues and normal liver tissues at preoperative and postoperative four weeks in the two groups were compared. Local tumor changes were recorded and efficiency was compared at four weeks post-operation. Adverse events were recorded and compared between the two groups, including fever, pain, frostbite, nausea, vomiting, pleural effusion and abdominal bleeding. RESULTS Guided scan times in the dual-slice group was longer than that in the 64-slice group (t = 11.445, P = 0.000). The freezing effective rate for tumors < 3 cm in diameter in the dual-slice group (81.58%) was lower than that in the 64-slice group (92.86%) (chi(2) = 5.707, P = 0.017). The HAP and HAPI of tumor tissues were lower at four weeks post-treatment than at pretreatment in both groups (all P < 0.05), and those in the 64-slice group were lower than that in the dual-slice group ( all P < 0.05). HAP and PVP were lower and HAPI was higher in tumor adjacent tissues at post-treatment than at pre-treatment ( all P < 0.05). Furthermore, the treatment effect and therapeutic efficacy in the dual-slice group were lower than the 64-slice group at four weeks post-treatment (all P < 0.05). Moreover, pleural effusion and intraperitoneal hemorrhage occurred in patients in the dual-slice group, while no complications occurred in the 64-slice group (all P < 0.05). CONCLUSION 64-slice spiral CT applied with cryoablation in targeted therapy for liver cancer can achieve a safe and effective freezing treatment, so it is worth being used.

Spiral multi-phase CT in evaluating resectability of pancreatic carcinoma

Objectives: To evaluate the specific manifestations of pancreatic carcinoma on spiral multi-phase CT and its resectability before operation. Methods: Ninety-seven patients were confirmed oper- atively and pathologically. Enhanced CT scan was performed with intravenous injection bolus of ap- proximately 75-120 ml (1-1.5 ml/kg body weight) contrast medium at a rate of 2.5-3 ml/s. In 68 pa- tients receiving dual-phase scan, the delayed scan time of arterial and venous phases was 18-20 s and 60-70 s, respectively, and in 29 patients receiving three-phase scan, the delayed scan time of arterial, pancreatic and portal venous phases was 18 s, 40 s and 75 s, respectively, with a slice of 3-5 mm thick- ness, a pitch of 1-1.5, and a reconstruction interval of 2.5-4.8 mm. Results: Positive and negative predictive values of un- resectable tumors were 97.65% and 75.86%, respec- tively. The sensitivity and accuracy were 90.67% and 90. 72%, respectively. Positive predictive values of dual-phase and three-phase were 95.83% and 100%, respectively; negative predictive values were 75% and 77.78%, respectively. Conclusions: Spiral multi-phase CT is superior in re- vealing the involvement of peripancreatic vessels, the invasion of the neighboring organs, the size, shape and range of carcinoma, and the metastasis of liver and lymph node. The predictability of resection is obviously increased for patients with pancreatic car- cinoma.

Diagnostic Value of 16 Slices Spiral-CT for Portal Vein Disorders

Summary: The diagnostic value of 16-slices spiral computed tomography (CT) for portal vein disorders was evaluated. Forty-one patients were scanned by the 16-slices spiral-CT. The celiac trunk, portal vein and their branches were reconstructed by volume rendering (VR), multiplanar volume reconstruction (MPVR) and maximum intensity projection (MIP) technique, and the results were compared with digital subtraction angiography (DSA). VR, MPVR and MIP could display celiac trunk, portal vein, inferior vena cava and their branches and extent of portal vein-vena cava shunt, portal vein emboli and the fistula of hepatic artery-portal vein. The results from 16-slices CT were better than DSA and identical with pathologic ones. The vessel three-dimension reconstruction technique of 16-slices spiral CT is valuable for evaluating the portal systemic disorders.

Difference of anterior and posterior orbital development in patients with congenital microphthalmia:a retrospective cohort study from China

AIM:To evaluate volume differences between anterior and posterior orbit and demographic characteristics of Chinese patients with congenital microphthalmia.METHODS:A retrospective cohort study,involving 169 unilateral congenital microphthalmia patients aged between 1 and 57 years old was conducted.Three-dimensional images of the orbit were generated from past CT scans,and digital orbital volume comprehensive measurement was done.The measured data included orbital volume(OBV),posterior orbital volume(POV),orbital width(OBW),orbital height(OBH),orbital depth(OBD),and posterior orbital area ratio.RESULTS:Significant differences were observed among OBV,POV,OBW,OBH,and OBD of the affected and unaffected eyes in different age-based groups(all P<0.001).Among them,OBH had the greatest different.The mean microphthalmic to contralateral ratio(MCR) of OBV,POV,OBW,and OBH continuously increased from 1 to 3 years old,whereas the MCR of POV decreased from 3 to 17 years old.The MCR of OBD was not found to be correlated to age.There was no significant difference between OBV,POV,OBW,and OBH in ages from 13 years old to adulthood(all P>0.05).The difference in posterior orbital area ratio between the affected and unaffected groups was not statistically significant(P>0.05).CONCLUSION:OBH is maximally affected,whereas OBD is minimally affected by microphthalmia.Posterior orbital retardation began 2y prior to orbital retardation and occurred at 3 years old in the affected eye,suggesting that intervention therapy should be done before the age of 4.

Expression of nm23, KAI1 and spiral computed tomography findings in primary gallbladder carcinoma

Primary gallbladder carcinoma is the most common malignant tumor of the biliary system. There is a reduced likelihood for radical cure of primary gallbladder carcinomas because of the insidious onset.1 Spiral computed tomography （SCT） scanning is an important means for diagnosing lesions involving the gallbladder. We determined the expression of anti-metastasis protein nm23 and KAI1 using immunohistochemical method and analyzed the relationship between their expression and the pre-operatively SCT imaging findings, the histopathologic grade, clinical stage, 5-year survival rate in 35 cases of primary gallbladder cancer.

Different therapeutic proportion of patients undergone coronary angiography in the era of development in MSCT

Objective To study the different therapeutic proportion of the patient populations undergone coronary angiography(CAG)in the era of development in multislice spiral computed tomography(MSCT).Methods Two hundred and fifty four consecutive patients(mean age 59.24±10.65),who underwent CAG at Daxing Hospital from February 2007 through October 2007,were enrolled,160 patients were male and 94 were female.By evaluating from the coronary angiogram,the patients were not diagnosed to have coronary heart disease(CHD)with less than 50%diameter stenosis of coronary artery;the patients to have CHD with more than or equal to 50%stenosis of coronary artery;the patients were performed the procedure of percutaneous coronary intervention(PCI)with more than or equal to 70%stenosis;the patients were proposed to have coronary aortic bypass graft(CABG)surgery with left main coronary artery lesions or diffuse triple coronary artery lesions.Results In the 254 consecutive patients,59 patients(23.2%)had not been diagnosed to have CHD;195(76.8%)to have CHD,of these patients with CHD,49 patients(19.3%)were not indicated for PCI(including the patients receiving follow-up coronary angiography after stenting),81(31.9%)had been performed the procedure of stent implantation,57(22.4%)proposed to have CABG,8(3.1%)the procedure of PCI had not been successful,or had not been performed because of patients opposing to this therapy.Conclusion Multislice spiral computed tomography can be applied as a non-invasive screening tool to exclude the presence of CHD,to increase the positive proportion of the populations with CHD in all patients receiving coronary angiograhpy,to avoid the use of CAG in a subset of patients.

Multi-slice spiral CT 3-dimensional reconstruction tech-nique to treat multi-segmental degenerative spinal steno-sis with traumatic instability of lower cervical spine

Objective: To study the feasibility of multi-slice spiral computed tomography (MSCT) 3-dimensional reconstruc-tion technique in assisting cervical pedicle screw fixation (PSF) and double-door laminoplasty to treat multi-segmen-tal degenerative spinal stenosis with traumatic instability (MDSTI) of lower cervical spine.Methods: From September 2006 to August 2007, PSF combined with double-door laminoplasty was performed in 9 patients with MDSTI of lower cervical spine. MSCT 3-dimensional reconstruction techniques, including volume rendering (VR) and multi-planar reconstruction (MPR), were used to assist preoperative diagnosis and measurement to guide the procedure. MPR was performed after operation. In coronal view, the degree of screw perforation was mea-sured precisely and the different positions of pedicle screws were divided into three grades according to Richter's method. In axial view, the canal sagittal diameter and trans-verse area of every laminoplasty level were measured.Results: Nine patients with MDSTI of lower cervical spine underwent PSF (total 44 screws). According to the classification of Richter, 72.7% (32/44) was in Grade 1 and 27.3% (12/44) was in Grade 2. No screw perforation occurred in Grade 3 and no screw revision was done for misplacement.No iatrogenic damage was observed. Double-door laminoplasty was performed in total 42 volumes. The post-operative sagittal diameter and transverse area of cervical spinal canal were significantly increased (P<0.05). The confi-dence intervals of mean increased ratio were 23.43%-40.65% in sagittal diameter and 23.18%-42.07% in transverse area. Six months after laminoplasty, based on MSCT axial view, complete union between "open door" and allograft bone was obtained in 76.19% of volumes (32/42), and allograft bone was absorbed partly in 23.81% (10/42). A solid union in bilateral gutters was achieved in all cases. They were followed up from 6 months to 1 year (mean 7.8 months). Post-operative neural function recovery in two cases improved 2 ASIA grade, 5 cases improved 1 grade and 2 cases remained the same as preoperative grade. No cases had lower ASIA grade.Conclusion: Assisted with MSCT 3-dimensional re-construction technique, PSF combined with double-door laminoplasty can be performed more safely and effectively to treat patients with MDSTI of lower cervical spine.

Value of multidetector spiral CT in diagnosis of acute thoracolumbar spinal fracture and fracture-dislocation

Objective: To investigate the diagnostic value of multidetector spiral CT (MSCT) in acute thoracolumbar spinal fracture and fracture-dislocation. Methods: CT imaging files of 152 consecutive traumatic patients with thoracolumbar fractures were retrospectively reviewed. MSCT scannings were performed with a collimation of 3-5 mm and a pitch of (5.5). The postprocessing included sagittal and coronal multiplannar reconstruction, and 3-D reconstruction.Results: There were 88 cases of compression fracture, 54 cases of burst fracture and 10 cases of fracture-dislocation. Transverse images of MSCT could visualize all fractures directly and determine whether spinal canal was intact. Postprocessing image was helpful in depicting the displacement of fragment and orientation of dislocation.Conclusions: MSCT plays an important role in diagnosis and management of acute thoracolumbar spinal fracture and fracture-dislocation.

Multidetector row-CT in evaluation of living renal donors

Background Multidetector-row CT （MDCT） has been evolving to the standard evaluating method of potential living donor in most centers, and can provide excellent details for selecting candidates and determining surgical technique.This study aimed to assess the value of MDCT in evaluation of the anatomy of living kidney donors and to reveal the prevalence of renal vascular variations in a Chinese population.Methods One hundred and four potential donors underwent MDCT and the data sets were post-processed for reformatted images with various techniques, such as maximum intensity projection （MIP）, a volume-rendering technique （VR）, and multiplanar reformation （MPR）. Donor nephrectomies were performed on 97 candidates after MDCT evaluation with the findings during surgery constituting the standard of reference. Resulting MDCT images were compared with actual anatomy found during surgery. Results The MDCT images accurately displayed the anatomic structure of the main renal arteries and veins as well as the upper ureters, except in one case with horseshoe kidney. The prevalence of accessory arteries revealed in images was 27.2% （28/103） and early branching was found in 12.6% （13/103）. Compared with findings during surgery, the detection of accessory arteries in MDCT images was 85.7% （6/7）, and the detection of larger accessory arteries （〉1.5 mm in diameter） was 100%. Detection of early branching was 100%.Conclusion MDCT helps accurately evaluate the renal anatomy of potential donors thus facilitating the planning of surgery.

Accuracy of the AAST organ injury scale for CT evaluation of traumatic liver and spleen injuries

Objective： Detection of abdominal in- jury is a very important component in trauma management, so a precise assessment of liver and spleen injuries includ- ing their severity degree is necessary. There is a good case to believe that in emergency situations the radiologists＇ performance may profit from a systematic approach using established scoring systems. Score systems as the organ injury scale （OIS） drawn up by the American Association for the Surgery of Trauma are a valuable guidance for objec- tive trauma assessment. Aim of this study was to evaluate retrospectively whether a structured approach using the OIS may help improve trauma assessment. Methods： Fifty-three patients, 38 male and 15 female who underwent CT and laparotomy after abdominal trauma were included in this study. The laparotomy was performed by experienced surgeons with a minimum experience of 6 years. While the original CT reports were written by differ- ent radiologists with a minimum experience of 3 years, and then a radiologist with experience of 4 years reviewed the same original CT pictures, resulting in the structured report. Both the original and structured CT results on liver and spleen injuries were transferred into OIS grades. Finally, the initial and structured CT results were compared with theintraoperative findings gathered from the surgery report. Results： Regarding the original CT report we found a mean divergence of 0.68±0.8 （r=-0.45） to the OIS finding in the surgery report for liver injuries （0.69±1.17 for spleen injuries; r=-0.69）. In comparison with the structured approach, where we detected a divergence of 0.8±0.68; r=-0.63 （0.47±0.77 for spleen injuries; r=0.91）, there was no significant difference. However we detected a lower rate of over-diag- nosis in structured approaches. Conclusion： Our study shows that a structured ap- proach to triage abdominal trauma using an imaging check- list does not lead to a significantly higher detection rate, but a nonsignificant trend to reduce the rate of over- diagnoses, thus being more precise in grading the severity grade. Concerning the bias by retrospective study design, further prospective investigations are needed to evaluate the impact of trauma scores on the workflow in emergency department procedure as structured reporting systems are a valuable guidance in other radiological disciplines.

A case with insulinoma localized by combined use of various means

A patient with insulinoma diagnosed by clinical features and localized preoperatively using a combination of contrast-enhanced ultrasonography （CEUS）, dual phase contrast enhanced spiral computed tomography （DPSCT） and arterial stimulation and venous sampling （ASVS） was reported. A 37-year-old man was admitted to our hospital because of hypoglycemic attacks, palpitations, and muscular weakness. Fajans＇ ratio reported to be an index for insulinoma was positive. Transabdominal computed tomography and ultrasonography failed to detect any abnormalities. CEUS showed a small low echoic lesion in the pancreatic body with blood flow and the early arterial phase of DPSCT revealed a small strengthening focus, which mimicked a pancreatic tumor in the pancreatic body. ASVS showed that the insulin levels in the hepatic vein were extremely increased by calcium injection to the gastroduodenal artery. An open intra-abdominal operation was performed and an insulinoma was confirmed in the pancreatic body. Enucleation of tumor was undertaken and histopathological examination showed an adenoma, insulin expression was positive in immunofluorescence staining.Symptomatic hypoglycemia never happened even without glucose infusion since the operation. His blood glucose level improved to within the normal range.

Diagnostic accuracy of Focused Abdominal Sonography for Trauma in blunt abdominal trauma patients in a trauma centre of Hong Kong

Objective： Focused Abdominal Sono graphy for Trauma （FAST） is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma （BAT）. This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre. Methods： This was a retrospective study of BAT pa tients over a 6 year period seen in a trauma centre in Hong Kong. FAST findings were compared with laparotomy, ab dominal computed tomography or autopsy findings, which served as the gold standard for presence of intraperi toneal free fluids. The patients who did not have FAST or gold standard confirmatory test performed, had preexisting peritoneal fluid, died at resuscitation or had imcomplete docu mentation of FAST findings were excluded. The performance of FAST was expressed as sensitivity, specificity, predictive values （PV）, likelihood ratios （LR） and accuracy. Results： FAST was performed in 302 patients and 153 of them were included in this analysis. The sensitivity, specificity, positive PV, negative PV, positive LR, negative LR and accuracy for FAST were respectively 50.0%, 97.3%, 87.0%, 84.6%, 18.8, 0.5 and 85.0%. FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients. Conclusion： FAST is a reliable investigation in the initial assessment of BAT patients. The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use.

Coronary artery calcification is associated with atherogenic lipid changes, cardiac dysfunction and morphologic abnormalities in HIV-1 infected black adults

The heart is an organ frequently affected in the acquired immunodeficiency syndrome.~1 But there is little information as to whether the coronary artery calcification can identify asymptomatic individuals at high risk for having cardiac morphological and functional abnormalities and cardiac risk factors in human immunodeficiency virus (HIV)-infected persons. Accordingly, the purpose of this study was to determine whether coronary artery calcification was associated with cardiac morphological and functional abnormalities, atherogenic lipid and C-reactive protein (CRP) changes in a black adult population with HIV-1 infection.