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 enha...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.展开更多
BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by ...BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.METHODS A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study.The nodal sizes measured on computed tomography(CT)images were compared with the pathology results.A receiver-operating characteristic curve was constructed,from which the critical value(CV)was calculated by using the data of the first 69 patients retrospectively.By using the CV,sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients.This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping.The intranodal pathological metastatic patterns were classified into the following four types:Small nodular,peripheral,large nodular,and diffuse.RESULTS Although all the cases were clinically suspected as having metastasis,81 had lymph node metastasis and 27 had no metastasis.The number of dissected,detected on CT,and metastatic nodes were,4241,897,and 801,respectively.The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis.The sensitivity was 91.4%and the specificity was 47.3%in the prospective phase.The large nodular and diffuse metastases were easy to diagnose becausemetastatic nodes with a large axis often exhibit these forms.CONCLUSION The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping,using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data.The sensitivity was as high as 91%,and would be improved when referring to the enhanced patterns.However,its specificity was as low as 47%,because most of metastatic nodes in gastric cancer being small in size.The small nodular or peripheral type metastatic nodes were often small and considered difficult to diagnose.展开更多
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 t...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.展开更多
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 c...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.展开更多
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 juxtap...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.展开更多
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 ...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.展开更多
AIM:To determine the accuracy of tomography in the linear measurement of alveolar bone at maxillary sinus/nose location.METHODS:Two dry skulls each marked with 10 pairs of guttaperchas placed on buccal and lingual sid...AIM:To determine the accuracy of tomography in the linear measurement of alveolar bone at maxillary sinus/nose location.METHODS:Two dry skulls each marked with 10 pairs of guttaperchas placed on buccal and lingual sides of the maxillary ridge were used in this in vitro study.The distance between the alveolar crest and the sinus/nasal floor was measured on tomographic views,prepared by linear and spiral techniques.The ridges were then sectioned so that each section would include one pair of buccal and lingual guttaperchas.The actual distances directly measured on the sections were compared to those of the equivalent tomographic sections(the magnification co-efficient was applied).Paired t-test was used to statistically analyze the data.RESULTS:The measurement error with the application of linear tomography and spiral tomography wasshown to be 0.455±0.838 mm(P=0.029)and 0.17±0.78 mm(P=0.347),respectively.There was a statistically significant difference between the liner tomography values and actual values(P=0.029).This difference was representative of underestimation.McNamara’s test was used to assess the±1 mm error;73.7%of the linear values and 84.2%of the spiral values were within the±1 mm error limit.Mc Namara’s test did not show any significant differences between the 2methods in this regard(P=0.625).The linear values were significantly different to the actual values(P=0.029)but not to the spiral values(P=0.185).CONCLUSION:Spiral tomography has enough accuracy for the measurement of alveolar ridge height.Although linear tomography somewhat underestimates the actual values it provides satisfactory accuracy.展开更多
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 comput...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)atrium (LA) and proximal PVs. Patients then underwent segmental radiofrequency ablation of PV 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≥1time 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.展开更多
Objective: The standard treatment for patients with locally advanced gastric cancer has relied on perioperativeradio-chemotherapy or chemotherapy and surgery. The aim of this study was to investigate the wealth of ra...Objective: The standard treatment for patients with locally advanced gastric cancer has relied on perioperativeradio-chemotherapy or chemotherapy and surgery. The aim of this study was to investigate the wealth of radiomicsfor pre-treatment computed tomography (CT) in the prediction of the pathological response of locally advancedgastric cancer with preoperative chemotherapy.Methods: Thirty consecutive patients with CT-staged Ⅱ/Ⅲ gastric cancer receiving neoadjuvant chemotherapywere enrolled in this study between December 2014 and March 2017. All patients underwent upper abdominal CTduring the unenhanced, late arterial phase (AP) and portal venous phase (PP) before the administration ofneoadjuvant chemotherapy. In total, 19,985 radiomics features were extracted in the AP and PP for each patient.Four methods were adopted during feature selection and eight methods were used in the process of building theclassifier model. Thirty-two combinations of feature selection and classification methods were examined. Receiveroperating characteristic (ROC) curves were used to evaluate the capability of each combination of feature selectionand classification method to predict a non-good response (non-GR) based on tumor regression grade (TRG).Results: The mean area under the curve (AUC) ranged from 0.194 to 0.621 in the AP, and from 0.455 to 0.722in the PP, according to different combinations of feature selection and the classification methods. There was onlyone cross-combination machine-learning method indicating a relatively higher AUC (〉0.600) in the AP, while 12cross-combination machine-learning methods presented relatively higher AUCs (all 〉0.600) in the PP. The featureselection method adopted by a filter based on linear discriminant analysis + classifier of random forest achieved asignificantly prognostic performance in the PP (AUC, 0.722~0.108; accuracy, 0.793; sensitivity, 0.636; specificity,0.889; Z=2.039; P=0.041).Conclusions: It is possible to predict non-GR after neoadiuvant chemotherapy in locally advanced gastriccancers based on the radiomics of CT.展开更多
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...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.展开更多
Background The abnormalities of coronary arteries, though rare and sometimes benign, may first present clinically as myocardial infarction or sudden death. Multi-detector computed tomography (MDCT) is a non-invasive...Background The abnormalities of coronary arteries, though rare and sometimes benign, may first present clinically as myocardial infarction or sudden death. Multi-detector computed tomography (MDCT) is a non-invasive test that is highly suitable for detecting these anomalies. The study aimed to review the 64-MDCT appearance of the coronary artery anomalies in 66 patients and to discuss the clinical importance of these anomalies.Methods In 6014 consecutive patients examined over 12 months by 64-MDCT for the study of coronary artery disease, 66 were diagnosed for coronary artery anomalies. All patients were symptomatic for one or more of the following diseases: chest pain, dyspnoea, palpitations, arrhythmia and myocardial infarction. Nine patients had undergone a coronary angiography. All the CT images were evaluated by two radiologists and one cardiologist. The right coronary artery (RCA) and the conus branch arising separately, myocardial bridging and duplication of arteries were not analysed in our study.Results The incidence of coronary artery anomalies found in our study group was 1.097%. In the selected patients, seven different types of coronary anomalies were found by 64-MDCT examination. The high takeoff, origin of the coronary artery from the opposite or noncoronary sinus with an anomalous course, and coronary artery fistula were the three common forms of anomalies (n=16, 18 and 16, respectively). Compared with the results of the coronary angiography, the number of the drainage sites of two coronary artery fistula was less in MDCT images (3 small sites in total). In all cases, coronary artery computed tomography angiography (CTA) technique was able to recognize the origin of the coronary artery, its three-dimensional course and its spatial relationship with the adjacent structures. Conventional coronary angiography in two cases, however, was unable to provide sufficient information for correct and complete diagnosis.Conclusions In conclusion, the study showed that 64-MDCT, especially the volume rendering technique (VRT), may be useful for the assessment of complex variations, even if the conventional angiography may not be sufficient. It may be considered as the first-choice imaging modality when an anomalous coronary artery is suspected.展开更多
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 pathological...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.展开更多
文摘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.
文摘BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.METHODS A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study.The nodal sizes measured on computed tomography(CT)images were compared with the pathology results.A receiver-operating characteristic curve was constructed,from which the critical value(CV)was calculated by using the data of the first 69 patients retrospectively.By using the CV,sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients.This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping.The intranodal pathological metastatic patterns were classified into the following four types:Small nodular,peripheral,large nodular,and diffuse.RESULTS Although all the cases were clinically suspected as having metastasis,81 had lymph node metastasis and 27 had no metastasis.The number of dissected,detected on CT,and metastatic nodes were,4241,897,and 801,respectively.The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis.The sensitivity was 91.4%and the specificity was 47.3%in the prospective phase.The large nodular and diffuse metastases were easy to diagnose becausemetastatic nodes with a large axis often exhibit these forms.CONCLUSION The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping,using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data.The sensitivity was as high as 91%,and would be improved when referring to the enhanced patterns.However,its specificity was as low as 47%,because most of metastatic nodes in gastric cancer being small in size.The small nodular or peripheral type metastatic nodes were often small and considered difficult to diagnose.
文摘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.
文摘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.
文摘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.
基金Supported by the Hebei Medical Science Project Research Program Project,No.20201411.
文摘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.
文摘AIM:To determine the accuracy of tomography in the linear measurement of alveolar bone at maxillary sinus/nose location.METHODS:Two dry skulls each marked with 10 pairs of guttaperchas placed on buccal and lingual sides of the maxillary ridge were used in this in vitro study.The distance between the alveolar crest and the sinus/nasal floor was measured on tomographic views,prepared by linear and spiral techniques.The ridges were then sectioned so that each section would include one pair of buccal and lingual guttaperchas.The actual distances directly measured on the sections were compared to those of the equivalent tomographic sections(the magnification co-efficient was applied).Paired t-test was used to statistically analyze the data.RESULTS:The measurement error with the application of linear tomography and spiral tomography wasshown to be 0.455±0.838 mm(P=0.029)and 0.17±0.78 mm(P=0.347),respectively.There was a statistically significant difference between the liner tomography values and actual values(P=0.029).This difference was representative of underestimation.McNamara’s test was used to assess the±1 mm error;73.7%of the linear values and 84.2%of the spiral values were within the±1 mm error limit.Mc Namara’s test did not show any significant differences between the 2methods in this regard(P=0.625).The linear values were significantly different to the actual values(P=0.029)but not to the spiral values(P=0.185).CONCLUSION:Spiral tomography has enough accuracy for the measurement of alveolar ridge height.Although linear tomography somewhat underestimates the actual values it provides satisfactory accuracy.
文摘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)atrium (LA) and proximal PVs. Patients then underwent segmental radiofrequency ablation of PV 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≥1time 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.
基金supported by the National Key Research and Development Program of China (No.2017YFC1309100)the National Natural Scientific Foundation of China (No. 81771912)the Applied Basic Research Projects of Yunnan Province, China [No. 2015FB071 and No. 2017FE467-084]
文摘Objective: The standard treatment for patients with locally advanced gastric cancer has relied on perioperativeradio-chemotherapy or chemotherapy and surgery. The aim of this study was to investigate the wealth of radiomicsfor pre-treatment computed tomography (CT) in the prediction of the pathological response of locally advancedgastric cancer with preoperative chemotherapy.Methods: Thirty consecutive patients with CT-staged Ⅱ/Ⅲ gastric cancer receiving neoadjuvant chemotherapywere enrolled in this study between December 2014 and March 2017. All patients underwent upper abdominal CTduring the unenhanced, late arterial phase (AP) and portal venous phase (PP) before the administration ofneoadjuvant chemotherapy. In total, 19,985 radiomics features were extracted in the AP and PP for each patient.Four methods were adopted during feature selection and eight methods were used in the process of building theclassifier model. Thirty-two combinations of feature selection and classification methods were examined. Receiveroperating characteristic (ROC) curves were used to evaluate the capability of each combination of feature selectionand classification method to predict a non-good response (non-GR) based on tumor regression grade (TRG).Results: The mean area under the curve (AUC) ranged from 0.194 to 0.621 in the AP, and from 0.455 to 0.722in the PP, according to different combinations of feature selection and the classification methods. There was onlyone cross-combination machine-learning method indicating a relatively higher AUC (〉0.600) in the AP, while 12cross-combination machine-learning methods presented relatively higher AUCs (all 〉0.600) in the PP. The featureselection method adopted by a filter based on linear discriminant analysis + classifier of random forest achieved asignificantly prognostic performance in the PP (AUC, 0.722~0.108; accuracy, 0.793; sensitivity, 0.636; specificity,0.889; Z=2.039; P=0.041).Conclusions: It is possible to predict non-GR after neoadiuvant chemotherapy in locally advanced gastriccancers based on the radiomics of CT.
文摘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.
文摘Background The abnormalities of coronary arteries, though rare and sometimes benign, may first present clinically as myocardial infarction or sudden death. Multi-detector computed tomography (MDCT) is a non-invasive test that is highly suitable for detecting these anomalies. The study aimed to review the 64-MDCT appearance of the coronary artery anomalies in 66 patients and to discuss the clinical importance of these anomalies.Methods In 6014 consecutive patients examined over 12 months by 64-MDCT for the study of coronary artery disease, 66 were diagnosed for coronary artery anomalies. All patients were symptomatic for one or more of the following diseases: chest pain, dyspnoea, palpitations, arrhythmia and myocardial infarction. Nine patients had undergone a coronary angiography. All the CT images were evaluated by two radiologists and one cardiologist. The right coronary artery (RCA) and the conus branch arising separately, myocardial bridging and duplication of arteries were not analysed in our study.Results The incidence of coronary artery anomalies found in our study group was 1.097%. In the selected patients, seven different types of coronary anomalies were found by 64-MDCT examination. The high takeoff, origin of the coronary artery from the opposite or noncoronary sinus with an anomalous course, and coronary artery fistula were the three common forms of anomalies (n=16, 18 and 16, respectively). Compared with the results of the coronary angiography, the number of the drainage sites of two coronary artery fistula was less in MDCT images (3 small sites in total). In all cases, coronary artery computed tomography angiography (CTA) technique was able to recognize the origin of the coronary artery, its three-dimensional course and its spatial relationship with the adjacent structures. Conventional coronary angiography in two cases, however, was unable to provide sufficient information for correct and complete diagnosis.Conclusions In conclusion, the study showed that 64-MDCT, especially the volume rendering technique (VRT), may be useful for the assessment of complex variations, even if the conventional angiography may not be sufficient. It may be considered as the first-choice imaging modality when an anomalous coronary artery is suspected.
基金This study was supported by the grant from the Program of Social Development Fund of the Jiangsu Provincial Science and Technology Commission (BS97046).
文摘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.