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.

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.

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.

64排螺旋CT检测冠心病患者冠状动脉斑块分型的分布特点与其血清IL-6、TNF-α含量的相关性

目的通过64排螺旋CT检测各型冠心病中软斑块、混合斑块、钙化斑块的分布,探讨冠脉斑块稳定性与IL-6和TNF-α含量的相关性。方法选择89例住院接受冠脉造影的患者根据临床诊断分为正常对照组、稳定型心绞痛组(SAP)和急性冠脉综合征组(ACS)(不包括急性ST段抬高的心肌梗死)。64排螺旋CT检查后根据斑块性质分为正常对照组、软斑块组、混合斑块组和钙化斑块组,测定血清IL-6和TNF-α。结果①在ACS组软斑块、混合斑块的分布显著高于钙化斑块(P<0.001),而在SAP组钙化斑块的分布显著高于ACS组(P<0.001);②各斑块组平均血清IL-6和TNF-α水平显著高于对照组(P<0.05);软斑块组、混合斑块组平均血清IL-6和TNF-α水平高于钙化斑块组(P<0.05);而于软斑块组和混合斑块组间平均血清IL-6和TNF-α水平比较差异无显著性(P>0.05);③ACS组平均血清IL-6和TNF-α水平显著高于对照组及SAP组(均P<0.01)。结论①64排螺旋CT冠脉造影可较准确地显示冠心病患者病变冠状动脉斑块的性质;②血清IL-6、TNF-α平可较好反映冠心病患者冠状动脉斑块的不稳定性;③64排螺旋CT检测分析斑块在各型冠心病分布特点及IL-6、TNF-α含量分析,可对冠状动脉斑块的稳定性进行评估,对预测心血管事件及危险分级提供有益参考。

多层螺旋CT三种图像后处理技术在肺栓塞诊断中的应用评价

目的比较不同重建层厚的各种图像后处理技术对肺动脉栓子的显示及诊断价值。方法收集40例经多层螺旋CT肺动脉成像检查并经临床及实验室检查确诊的肺动脉栓塞(PE)图像资料,利用原始数据分别行层厚0.625、1.25、2.5、5.0 mm重建图像,然后运用多平面重组(MPR)、最大密度投影(MIP)及容积成像(VR)3种图像后处理方法对于在不同层厚的各级肺动脉显示及其栓子分布情况进行观察分析。结果本组40例PE均为双肺多发肺栓塞,共累及各级肺动脉分支409处,范围从肺动脉主干至亚段动脉。40例PE中,对亚段动脉栓子检出率,0.625、1.25、2.5 mm MPR图像和MIP图像的差异无统计学意义,5 mm MPR、5 mm MIP及VR图像对亚段动脉栓子显示较0.625、1.25、2.5 mm MPR及MIP图像差异有统计学意义。结论肺栓塞的诊断主要依靠薄层横断图像,对亚段动脉栓子的观察至少要用2.5 mm重建层厚的MPR或MIP图像,两者任选择一项即可。而1.25 mm层厚对亚段动脉栓子不易漏诊,且能大大地提高观察者阅片速度,故1.25 mm层厚的MPR或MIP为最佳成像方法。

New progress in CT and MRI examination and diagnosis of small intestinal tumors

Precise examination and diagnosis of small intestinal tumors is difficult because of the curved course and overlapping canal of the small intestine. Traditional technology for intestinal canal examination and endoscopy cannot exhibit the intestinal wall and extra-luminal structure well. With the development and advancement of multi-slice spiral computed tomography and magnetic resonance imaging (MRI), computed tomography enteroclysis (CTE) and magnetic resonance enteroclysis (MRE) are widely used in the examination and diagnosis of small intestinal tumors. CTE and MRE, with three-dimensional imaging capabilities and excellent soft-tissue contrast, can analyze the abnormalities of peripheral intestinal structure as well as the tunica mucosa. In addition, these two technologies can clearly reveal the localization, appearance, degree of mesenteric infiltration and remote tumor metastasis, which increases our cognition of the imaging diagnosis for intestinal tumors. Here we review recent progress in imaging (CT and MRI) examination and diagnosis of small intestinal tumors.

X线检查和CT扫描对胸部创伤的诊断价值分析

目的对比分析X线检查和CT扫描对胸部创伤的诊断价值。方法回顾性分析我院2007年12月—2009年5月收治的78例胸部创伤患者的X线检查和CT扫描资料。结果 CT扫描对肋骨骨折、肺挫伤及液气胸的检出率分别为97.56%、100.00%及95.83%,均高于X线检查的85.37%、69.23%及66.67%,差异均有统计学意义(χ2=3.9048,4.7273和6.7009,P<0.05)。结论 CT扫描对胸部创伤的检出率更高,值得临床推广使用。

高场强多参数MRI与多层螺旋CT对膀胱癌术前T分期的诊断效能比较

目的 对比高场强多参数MRI与多层螺旋CT对膀胱癌术前T分期的诊断效能。方法 选取2019年1月-2021年3月天津医科大学中新生态城医院就诊治疗的97例膀胱癌患者为研究对象,术前均行高场强多参数MRI[MRI-T2WI+MRI-DWI+MRI-DCE]和多层螺旋CT检测,由2名放射科专家采用双盲法进行阅片并确定患者术前膀胱癌T分期。以术后病理检查为诊断的金标准,比较不同检查方法对膀胱癌患者术前T分期的诊断效能。结果多层螺旋CT对膀胱癌T分期的总诊断正确率为68.04%(66/97),高场强多参数MRI对膀胱癌T分期诊断的总正确率为87.63%(85/97),均优于T2WI扫描、DWI扫描和DCE扫描,高场强多参数MRI对膀胱癌T分期诊断正确率高于多层螺旋CT检查,组间正确率比较差异有统计学意义(χ^(2)=9.846,P<0.05),且与病理结果一致性程度最强(Kappa=0.829,P<0.05)。高场强多参数MRI对膀胱癌术前T1-T4分期的准确率分别为94.85%、90.72%、95.88%、93.81%,约登指数为0.898、0.792、0.738、0.934,多层螺旋CT对膀胱癌术前T1-T4分期的准确度分别为79.38%、70.10%、87.63%和98.97%,约登指数为0.891、0.438、0.501和0.989;高场强多参数MRI诊断T1分期的敏感度、诊断T2-T3分期的特异度、诊断T1-T3分期的准确率均高于多层螺旋CT,组间比较差异均有统计学意义(P<0.05)。结论 术前利用高场强多参数MRI对于T期膀胱癌的诊断性能高于多层螺旋CT,在膀胱癌术前T分期诊断和临床分期判断中具有重要价值。