子宫输卵管X线影像造影诊断不孕症应用探讨

目的:探索子宫输卵管在进行X线造影诊断的时候所呈现出的影像学的表现。方法:选择2009～2011年进行X线造影检查的73例患者的资料。通过对患者子宫输卵管造影扫描图像进行分析,进而讨论X线对于诊断患者的不孕不育症所呈现的影像的表现。结果:在就诊的73例不孕不育症的患者中,单侧输卵管通畅者10例,约占13.7%;双侧输卵管通畅者8例,约占10.9%;子宫畸形2例,约占2.7%;单侧输卵管积水5例,约占6.8%;双侧输卵管积水9例,约占12.3%;单侧输卵管阻塞并积水25例,约占34.2%(其中不完全梗阻并积水11例,占输卵管总数的15%,完全梗阻并积水14例,占输卵管总数的19.2%);双侧输卵管阻塞并积水14例,约占19.2%(其中不完全梗阻并积水9例,占输卵管总数的12.3%,完全梗阻并积水5例,占输卵管总数的6.8%)。结论:X线对于患者子宫输卵管的检查是一种较好的方式,应该在临床中进行推广。

0D-1D coupling model and 3D fluid-structure interaction model based on coronary CT angiography for displaying hemodynamic characteristics of coronary artery stenosis

Objective To observe value of 0D-1D coupling model and 3D fluid-structure interaction(FSI)model based on coronary CT angiography(CCTA)for displaying hemodynamic characteristics of coronary artery stenosis.Methods Based on CCTA data of the stenosed left anterior descending branch(LAD)in a patient with coronary heart disease,an 0D-1D coupling model and 3D FSI model were built,respectively.Then hemodynamic characteristic indexes,including the pressure,flow velocity and wall shear stress(WSS)were obtained in every 0.01 s during 1 s at 5 sampling points(i.e.sampling point 1—5)using these 2 models,respectively,and the consistencies of the results between models were evaluated with Spearman correlation coefficient r s.Results The time consuming for construction of 0D-1D coupling model and 3D FSI model was 0.033 min and 704 min,respectively.Both models showed basically distribution of the pressure,flow velocity and WSS of the stenosed LAD.For more details,the pressure at the stenosed segment of LAD and the proximal segment of stenosis were both higher,which gradually decreased at the distal segment of stenosis,and the flow velocity at the proximal segment of stenosis was in a relatively slow and uniform condition,with significantly increased flow velocity and WSS at the stenosed segment.Compared with 3D FSI model,0D-1D vascular coupling model was relatively unrefined and lack of distal flow lines when displaying blood flow velocity.For sampling point 2 at the stenosed segment of LAD,no significant consistency for pressure between 2 models was found(P=0.118),but strong consistency for the flow velocity and WSS(r s=0.730,0.807,both P<0.05).The consistencies of pressure,flow velocity and WSS between 2 models at the proximal and distal segment of stenosis,i.e.1,3—5 sampling points were week to moderate(r s=0.237—0.669,all P<0.05).Conclusion 0D-1D coupling model exhibited outstanding computational efficiency and might provide relatively reasonable results,while 3D FSI model showed higher accuracy for details and streamline when simulating LAD stenosis.

Magnetic Resonance Urography and X-ray Urography Findings of Congenital Megaureter

Objective To observe the imaging findings of congenital megaureter in order to enhance the understanding of this disease. Methods Image data of 5 patients with congenital megaureter and 2 misdiagnosed patients were analyzed, and image findings of congenital megaureter were summarized. Elscint Prestig 2.0T superconductive magnetic resonance urography （MRLI） with conventional sequence （spin-echo, T 1W1560 ms/16 ms; fast spin-echo, T2WI 9600 ms/96 ms） was performed. Raw data were acquired with fast spin-echo sequence from heavy T2-weighted image （9600 ms/120 ms）. Post-processing method of MRH was the maximum in- tensity projection with three-dimensional reconstruction in the workstation. Intravenous pyelography （IVP） was conducted, in which X-ray films were taken 7 minutes, 15 minutes, and 30 minutes after injecting contrast agent, except that in 2 patients the films were taken delayed at 60 and 90 minutes. X-ray retrograde pyelography was performed on 2 patients, successful in one but failed in the other. Results The dilated ureter showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images in conventional MRI. The mass wall was intact, uniform in thickness, and showing hy- pointensity on Tl-weighted and T2-weighted images. The MRH images showed a retroperitoneal mass appearing as an elongated tubular cystic structure spreading from kidney to bladder. MRLI also revealed dilated calices and renal pelvis, pelviureteric obstruction, and renal duplication. The main signs of congenital megaureter in X-urography was significant dilatation of ureter, or normal renal pelvis with ureter dilatation, hydronephrosis, deformity, and displacement. Conclusions MRH with X-urography could visualize the characteristics of congenital megaureter, including the dilation of renal pelvis and ureter, calculi, urinary tract duplication, and stenosis location. The two techniques can complement each other in disease diagnosis and provide more detailed information for preoperative treatment.

NON-INVASIVE IMAGING OF CORONARY ARTERY WITH 16-SLICE SPIRAL COMPUTED TOMOGRAPHY

To evaluate the value of 16-slice spiral CT in the demonstration of coronary artery and in the diagnose of coronary artery stenosis. Methods Plain and enhanced CT scans were performed with a 16-slice CT scanner (Sensation 16, Siemens, Germany) in 230 patients with suspected coronary heart disease (CHD). Parameters of the plain scan were: 120 kV, 133 mA, slice col-limation 16 mm×1.5 mm, rotation time 0.42 seconds, increment 1.5 mm, and slice width 3 mm. Parameters of the enhanced scan were: 120 kV, 500 mA, slice collimation 16 mm×0.75 mm, rotation time 0.42 seconds, increment 0.5 mm, and slice width 1 mm. Enhanced CT scan was performed with a rapid intravenous injection of 100 mL iothalamate meglumine (Ultravist) (370 mgI/mL) or Omnipaque (350 mgI/mL) and 30 mL 0.9% NaCl chaser bolus at a flow rate of 3.5 mL/s. Calcium scoring with plain scan images and two and three dimensional reconstruction with enhanced scan images were made in all cases, among which 30 cases underwent conventional coronary angiography. Demonstration of coronary arteries and their stenosis were evaluated and the factors that might influence the image quality were analyzed. Results Coronary calcium scores were calculated and coronary artery was demonstrated in our study. In the evaluationof image quality with volume rendering technique (VRT) images, 78.3% of the images were of the first class, 12.2% the sec-ond class, and 9.6% the third class. Multi-planar reconstruction (MPR) and maximal intensity projection (MIP) were better than VRT in the demonstration of small branches. The image quality was related to the heart rate, with or without arrhythmia, and breath-hold ability of patients. Comparative study of the stenosis of coronary arteries in 30 cases showed that the sensi-tivity and specificity of 16-slice coronary CT angiography (CTA) to diagnose significant stenosis were 95.8% and 94.8% resp-ectively. Conclusion As a non-invasive and quick method, 16-slice coronary CTA is sensitive and specific to diagnose the stenosis of coronary arteries and can be used as a screening method in the diagnosis of CHD.

Clinical value of multi-slice helical CT angiography in diagnosis of cerebral vascular diseases

Objective: To evaluate the clinical value of multi-slice helical CT angiography (MSCTA) in diagnosis of cerebral vascular diseases. Methods: 52 patients with cerebral vascular diseases were examined with GE Light Speed 4-slice and 16-slice helical CT. Pitch: 0.5–3, slice thickness: 0.625–1.25 mm, adult injection dosage: 90–100 mL, children injection dos- age: 2 mL/kg, injection rate: 2.5–4.0 mL/s, delay time: 15–22 s. Intelligent track scan (Smart prep Rx) were adopted in parts of these cases. Three-dimensional cerebral vascular images were processed at ADW 3.1 and ADW 4.2 workstation. Results: MSCTA could clearly display spacious anatomic details of cerebral aneurysm, including its origin, size, neck width, and trend etc. MSCTA results of 19 cases were consistent with those of operations. The diameter of the smallest cerebral aneurysm shown in our research was about 3 mm. As a non-invasive examination, MSCTA could also be applied in post-operational evaluation of cerebral aneurysm by observing the location of silver clip and the distant vessels. Besides, MSCTA could be used to diagnose arteriovenous malformation and moyamoya disease. Of all the three-dimentional imaging methods, volume rendering (VR) is the best means to display the cerebral vascular diseases. Conclusion: As a non-invasive examination, MSCTA plays an important role in detection, pre-operational and post-operational evaluation of cerebral vascular diseases.

EVALUATION OF CAPTOPRIL RENOGRAPHY WITH^（99m）Tc－MAG_3 IN THE DIAGNOSIS OF RENOVASCULAR HYPERTENSION

Eighty-one patients with suspected renovascular hypertension (RVH) were studied using 99m Tc-MAG3 renography before and after administration of 25 mg captopril (CAP). Among the 81 cases, 22 were proven by renal arteriography or DSA. The results showed that by using CAP, the sensitivity and specificity of renography in RVH diagnosis increased from 66% to 72% and from 33% to 100%, respectively. We conclude that renography is a simple, noninvasive . sensitive and specific method for screening RVH and is suitable for use in hospitals with no Y-cameras.

Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones:Results of a retrospective,single center study between 1996-2002

AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).METHODS: Patients undergoing preoperative ERCP (≤90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1^st of January 1996 to the 31^st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (≥8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCRRESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%,for three 72.5%, for four or more 91.4%.CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients).Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g.skill of the endoscopist, other diagnostic tools).

Classification of Medical Brain Images

Since brain tumors endanger people’s living quality and even their lives, the accuracy of classification becomes more important. Conventional classifying techniques are used to deal with those datasets with characters and numbers. It is difficult, however, to apply them to datasets that include brain images and medical history (alphanumeric data), especially to guarantee the accuracy. For these datasets, this paper combines the knowledge of medical field and improves the traditional decision tree. The new classification algorithm with the direction of the medical knowledge not only adds the interaction with the doctors, but also enhances the quality of classification. The algorithm has been used on real brain CT images and a precious rule has been gained from the experiments. This paper shows that the algorithm works well for real CT data.

Nanoparticulate X-ray CT contrast agents

X-ray computed tomography(CT) has been widely used as a powerful diagnostic tool in clinics because it can provide high-resolution 3D tomography of the anatomic structure based on the distinctive X-ray absorptions between different tissues. Currently, CT contrast agents are mainly small iodinated molecules, which suffer from drawbacks such as short blood- retention time, nonspecific in vivo biodistribution, and renal toxicity. Utilization of nanoparticles as potential CT contrast agents to overcome the aforementioned issues has advanced rapidly. In this mini review, we introduce current research efforts in the development of nanoparticulate CT contrast agents and discuss the challenges for additional breakthroughs in this field.

Computerized tomography pleurography: a new method for detecting minor pleural lesion

Objectives To evaluate the ability of CT pleurography (CTP) in detecting minor pleural lesions in patients with pleural effusion and to assess its value in distinguishing malignant from benign pleural lesions. Methods A prospective study of 50 patients with pleural effusion was conducted using conventional CT and CTP. CT scan was run after injecting an appropriate amount of contrast medium into the pleural cavity. Results In 24 patients, all lesions detected by conventional CT were demonstrated by CTP. In 13 of 24 patients, CT pleurography detected additional lesions. In 20 of 26 patients with negative findings on conventional CT, CTP was capable of demonstrating the presence of pleural lesions. The sensitivity, specificity and accuracy of detecting pleural lesions were 25%, 100% and 30% for conventional CT, 86%, 100% and 87% for CTP, respectively. Conclusion CTP is superior to conventional CT in detecting and for the differential diagnosis benign and malignant pleural lesions.

PAA-capped GdF3 nanoplates as dual-mode MRI and CT contrast agents

Aiming at improving the sensitivity and accu- racy 9f diagnosis, the combination of magnetic resonance imaging （MRI） and X-ray computed tomography （CT） in a single probe is in urgent need. Here, we report the devel- opment of polyacrylic acid （PAA）-capped GdF3 nanoplates （NPs） as novel MRI and CT dual-mode contrast agents （CAs） with high longitudinal relaxivity （rl） and large X-ray attenuation coefficient. Uniform GdF3 rhombic NPs were fabricated by controlling reaction conditions and intro- ducing dopants. The average size of GdF3 NPs is （10.6 ：k 1.1） nm in long diagonal, （7.0 -t- 0.8） nm in short diagonal, and （4.2 -4- 1.2） nm in thickness. Ligand-exchange treat- ment was performed to render the NPs water-dispersible. The rl of PAA-capped GdF3 NPs （15.8 L/（mmol s）） is four times higher than that of clinically used Gd-DTPA. We suppose that the high r~ value originates from the con- struction of two-dimensional （2D） nanostructures, which endows nanocrystals with larger surface areas and longer rotational correlation time than those of sphere nanostruc- tures with the same volume. The CT contrast enhancement ability of PAA-capped GdF3 NPs was evaluated in com- parison with clinically used Iohexol. The above results suggest that the PAA-capped GdF3 NPs could serve as CAs for MRI and CT dual-mode imaging.