The diagnostic value of 3D spiral CT imaging of cholangiopancreatic ducts on obstructive jaundice

Objective: Computerized tomography (CT) plays an important role in the diagnosis of diseases of biliary tract. Recently, three dimensions (3D) spiral CT imaging has been used in surgical diseases gradually. This study was designed to evaluate the diagnostic value of 3D spiral CT imaging of cholangiopancreatic ducts on obstructive jaundice. Methods: Thirty patients with obstructive jaundice had received B-mode ultrasonography, CT, percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP), and 3D spiral CT imaging of cholangiopancreatic ducts preoperatively. Then the diagnose accordance rate of these examinational methods were compared after operations. Results: The diagnose accordance rate of 3D spiral CT imaging of cholangiopancreatic ducts was higher than those of B-mode ultrasonography, CT, or single PTC or ERCP, which showed clear images of bile duct tree and pathological changes. As to malignant obstructive jaundice, this examinational technique could clearly display the adjacent relationship between tumor and liver tissue, biliary ducts, blood vessels, and intrahepatic metastases. Conclusion: 3D spiral CT imaging of cholangiopancreatic ducts has significant value for obstructive diseases of biliary ducts, which provides effective evidence for the feasibility of tumor-resection and surgical options.

Application of spiral CT image 3D reconstruction in severe talar neck fracture

Objective： To explore the application of the spiral computerized tomography （CT） image three-dimensional （ 3D ） reconstruction technique associated with the conventional radiography in the diagnosis and treatment of severe talar neck fracture. Methods： Using the multi-slice spiral CT image 3D reconstruction technique, we analysed Ⅱ cases of talar neck fracture. The fractures were reduced and fixed through a minimal incision and internal fixation with titanium cannulated lag screws. Results. In the Ⅱ cases, the results of CT image 3D reconstruction were in concordance with plain radiograph in 6 case of Hawkins type Ⅱ. And the remaining 5 cases of Hawkins types Ⅲ and Ⅳ could not be classified exactly only by radiographs, one of whom was misdiagnosed. After using the CT image 3D reconstruction, the 5 cases were classified exactly before osteosynthesis. The classifications of these Ⅱ cases were confirmed finally by surgical findings. The duration of operation were 45-Ⅰ40 min, averaging 8Ⅰ min （including the duration of C-arm fluoroscopy）. X-ray exposure time was 6-58 seconds, averaging 22 seconds. The blood loss was less than Ⅰ00 ml. The fracture union was achieved in 3 months. No nonunion, talus avascular necrosis or joint surface collapse occurred. Postoperative follow-up was from Ⅰ to 25 months. According to Hawkins score, excellent result was found in 6 type Ⅱ cases and Ⅰ type Ⅲ case; good result in I type Ⅲ case with both medial and lateral malleolar fracture, Ⅰ type Ⅲ with medial malleolus fractures and Ⅰ open type Ⅲ; fair result in Ⅰ open type Ⅳ with lateral malleolus fracture. Conclusions ： By using the multl-slice spiral CT image 3D reconstruction associated with radiography to diagnose and treat severe talar neck fractures, the accuracy of diagnosis can be improved obviously. Based on this technique, more consummate operational plan can be designed and performed so as to achieve a better therapeutic effect.