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.

Diagnostic ability of multi-detector spiral computed tomography for pathological lymph node metastasis of advanced gastric cancer

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.

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 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.

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.

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.

Computed tomography-based radiomics for prediction of neoadjuvant chemotherapy outcomes in locally advanced gastric cancer: A pilot study

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.

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.

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.

Sixty-four-multi-detector computed tomography diagnosis of coronary artery anomalies in 66 patients

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.

儿童新型冠状病毒感染并发纵隔气肿八例影像学及临床特点研究

背景儿童新型冠状病毒感染(COVID-19)影像学与成人有一定差异,主要表现为胸膜下磨玻璃影、斑片状高密度影、实变影等,合并纵隔气肿者并不多见。大量气肿形成可严重影响呼吸及循环功能,导致明显喘憋、低氧血症,需积极处理。目的分析并总结儿童COVID-19并发纵隔气肿的影像学及临床特征。方法回顾分析2022-12-01—2023-01-30在长江大学附属荆州医院儿科住院的8例COVID-19并发纵隔气肿的患儿年龄、性别、影像学、临床特点及诊疗情况。结果8例患儿年龄3岁7个月~12岁,男女比3∶5,高分辨率CT(HRCT)均显示双肺感染合并纵隔气肿。气肿多同时累及颈部及胸壁。肺部表现多种多样:胸膜下磨玻璃影、实变、树芽征、支气管血管束增粗、支气管壁增厚及网格征等,未见大片实变及“白肺”。1例患儿合并少量胸腔积液。临床表现除有发热、咳嗽外,均有明显气促,肺部听诊干湿啰音可不显著。4例合并肺炎支原体感染、1例合并卡他布兰汉菌感染。合并肺炎支原体感染者应用阿奇霉素,合并卡他布兰汉菌感染者给予头孢噻肟治疗。8例患儿均给予氧疗。1例患儿白细胞总数及超敏C反应蛋白明显升高,明显气急,低氧血症,常规治疗无好转,给予有创呼吸机治疗3d后好转撤机。5例应用静脉丙种球蛋白(IVIG),3例使用糖皮质激素。1周后复查胸部CT,纵隔气肿均完全吸收,肺部病灶明显好转。结论COVID-19并发纵隔气肿者多为学龄前期或学龄期儿童,婴幼儿少见。可同时合并颈部及胸壁积气。肺部病变可累及间质或实质、双肺均受累,表现形式多样。起病多有明显气急,积极氧疗。白细胞计数明显升高,同时超敏C反应蛋白明显升高者,要密切关注呼吸情况,积极使用IVIG,适时适量应用糖皮质激素,必要时采用呼吸机人工辅助通气。

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.

Feasibility and Diagnostic Accuracy for Assessment of Coronary Artery Stenosis of Prospectively Electrocardiogram-gated High-pitch Spiral Acquisition Mode Dual-source CT Coronary Angiography in Patients with Relatively Higher Heart Rates: in Comparison wit

Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.

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.

Evaluation of spiral CT imaging in the diagnosis of the primary ureteral carcinoma

Objective: To explore the characteristics of the primary ureteral carcinoma (PUC) and discuss the value of spiral CT (SCT) in the diagnosis of PUC. Methods: The SCT findings of the primary ureteral carcinoma in 16 cases were analyzed and compared with the histopathological diagnosis and staging. Results: The transverse diameters of the lesions were 1.0–2.1 cm, and the longitudinal lengths were 1.5–15.2 cm. There were no statistically significant differences (P>0.1) in diam- eters and lengths among the low staging group (pT0–T2) and the high staging group (pT3–T4). The average CT value of the lesions was 43 HU on plain scanning, and 73 HU on CE scanning. The increment was 30 HU. The lesions were clearer on CE scanning. Curved planar reconstruction (CPR) could show the entire course of the urinary tract. Among 6 cases of pT3 stage, CT gave a correct diagnosis in 1 case. For 2 cases of pT4 stage, CT gave correct diagnoses in both cases. Conclusion: The carcinomatous lesions spread along the ureter. The longitudinal length of each lesion is longer than its transverse diameter. Tumor cannot be staged merely according to its diameter and length. CT is difficult to differentiate stage T0–T3, while for stage T4, CT diagnosis is accurate. Contrast enhancement CT scanning has the confirming and differentiating roles. CPR offers direct and easy observing images for clinical doctors.

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.

肝海绵状血管瘤Spiral或Helical CT影像特征

目的:评价螺旋CT对肝海绵状血管瘤影像诊断价值.方法:搜集经手术病理证实的肝海绵状血管瘤23例,回顾性分析其CT影像表现特点.结果:平扫:圆形或类圆形,呈低、等或高密度,巨大血管瘤密度欠均匀,中央见裂隙状、星状更低密度区.增强:较大者动态双期或多期扫描呈典型"快进慢出"时间密度曲线.巨大者,除典型强化表现外,中央可见裂隙状、星状或不规则无强化区.较小者强化形式呈多样化,但延迟期大部分有等密度填充.结论:血管瘤CT影像表现具有一定的特征性.典型者呈快进慢出的时间密度曲线,CT可确诊.不典型者,动脉及门脉期强化形式多样化,但其延迟扫描之等密度填充可提示诊断.极少数CT表现无特异性,需借助于临床病理学诊断.

CT双能量成像参数对肺结节病变性质的鉴别价值研究

目的:研究CT双能量成像参数对肺结节病变性质的鉴别价值。方法:2021年12月一2023年1月合肥市第二人民医院收治的102例恶性肺结节患者作为恶性组,同期收治的106例良性肺结节患者作为良性组,所有患者均经病理学检查确诊,比较两组患者影像学特征及CT双能量成像参数,进行肺结节病变性质的CT双能量成像征象、参数多因素分析,采用受试者工作特征(ROC)曲线分析CT双能量成像参数对肺结节病变性质的鉴别价值。结果:恶性组强化不均匀、淋巴结增大、结节边缘毛刺/分叶、血管受累患者占比高于良性组(P<0.05)。恶性组动脉期、静脉期能谱曲线斜率及容积CT剂量指数均高于良性组(P<0.05)。多因素Logistic回归分析结果显示,动脉期、静脉期能谱曲线斜率及容积CT剂量指数较高是肺结节恶性病变的危险因素(OR=1.451、1.502、1.640,P<0.05)。动脉期、静脉期能谱曲线斜率及容积CT剂量指数联合鉴别肺结节病变性质的曲线下面积(AUC)值高于三者单独检测(P<0.05)。结论:肺结节良性病变和恶性病变患者之间影像学特征、动脉期及静脉期能谱曲线斜率、容积CT剂量指数存在明显差异,且动脉期、静脉期能谱曲线斜率及容积CT剂量指数是肺结节恶性病变的危险因素,三者联合对肺结节病变性质的鉴别具有较好价值。

超高端螺旋CT单心跳心脏技术判别冠脉狭窄和斑块性质的临床价值及合并基础疾病对准确性的影响

目的:研究超高端螺旋CT单心跳心脏技术判别冠脉狭窄和斑块性质的临床价值及合并基础疾病对准确性的影响。方法:本研究采用前瞻性研究方法,以我院2022年7月—2023年1月诊断并进行治疗的冠心病患者96例作为研究对象,根据患者的冠脉狭窄程度,Ⅰ级病变患者33例,Ⅱ级病变患者22例,Ⅲ级病变患者41例。根据斑块性质分析,其中稳定性斑块患者55例,不稳定性斑块患者41例,所有患者入组后均接受256排CT行单心跳心脏冠脉成像、冠脉造影(ICA)和血管内超声(IVUS)检查,比较单心跳心脏冠脉成像诊断冠脉血管狭窄以及不稳定性斑块的诊断效能,研究合并基础疾病对准确性的影响。结果:本研究中,单心跳心脏冠脉成像诊断冠脉血管狭窄Ⅲ级病变的灵敏度为80.49%,单心跳心脏冠脉成像诊断冠脉血管狭窄Ⅲ级病变的ROC曲线下面积为0.771,合并高血压、糖尿病、高脂血症等,会造成单心跳心脏冠脉成像诊断冠脉血管狭窄Ⅲ级病变的效能下降。单心跳心脏冠脉成像诊断冠脉血管不稳定斑块的灵敏度为80.21%,单心跳心脏冠脉成像诊断冠脉血管不稳定斑块的ROC曲线下面积为0.775,合并高血压、糖尿病、高脂血症等,会造成单心跳心脏冠脉成像诊断冠脉血管不稳定斑块的诊断效能下降。结论:超高端螺旋CT单心跳心脏技术判别冠脉狭窄和斑块性质的灵敏度均超过80%以上,合并高血压、糖尿病以及高脂血症患者,会造成冠脉狭窄和斑块性质的判定准确性以及灵敏度的下降。