子宫肌瘤介入治疗前后CT动态扫描血供变化的研究

目的 研究子宫肌瘤介入治疗前后子宫与肌瘤血供变化。方法 16例单发症状性子宫肌瘤患者接受子宫动脉栓塞治疗，术前、术后7d及术后3个月选择同层面进行CT动态增强扫描，测量正常子宫及肌瘤的CT值，进行栓塞前后对比分析。结果 16例患者每次均顺利完成CT动态增强扫描，术前、术后7d及术后3个月正常子宫组织动态增强曲线及CT值无明显改变，而肌瘤动态增强曲线及CT值有明显改变，肌瘤栓塞后处于持续性缺血状态。结论 子宫动脉栓塞术治疗子宫肌瘤是一种安全，有效的新疗法，子宫动脉栓塞后非肌瘤子宫组织血供不受影响。     

肝脏良性富血供肿瘤的CT诊断

目的：通过分析30例肝脏良性富血供肿瘤的CT表现，探讨各自的CT特征。方法：回顾性分析20例肝血管瘤、5例肝腺瘤、3例肝局灶性结节增生、2例肝血管平滑肌脂脑瘤的CT表现产进行分析。结果：肿瘤最大直径平均约10cm。多数呈圆形或类圆形、轮廓光整、边界清晰，有脂肪密度者2例，均匀实质一生肿缺21例，非均匀实质性肿块9例。所有病例均呈明显增强。结论：肝脏良性富血供肿瘤CT表现均有一定的特征性，有助于定性诊断。     

普美显动态增强MRI和动态增强CT对肝细胞肝癌血供的评估与病理对照分析

目的 基于普美显(EOB)动态增强MRI和动态增强CT检查探讨肝细胞肝癌(HCC)的血供特点并与病理对照分析.方法 回顾性分析经手术病理证实为HCC患者36例共计43个病灶,术前同时行EOB动态增强MRI及动态增强CT检查.根据手术病理结果将HCC患者分为高分化组(12个)、中分化组(22个)和低分化组(9个).观察H...     

肝癌供血特点与螺旋CT多期扫描相关性

目的：探讨原发性肝癌(PHCC)供血特点与螺旋CT多期扫描的相关性及其对临床诊断治疗的指导意义。材料与方法：搜集我院经病理或临床证实98例的PHCC患者，采用GE Hispeed Nxh双螺旋CT机扫描，分析其供血特点及螺旋CT多期扫描表现及其相关性。结果：98例PHCC中，肝动脉供血型80例，占81．6％；双重血供型13例，占13．2％；门静脉供血型4例，占4％；少血供型1例。结论：螺旋CT多期扫描可以清晰显示PHCC供血特点，利于早期发现小肝癌及对PHCC诊断及治疗有指导作用。     

供血来自降主动脉的纵隔恶性神经鞘瘤误诊一例

患者　女 ,30岁。体检时偶发现胸部肿块 ,无任何不适 ,肺部听诊无异常。胸部ＣＴ平扫 (图 1) :左侧胸腔见 9ｃｍ× 10ｃｍ× 13ｃｍ的囊实性肿块 ,形态规整 ,边缘清晰 ,内部可见散在多发的斑点状钙化灶 ,左侧肺组织及支气管受压移位 ,肿块与后胸壁紧密相连 ,局部椎间孔未见扩大 ,骨质未见破坏。左侧胸腔积液 ,余肺叶未见异常。增强扫描 (图 2、3)见肿块包膜轻度强化 ,内部见线状、圆形轻度强化 ,其上、下缘分别见 2条发自邻近降主动脉的血管通向肿块并包绕 ,直径分别约 0 .2ｃｍ和 0 .3ｃｍ。初步诊断 :左侧先天性肺隔离症。手术所见 :左侧…     

孤立性肺结节的CT增强特点及其血供病理学基础

孤立性肺结节 (ｓｏｌｉｔａｒｙｐｕｌｍｏｎａｒｙｎｏｄｕｌｅｓ ,ＳＰＮ)是指肺内直径≤ 4ｃｍ的类圆形病灶 ,并且没有肺不张、卫星灶及淋巴结肿大[1] 。ＳＰＮ的定性诊断是临床工作中的重点之一 ,因为它直接关系到治疗方法的选择与预后 ,同时 ,它又是难点之一 ,各种ＣＴ增强扫描技术迅速发展 ,使ＳＰＮ的误诊率大为降低。现已成为ＳＰＮ定性诊断的一个强有力的手段 ,笔者就ＳＰＮ的动态增强ＣＴ扫描作一综述。1　检查技术与方法ＣＴ扫描技术分为动态扫描与螺旋扫描 2种 ,动态扫描分为单层与多层动态扫描技术 ,单层动态扫描技术的优点是…     

原发性肝癌血供特点的螺旋CT表现及其与病理学特性的相关研究

目的 探讨原发肝细胞性肝癌（ＰＨＣＣ）的血供方式及其与癌细胞分化程度、组织学类型的相关性。方法 盲法下观察５０例经手术病理证实的ＰＨＣＣ病例的螺旋ＣＴ强化方式及影像学表现,将ＰＨＣＣ的血供分为４型。并将ＰＨＣＣ血供类型与癌细胞分化程度（Ｅｄｍｏｎｓｏｎ分类法）和组织学类型（ＷＨＯ分类法）的相关性作统计学分析。结果 ５０例ＰＨＣＣ中,肝动脉供血型共３６例,占７２％;肝动脉和门静脉双重供血型共６例,占     

乳腺癌术前灌注化疗与肿瘤供血的研究

目的：通过对乳腺癌肿瘤血供的研究，为动脉灌注化疗奠定基础。材料与方法：６例乳腺癌患者，采用Ｓｅｌｄｉｎｇｅｒ技术，行锁骨下动脉造影，然后选择性动脉内灌注ＡＤＭ６０ｍｇ，ＣＤＤＰ８０ｍｇ，ＭＭＣ１２－１８ｍｇ。结果：（１）肿瘤主要血供５０％来自胸廓外劝脉，肩胛下动脉及胸内动及 占２５％，与以往观点不同；（２）６例乳腺癌经动脉灌注后原发灶及淋巴结均明显缩小。结论：乳腺同供血主要是胸廓外侧动脉，其次为肩     

动脉CT血管造影对肺转移瘤的血供研究

目的　用支气管动脉 (BA)和肺动脉 (PA)CT血管造影 (BA CTA和PA CTA)的方法研究肺转移瘤血供。方法　对 1 5例肺转移瘤患者分别行BA和PA数字减影血管造影 (BA DSA和PA DSA)后 ,留置导管行多层螺旋CT的PA CTA和BA CTA ,判定BA和PA对肺转移瘤的血供。结果　 1 5例患者共 33个结节在BA DSA上 2 2个结节可见支气管动脉肿瘤染色 ,1 1个结节未见肿瘤血管或染色。PA DSA均未见肿瘤染色。PA CTA上肺动脉参与供血的 1 6个结节和未参与供血的 1 7个结节离胸壁最短距离差异有统计学意义 (t=3 32 ,P <0 0 5 ) ;而结节直径间差异无统计学意义 (t=1 1 3,P>0 0 5 )。BA CTA上支气管动脉参与供血的 2 7个结节和未参与供血的 6个结节离胸壁最短距离差异有统计学意义 (t=3 95 ,P <0 0 1 ) ;而结节直径间差异无统计学意义 (t=1 2 7,P >0 0 5 )。结论　BA仍是肺转移瘤的主要供血动脉 ,PA仅部分参与周围肺转移结节的血供。     

Current status and guidelines for the assessment of tumour vascular support with dynamic contrast-enhanced computed tomography

Dynamic contrast-enhanced computed tomography (DCE-CT) assesses the vascular support of tumours through analysis of temporal changes in attenuation in blood vessels and tissues during a rapid series of images acquired with intravenous administration of iodinated contrast material. Commercial software for DCE-CT analysis allows pixel-by-pixel calculation of a range of validated physiological parameters and depiction as parametric maps. Clinical studies support the use of DCE-CT parameters as surrogates for physiological and molecular processes underlying tumour angiogenesis. DCE-CT has been used to provide biomarkers of drug action in early phase trials for the treatment of a range of cancers. DCE-CT can be appended to current imaging assessments of tumour response with the benefits of wide availability and low cost. This paper sets out guidelines for the use of DCE-CT in assessing tumour vascular support that were developed using a Delphi process. Recommendations encompass CT system requirements and quality assurance, radiation dosimetry, patient preparation, administration of contrast material, CT acquisition parameters, terminology and units, data processing and reporting. DCE-CT has reached technical maturity for use in therapeutic trials in oncology. The development of these consensus guidelines may promote broader application of DCE-CT for the evaluation of tumour vascularity. Key Points ? DCE-CT can robustly assess tumour vascular support ? DCE-CT has reached technical maturity for use in therapeutic trials in oncology ? This paper presents consensus guidelines for using DCE-CT in assessing tumour vascularity.     

Quantitative assessment of early experimental diabetes in rats using dynamic contrast-enhanced computed tomography

Purpose

To quantitatively assess the time course of changes of the renal volume and function in the early phase of streptozotocin (STZ)-induced diabetes in rats using dynamic contrast-enhanced computed tomography (DCE-CT).

Methods

The DCE-CT studies were performed in 24 male Sprague-Dawley rats (n = 6 for control and n = 18 for STZ-treated group) on days 0, 4, 7, 11, and 14 using a multi-detector row CT. The rats of an STZ-treated group were given intraperitoneally 65 mg/kg body weight of STZ on day 0, and were divided into two groups based on the blood glucose concentration on day 4 being less than 300 mg/dL [STZ-treated group (L), n = 8] or greater than 300 mg/dL [STZ-treated group (G), n = 10]. The contrast clearance per unit renal volume (K₁) was estimated from the DCE-CT data using the Patlak model. The renal volume (V_CT) was calculated by manually delineating the kidney on the contrast-enhanced CT image. The contrast clearance of the entire kidney (K) was obtained by K₁ × V_CT.

Results

V_CT in the STZ-treated group was significantly enlarged on day 4 compared to that on day 0 and continued until day 14. Although there were no significant changes in the time course of K₁ in all groups, K in the STZ-treated groups (L) and (G) significantly increased on days 7 and 4, respectively, and continued until day 14, suggesting that hyperfiltration occurs in parallel with renal volume enlargement.

Conclusion

The present method appears useful for quantitatively evaluating the time course of STZ-induced diabetes in rats, because it allows repeated and simultaneous evaluation of renal morphology and function.     

Preliminary report of contrast-enhanced computed tomography for patients with a percutaneous cardiopulmonary support system

The purpose of this study was to investigate a suitable protocol of contrast-enhanced computed tomography (CECT) in cases with a cardiopulmonary support system. Contrast-enhanced computed tomography with intra-arterial injection (IAI) of contrast medium (CM) via a perfusion cannula showed sufficient contrast enhancement in 2 cases of cardiac decompensation (CD). Contrast-enhanced computed tomography with intravenous injection of CM showed insufficient and delayed contrast enhancement of the aorta in 2 cases of CD and 3 cases of pulseless electrical activity. We encourage administration of CM by means of IAI.     

Two-phase dynamic contrast-enhanced computed tomography with water-filling method for staging of gastric carcinoma.

The objective of the study was to evaluate the usefulness of two-phase incremental contrast-enhanced computed tomography (CT) with water-filling method in the preoperative assessment of stomach carcinoma. Dynamic CT was done in 20 patients with biopsy-proven gastric cancers and the findings were compared with surgery. A 150-ml ionic contrast medium was administered intravenously at a flow rate of 3.5 ml/s. CT scanning was done at 45 s (early phase) and 3 min (equilibrium phase) after the start of intravenous injection. Primary tumors were detected in all the cases. The overall accuracies of dynamic CT in determining depth of tumor invasion, pancreatic invasion, adjacent liver infiltration, and lymph node metastasis were 85% (17/20), 90% (18/20), 85% (17/20), and 69% (13/19), respectively. The early phase of dynamic CT is highly accurate in determining the depth of tumor invasion of advanced gastric cancers but has low sensitivity in the detection of nodal metastasis. The delayed phase scans do not add any additional information and hence, should not be routinely used for staging.     

Ablation margin assessment of liver tumors with intravenous contrast-enhanced C-arm computed tomography

AIM:To determine the influence of anthropomorphic parameters on the relationship between patient centering,mean computed tomography(CT) numbers and quantitative image noise in abdominal CT.METHODS:Our Institutional Review Board approved study included 395 patients(age range 21-108,years;male:female = 195:200) who underwent contrast-enhanced abdominal CT on a 16-section multi-detector row scanner(GE LightSpeed 16).Patient centering in the gantry isocenter was measured from the lateral localizer radiograph(off center S = patient off centered superior to isocenter;off center I = patient off centered inferior to isocenter).Mean CT numbers(Hounsfield Units:HU) and noise(standard deviation of CT numbers:SD) were measured in the anterior(aHU,aSD) and posterior(pHU,pSD) abdominal wall subcutaneous fat and liver parenchyma(LivHU,LivSD) at the level of the porta hepatis.Patients’ age,gender,weight,body mass index and maximal anteroposterior diameter were recorded.The data were analyzed using linear regression analysis.RESULTS:Most patients(81%;320/395) were not correctly centered in the gantry isocenter for abdominal CT scanning.Mean CT numbers in the abdominal wall increased significantly with an increase in the offcentering distance,regardless of the direction of the off-center(P < 0.05).There was a substantial increase in pSD(P = 0.01) and LivSD(P = 0.017) with off-centering.Change in mean CT numbers and image noise along the off-center distance was influenced by the patient size(P < 0.01).CONCLUSION:Inappropriate patient centering for CT scanning adversely affects the reliability of mean CT numbers and image noise.     

Current status of viability assessment with positron tomography

Accurate detection of reversible myocardium has great clinical importance, especially in patients being considered for interventional therapy. Positron emission tomography (PET) with fluorine 18-labeled fluorodeoxyglucose (FDG) has been used for this purpose, based on the residual metabolic activity in reversible ischemic areas. Although thallium imaging has been widely used for the evaluation of tissue viability in clinical cardiology, PET-FDG may provide independent values and thus may enhance the accuracy of studies for identifying ischemic myocardium. This review considers the advantages of PET technique, the clinical value of PET-FDG for assessing tissue viability, and the development of other new PET techniques.     

Dual-energy computed tomography for the assessment of early treatment effects of regorafenib in a preclinical tumor model: comparison with dynamic contrast-enhanced CT and conventional contrast-enhanced single-energy CT

Objectives

The potential diagnostic value of dual-energy computed tomography (DE-CT) compared to dynamic contrast-enhanced CT (DCE-CT) and conventional contrast-enhanced CT (CE-CT) in the assessment of early regorafenib treatment effects was evaluated in a preclinical setting.

Methods

A rat GS9L glioma model was examined with contrast-enhanced dynamic DE-CT measurements (80 kV/140 kV) for 4 min before and on days 1 and 4 after the start of daily regorafenib or placebo treatment. Tumour time-density curves (0-240 s, 80 kV), DE-CT (60 s) derived iodine maps and the DCE-CT (0-30 s, 80 kV) based parameters blood flow (BF), blood volume (BV) and permeability (PMB) were calculated and compared to conventional CE-CT (60 s, 80 kV).

Results

The regorafenib group showed a marked decrease in the tumour time-density curve, a significantly lower iodine concentration and a significantly lower PMB on day 1 and 4 compared to baseline, which was not observed for the placebo group. CE-CT showed a significant decrease in tumour density on day 4 but not on day 1. The DE-CT-derived iodine concentrations correlated with PMB and BV but not with BF.

Conclusions

DE-CT allows early treatment monitoring, which correlates with DCE-CT. Superior performance was observed compared to single-energy CE-CT.

Key Points

? Regorafenib treatment response was evaluated by CT in a rat tumour model. ? Dual-energy contrast-enhanced CT allows early treatment monitoring of targeted anti-tumour therapies. ? Dual-energy CT showed higher diagnostic potential than conventional contrast enhanced single-energy CT. ? Dual-energy CT showed diagnostic potential comparable to dynamic contrast-enhanced CT. ? Dual-energy CT is a promising method for efficient clinical treatment response evaluation.