胆囊颈管结石致胆总管扩张的研究

目的：以前瞻性方式研究对比胆囊颈管结石（ｎ＝３０）与胆囊体部结石（ｎ＝５０）对胆总管直径的影响。材料和方法：对比两组胆总管超声内径和术中实测外径。结果：胆囊颈管结石组胆总管超声内径和术中实测外径（６９ｍｍ，１１５ｍｍ）大于胆囊体结石组（４７ｍｍ，８２ｍｍ）。结论：胆囊颈管结石是胆总管轻度扩张的原因之一。     

电子十二指肠镜腹腔镜联合治疗胆囊及胆总管结石20例临床体会

作者回顾性总结了电子十二指肠镜、腹腔镜（简称两镜）联合治疗胆囊及胆总管结石20例患者的临床体会。两镜联合治疗胆囊及胆总管结石巳成为一种疗效确切的治疗手段。其突出优点是创伤小、住院时间短、痛苦轻、死亡率低等。充分体现微创治疗的优越性，并大大充实和丰富了原有传统治疗方法的内容。     

腹腔镜胆囊切除术前MRCP诊断胆总管结石的检查方案优化研究

目的通过比较7个磁共振胰胆管成像(MRCP)序列在不同配合度情况下图像质量及对胆总管结石的诊断性能,优化腹腔镜胆囊切除术(LC)术前MRCP检查方案。资料与方法 125例行7个序列的MRCP检查,根据患者不同的屏气与呼吸触发配合度分成9组。两名放射科医师使用双盲法对二维图像质量进行评价,使用单因素方差分析。同时计算7个序列诊断胆总管结石的敏感性、特异性、假阳性率、假阴性率、总的诊断正确率。结果9组7个MRCP序列二维图像质量评分差别有显著统计学意义(P<0.01)。B1R1组FIESTA 2D B、FIESTA 3DB、FRFSE 2D R、SSFSE 2D B Thk图像质量好;B1R2组与B1R3组FIESTA 2D B、FIESTA 3D B、SSFSE 2D B Thk图像质量好;B2R1组FRFSE 2D R、SSFSE 2D B Thk图像质量好;B2R2组与B2R3组SSFSE 2D B Thk、FIESTA 2D B、FI-ESTA 3D B、SSFSE 2D B Thn、FRFSE 3D B图像质量好;B3R1组FRFSE 2D R图像质量最好;B3R2组与B3R3组FI-ESTA 2D B、SSFSE 2D B Thk图像质量好。7个序列诊断胆总管结石的敏感性、特异性、假阳性率、假阴性率、总的诊断正确率分别为FRFSE 3D R,72%、98%、2%、28%、89.5%;FRFSE 2D R,92.6%、100%、0%、7.4%、97.5%;FIES-TA 2D B,93.5%、97.1%、2.9%、6.5%、96%;SSFSE 2D B Thk,87.9%、81.8%、18.2%、12.1%、83.8%;FRFSE 3DB,89.7%、100%、0%、10.3%、96.8%;FIESTA 3D B,82.1%、100%、0%、17.9%、94.6%;SSFSE 2D B Thn,90.9%、97%、3%、9%、95%。结论 LC术前诊断胆总管结石的MRCP优化检查方案为:呼吸触发配合度达到一级优先使用FRFSE 2D R;呼吸触发配合度不能达到一级的建议使用FIESTA 2D B。     

术前EST与腹腔镜联合术中EST治疗胆囊和胆总管结石的临床研究

目的：通过比较分析顺序治疗即内镜下十二指肠乳头括约肌切开术（ EST ）后行腹腔镜胆囊切除术（ LC）与腹腔镜联合术中EST治疗胆囊－胆总管结石的成功率、住院时间、临床效果及费用,来评价两者的临床治疗价值。方法回顾分析2010年6月～2012年7月的125例胆囊－胆总管结石病人,行顺序治疗即EST后行LC患者为95例,而行腹腔镜联合术中EST治疗的为30例,按手术方式不同分为顺序组和联合组,观察两组病例的手术成功率、术后住院日、手术并发症及住院费用情况。结果胆总管结石清除率,联合组为93．3％,顺序组为90％（ P＜0．05）。住院时间,联合组比顺序组短,为4．2天：6．0天（ P＜0．01）。并发症情况,联合组1例出现迟发性的十二指肠穿孔,经保守治疗后治愈,顺序组1例EST术后出现轻型胰腺炎,2例出现胆总管残余结石而再次行EST术。平均住院费用,联合组比顺序组明显减少,12300RMB：16500RMB（P＜0．05）。结论与LC术前行EST相比,腹腔镜联合术中EST的手术成功率更高,住院时间更短,并发症及费用也更少,应用前景值得期待。     

结石性胆囊炎患者心电图及心电向量图研究

在心电检查中发现,结石性胆囊炎患者心电图、心电向量图(以下分别称ECG、VCG)异常发生率呈增高趋势.现将我院2007 - 01～2010 - 01的100例结石性胆囊炎患者的ECG、VCG分析总结报告如下.     

CT与MRI在胆系结石诊断中的对比研究

目的比较CT与MRI诊断胆系结石疾病的临床价值。资料与方法对28例胆系结石患者进行CT与MRI检查，并与临床诊断或手术结果对照，其中胆囊结石11例，胆管结石8例，胆囊结石合并胆管结石9例。CT采用常规1次屏气螺旋扫描，MRI采用FLASH、HASTE、TRUEFISP序列及磁共振胰胆为5管造影(MRCP)成像技术。结果28例中，CT检查明确诊断结石16例(准确性7．1％)，MRI检查明确诊断27例(准确性为96．4％)。结论CT与MRI对胆系结石均有较好的诊断价值，但MRI具有成像参数多、可多平面观察及可特殊成像(MRCP)等特点，对胆系结石的诊断明显优于CT。     

MRCP在胆系结石中的应用价值及与CT、B超对比研究

目的:评价MRCP在胆系结石中的应用价值。方法:对107例临床拟诊胆系结石的患者MRCP图像进行分析,同时通过胆系结石的不同部位与CT、B超进行对比研究。结果:MRCP诊断肝内胆管结石准确率为92.7%,胆囊结石准确率为94.7%,胆总管结石准确率为96.3%,总准确率为94.9%。MRCP对肝内胆管结石的诊断准确率与CT、B超无显著性差异(P>0.05),对于胆总管结石的诊断准确率有显著性差异(P<0.05),MRCP明显高于其他两种影像学检查方法。结论:MRCP检查无创伤性、安全、对胆系结石的诊断准确率高,尤其对胆总管结石的诊断具有明显优势,可成为胆系结石的首选检查方法。     

EOS 2D与3D测量双下肢各参数可靠性和稳定性的对比研究

目的:对比研究EOS 2D与3D测量在双下肢冠、矢状面各参数中的可靠性和稳定性。方法:搜集2019-2020年1年内于本影像中心行双下肢或全身EOS检查的50例患者,两位医师对50例患者的影像数据进行2D和3D测量,保存所得数据,生成Excel表格并进行统计学分析。采取一致性检验对各测量参数进行分析,并计算出组内相关系数和组间一致性相关系数。结果:除股骨外翻角外,EOS 2D与3D测量各组的组内相关系数与组间一致性相关系数均>0.9,表示两者一致性极佳;股骨外翻角的组内相关系数和组间一致性相关系数亦均>0.6;进一步的线性回归模型分析结果也显示各测量参数的2D与3D测量之间显著相关(皮尔森系数r>0.80);Bland-Altman图显示大于92%(4/50)的点在均值为±1.96标准差范围内,显示两种测量方式具备较好的一致性和稳定性。结论:EOS常规2D与3D两种测量方式结果无差异统计学意义,两者都具备较高的可靠性和稳定性。     

骨关节外伤X线平片、CT及三维CT对比研究

目的 本对４９例骨关节外伤患的Ｘ线平片、ＣＴ及三维ＣＴ三种检查进行对比研究，评估在临床诊断中的价值。材料与方法 ４９例中男２８例，女２１例，年龄９－８７岁，平均４２岁。全部病例均经Ｘ线平片、常规ＣＴ及三维ＣＴ成像。Ｘ线平片包括常规位置和特殊位置。ＣＴ为ＳＯＭＡＴＯＭＣＲＦ。结果 ４９例骨关节外伤中平片阳性３５例，ＣＴ阳性４７例，三维ＣＴ阳性４８例，阳性率比较有显差异。４９例６５处骨折或脱位中     

The value of drip infusion cholangiography using multidetector-row helical CT in patients with choledocholithiasis

The purposes of this study were to investigate the feasibility of drip infusion cholangiography computed tomography (CTCh) for choledocholithiasis and to compare the detection of the stone on CTCh with that of MR cholangiopancreatography (MRCP). CTCh examinations were performed after infusion of intravenous biliary contrast material (iotroxic acid meglumine, 100 ml) for patients with suspected biliary diseases and were reconstructed to maximum intensity projection (MIP) and multiplanar reformation (MPR). Of 432 patients who underwent CTCh, we identified 15 who underwent surgery or cholangioscopic removal for choledocholithiasis and 32 patients who underwent cholecystectomy due to cholecystolithiasis. Their MRCP images were compared with the CTCh images. The sensitivity and specificity of CTCh for detecting choledochal stones were 87% and 96% whereas those of MRCP were 80% and 88%. The sensitivity and specificity of CTCh for detecting gallstones were 78% and 100% whereas those of MRCP were 94% and 88%. CTCh allowed high sensitivity and specificity for detecting choledochal stones but diminished the detection for cholecystolithiasis compared with MRCP.     

Magnetic resonance cholangiopancreatography in conjunction with 3D for assessment of different biliary obstruction causes

Objective

To assess the diagnostic value of magnetic resonance imaging in conjunction with 3D-MRCP, with maximum intensity projections and volume rendered images in different biliary obstruction causes.

Patient and methods

This study retrospectively reviewed the radiology records of 29 patients (18 females and 11 males) suffering from obstructive jaundice. All patients were subjected to magnetic resonance imaging (MRI), 3D-MRCP with maximum intensity projection (MIP) and volume rendered (VR) reformatted images for biliary obstruction diseases in Zagazig University Hospitals between November 2008 and January 2010. MR studies were performed with 1.5-T superconductive magnet (Philips Achieva, class II a). The patient ages were ranging from 23 to 66 years (mean age: 34 years). This study was done to evaluate the diagnostic value and accuracy of the new MRI techniques as a non-invasive tool to diagnose and differentiate between benign and malignant variants of biliary obstruction diseases and to facilitate the management planning. All cases were evaluated by clinical examination, laboratory values, grey and colored scale ultrasonography, conventional MRI, three-dimensional (3D-MRCP), MIP, and VR images. Our results were correlated with the histology of the resected specimen, operative (ERCP) or image-guided biopsy in inoperable patients.

Results

The mean age of benign patients was 30 years compared with 54 years in malignant biliary obstruction. Seventeen patients had benign cases 58.6% (6 cases of benign stricture and 11 cases with choledocholithiasis). The other 12 cases had malignant aetiology. Twenty-three patients were subjected to operative procedures, while the remaining six had ERCP/PTC and stenting. The MRI/MRCP images were of good quality in all patients. The intra- and extra-hepatic biliary radicals were visualized completely including the proximal and distal extent of the stricture. Regarding the benign cases (16/17) were satisfactorily diagnosed, however, one case was false negative, due to missed small stone at the MIP reconstructions. The 12 malignant biliary obstruction cases were as follows: five cases were cholangiocarcinoma (one peripheral type, one perihilar position, one Klatskin’s type, and two cases of the distal type), three pancreatic neoplastic lesions, two ampullary carcinoma, and two malignant lymph nodes. Regarding the benign cases 3D-MRCP had 94.1% diagnostic accuracy, otherwise more accuracy reported in malignant causes 100%.

Conclusion

3D-MRCP with MIP creates global images for pancreatico-biliary system. It is as effective as ERCP in detection of biliary obstruction and can precisely determine its level as well. Furthermore, it can provide a road map for management planning. By avoiding the flow artifacts, the false negative results that previously reported in past studies can be reduced.     

低剂量螺旋CT最大密度投影对肺微小结节的诊断价值

目的 研究螺旋CT低剂量扫描图像最大密度投影(MIP)对肺微小结节的诊断价值。方法 6例煤工尘肺的尸检离体肺脏制成充气固定肺标本，分别行螺旋CT常规剂量(100mA)和低剂量(65mA，30mA)1．5mm的薄层扫描，并行8．5mmMIP重建，比较不同剂量重建图像对微小结节的显示。结果 与常规剂量MIP重建图像比较，65mA和30mA组与常规剂量组对结节的发现无显性差异，65mA和30mA组的敏感性分别为97．97％、97．29％，阳性预测值分别为96．03％、96．00％。结论 低剂量螺旋CT扫描MIP重建能理想地显示常规剂量扫描MIP重建所能显示的结节。     

螺旋CT最大密度投影(MIP)对上颌埋伏牙定位的研究

目的　探讨螺旋CT最大密度投影(MIP)对上颌埋伏牙定位的应用价值。方法　对26例疑为上颌埋伏牙的患者做上牙齿轴位螺旋CT扫描,应用图像后处理功能,做最大密度投影,并将MIP图像与多平面重建(MPR),曲面重建(CPR),表面遮盖重建(SSD)对上颌埋伏牙定位的显示率进行比较。结果　4种重建图像中,MIP图像对上颌埋伏牙定位的显示率最高,对埋伏内部结构的密度差异显示最好。26例患者中, 14枚埋伏牙位于腭侧, 10枚位于唇侧; 1枚埋伏牙牙根位于唇侧,而牙冠位于腭侧向内、下生长;另1枚萌出方向与其完全相反。结论　MIP图像对上颌埋伏牙定位的显示效果明显优于MPR、CPR、SSD,可作为颌埋伏牙CT定位的首选图像。     

Diagnostic performance of three-dimensional MR maximum intensity projection for the assessment of synovitis of the hand and wrist in rheumatoid arthritis: A pilot study

Purpose

To evaluate the diagnostic performance of three-dimensional (3D) MR maximum intensity projection (MIP) in the assessment of synovitis of the hand and wrist in rheumatoid arthritis (RA) compared to 3D contrast-enhanced magnetic resonance imaging (CE-MRI).

Materials and methods

Twenty-five patients with RA underwent MR examinations. 3D MR MIP images were derived from the enhanced images. MR images were reviewed by two radiologists for the presence and location of synovitis of the hand and wrist. The diagnostic sensitivity, specificity and accuracy of 3D MIP were, respectively, calculated with the reference standard 3D CE-MRI.

Results

In all subjects, 3D MIP images yielded directly and clearly the presence and location of synovitis with just one image. Synovitis demonstrated high signal intensity on MIP images. The k-values for the detection of articular synovitis indicated excellent interobserver agreements using 3D MIP images (k = 0.87) and CE-MR images (k = 0.91), respectively. 3D MIP demonstrated a sensitivity, specificity and accuracy of 91.07%, 98.57% and 96.0%, respectively, for the detection of synonitis.

Conclusion

3D MIP can provide a whole overview of lesion locations and a reliable diagnostic performance in the assessment of articular synovitis of the hand and wrist in patients with RA, which has potential value of clinical practice.     

Value of axial and coronal maximum intensity projection (MIP) images in the detection of pulmonary nodules by multislice spiral CT: comparison with axial 1-mm and 5-mm slices

The purpose of this study was to investigate the diagnostic accuracy of non-overlapping 10-mm axial and coronal maximum intensity projections (MIP) in comparison with standard axial 1-mm and 5-mm slices in the detection of pulmonary nodules. Sixty patients with suspected nodules who underwent multislice spiral CT of the chest were evaluated. Axial 1-mm and 5-mm slices as well as non-overlapping 10-mm axial/coronal MIPs were interpreted independently by three blinded radiologists. After initial review, a retrospective consensus session was performed for agreement on final nodule counts using the axial 1-mm slices as gold standard. Small nodules of less than 5 mm in size were most accurately detected by the axial MIPs. Receiver operating characteristic (ROC) analysis of these small nodules showed that 5-mm slices were not capable of a statistically significant differentiation of nodules from other focal lesions in two observers (p=0.034 and p=0.012, respectively) whereas 1-mm slices and coronal/axial MIPs did allow a statistically significant differentiation in all observers (p<0.001). Nodules larger than 5 mm were equally well depicted with all modalities. Non-overlapping 10-mm axial MIPs improve the accuracy in the detection of small pulmonary nodules.     

Study on the usefulness of whole body SPECT coronal image,MIP image in<Superscript>67</Superscript>Ga scintigraphy

In this study, we examined the usefulness of whole body coronal images and whole body cine display MIP images (CMIP) upon which image processing was carried out after whole body SPECT in comparison to the usefulness of whole body images (WB/SC) compensated by scattered radiation in tumor/inflammation scintigraphy with 67Ga-citrate (67Ga). Image interpretation was performed for the 120 patients with confirmed diagnoses, and the accuracy of their diagnoses was studied by three nuclear medical physicians and two clinical radiological technologists by means of sensitivity, specificity and ROC analysis. The resultant data show that sensitivity, specificity, accuracy and the area under the ROC curve Az in the WB/SC were approximately 65%, 86%, 74% and 0.724, respectively, whereas sensitivity, specificity, accuracy and Az of the image reading system in which CMIP is combined with whole body coronal images reconstructed by the OS-EM method were approximately 93%, 95%, 94% and 0.860, respectively. Furthermore, coronal images reconstructed by the OS-EM method tended to be superior to those produced by the FBP method in both diagnostic accuracy and ROC analysis. In conclusion, the image reading system in which CMIP is combined with whole body coronal images reconstructed by the OS-EM method was shown to be superior in diagnostic accuracy and ROC analysis. Our data suggest that whole body SPECT is an excellent technique as an alternative to WB/SC.     

Pulmonary nodule detection on MDCT images: evaluation of diagnostic performance using thin axial images,maximum intensity projections,and computer-assisted detection

This study aimed at evaluating the diagnostic benefits of maximum intensity projections (MIP) and a commercially available computed-assisted detection system (CAD) for the detection of pulmonary nodules on MDCT as compared with standard 1-mm images on lung cancer screening material. Thirty subjects were randomly selected from our database. Three radiologists independently reviewed three types of images: axial 1-mm images, axial MIP slabs, and CAD system detections. Two independent experienced chest radiologists decided which were true-positive nodules. Two hundred eighty-five nodules ≥1 mm were identified as true-positive by consensus of two independent chest radiologists. The detection rates of the three independent observers with 1-mm axial images were 22 ± 4.8%, 30 ± 5.3%, and 47 ± 2.8%; with MIP: 33 ± 5.4%, 39 ± 5.7%, and 45 ± 5.8%; and with CAD: 35 ± 5.6%, 36 ± 5.6%, and 36 ± 5.6%. There was a reading technique effect on the observers’ sensitivity for nodule detection: sensitivities with MIP were higher than with 1-mm images or CAD for all nodules (F-values = 0.046). For nodules ≥3 mm, readers’ sensitivities were higher with 1-mm images or MIP than with CAD (p < 0.0001). CAD was the most and MIP the less time-consuming technique (p < 0.0001). MIP and CAD reduced the number of overlooked small nodules. As MIP is more sensitive and less time consuming than the CAD we used, we recommend viewing MIP and 1-mm images for the detection of pulmonary nodules. This study was presented at the ECR 2006.     

Preoperative evaluation of living renal donors: value of contrast-enhanced 3D magnetic resonance angiography and comparison of three rendering algorithms

The aim of this study was to assess the value of contrast-enhanced three-dimensional MR angiography (CE 3D MRA) in the preoperative assessment of potential living renal donors, and to compare the accuracy for the depiction of the vascular anatomy using three different rendering algorithms. Twenty-three potential living renal donors were examined with CE 3D MRA (TE/TR=1.3 ms/3.7 ms, field of view 260–320×350 mm, 384–448×512 matrix, slab thickness 9.4 cm, 72 partitions, section thickness 1.3 mm, scan time 24 s, 0.1 mmol/kg body weight gadobenate dimeglumine). Magnetic resonance angiography data sets were processed with maximum intensity projection (MIP), volume rendering (VR), and shaded-surface display (SSD) algorithms. The image analysis was performed independently by three MR-experienced radiologists recording the number of renal arteries, the presence of early branching or vascular pathology. The combination of digital subtraction angiography (DSA) and intraoperative findings served as the gold standard for the image analysis. In total, 52 renal arteries were correspondingly observed in 23 patients at DSA and surgery. Other findings were 3 cases of early branching of the renal arteries, 4 cases of arterial stenosis and 1 case of bilateral fibromuscular dysplasia. With MRA source data all 52 renal arteries were correctly identified by all readers, compared with 51 (98.1%), 51–52 (98.1–100%) and 49–50 renal arteries (94.2–96.2%) with the MIP, VR and SSD projections, respectively. Similarly, the sensitivity, specificity and accuracy was highest with the MRA source data followed by MIP, VR and SSD. Time requirements were lowest for the MIP reconstructions and highest for the VR reconstructions. Contrast-enhanced 3D MRA is a reliable, non-invasive tool for the preoperative evaluation of potential living renal donors. Maximum intensity projection is favourable for the processing of 3D MRA data, as it has minimal time and computational requirements, while having similar or superior accuracy for the depiction of vessel anomalies or pathology compared with VR and SSD, respectively. Electronic Publication     

Orthogonal subspace projection-based approaches to classification of MR image sequences

Orthogonal subspace projection (OSP) approach has shown success in hyperspectral image classification. Recently, the feasibility of applying OSP to multispectral image classification was also demonstrated via SPOT (Satellite Pour 1’Observation de la Terra) and Landsat (Land Satellite) images. Since an MR (magnetic resonance) image sequence is also acquired by multiple spectral channels (bands), this paper presents a new application of OSP in MR image classification. The idea is to model an MR image pixel in the sequence as a linear mixture of substances (such as white matter, gray matter, cerebral spinal fluid) of interest from which each of these substances can be classified by a specific subspace projection operator followed by a desired matched filter. The experimental results show that OSP provides a promising alternative to existing MR image classification techniques.