Bamboo skewer perforation of the bowel: Computed tomography appearances

A 25-year-old Chinese woman presented with a painful left-lower-quadrant abdominal mass. Computed tomography (CT) demonstrated a dense forked foreign body within an extraluminal mass. A 2.5 cm bamboo skewer surrounded by inflamed omentum was found at laparotomy. Different CT densities of bamboo skewers were obtained when exposed to air, water and 2% Gastrografin in an in vitro experiment. Awareness of the possible variations in appearances of wooden foreign bodies in and around the bowel may aid their CT diagnoses.     

Study of patients with intravenous contrast extravasation on CT studies, with radiology staff and ward staff cannulations

Introduction: Intravenous (IV) contrast extravasation is an adverse outcome of computed tomography (CT) studies. This study evaluates for any differences in rates of extravasation between radiology (radiographer) staff and ward medical staff cannulations, and secondarily by cannula size and study type. Method: A prospective study of 26 854 studies in adults between September 2004 and April 2008 accumulated 119 extravasations. Patients were divided into two groups, those cannulated by radiology staff and those cannulated by non‐radiology staff. Patients with extravasations were followed for treatment outcomes. Statistical analysis between our groups was undertaken. Results: The total extravasation rate was 0.44%. The extravasation rate for those patients cannulated by radiology staff was 0.34% (n = 11 470 cannulations) and those cannulated by non‐radiology staff was 0.52% (n = 15 384 cannulations). This was not statistically significantly different. The site where most extravasations occurred was at the elbow (71.4%). The injection rate where most extravasations occurred was in the 1–2 mL/s range (42%). No patient required surgical intervention or had any significant morbidity. Conclusion: Radiology radiographer staff can provide safe administration of IV contrast in CT scanning with low rates of extravasation. Extravasation may occur with high or low injection rates and when small or large size cannulas are used.     

MSCT充气造影检查对食管疾病的诊断价值

目的：探讨多层螺旋CT（MSCT）充气造影检查对食管疾病的诊断价值。方法选择100例经胃镜及手术病理证实的食管疾病患者,均行MSCT充气造影检查,将扫描后的图像进行薄层重建及后处理,对MSCT充气造影结果与病理结果进行比较,并采用Kappa检验分析其一致性。结果100例食管疾病患者中,经消化胃镜及术后病理证实,食管平滑肌瘤62例,食管癌8例,食管憩室6例,食管囊肿8例,隆突下增大淋巴结结核2例,食管血管瘤4例,正常食管10例。所有患者均顺利完成MSCT充气造影检查,食管管腔扩张良好。经Kappa检验,MSCT充气造影结果与病理结果具有良好的一致性（Kappa值=0.898,P﹤0.001）。MSCT充气造影诊断食管平滑肌瘤的特异度、灵敏度和准确率分别为96.8%、78.9%、90.0%,诊断食管癌的特异度、灵敏度和准确率均为100%。结论 MSCT充气造影检查作为一种诊断食管疾病的新方法,有利于提高食管疾病的检出率,在临床中具有重要的应用价值。     

静脉注射造影剂对妇科肿瘤全盆腔放疗剂量分布的影响

目的探讨静脉注射造影剂对妇科肿瘤术后全盆腔放疗剂量分布的影响。方法选择10例接受术后全盆腔放疗的子宫内膜癌和子宫颈癌患者。对每例患者静脉注射造影剂前后相同体位下行CT模拟定位扫描,在平扫图像和增强图像上为每例患者设计相同的三维适形全盆腔放疗计划。比较两组计划靶区、危及器官和正常组织剂量分布。结果增强计划的靶区、危及器官和正常组织平均剂量均低于平扫计划,但两组计划间差异均〈1.0Gy,危及器官和正常组织最大剂量差异均〈2.0 Gy,差异均无统计学意义。结论静脉注射造影剂对妇科肿瘤术后全盆腔适形放疗剂量分布影响很小,临床上可以忽略。     

低对比剂用量条件下256层螺旋CT诊断肺动脉栓塞

目的:探讨低对比剂用量条件下256层螺旋CT(256-MSCT)对分支肺动脉栓塞的诊断价值及预后评估.方法:收集我院行256层MSCT肺动脉CTA检查诊断为肺动脉栓塞患者20例.对采集的数据进行多平面重建(MPR)、立体重建(VR)等后处理重建,分析各种肺动脉栓塞的影像学特征.结果:肺叶及分支肺动脉栓塞5例,肺段及分支肺动脉栓塞6例,亚段肺动脉栓塞9例.结论:低对比剂用量条件下256层螺旋CT能较准确显示肺内较小分支肺动脉内的肺栓塞.     

螺旋CT双低技术在肺结节检查中的应用

目的:研究双低技术在肺结节CT增强成像的临床意义.方法:胸部检查发现肺结节需行CT扫描增强的患者40例,按体质量指数BMI:18～26 kg/m2随机分两组:常规剂量组(采用滤波反投影重建)和低剂量组(等渗低浓度对比剂)迭代重建.结果:100 kV扫描条件下采用40％ASIR迭代重建与120 kV扫描条件下采用FBP滤...     

多层螺旋CT诊断恶性胃肠道间质瘤乙型肝炎病毒衣壳作为肝癌细胞靶向性基因转移载体的研究

Objective  

The aim of this study was to investigate the value of multi-slice spiral CT (MSCT) in the diagnosis of malignant gastrointestinal stromal tumors (GISTs).     

Efficacy of patient questionnaire in predicting renal dysfunction in outpatients older than 60 years of age prior to contrast-enhanced computed tomography

Introduction: Contrast‐induced nephropathy (CIN), a common iatrogenic cause of acute renal failure, is preventable. Identification of impaired renal function prior to intravenous contrast is important. Questionnaire screening has been useful to negate the need for cumbersome and costly renal function testing on all patients prior to contrast‐enhanced CT (CECT). The Royal Australian and New Zealand College of Radiologists guidelines include age older than 60 as a risk marker requiring renal function testing. The aim of this retrospective study is to assess the efficacy of the pre‐CT questionnaire in identifying patients with pre‐existing renal impairment even in this older than 60 age group. Methods: All outpatients were given questionnaires containing 11 CIN risk markers prior to CECT. Radiographers documented age, gender, serum creatinine and/or estimated glomerulofiltration rate (eGFR mL/min/1.72 m²) within 3 months of CT. Questionnaires of all patients older than 60 years were collated. The data was tabulated and analyzed. Incomplete questionnaires were excluded. Results: 134/171 (78.4%) patients had eGFR ≥ 60 and 37/171 (21.6%) had eGFR < 60, with 31/171 (18.1%) having eGFR between 30 and 60 and 3/171 (1.8%) having eGFR < 30. 47/171 (27.5%) circled ‘no’ to all risk markers. Percentage for sensitivity is 81.1% (95% confidence interval (CI) 64.8–92%), for specificity 29.9% (95% CI 22.3–38.4%), for positive predictive value 24.2% (95% CI 17–32.7%) and for negative predictive value 85.1% (95%CI 71.7–93.8%). Kidney disease, anaemia, myeloma and vasculitis seem to be statistically significant risk factors (P < 0.05). All three true‐positive patients with eGFR < 30 indicated known kidney disease. Seven false‐negative patients had eGFR 30–60, with 4/7 (57.1%) having CIN risk markers in their medical records. Conclusion: Questionnaire screening for CIN risk has a high negative predictive value (85.1%) even in patients older than 60 years.     

Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

The aim of the study was to carry out a systematic review determining the accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding. A search of published work in Medline and manual searching of reference lists of articles was conducted. Studies were included if they compared CT angiography to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute gastrointestinal bleeding. Eight published studies evaluating 129 patients were included. Data were used to form 2 x 2 tables. Computed tomography angiography showed pooled sensitivity of 86% (95% confidence interval 78-92%) and specificity of 95% (95% confidence interval 76-100%), without showing significant heterogeneity (chi(2) = 3.5, P = 0.6) and (chi(2) = 5.4, P = 0.6), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.93. Computed tomography angiography is accurate in the diagnosis of acute gastrointestinal bleeding and can show the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review because of the methodological limitations and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.     

Diagnostic Accuracy of MRI Compared to CCT in Patients with Brain Metastases

Objectives. In patients with extracranial neoplasms, the occurrence and number of brain metastases (BM) are critical for further diagnostic approaches and therapeutic strategies and the patient's prognosis. Although widely accepted, there is surprisingly little evidence in the literature that MRI is superior to CCT. Therefore, in patients with solitary BM according to diagnostic contrast-enhanced computed tomography (CCT), we investigated, what additional information could be gained by contrast-enhanced magnetic resonance imaging (MRI). Methods/Results. Among 55 patients with solitary BM according to CCT, 17 had multiple BM on MRI (31%) and 38 had solitary BM in both. Based on a presumed binomial distribution of our data, we calculated a rate of at least 19% of patients with solitary BM on CCT, in which MRI would show multiple lesions (p=0.05). The two main characteristics for BM missed by CCT were the smaller diameter, which averages 2cm less than in BM identified with both modalities, and a preferential frontotemporal location. Conclusion. MRI is indeed superior to CCT in the diagnosis of BM the essential reasons besides detection of smaller lesions being a better soft tissue contrast, significantly stronger enhancement with paramagnetic contrast agents, the lack of bone artifacts, fewer partial volume effects, and direct imaging in three different planes. Therefore, MRI is indispensable in the diagnostic workup of patients with BM for choosing the optimum therapeutic approach, especially with regard to the decision whether to operate or to primarily irradiate the patient's metastases.     

低剂量对比剂在64排螺旋CT主动脉成像中的探讨

目的探讨64排螺旋CT不同体重注射不同对比剂量在胸腹主动脉血管成像的中应用。方法临床可疑主动脉病变患者,知情同意后分A、B两组。A组20例:体重在60 kg以上注射60ml对比剂+40 ml生理盐水、B组20例:体重在60 kg以下按1 ml/kg对比注射+适量的生理盐水;两组均采用相同注射速率和浓度行对比剂浓度实时监控触发扫描,测量升主动脉、胸7(T7)及腰2(L2)水平降主动脉、主动脉分叉处CT值及血管横截面直径,并在扫描前测量患者的体重、身高、血压、心率。由两位影像诊断高级职称医师对重组主动脉及分支血管显示进行评价,并对血管强化程度、血管横截面直径、体重、身高、血压、心率数据进行统计学分析。结果两组在升主动脉、胸7(T7)及腰2(L2)水平降主动脉、主动脉分叉等处的平均CT值分别为:331.10 Hu、342.52 Hu、308.71 Hu、299.75 Hu和337.10 Hu、325.59 Hu、322.06 Hu、308.34 Hu,血管横截面平均直径为:37.40 mm、25.12mm、17.91 mm、15.50 mm和35.20mm、23.08 mm、12.37 mm、11.80 mm,体重为:72.50 kg、49.50 kg,身高为:175.70 cm、150.50 cm,血压为:130/78 mmHg、124/78 mmHg,心率76.5次/分、74.6次/分;两组间各点的平均CT值强化不具有统计学意义(P>0.05),重组血管清晰度及显示血管分支也无差异,各点的血管横截面平均直径具有统计学意义(P<0.05),体重、身高具有明显差异(P<0.01)、血压、心率各组不具有统计学意义(P>0.05)。结论 64层螺旋CT行主动脉MSCTA检查时,个性化因人而异不同体重注射不同对比剂量可获得良好的CTA图像,并满足诊断要求,为临床提供可靠的诊断依据,还降低了CIN潜在的风险。     

49例胃肠间质瘤多排螺旋CT表现与病理对照研究

背景与目的：胃肠间质瘤（gastrointestinal stromal tumor,GIST）是消化系统最常见的间叶源性肿瘤,影像学检查在其术前诊断及术后疗效评价中起着重要作用。本研究旨在分析胃肠间质瘤的螺旋CT表现和病理特点．以及它们之间的关系。方法：回顾性分析49例共53个经病理证实的胃肠道间质瘤的螺旋CT表现和病理学资料,将CT表现（包括大小、形态、生长方式、密度及强化方式）与生物学危险性进行对比研究。结果：53个GIST病灶的生物学危险性：极低度14个,低度11个,中度10个,高度18个。CT检查发现36个病灶（67．9％）。最大径≥50mm者,CT表现为形态不规则,呈浸润性生长,可见囊变坏死,明显不均匀强化,多为高度危险性;最大径〈50mm者,大多形态规则,密度均匀,呈膨胀性生长．中度均匀强化,多为中度及以下危险性。发现血道转移5例,未见淋巴结转移。免疫组化结果仅有3个病灶S100阳性,CT均表现为沿胃壁或肠壁环形浸润。结论：CT检查有助于判断胃肠间质瘤的危险性,但对于微小病灶的检出有一定困难。神经方向分化（S100阳性）的间质瘤呈浸润性生长,其CT表现较难与胃癌鉴别。     

CT features of peripheral T-cell lymphoma in the gastrointestinal tract in Chinese population and literature review

Introduction: The aim of the study was to retrospectively investigate the CT features in peripheral T‐cell lymphoma (PTCL) of the gastrointestinal tract in the Chinese population. Methods: Computed tomography scans of 15 histopathologically proven cases of PTCL involving the gastrointestinal tract were retrospectively reviewed for characteristics such as sites, multiplicity, morphological features, the pattern and degree of contrast enhancement, lymphadenopathy, involvement of other organs and complications such as perforation, intussusceptions, ascites and so on. By reviewing the literature, CT findings of PTCL involving the gastrointestinal tract were compared with that involved by B‐cell lymphoma. Results: PTCLs involved the stomach and intestine in six and nine patients, respectively. Multiplicity was seen in seven patients, and solitary involvement was seen in eight. At CT, wall thickening was the predominant finding in all cases with an exception of one intestinal PTCL case presented as polypoid mass. Among the 14 patients, the gastric or bowel wall thickening was mild (<10 mm) in three, moderate (10–20 mm) in 10 and severe (>20 mm) in one. Nine cases demonstrated mild homogeneous enhancement, whereas six showed mild heterogeneous enhancement. Lymphadenopathy was present in eight patients, five of which were non‐bulky (diameter <5 cm) and diffuse type and the rest (three) were non‐bulky and localised type. Other organs were involved in four patients. Perforation as complication was evident in one gastric and five intestinal lymphomas (55.6%). Among the nine intestinal PTCLs, seven of the patients were male (77.9%) and the rest (two) were female with a median age of 37.1 years old. Intestinal PTCLs predominantly involved colon (n = 5). Other sites of involvement were ileum (n = 1), ileocaecum (n = 1), ileum and ileocaecum (n = 1) and entire bowel segment from distal ileum to transverse colon (n = 1). Conclusion: PTCLs have some distinguishing radiological features from B‐cell type gastrointestinal lymphomas as mild or moderate gastric or bowel wall thickening and higher incidence of perforation with multiplicity. In China, intestinal PTCLs are not usually associated with coeliac disease and commonly present in a young male population with colon being the most frequent site of involvement.     

Haemoperitoneum due to spontaneous rupture of hepatic haemangiomatosis: Treatment by superselective arterial embolization and partial hepatectomy

A case is reported of a 36 year old woman with haemoperitoneum due to spontaneous rupture of hepatic haemangiomatosis. Computed tomography showed a subcapsular hepatic mass in the posterior segment of the right hemiliver (subsegment 7) containing a fluid-fluid level. Magnetic resonance imaging depicted a subcapsular hepatic mass displaying an internal fluid-fluid level suggestive of haematoma. Hepatic angiography showed an intense arterial blush in the area of the subsegment 7 and permitted a subsequent and temporarily effective superselective transcatheter embolization of the subsegmental arterial branch for subsegment 7. Because of a recurrence of intraperitoneal haemorrhage 15 days after the first embolization, a new selective hepatic artery embolization was performed. However, intraperitoneal haemorrhage recurred 10 days after the second embolization, and the patient underwent resection of the posterior segments of the right hemiliver (subsegments 6 and 7). This case suggests that superselective arterial embolization, when used alone, does not provide a permanent treatment of haemoperitoneum due to spontaneous rupture of hepatic haemangiomatosis. However, this technique seems to be useful in avoiding an emergency surgery, allowing a planned hepatic resection.     

The challenges of Bacillus of Calmette-Guerin (BCG) therapy for high risk non muscle invasive bladder cancer treatment in older patients

Objectives

To evaluate the efficacy and safety of a tailored endovesical immunotherapy protocol with biweekly BCG for elderly Patients with high risk non muscle invasive bladder cancer (HG-NMIBC).