多排螺旋CT在胃癌术前TN分期中的应用价值

目的:利用多层螺旋CT(MDCT),前瞻性的对胃癌进行术前TN分期,并与术后病理结果对照,评估其分期的准确性及临床价值。方法:对经胃镜证实的48例胃癌患者,于术前进行MDCT三期动态增强扫描。分别利用CT轴位图像和轴位结合多层面重组(MPR)图像对胃癌进行TN分期,并将CT分期结果与术后病理结果相对照,分期的准确性比较采用McNemar检验,取P<0.05为检验标准。结果:轴位和轴位结合MPR对胃癌病灶的检出率分别为91.6%(44/48)、97.9%(47/48)。轴位和轴位结合MPR对所有患者胃癌胃壁浸润深度(T分期)评估的准确率的分别为72.9%(35/48)、89.5%(43/48),两者之间差异具有统计学意义(P=0.041)。轴位和轴位结合MPR对所有患者转移淋巴结(N分期)评估的准确率的分别为72.9%(35/48)、77.1%(37/48),两者之间差异没有统计学意义(P=0.113)。结论:MDCT能对胃癌术前TN分期做出较准确的评估。MPR能显著改善胃癌T分期的准确率,但不能明显提高N分期的准确率。     

Role of multidetector computed tomography (MDCT) in diagnosis of subhepatic appendicitis

Background

Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications.Ascending subhepatic appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract.

Aim of the work

To study the role of multidetector computed tomography in diagnosis of subhepatic appendicitis.

Subjects & methods

In the current study, we included fifteen patients diagnosed radiologically and confirmed surgically as subhepatic appendicitis.Ultrasonography followed by multidetector computed tomographic examination were performed to all patients before surgery.

Results

The clinical diagnosis of the patients included in this study at presentation was acute cholecystitis in four patients, pyelonephritis in three, and ureteric colic in three. Five patients were referred with uncertain diagnosis.The presence of subhepatic appendicitis was confirmed sonographically only in two patients. Computed tomography (CT) identified correctly subhepatic appendicitis in all cases.

Conclusion

Our study indicates the usefulness of multidetector CT in diagnosing atypical ascending subhepatic appendicitis.     

Gastrointestinal stromal tumors (GISTs): Diagnostic value of multi-detector computed tomography

Background

GISTs are considered the commonest mesenchymal neoplasms of the GIT originating from the gastrointestinal tract, mesentery, omentum, or retroperitoneum. They arise within the gut musculosa having exophytic growth pattern. They characteristically have hemorrhage, necrosis, or cyst formation that appears as focal areas of low attenuation on computed tomographic images.With multidetector CT (MDCT) capabilities, the exact origin of the GIST can be easily confirmed to differentiate it from other mesenchymal origin tumors.

Materials and methods

Retrospective search for GIST cases in the digital archives of our institute, during a 15 months duration (April 2010 to July 2011). Workstation reviewing of their imaging features.

Results

This study included 24 pathologically proved GISTs (12 gastric, 8 small intestinal, two colonic, one mesenteric and one anorectal) demonstrating the radiologic features of GISTs depending on tumor size and organ of origin.

Conclusion

MDCT with its multiplanar capabilities and isotropic z-axis resolution allows the radiologist to examine the detailed relation of the mass to the surrounding bowel wall, vessels and other structures. It also helps to map the vascular pedicle in cases of hypervascular GIST’s, which may be crucial for trans-catheter embolization in cases presenting with acute gastrointestinal bleeding.     

Role of multidetector computed tomography (MDCT) in diagnosis and staging of gall bladder carcinoma

Background

Carcinoma of the gall bladder is the fifth most common malignancy of the gastrointestinal tract after colorectal, pancreatic, gastric and esophageal carcinomas.

Aim of the work

To study the role of multidetector computed tomography in the diagnosis and staging of gall bladder carcinoma.

Subjects and methods

This study included twenty-five patients presented to us during the period from June 2011 till May 2012 and were diagnosed radiologically by multidetector computed tomography as carcinoma of the gall bladder and the diagnosis was confirmed histopathologically. All the patients were subjected to ultrasonography followed by multidetector computed tomographic imaging using triphasic examination technique.

Results

Among the twenty-five patients included in this study there were fifteen females and ten males. Their ages ranged from 50 to 70 years old (average 60 years). All the patients were radiologically diagnosed as gall bladder carcinoma based on the multidetector computed tomographic findings. Infiltrating masses were detected in fifteen patients (60%), Intraluminal polypoidal masses were detected in nine patients (36%) while one patient (4%) presented with mural thickening of the gall bladder wall.

Conclusion

We conclude that multidetector CT is the diagnostic tool of choice in the detection and staging of gall bladder carcinoma.     

CT测量胃癌体积对N分期评估的初步研究

目的：探讨多层螺旋 CT 测量胃癌体积在 N 分期预测方面的价值。方法收集经病理证实的胃癌患者(n=193)CT 资料,测量门脉期肿瘤体积,比较该结果和相应 N 分期的相关性并用 ROC 曲线分析其区分不同 N 分期的诊断效能。结果肿瘤体积测量结果具有较好的一致性(Kappa 值分别为0.77、0.72、0.69,P <0.05),且与相应的 N 分期呈正相关(r =0.568,P <0.05)。区分 N0和 N1~N3组、N0~N1和 N2~N3组、N0~N2和 N3组曲线下面积分别为0.79、0.80、0.82,体积阈值12.06 cm3、22.35 cm3、25.95 cm3,敏感度55%、66%、62%,特异度95%、86%、89%。结论CT 测量胃癌体积对 N 分期评估有一定应用价值,有利于指导临床选择个体化的治疗方案。     

Comparision between transrectal ultrasonography and computed tomography with rectal inflation of gas in preoperative staging of lower rectal cancer

Computed tomography with rectal air insufflation was compared with transrectal ultrasonography (TRUS) in 63 patients. The CT protocol involved pre- and postcontrast scans with 5 mm slice thickness following air insufflation in IV antiperistaltic agent. Of the patients, 79 % were scanned in the prone position. Results of the preoperative examinations were compared with the histological findings. The CT examination had an accuracy rate of 74 %, predicting perirectal spread with a sensitivity of 83 % and a specificity of 62 %, whereas the corresponding figures for TRUS were 83, 91 and 67 %. The accuracy, sensitivity and specificity of CT and TRUS for nodal involvement were 57, 56, 57, 66, 68 and 64 %-respectively. These findings confirm that TRUS is more accurate than CT in local tumour (T) staging and in detecting nodal (N) spread. However, the appropiate CT technique shows spread of tumour outside the rectal wall and locoregional lymph nodes with reasonable accuracy. Lymphatic spread correlated with nodal size. TRUS and CT correctly staged only 57 and 43 %, respectively, of cases with nodal metastases with maximum diameter of 5 mm. TRUS sometimes overstaged perirectal growth of tumour in 7 patients, due to inflammation (5 patients) or incorrect positioning of the ballon in relation to the tumour surface (2 patients). Received 11 April 1995; Revision received 22 January 1996; Accepted 24 January 1996     

Multidetector computed tomography evaluation in neonatal respiratory distress: Clinical implication

Objective

To assess the value of multiplanar reformation (MPR) and three-dimensional multidetector computed tomography (MDCT) images in evaluating respiratory distress in neonates.

Materials and methods

Sixteen neonates (?30 days) who presented with respiratory distress (RD) and admitted in the neonatal intensive care unit of the Assuit university children hospital who were selected from a total of 1295 patients presented with RD in whom chest X-ray was inconclusive, so those 16 neonates underwent 64-rows MDCT in the period between November 2010 and November 2011. The recruited patients were sedated before examination and IV contrast medium administration was needed when there was suspected vascular anomaly. Scans were performed in supine position to cover the root of the neck down to the level of the adrenal glands. The images were sent to the workstation to be reviewed in the multiplanar and 3D images.

Results

The final radiologic diagnoses included cystic adenomatoid malformation (n = 4, 25%), congenital lobar emphysema (n = 1, 7%), pneumonia (n = 5, 36%), hypoplastic lung (n = 3, 22%), diaphragmatic hernia (n = 2, 14%) and postoperative hydro-pneumothorax (n = 1, 7%).

Conclusion

The combination of fast speed, high spatial resolution, and enhanced quality of MPR and 3D images makes MDCT an ideal non-invasive method for evaluating surgical causes of neonatal respiratory distress.     

Multidetector computed tomography of the renal arteries in vascular emergencies

Multidetector computed tomography (MDCT) has drastically changed the diagnostic imaging protocol in both traumatic and non-traumatic vascular emergencies, replacing almost completely the traditional primary role of catheter angiography. MDCT is a well-established tool for the elective evaluation of stenoses, malformations, and dysplasias in the settings of renovascular hypertension, but probably less used in the settings of acute traumatic and non-traumatic clinical situations. The aim of this review is to define the role of MDCT in renal arteries emergencies.     

Brain computed tomography in morbid obesity before and after gastric restriction surgery: a prospective quantitative study

Summary Linear brain parameters were measured by CT in 19 patients with morbid obesity (mean weight 126.4±20.5 kg) and 20 age and sex matched normal weight subjects (mean weight 62.6±14.9 kg). Ventricular parameters were slightly smaller and cortical parameters were slightly larger in the preoperative obese than in control subjects. However, only the four cortical sulci ratio was significantly different in the two groups (P=0.02). After gastric restriction surgery and drastic weight loss (mean postoperative weight 82.9±27.4 kg), all the ventricular and cortical parameters increased, with significant change in the frontal interhemispheric fissure ratio (P<0.05). Obese patients followed for 23 months after surgery had less striking changes than those followed for 6 months. Morbidly obese subjects have altered brain CT dimensions which are partly reversible after weight correction.Presented at the 5th International Congress on Obesity, September 16, 1986, Jerusalem, Israel     

Pulmonary embolism, right ventricular strain, and intracardiac thrombus-in-transit: Evaluation using comprehensive cardiothoracic computed tomography

A 67-year-old woman presented with symptoms of exertional chest discomfort and dyspnea that had been progressive over the past few days. Her initial evaluation was significant of a mildly elevated troponin-T level and T-wave inversion in leads V₁-V₂ on an electrocardiogram (ECG). Initial suspicion was for acute coronary syndrome. However, a transthoracic echocardiogram showed normal left ventricular systolic function, moderate right ventricular enlargement with moderate decrease in systolic function, possible left atrial mass or thrombus, and a possible right atrial mass or thrombus versus a prominent Chiari network. ECG-gated comprehensive cardiothoracic computed tomography (CT) with a 64-slice multidetector CT was done to assess for pulmonary embolism or acute coronary syndrome and to further evaluate the possible right and left atrial masses. This showed large bilateral pulmonary embolism, interatrial thrombus in transit through a patent foramen ovale, and minimal coronary atherosclerosis. Dynamic imaging showed right ventricular enlargement with severe systolic dysfunction. The patient underwent successful pulmonary thromboembolectomy, removal of intracardiac thrombus, and closure of patent foramen ovale.     

Multidetector computed tomography (MDCT) evaluation of myocardial viability: intraindividual comparison of monomeric vs. dimeric contrast media in a rabbit model

To evaluate the influence of different types of iodinated contrast media on the assessment of myocardial viability, acute myocardial infarction (MI) was surgically induced in six rabbits. Over a period of 45 min, contrast-enhanced cardiac MDCT (64 × 0.6 mm, 80 kV, 680mAs_eff.) was repeatedly performed using a contrast medium dose of 600 mg iodine/kg body weight. Animals received randomized iopromide 300 and iodixanol 320, respectively. Attenuation values of healthy and infarcted myocardium were measured. The size of MI was computed and compared with nitroblue tetrazolium (NBT)-stained specimen. The highest attenuation differences between infarcted and healthy myocardium occurred during the arterial phase with 140.0 ± 3.5 HU and 141.0 ± 2.2 HU for iopromide and iodixanol, respectively. For iodixanol the highest attenuation difference on delayed contrast-enhanced images was achieved 3 min post injection (73.5 HU). A slightly higher attenuation difference was observed for iopromide 6 min after contrast medium injection (82.2 HU), although not statistically significant (p = 0.6437). Mean infarct volume as measured by NBT staining was 33.5% ± 13.6%. There was an excellent agreement of infarct sizes among NBT-, iopromide- and iodixanol-enhanced MDCT with concordance-correlation coefficients ranging from ρ_{(c)  =} 0.9928–0.9982. Iopromide and iodixanol both allow a reliable assessment of MI with delayed contrast-enhanced MDCT.     

MSCT在活体肾移植术前评估中的应用

目的:探讨MSCT在活体肾移植供体术前评价中的价值.方法:174例供肾者接受了MSCT多期扫描,所有图像由2位放射科医师进行分析和评价,记录肾血管和集尿系统的解剖、变异以及其他可能影响肾移植的因素.与术中结果对照,计算MSCT对肾移植供体术前评价的敏感度和特异度.结果:174例供肾者共检出348个肾,61例供肾者可见副肾动脉,26例供肾者存在肾动脉提前分叉,5例供肾者存在肾盂输尿管重复畸形,29例供肾者存在肾静脉畸形,包括副肾静脉、环腹主动脉左肾静脉、主动脉后左肾静脉.47例供肾者进行供肾切除,其中36例行左肾切除术,11例行右肾切除术.MSCT在诊断肾血管和集尿系统解剖方面,敏感度和特异度均为100％.结论:MSCT可准确显示供肾血管、尿路和肾实质的结构,在活体肾移植术前评估中有重要作用.     

Multidetector row computed tomography findings from ischemia to infarction of the large bowel

OBJECTIVE: MDCT is performed as first imaging examination for patients with acute abdomen in most Emergency Departments. Clinical suspicion of ischemic colitis and infarction is related to specific findings, however, differential diagnosis as well as the staging for a confirmed ischemic affection may be critical. The individual signs from ischemia to infarction of large bowel is a captivating topic. In this study, we report our experience of the MDCT assessment of acute colonic disease from vascular mesenteric disorders. MATERIALS AND METHODS: We retrospectively reviewed the MDCT findings of 71 patients admitted to our attention for acute abdomen, with final proven diagnosis of colonic ischemia and/or infarction made by surgery and/or endoscopy. CT-scanning of the abdomen and pelvis was performed after i.v. contrast medium administration, using a multidetector row CT equipment. We correlated the presence of parietal disease, the evidence of mesenteric arterial or venous vessels occlusion, the parietal features as well as others findings, such as free fluid and/or air in peritoneal recess or in retroperitoneum, with the surgical and/or endoscopic findings. RESULTS: Analysis of our data showed a segmental (84%) or complete (16%) involvement of the colon; 57 cases were related to ischemia, 14 to infarction. Inferior mesenteric vessels defect of opacification was noted in 10 cases. Various degree of wall thickening and parietal enhancement, peritoneal fluid, mural or portal-mesenteric pneumatosis were compared to evidence of mesenteric arterial or vein occlusion and to final proven diagnosis. A classification in a multi-stage grading for both decreased of arterial supply or impaired venous drainage disorders was done. CONCLUSIONS: A grading scale from ischemia to infarction affecting the large bowel from arterial or venous mesenteric vessels origin has been not previously reported in a series at our knowledge. MDCT findings may support the clinical evaluation of patients affected by acute colon from vascular disorders. In particular, it seems to provide effective and valuable information's in differentiating etiology and stage of disease.     

The value of PET/CT for preoperative staging of advanced gastric cancer: Comparison with contrast-enhanced CT

Aim

To date, no data are available on the use of PET/CT for preoperative staging of gastric cancer. We attempted to evaluate the value of PET/CT for preoperative staging of advanced gastric cancer, and to compare the use of PET/CT with contrast-enhanced CT (CECT).

Materials and methods

We analyzed PET/CT of 78 patients with surgically proven advanced gastric cancer who had undergone preoperative CECT. Qualitative analysis was conducted by assessing the presence of primary tumors and metastases with PET/CT and CECT.

Results

Among 71 patients who underwent a gastrectomy, 69 primary tumors (93%) were diagnosed by PET/CT, while 64 primary tumors (90%) were detected by CECT (p = 0.55). For regional lymph node metastasis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT vs. CECT were 41% vs. 25% (p = 0.00019), 100% vs. 92% (p = 0.31), 100% vs. 98% (p = 0.46), 26% vs. 42% (p = 0.14), and 51% vs. 72% (p = 0.00089), respectively.

Conclusion

Overall, PET/CT showed comparable diagnostic performance to CECT in diagnosing primary tumors and regional lymph node metastases, though PET/CT was inferior to CECT for the sensitivity and accuracy in diagnosing regional lymph node metastases. Nevertheless, PET/CT would be useful when CECT findings were equivocal due to its high positive predictability.