1.Gastrointestinal Perforation: The Value of the Periportal Free Air Sign on Multidetector Spiral Computed Tomography
Baoguo JIANG ; Jiazheng LIU ; Yanxia CHEN ; Ling YUE
Journal of Practical Radiology 2010;26(2):193-195
Objective To evaluate the value of the periportal free air(PPFA) sign at computed tomography(CT) in distinguishing between upper and lower gastrointestinal(GI) tract perforation. Methods CT images of 62 patients with surgically proven GI tract perforation were retrospectively analyzed. 62 cases included upper and lower GI tract perforation in 35 cases and 27 cases,respective-ly. When there was free air in the periportal area,it was defined as positive periportal free air(PPFA) sign. The difference of PPFA sign in upper and lower GI tract perforation, and the sensitivity, specificity, positive predictive value, negative predictive value and ac-curacy of PPFA sign in diagnosing gastrointestinal perforation were analysed respectively. Results The PPFA sign was seen in 33 of 35(94%) patients with upper GI tract perforation,but only in 10 of 27 (37%) patients with lower GI tract perforation,there was sig-nificant difference between them(P<0.05). For diagnosis of super GI perforation with PPFA sign, the sensitivity, specificity, positive predictive value,negative predictive value and accuracy were 94% (33/35), 63%(17/27), 770%(33/43), 89%(17/19) and 81% (50/ 62), respectively. Conclusion The PPFA sign is a useful finding in distinguishing between upper and lower GI tract perforation.
2.Clinical Value of 64-slice Computed Tomography in the Diagnosis of Complex Congenital Heart Disease
Gengwu LI ; Bin LIU ; Wanqin WANG ; Xingwang WU ; Hong ZHAO
Journal of Practical Radiology 2010;26(2):183-188
Objective To study the clinical value of 64-slice spiral computed tomography(64SCT) contrast-enhanced scan and three-dimensional reconstructed techniques in the diagnosis of complex congenital heart disease(CCHD). Methods 39 patients with CCHD underwent CT angiography and transthoracic echocardiograms (TTE). Of them, the electrocardiographic-gating technique was used in 8 cases. The accurate rates in diagnosing CCHD with CT, TTE and CT with or without electrocardiographic-gating were analysed compared with that of operation and χ~2 test using SPSS13.0 tool. Results A total of 102 cardiac deformities con-firmed by operations,those included 47 intracardiac deformities,the diagnostic accuracys with CT and TTE were 85.1% and 95.7%, respectively, and there was no obvious difference among them (χ~2=2.68, P>0.05). 55 extracardiac deformities, the definite diagnos-tic rates with CT and TTE were 98.2% and 78.2%, respectively. CT was superior to TTE in the indentification of extracardiac de-formities(χ~2= 14.64 ,P<0.01). There was no obvious difference between with and without electrocardiographic-gating technique during CT scanning in diagnosis of cardiac deformities(χ~2=1.84, P>0.05). Conclusion 64SCT has significant value in diagnosis of CCHD,and there was no obvious difference in diagnosis of cardiac deformities by 64SCT between with and without electrocardio-graphic-gating technic.
3.The Features of Crush Maxillofacial Fractures in the 5·12 Massive Wenchuan Earthquake: Evaluation with Multi-slice Spiral CT
Zhigang CHU ; Jianqun YU ; Zhigang YANG ; Zhihui DONG
Journal of Practical Radiology 2010;26(2):168-171
Objective To investigate the multi-slice spiral computed tomography (MSCT) features of crush maxillofacial frac-tures in the massive Wenchuan earthquake. Methods MSCT data of 85 patients with crush maxillofacial fractures caused by earth-quake were retrospectively analyzed. The anatomic distribution of fractures was evaluated. Results In 85 patients, single bone frac-tures (59 patients) were more common than multiple bone fractures (26 patients) (P<0.05). The fractures involved isolated mid-face, isolated mandible, and both were found in 49 patients (57.6%), 24(28.2%), and 12(14.2%), respectively. Midface frac-tures were most frequent (P<0.05). The fractures of condyle, posterolateral and anterior wall of maxillary sinus, zygomatic arch and lateral orbital wall accounted for 47.1%(24/51) ,41.5%(22/53) , 37.7%(20/53),71.9% (23/32) and 63.2%(24/38) of the total fractures of the corresponding maxillofacial bones. Conclusion Isolated bone fracture and midface factures are the main fea-tures of crush maxillofacial fractures resulted from the massive earthquake. MSCT and three-dimensional reconstruction images can demonstrate maxillofacial fractures well.
4.MRI Features and Dissemination Approach of Intracranial Gliomas after Operation
Guixiang ZHANG ; Linfeng ZHENG ; Xifu WANG ; Jinglong ZHAO ; Kangan LI ; Genquan ZHOU ; Yunsheng HU ; Yujie LI
Journal of Practical Radiology 2010;26(2):153-157
Objective To analyse the routes and MRI characteristics of disseminated intracranial gliomas after operation. Methods 10 patients of intracranial gliomas confirmed by pathology and intracranial dissemination after operation underwent MRI examina-tions including T_1 WI, FSE T_2 WI, FLAIR and fat-suppressed T_1 WI after intravenous injection of Gd-DTPA. In addition, 4 cases were also examinated with DWI, 1 case with SWI and DTI. Results In 10 cases,there were glioblastoma in 7 cases,grade Ⅱ astro-cytoma in 2 and grade Ⅲ astrocytoma in one. The disseminated tumors were found by MRI in 4 to 56 months after operation. The le-sions in all patients were confirmed with the comparison of contrast-enhanced MRI positive signs between preoperation and post-operation. Plain MR scanning showed line-like thicking with isointensity in 1/7 case/time (C/T)and multiple noduli in 5/7 (C/T) on T_1 WI respectively;shallowed cortical sulci and cistern in 2/7(C/T) and nodular in 5/7(C/T) on T_2 WI;shaUowed cortical aulci and cistern in 2/7 (C/T) and nodular in 6/7(C/T) on FLAIR. The signal intensity of noduli of disseminated tumors in 7 cases were in complete consistency with that of primary neoplasm , however, in 3 cases, it was inconsistent. Enhanced scanning showed 7 ca-ses with the signs of line-like thicking, 7 cases with noduli , 6 cases with :cast-like shape" sign and 6 cases with different extent of hydrocephalus. Conclusion Enhanced MRI can be used as a most useful and reliable monitoring tools for detecting dissemination of brain glioma.
5.The Experience in Treatment of Bleeding after Mini-invasive Percutaneous Nephrolithotomy by Interventional Therapy
Qing YANG ; Ruping YANG ; Jiaping WANG ; Li GUO ; Yingchun LI ; Mingxia DING
Journal of Practical Radiology 2010;26(1):101-102
Objective To investigate the value of interventional therapy for nephrorrhagia after mini-invasive percutaneous nephrolithotomy(MPCNL).Methods From February 2007 to December 2008,16 cases with nephrorrhagia after MPCNL underwent interventional therapy,of them,14 cases treated with super-selective embolization,one case treated by kindey arterial embolization and one case with renal subcapsular bleeding treated by reptilase intra-arterial infusion.Results In 16 cases,15 cases were successfully treated by embolization.Conclusion Interventional therapy is the first choice method for treating nephrorrhagia after MPCNL.
6.Clinical Application of the Covered Stent in the Treatment of Malignant Upper Gastrointestinal Tract Obstruction
Yong CHEN ; Zhiling GAO ; Yulin GUO
Journal of Practical Radiology 2010;26(1):97-100
Objective To evaluate the clinical efficacy and complications of the covered stents in the treatment of malignant upper gastrointestinal tract stricture.Methods 53 cases with malignant upper gastrointestinal tract obstruction underwent treatment with covered stents.The therapeutic efficiency and the complications were observed.Results The procedures were successful in 50 cases in one time,the successful rate was 94.3%.The complications included chest pain and foreign body sensation,diarrhea,restenosis,stent migration,esophagus reflux,bleeding.Conclusion The treatment with covered stents was a safe,simple and effective management for the patients with malignant upper gastrointestinal tract obstruction who had lost the chance of surgical resection or refused to undergo operation.
7.The Application of Multi-slice Spiral CT Angiogrpahy in Showing the Right Gastroepiploic Artery
Yufei ZHENG ; Shuzhi WANG ; Jianping GU ; Xindao YIN ; Lingquan LU ; Qing LU
Journal of Practical Radiology 2010;26(1):87-90
Objective To evaluate the clinical value of MSCTA in displaying the right gastroepiploic artery(RGEA).Methods 16-slice spiral CT enhanced images of abdomen in 80 cases were retrospectively reviewed.The course and the length of RGEA were observed and the diameters of RGEA at the origin and the end were also measured on maximum intensity projection(MIP),thin slice maximum intensity projection(TSMIP) and volume rendering(VR) images.Results The displaying rate of RGEA by MSCTA was 100% including long type in 22 cases(27.50%),moderate type in 53 cases(66.25%) and short type in 5 cases(6.25%).The average length of RGEAs was (19.5±4.5) cm.The average diameters of RGEAs at the origin in long,moderate and short type respectively were (2.69±0.26) mm,(2.70±0.18) mm,(2.68±0.12) mm respectively.The average diameters of RGEAs at the end in these three types were (1.76±0.17) mm,(1.75±0.18) mm and (1.74±0.05) mm respectively.The average diameters of RGEA in different length were no of statistical significance(P>0.05).Conclusion RGEA can be evaluated with MSCTA before coronary artery bypass grafting.
8.Assessment of Breast Cancer Response to Neoadjuvant Chemotherapy with Tumor's Size at MR Imaging
Chunxue WU ; Xiaoying WANG ; Naishan QIN ; Li GUO ; Xuexiang JIANG
Journal of Practical Radiology 2010;26(1):77-83
Objective To investigate the clinical value of tumor's longest diameter and volume in assessing pathologic response in locally advanced breast cancer treated with neoadjuvant chemotherapy(NAC).Methods A prospective study was undertaken in women undergoing NAC for locally advanced breast cancer in order to determine the ability of quantitative MRI to assess the final pathologic response. 36 cases with pathologically confirmed locally advanced breast cancer who had been undergone four courses of NAC underwent preoperative breast MRI three times during the NAC. Pathologic response was assessed according Miller & Payne grading system, of which grade 4 and 5 defined as major histological response (MHR), and grade 1 to 3 as non-major histological response (NMHR). The tumor's longest diameters and volumes in MHR were compared with those in NMHR by Mann-Whitney U test before, after the second and fourth cycle of NAC. Concordance correlation coefficient (CCC) were assessed to evaluate the agreement between the two method. Receiver operating characteristic curve (ROC) analysis was carried out to assess the clinical value of tumor size and the change rate.Results Before,after the second and the fourth cycle of NAC, the difference of tumor's longest diameters and their first change rate between MHR [(2.75±1.16) cm,(2.19±1.07) cm ,(1.58±0.75) cm and (21.70±15.09)%]respectively,and NMHR [(2.71±1.10) cm,(2.33±0.90) cm,(2.01±0.94) cm and (11.68±10.27)%] respectively were not significant(P>0.05). The second change rate of tumor's longest diameter in MHR [(39.00±15.38)% ] was significantly higher than that in NMHR[ (25.83±21.77)% ](P=0.04). Before, after the second and the fourth cycly of NAC, the differences of tumor volumes and their first change rate between MHR [ median 14.00 cm~3 ( range 2.96~83.41 cm~3 ) , median 7.31 cm~3 (range 0.05~55.35 cm~3), median 2.69 cm~3 (range 0~33.40 cm~3 ) , median 48.65% (range 33.64%~98.48%) ] and NMHR [median 4.25 cm~3 (range 4.78~106.55 cm~3), median 10.53 cm~3 (range 1.72~42.85 cm~3), median 7.56 cm~3 (range 0.68~156.58 cm~3), median 52.04% (range-35.79%~78.31%) ] were not significant. The second changing rate of tumor's volume in MHR [median 85.37% (ranged 27.52%~100%)] was significantly higher than that in NMHR [median 68.80% (ranged -289.60%~94.24%)](P=0.01). CCC was computed before and (0.82), after the second cycle (0.67) and after the fourth cycle (0.55), in all examinations pooled together (0.78).The second change rates of tumor's longest diameter and volume were equal to predict the final pathologic response, and the area under curve were 0.75 and 0.80, respectively (P=0.61). Conclusion The agreement between the tumor's longest diameters and tumor's volumes is good in all in breast carcinoma. The assessment efficacy of the change rate of tumor's longest diameter and that of volume were low.
9.CT,MRI and DSA Appearances of Giant Cell Tumors of Bone in Unusual Sites
Wanyin SHI ; Xindao YIN ; Liping WANG ; Jianping GU
Journal of Practical Radiology 2010;26(1):74-76
Objective To investigate retrospectively CT,MRI and DSA appearances of giant cell tumors(GCT) of bone in unusual sites,in order to improve the diagnosis of it.Methods CT,MRI and DSA features of GCT in 11 cases proved by surgery and pathology,were retrospectively analyzed.GCTs located in iliac bone in 4,sacral vertebrae in 3,ischial bone in 2, calcaneus and temporal bone in one respectively.Results (1) At CT,the tumors were mainly showed as expanding growth and osteolytic destruction,without periosteal reaction and calcification.(2)At MRI,the tumors were hypo-,isointensity on T_1WI and heterogeneously iso, hyperintensity on T_2WI.Low intensity curvilinear strips inside the tumor on T_1WI and T_2WI were found in 5 patients,and "bright patches sign" on T_2WI were also displayed in 2 cases.(3)At DSA,abundant blood supply to the tumors was demonstrated,the thickened and twisted feeding artery and,"tumor's stain sign" were also found.Conclusion To analyse imaging data synthetically,including CT,MR imaging and DSA,can improve the knowledge of GCT of bone in unusual sites.
10.MRI Analysis of the Way in Showing Collateral Ligaments of Knee
Lei ZHANG ; Tao CHEN ; Li LI ; Jing LI ; Junwei ZHANG ; Xiaoguang GOU ; Zhuanqin REN
Journal of Practical Radiology 2010;26(1):71-73
Objective To study the way in showing collateral ligaments of knee by MRI and MRI findings of the normal collateral ligaments.Methods MR imaging examinations were performed in 55 healthy volunteers . MR imaging included T1WI and PDWI sequence on the coronal, sagittal and coronal posterior oblique plane, in order to observe the collateral ligaments, and to measure the medial collateral ligament and the lateral collateral ligament dimension, which were compared with the results of the cadaver published in the related anatomic literatures.Results (1)On sagittal MRI, the angle between the line of medial collateral ligament and the tibia long axis was 0.55°±0.25°,the angle between the line of lateral collateral ligament and the long axis of the fibular neck was 11.47°±1.61)°.(2)On coronal MRI, 96% of the medial collateral ligaments was completely showed on only one slice, at the same time, 82% of the lateral collateral ligaments was completely showed on only one slice .On 11°coronal posterior oblique plane,90% of the lateral collateral ligaments was completely showed on only one slice .(3)The normal medial and lateral collateral ligaments were hypointense string on both T1WI and PDWI coronal MR images , with an average length of 11.53 cm for the medial collateral ligament and 5.31 cm for the lateral collateral ligament.Conclusion Using sagittal plane completely shown the tibia and fibular neck as the standard plane and thickness of 3mm in examining the collateral ligaments of knee by MR imaging can display the medial and the lateral collateral ligament clearly .