Objective To evaluate the application value of multi-slice spiral CT(MSCT)in D2 radical total gastrectomy for gastric carcinoma.Methods CT and clinical data of 353 cases with D2 radical total gastrectomy for gastric carcinoma was analyzed retro-spectively.Results Operative time was 236 (1 91-35 1)mins VS.245 (189-308)mins,no significant difference was observed be-tween the CT scan group and the non-CT scan group(P >0.05).The number of lymph nodes dissected was (27 ±3)VS.(20±2), there was significant difference between the CT group and the non-CT group (P <0.05).The blood loss in the CT group and no CT group was less 168 (110-600)mL and 280 (150-720)mL respectively(P<0.01).Postoperative hospital stay was shorter (11.2±2.1)days in CT group than no CT group (14.5±2.0)days (P <0.01).Postoperative complications developed in 1 7 patients in the CT group and in 29 patients in the non-CT group.The difference didn’t show statistically significant between the two groups (P >0.05).Conclusion Multi-slice computed tomography scanning has a great value in D2 radical total gastrectomy for gastric carcinoma.

Purpose　To evaluate the clinical safety of ionic contrast media made in china and compare with nonionic contrast media being imported. Methods　Among contrast-enhanced CT 1096 cases, 76% meglumine diatrizoate were administed in 864 cases and ultravist in 232 cases , comparative studies on adverse drug reactions(ADRs) and image quality were performed. Results　In 76% meglumine diatrizoate group , the prevalence of overall and mild -middle ADRs was higher than in the ultravist group , the prevalence of severe and potentially life-threatening ADRs was approximate in the ultravist group , the image quality was well than in the ultravist group.Preventive inoculation alleviated ADRs at all levels. Conclusion　Ionic contrast media made in china was safe and effective in patients without hyperthyroidism after preventive inoculation.

Objective To determine the value and limitation of water enema spiral CT (WESCT) in staging of colorectal carcinoma.Methods Forty-eight patients with histologically proven rectum or colon carcinoma were included in this study. All of them were examined by SCT ,and the preoperative staging of TNM and Duke were used based on the findings of SCT.The results of WESCT were compared with those of surgical and pathological examination in all cases. Results All lesions in the 47 cases were demonstrated clearly by WESCT and the sensitivity was 97.9% ; 39 cases of 48 patients were correctly staged with TNM and 42 cases with Duke , the accuracy was 81.3% and 87.5% respectively, which were higher than the overall 50 % accuracy reported by references ;⑶The accuracy of WESCT was 89.6% (43/48) in T stage and 81.3% (39/48) in N stage. Three casas in M stage were all diagnosed correctly;Conclusion WESCT scan is a better method of depicting the colorectal carcinoma. It allows for accurate depiction and staging of colorectal carcinoma, especially detecting the invasion of adjacent tissues and distant metastasis. It is the best imaging method for staging the colorectal carcinoma . However the value of WESCT for early T staging in colorectal carcinoma and minute metastasis of lymph nodes or liver is limited.

Objective To evaluate the diagnostic value and clinical significance of preoperative staging in gastric cancer with induced pneumoperitoneum in spiral CT (SCTPP). Methods Both routine SCT and SCTPP were performed in 52 lean patients suffered from gastric cancers, and comparison was made between SCT findings and surgical and histopathologic findings. Results The accuracy of routine SCT and SCTPP in determining the T-staging was 72% and 96%, respectively (?2=8.0, P0.05). The sensitivity in determining M-staging was 61% and 100%, respectively (?2=0.04, P

Objective To analyze the CT features of renal carcinoma associated with Xp11.2 translocations/TFE3 gene fusions (Xp11.2 RCC),and to improve the diagnostic accuracy.Methods Clinical data,CT imaging and pathological features of 12 cases with pathology proved Xp11.2 RCC were analyzed retrospectively.Results All the 12 cases were solid masses.11 cases were oval or quasi-circular,1 case was irregular.Tumors were iso-density or hyperdensity on CT plain scan images.The density was heterogene-ous,combined with necrosis in 11 cases and spotty or patchy calcification in 7 cases.After injection of contrast,moderate or obvious enhancement of tumors was found,1 case had retroperitoneal lymph node metastasis,1 case was found with mass formation in the re-nal hilus,1 case had adrenal metastasis.Another one was found with psoas major muscle and lumbar 5 invaded.Conclusion The Xp11 .2 RCC has certain CT characteristics.This disease should be considered when a renal tumor is iso-density or hyperdensity on the CT plain scan images and has moderate or obvious enhancement,combined with necrosis or calcification.

Objective To study the relationship between the CT features and pathological grade of malignancy of the gastric stro-mal tumors (GST).Methods A retrospective review was performed based on the database of 80 consecutive patients with GST.Age and gender of the patients were recorded,and the CT findings of GST including growth pattern,morphology,tumor site,boundary, mucosa,serosa,ulcer,volume and maximum diameter of the tumor were also measured.The patients were divided into three groups:very low and low risk group,intermediate risk one and high risk one according to the pathology.All parameters were ana-lyzed by one-way ANOVA or Fisher’s exact test.Results The patients in 3 groups (from low risk to high one)were 30,30 and 20 respectively.There were no significant differences in age,gender,location and mucosa among 3 groups(P>0.05).However,the growth pattern,morphology,boundary,serosa,ulcer,volume and maximum diameter of the tumor were significantly different (P<0.05).Conclusion The CT features including growth pattern,morphology,boundary,serosa,ulcer,volume and maximum diameter of the tumor can be used to evaluate the grades of malignancy in GST.

Objective To investigate the effectiveness of organ dose modulation (ODM) technology with respect to dose reduction and image quality of the sensitive organs during CTA of craniocervical arteries. Methods Ninety one patients suspected of arterial vascular disease and evaluated by CTA of craniocervical arterires were enrolled in this study. Patients were divided into group A (n=46) and group B (n=45) according to the order of examination. All patients hadCTA examination of craniocervical arteries. The ODM technique was used only in plain phase in group A and was used both in the plain phase and enhanced phase in group B. The tube current in the four direction (anterior,posterior,left,right) of thyroid and orbital area and radiation dose were recorded. The image quality of group A and group B was evaluated by objective indicators [CT attenuation values and contrast-to-noise ratio (CNR) of vessels in the thyroid area and orbital region ]and the subjective score. The independent samples t test was used for the statistical analysis of the objective indicators and nonparametric rank sum Mann-Whitney U test were used for subjective score. Results For A group, There were significant differences for the tube current at all directions of the thyroid gland and orbital area between the plain phase and the enhanced phase except the current at the posterior of the thyroid gland area(P value all<0.05),and the current in plain phase lower than that in enhanced phase. The mean current of thyroid gland and the orbital area were (604±43) mA and (656± 22) mA in the plain phase and (341±54) mA and (409±63) mA in enhanced phase. The differences were significant (t values were -10.909 and -38.454,P<0.01).CTDIvol and ED were (15.6±1.4) mGy and (1.44± 0.17) mSv in the plain phase and (17.4 ± 1.4) mGy and (1.60 ± 0.18) mSv in the enhanced phase, the differences were significant (t values were - 42.008 and - 32.130, P<0.01) . There was no significant differences for the objective indicators and the subjective score between group A and group B(P>0.05). Conclusion ODM technique can provide protective effect on the sensitive organs during craniocervical CTA examination without compromising the image quality.

ObjectiveTo assess whether intravenous contrast medium would result in acute kidney injury (AKI), and to determine the risk factors associated with contrast induced AKI (CI-AKI) and its outcome.Methods A retrospective observational study was conducted in intensive care unit (ICU) of Fuyang People's Hospital in Zhejiang Province from January 1st 2011 to December 31st 2014. All enrolled critically ill patients had accepted CT scan, and the hospital length of stay was longer than 48 hours, and the patients who needed renal replacement treatment were excluded. Patients were divided into contrast medium group and control group. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria (serum creatinine content over 26.4μmol/L or 50% increase of it from baseline within 48 hours). The incidence of AKI was compared between the two groups, and risk factors for CI-AKI were determined by multiple logistic regression analysis. The relationship of CI-AKI and outcomes were also analyzed. Results A total of 2 370 critically ill patients were enrolled during the period. 474 (20.0%) of the 2 370 patients received contrast medium, and 70 of them suffered from CI-AKI (14.8%). In 1 896 patients who did not receive contrast medium, 235 of them suffered from AKI (12.4%). There was no significant difference in the incidence of AKI between two groups (χ2= 1.905,P = 0.168). After several confounding factors were adjusted, multiple logistic regression analysis showed that contrast medium was not found to associate with AKI in critically ill patients [odds ratio (OR) = 1.66, 95% confidence interval (95%CI) = 0.72-3.90,P = 0.201], and high acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (OR = 1.70, 95%CI = 1.33-2.40,P< 0.001), sepsis (OR= 8.06, 95%CI =3.28-17.80,P< 0.001), shock (OR= 3.57, 95%CI = 1.73-8.01,P< 0.001) and use of nephrotoxic agent (OR= 1.96, 95%CI = 1.25-2.63,P = 0.015) were risk factors of CI-AKI. Ten of 70 patients with CI-AKI died (14.3%), and 21 out of 404 patients without CI-AKI, died (5.2%). There was no significant difference in the mortality rate (χ2= 8.060, P = 0.005). It was shown by multiple logistic regression analysis that age (OR=1.30, 95%CI = 1.05-1.71,P = 0.027), male sex (OR = 1.13, 95%CI = 1.05-1.20,P = 0.039), APACHEⅡscore (OR = 1.07, 95%CI = 1.03-1.18,P< 0.001), and sepsis (OR = 3.29, 95%CI = 1.92-6.46,P< 0.001) were highly associated with mortality of critically ill patients in whom contrast medium was used. However, the occurrence of CI-AKI showed no influence on the mortality rate (OR = 1.70, 95%CI = 0.88-3.56,P = 0.227).Conclusions The use of contrast medium is not a risk factor of CI-AKI in critically ill patients. CI-AKI will not raise mortality rate in ICU patients.

Objective To investigate the application of automatic biopsy gun in CT-guided percutaneous biopsy for the diagnosis of pulmonary sub-centimeter nodules (≤1 cm).Methods A total of 78 patients with pulmonary sub-centimeter nodules were enrolled in this study. Under CT guidance, percutaneous multi-point and multi-sampling puncture biopsy with automatic biopsy gun was carried out in all patients. The success rate of puncturing, the complications and pathological results were analyzed. Results The success rate of puncturing was 91.0% (71/78). The incidence of pneumothorax was 17.9% (14/78) and the incidence of hemorrhage was 30.8%(24/78). In all patients, no pulmonary infection, tumor tract seeding or metastasis was observed during the follow-up period. Among the 71 patients who had a successful biopsy, squamous cell carcinoma was detected in 7, adenocarcinoma in 25, small cell carcinoma in 5, metastatic lesion in 3, chronic interstitial lung inflammation in 13, granulomatous inflammation in 12, pulmonary fungus in 4, pneumoconiosis nodule in one and pulmonary hamartoma in one. Conclusion For CT-guided percutaneous puncture biopsy of pulmonary sub-centimeter nodules, the use of automatic biopsy gun is safe and reliable with higher success rate.

Objective To assess the effects of image fusion of CT spectral monochromatic imaging on image quality in small hepatocellular carcinoma (HCC).Methods Thirty patients with 40 pathologically proven small HCCs (≤3 cm) underwent upper abdominal plain CT and dual-phase enhanced spectral CT scan were analyzed retrospectively.Conventional 140 kVp polychromatic images (group A) and monochromatic images with energy levels from 40 to 140 keV were reconstructed by using spectral imaging viewer.Monochromatic images with highest CNR (group B)and 70 keV images with lowest noise (group C) were fused to generate fused images (group D) with image fusion software.Objective evaluation of 40 HCCs [contrast-to-noise ratio (CNR) of lesion,image noise in HU] and subjective rating score of 30 patients (image noise score,overall image quality score,and lesion conspicuity score) among the four groups were compared by using One-way ANOVA and Kruskal-Wallis H test.Results CNR (1.3±0.6,2.1±0.6,1.5±0.6 and 2.4± 1.3 respectively) and image noise [(20±7),(32±9),(18±3) and (24±6) HU respectively] among group A,B,C and D all had statistical differences (F =5.724 and 13.619,both P values ＜ 0.01).CNR in group D was higher as compared with group A and C (both P values ＜ 0.05),but was similar to group B (P ＞ 0.05).Image noise in group D was lower than group B and higher than group C,but showed no difference from group A (all P values ＞ 0.05).Image noise scores [(3.5±0.5),(3.3±0.4),(3.6±0.5)and(3.5±0.4)point,respectively],overall image quality scores [(3.2 ± 0.4),(3.3 ± 0.3),(3.1 ± 0.3) and (3.7 ± 0.4) point respectively] and lesion conspicuity scores [(3.3 ±0.4),(3.9±0.4),(3.2±0.4) and (3.7 ±0.4) point,respectively] among the four groups all had statistical differences (Z =9.581,37.495 and 43.436,all P values ＜ 0.05).Scores of the four groups were all greater than 3 and met the clinical diagnostic level.Group D was higher than group B in image noise score,higher than the other three groups in overall image quality score,higher than group A in lesion conspicuity score (all P values ＜ 0.05).Conclusion Combined use of CT spectral monochromatic imaging and image fusion can improve overall image quality while maintaining or increasing CNR in small HCC.