Objective To investigate the CT presenting rate and features of gastric bare area (GBA, including the area posterior to GBA and the adipose tissue in the gastrophrenic ligament) without pathologic changes.Methods Thirty cases with superior peritoneal ascites, but without pathological involvement of GBA were included into the study to show the normal condition of GBA, including the presenting rate and CT features. We selected some cases with GBA invasion by inflammation or neoplasm to observe their CT features. Results All cases with superior peritoneal ascites showed the GBA against the contrast of ascites with the presenting rate of 100%. The GBA appeared at the level of gastric esophageal conjunction and completely disappeared at the level of hepato duodenal ligament and Winslow’s foramen. The maximum scope of GBA presented at the level of the sagital part of the left portal vein with mean right to left distance of (4.39? 0.08 )cm (3.8～5.7 cm) (distance between the left and right layer of the gastrophrenic ligament). In acute pancreatitis, the width of GBA increased, in which local hypo density area could be seen. In gastric leiomyosarcoma invading GBA, the mass could not separate from the crus of the diaphragm. In lymphoma and metastasis invading GBA, the thickness of GBA increased and the density was heterogeneous, in which lymph nodes presenting as small nodes or fused mass. Conclusion The results of this study show that it is helpful to use contrast enhanced spiral CT scanning to observe the change of GBA and to diagnose retroperitoneal abnormalities that involving GBA comprehensively and accurately.

Objective To investigate the value of magnetic resonance (MR) imaging in the assessment of bile duct complications after cholecystectomy. Methods Fifty patients of having bile duct complications after cholecystectomy underwent MR imaging and had some positive manifestations. The indication for cholecystectomy was symptometic cholelithiasis in all cases. MR imaging was performed with a 1.5 T clinical imager including all of the sequences of: ①T1 weighted imaging (T1WI) was performed in transverse and coronal plane before and after gadolinium enhanced. ②T2 weighted imaging (T2WI) was performed in transverse plane. ③A true fast imaging with steady state precession sequence (True fisp) was performed in coronal plane. ④MR cholangiopancreatography was also obtained. Results The bile duct complications after cholecystectomy including: 22 cases of cholelithiasis, 15 cases of chronic cholangitis with or without bile duct abscess. Bile duct strictures or abruption at the confluence of hepatic and common bile duct in 6 and 3 cases respectively. Tumors of bile duct or pancreas in 9 cases. The other complications after cholecystectomy including bile leak with choleperitonitis and/or biloma and acute pancreatitis.Conclusion MR imaging was a valuable method for the assessment of bile duct complications after cholecystectomy. MR imaging could assess the etiology of bile duct complications. If there were bile duct obstruction, MR imaging could assess the location and the severe of obstruction. For bile duct or pancreatic tumors, MR imaging could assess the areas of tumor infiltration and resection and was helpful to select treatment methods. Before lapatoscopic cholecystectomy, the overall and careful imaging assessment for bile duct and gallbladder and its adjacent hepatic tissue and pancreas so to avoid missing the relative tumors.

Objective To investigate the MR imaging (MRI) appearances of postoperative residual liver after hepatic resection for hepatocellular carcinoma (HCC) and the MRI features of tumor recurrences.Methods Twenty patients with previous surgical resection of HCC underwent MR examination of upper abdomen for routine follow-up study or due to clinical suspicion of tumor recurrence. MRI protocol included T1W axial unenhanced images and Gadolinium-enhanced sequences, Gadolinium-enhanced VIBE sequence, unenhanced T2W axial images and coronal TrueFisp sequence.Results Thirteen patients showed normal edge of surgical resection, while 6 patients demonstrated MR signs of incision edge recurrence of HCC and 1 patient was suspicious of tumor recurrence at the incision edge. Among the 20 patients, 12 had MRI features of tumor recurrence of the residual liver, including invasion of left, right and common hepatic ducts 3 cases. Three patients had metastatic lymphadenopathy in portal hepatis, portacaval space and retroperitoneal space. Two patients showed extensive tumor implantation of peritoneum and mesentery. Conclusion MRI is effective in differentiating normal surgical incision edge of residual liver from tumor recurrence. It is also very useful for the early detection of intra-hepatic and extra-hepatic tumor lesions.

Objective To explore the clinical efficacy and safety of bevacizumab combined with docetaxel in treatment of advanced cervix cancer.Methods Seventy-five patients with advanced cervix cancer accepted in our hospital from April 2011 to April 2016 were selected and divided into observation group with 43 cases and control group with 32 cases according to different treatment methods.Patients in control group were given docetaxel,and patients in observation group were combined with bevacizumab on the basis of control group.The clinical efficacy,adverse reactions,life quality and pharmacoeconomics of two groups were observed and compared.Results The total efficacy and clinical control rate of observation group were all higher than control group with statistically significance (P ＜ 0.05).The adverse reaction rate of two groups had no difference.Total efficacy of life quality improvement was 83.72％,which was obviously higher than control group 62.50％ with statistically significance (P ＜ 0.05).The average cost of observation group was (83 ± 10) thousands,of control group was (18± 6) thousands.The cost of observation group was obviously higher than control group with statistically significance (P ＜ 0.05).Conclusion Using bevacizumab combined with docetaxel in treatment of advanced cervix cancer has better effect clinical but costs much than docetaxel.We should set on treatment according to patients' own situation.

Objective To evaluate the role of contrast enhanced CT (CECT) scanning in the diagnosis and treatment planning of some rare liver tumors. Methods We retrospectively reviewed the CECT imaging features of 10 cases with rare tumors of the liver proved by surgical pathology in 8 cases or by liver biopsy in 2 cases, with correlation of relevant clinical manifestations, laboratory results and surgical findings. Results Three cases were histopathologically proved to be benign, and 7 cases were malignant. On CT images, the liver lesions were mixed cystic solid in 5 cases, totally solid in the other 5. Eight cases demonstrated heterogeneous enhancement, while 2 cases of liver lymphoma had no enhancement. The anatomic relationship of tumors to intrahepatic vasculature, the compression and infiltration of neighboring abdominal structures were accurately delineated by CT as compared with findings at operation. Clinical manifestations and laboratory findings were not useful for the qualitative diagnosis of rare liver tumors, except for hepatocellular carcinoma. Conclusion CECT is very useful for the detection of rare liver tumors and the fine depiction of local extent of these tumors. When correlated with clinical and laboratory information, it helps to differentiate rare liver tumors from hepatocellular carcinoma. But its role in the characterization of rare liver tumors is limited.

Objective To investigate the CT manifestations of chronic virus hepatitis Methods According to the inclusion and exclusion criteria, the clinical data and laboratory information of 120 patients with chronic virus hepatitis B were reviewed retrospectively. All patients underwent standardized contrast enhanced spiral CT dual phase scanning of the upper abdomen. The changes of the liver, bile duct, spleen, portal venous system, lymph node of the upper abdomen, peritoneal cavity and pleural cavity were observed and noted. Results CT manifestations of chronic virus hepatitis B were as follows: ①changes of the configuration and shape of the liver, ② changes of the density of the liver, ③intrahepatic perivascular lucency, ④thickening of gallbladder wall and edema of the gallbladder fossa, ⑤splenomegaly, ⑥enlargement of abdominal lymph nodes, ⑦ascites, ⑧abnormalities related to portal hypertension (collateral circulation), and ⑨secondary thoracic changes (pleural and pericardial effusion). ]Conclusion Chronic virus hepatitis B can demonstrate several abnormal findings involving the liver, gallbladder, lymph nodes, spleen, etc on contrast enhanced CT scanning.

Objective To explore the use of magnetic resonance imaging (MRI) in the display of detailed anatomical structures at the pancreaticobiliary junction. Methods 112 patients who received enhanced MRI of upper abdomen were included in the study. Patients with pancreatic and/or biliary diseases diagnosed clinically and with laboratory tests were excluded. The types of junction between the terminal common bile duct and the pancreatic duct, and the location of the major duodenal papilla were studied on MRI. We measured the angle between the duodenum and the common pancreaticobiliary duct or the common bile duct. Results Of the 112 patients, the duodenal papillas were located at the upper, middle, and lower segment of the duodenum in 17. 0%, 66. 0% and 17. 0%, respectively.The angle between the common pancreaticobiliary duct or the distal common bile duct and the descending duodenum was 44. 4°±17. 3°. The pancreatic duct and the common bile duct opened separately in 9 patients (8. 0%). The confluence of the two ducts was present inside and outside of the duodenum wall in 13 (11. 6%) and 90 patients (80. 4%), respectively. The angle between the distal common bile duct and the pancreatic duct was 37. 8°±15.1°. Conclusion MRI was able to display detailed anatomical structures of the pancreaticobiliary junction, including the angle of the junction between the two ducts and the location of the duodenal papilla. It has the ability to provide meticulous anatomical data for the diagnosis and treatment of diseases at the pancreaticobiliary junction and to help surgeons formulate operative plans.

Objective To find up a suitable beginning scan time so that to assure the image quantity during CTA of brain.Methods 30volunteers were checked by heart colour sonography first,then CTA at earlier stage was done,when the density in basilar artery high up to120 HU,that time was regarded the time as beginning scan time,the relative curve between beginning scan time and ejection fraction(EF) was drew,according to this relative curve,34 patients were examined by CTA,the displaying situation of vessel was evaluated comparatively with DSA in part of patients.Results According to this method,the successful rate of CTA in patient’s group was 100%,the trunk of brain vessel and its 1~3 level branch were showed in 100%,the 4~5 level branch of middle cerebal artery showed in 94.1%(32/34).Conclusion According to EF of heart to determine the beginning scan time of CTA is practical,that the image quantity of CTA can be assured.

Objective To investigate the appropriate reconstruction techniques of multi-detector-row spiral CT angiography (MDCTA) to depict the collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC). Methods MDCTA scanning was performed during the portal venous phase after intravenous contrast materials in 18 HCC patients with CTPV induced by tumor thrombosis. Raw data were reconstructed with thin slice thickness followed by 2D and 3D angiographic reconstruction methods, including maximum intensity projection(MIP), shade surface display (SSD) and volume rendering technique(VRT). Results MDCTA with MIP reconstruction accurately depicted both the tumor thrombus within the portal vein and the collateral vessels of CTPV including the biliary (cystic vein and pericholedochal veinous plexus) and the gastric (left and right gastric veins) branches. However, VRT and SSD methods did poorly in showing the tumor thrombus and the collateral vessels. Conclusion MDCTA with MIP reconstruction is the method of choice to evaluate the collateral vessels of CTPV.

Objective To investigate the imaging features of malignant invasion of major intrahepatic ductal structures (the portal and hepatic venous vasculature, the bilie duct) by primary hepatocellular carcinoma (HCC) using multi-detector-row spiral CT (MDCT). Methods We retrospectively analyzed 68 documented HCC patients with tumorous invasion of the major intrahepatic ductal structures who had undergone contrast-enhanced dual-phase MDCT scanning of the upper abdomen.The morphological changes of the portal and hepatic venous vasculature, the bile duct, and the liver parenchyma at both the hepatic arterial phase and portal venous phase images were carefully observed and recorded. Results Among the 68 patients, 47 patients had malignant invasion of the intrahepatic portal venous vessels with secondary tumor thrombus formation; 12 patients had tumor involvement of the hepatic veins and intraheptic segment of the inferior vena cava; Tumor invasion of the bile duct was seen in 9 patents. The direct CT signs of tumor invasion of intrahepatic venous vessels included: ①dilatation or enlargement of the involved vein with intraluminal soft-tissue “filling defect”; ②enhancement of the tumor thrombus at hepatic arterial phase, the so-called “venous arterialization” phenomenon. The indirect CT signs included: ①arterial-venous shunt, ②early and heterogeneous enhancement of the hepatic parenchyma adjacent to HCC focus, ③cavernous transformation of the portal vein. The CT signs suggesting tumor invasion of the bile duct included: ①dilation of the bile ducts near or proximal to HCC lesion, ②soft-tissue nodule or mass inside the bile ducts. Conclusion Invasion of major intrahepatic ductal structures by HCC will present corresponding CT imaging features. Contrast-enhanced MDCT dual-phase scanning combined with appropriate image post-processing techniques can better evaluate the malignant invasion of major intrahepatic ductal structures.