Objectives:To evaluate the diagnostie value of 16 row helical CT with application of volume viewer. Methods:A retrospective analysis of 52 patienis'numerical data was made. All patients with clinical suspected cerebral vessels disease were detected by the 16 row helical CT angiography with application of voltume viewer, and the imaging data were compared with those of DSA or pathology. Results:of 52 cases,a total of 33 intracranial aneurysms were detected by the application of volume viewer, which clearly displayed the body, neck and parenl artery of intracranial aneurysms, and showed the aneurysms relation with peripheral vessels and cranioaural. In 52cases, 8 cases of cerebral vascular malformations showed Ihe form, the size and the hemisphere of cacogenesis cerehral vessels, as well as the amount of feeding artery and draining vein. In 2 case Moyamoya disease, 16 row helical CT angiography showed paragraph of obliteration Cerebral vessels and branch stem paraplasm. Conclusion:There is clinical application value in 16 row helical CT angiography for the diagnosis of cerehral vessels disease, which provides guidance fur clinical treatment.

Objective To evaluate the diagnostic value of the multislice spiral computed tomography angiography (MSCTA) in the diagnosis of moyamoya disease and explore its future application. Method The image data of 10 patients with moyamoya disease undertaken MSCTA and digital subtraction angiography (DSA) were reviewed analysis. Results MSCTA could clearly show stenosis, multiple occlusion or abnormalities of the cerebral vessels. Volume-rendering helped to show the relationship between the abnormal vessels and the surrounding tissues. Combined maximum intensity projection (MIP) and multiplsnar reconstruction (MPB) images could clearly show abnormally increased vessels (moyamoya disease vessels). The rate of occlusion and stenosis showed by MSCTA were 66.2%(53/80)and 67.5%(54/80)by DSA. There was no significant difference between the two methods (P>0.05). The images of MSCTA were basically same as those of DSA. Conclusions MSCTA is sensitive in diagnosing moyamoya disease, which is an important basis for early diagnosis. Early diagnosis and treatment is effective in improving prognosis of moyamoya disease.

Objective To observe the MRI characteristics in subacute combined degeneration (SCD)of the spinal cord.Methods The data of 1 9 SCD patients were retrospectively analyzed by the clinical characteristics and MR images.Results Among the 1 9 pa-tients of SCD,1 6 cases showed abnormal findings.Most of intramedullary lesions located in posterior column of thoracic and cervical spinal cord,and only one case located in cerebellar cortex and medulla oblongata.Lesions were involved in muti-segmental spinal cord,and mainly located in the dorsal or lateral spinal cord,and only two cases located in the anterior spinal cord.Different segmental spinal cord lesions had a different morphological characteristics with no enhancement.After treatments with vitamin B1 2 ,the lesions diminished and even disappeared in 2 cases.Conclusion MRI has important value in the diagnosis and treatment monitor of the SCD.

Objective: To investigate the diagnostic value of 18F-FDG PET/CT combined with MR cholangiopancreatography (MRCP) multimodal imaging in diagnosis of malignant and benign obstructive jaundice. Methods Totally 57 biliary obstruction patients were enrolled and divided into malignant obstruction group (n=31) and benign obstruction group (n=26). The diagnostic efficacy of 18F-FDG PET/CT, MRCP and multimodal imaging of obstructive jaundice were analyzed and compared. Results In malignant obstruction group, moderate to severe biliary expansion accounted for 41.94% (13/31), while in the benign obstruction group, the rate was 3.85% (1/26), and the difference between the two groups was statistically significant (P=0.047). The maximum standard uptake value (SUVmax) of malignant obstruction group (10.54±6.69) was significantly higher than that of the benign obstruction group (3.78±1.68; P<0.001). The sensitivity of 18F-FDG PET/CT and MRCP in diagnosis of malignant obstructive jaundice was 90.32% (28/31) and 61.29% (19/31), the difference was statistically significant (P=0.046); the specificity was 84.62% (22/26) and 76.92% (20/26), the difference was not statistically significant (P=0.725); the accuracy was 87.72% (50/57) and 68.42% (39/57), and the difference was statistically significant (P=0.013). The sensitivity, specificity and accuracy of 18F-FDG PET/CT combined with MRCP multimodal imaging in diagnosis of malignant obstructive jaundice were 96.77% (30/31), 88.46% (23/26) and 92.98% (53/57), respectively, the differences were not statistically significant compared with PET/CT (all P>0.05), while compared with MRCP, the differences in sensitivity and accuracy were statistically significant (P=0.002, 0.002), the difference in specificity was not statistically significant (P=0.463). Compared with final results, the Kappa coefficients of multimodality imaging, 18F-FDG PET/CT and MRCP were 0.858, 0.752 and 0.375, respectively. Conclusion 18F-FDG PET/CT combined with MRCP multimodal imaging is helpful to improvement of the diagnostic accuracy of obstructive jaundice, which has important guiding significance for diagnosis and clinical treatment decision-making.

Objective To explore the diagnostic value of 18F-FDG PET/CT in biliary obstruction.Methods Totally,28 biliary obstruction patients were divided into benign obstruction group (n =11) and malignant obstruction group (n =17)according to the cause of obstruction.Imaging characteristics of 18F-FDG PET/CT and maximal standard uptake value (SUVmax) were compared between the two groups.Efficacy of PET/CT and MRI in the diagnosis of obstructive jaundice were compared.Results In 28 cases,no or mild dilatation of biliary tract accounted for 53.57％ (15/28),moderate to severe dilatation of biliary tract accounted for 46.42％ (13/28).Among the malignant obstruction group,2 cases of hilar cholangiocarcinoma,5 cases of bile duct carcinoma,6 cases of carcinoma of the head of pancreas,and 4 cases of ampullary carcinoma were included,18F-FDG PET/CT showed proximal high metabolic nodules of the obstruction site in 14 cases.Among the benign obstruction group,7 cases were bile duct inflammatory stricture,of which 4 cases with bile duct stones.18F-FDG PET/CT showed a slight increase with patchy or nodular mild metabolism in 6 cases.There were 4 cases of autoimmune pancreatitis.The imaging 18 F-FDG PET/CT demonstrated multi-segmental or multiple nodular enlargement of the pancreas,with generally increased metabolism.SUVmax of malignant obstruction group (6.88± 2.81) was significantly higher than that of benign obstruction group (4.20± 1.70;t=3.143,P＜0.05).The sensitivity,specificity and accuracy of 18F-FDG PET/CT and MRI in the diagnosis of malignant obstructive jaundice were 94.12％ (16/17) and 58.82％ (10/17;x2=4.086 5,P=0.043),81.82％ (9/11) and 63.64％ (7/11;x2=0.229 2,P=0.632),89.29％ (25/28) and 60.71％ (17/28;x2 =4.666 7,P=0.031),respectively.Conclusion 18F-FDG PET / CT has a great value in the diagnosis of obstructive jaundice,which is of great significance for clinical decision-making.

BACKGROUNDThe new medical insurance policy (JRSYF(2010) No.255) was released by the Beijing Municipal Government and became effective on January 1, 2011. Medical expenses incurred during a stay in an emergency department (ED) observation unit can be reimbursed as a hospital admission. The aim of this study was to evaluate the impact of a new charging scheme during stays in ED observation unit under Beijing's Basic Medical Insurance.

METHODSData for those patients who had stayed in ED observation unit in 2010 (before the implementation of a new charging scheme) and 2012 (after the implementation of this policy) were retrospectively analyzed in terms of length of stay, patients who were observed (PO), and median medical costs.

RESULTSAfter the implementation of a new charging scheme, compared with the year of 2010, in year of 2012, there were statistically significant longer lengths of stay at the observation unit (6 (4-9) vs. 5 (4-7) days; P < 0.001), more PO (2 257 vs. 1 783; P < 0.001), and more median medical costs (RMB 6 026 vs. 3 650 Yuan; P < 0.01). The proportion of elderly patients (≥ 60 years of age) in 2012 was larger than that in 2010 (70.22% vs. 63.71%; P < 0.01). It was performed on those patients who were admitted after the implementation of a new charging scheme. Compared with patients who were not admitted had stayed in ED observation units, the patients who were admitted had stayed in ED observation units that had a higher proportion for >15 days (36.22% vs. 5.61%; P < 0.01); they had higher median medical costs RMB (9 186 vs. 5 668 Yuan; P < 0.001) and they were more elderly (≥ 60 years of age) (86.10% vs. 66.39%; P < 0.01).

CONCLUSIONSThe new charging scheme under Beijing's Basic Medical Insurance allows patients to get access to inpatient admission more easily. It lowers patients' financial burden in ED observation unit. Since more people stay at ED observation unit, it increases ED payments by the insurance system. However, it slows the turnover rate of ED observation unit and causes overcrowding in ED. Hence, the advantages and disadvantages of the new policy are obvious.

Adult ; Aged ; Emergency Service, Hospital ; economics ; Female ; Hospitalization ; economics ; Humans ; Insurance, Health ; economics ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies