Objective To investigate the qualitative diagnostic value of MRCP in patients with benign obstructive jaundice.Methods MRCP and conventional MR images were performed in 128 patients with benign obstructive jaundice on a superconductive MR scanner (Plilips medical systems Inc. Eclipse. 1.5T) . Final diagnosis was confirmed by surgical and histopathological findings in 123 patients and other 5 patients by follow-up.Results The accuracy of location diagnosis of MRCP was 100%; the qualitative diagnosis was 95.3%. The specificity, accuracy, sensitivity of the deadwood-sign for diagnosis of benign obstructive jaundice were 100%, 95.3%, 85.7% respectively. Conclusion The deadwood-sign was a specific indicator in MRCP of benign obstructive jaundice.

The current situation of large-scale medical imaging equipment in Zhenjiang region is briefly summarized.Investigation and study are made on DSA,CT and MR of 19 hospitals in Zhenjiang.Data are treated statistically.Suggestions on management and disposition of large scale medical imaging equipment are put forward at last.

Objective To analyze the MRI features of hydrosalpinx and to investigate its clinical value.Methods MRI and ultrasound manifestations in 40 patients with hydrosalpinx in 53 fallopian tubes confirmed by operative and pathological findings were analyzed retrospectively,and these findings were also compared with the results of aparoscopy and pathology.Results Among 53 fallopian tubes with hydrosalpinx,bilateral tubes in 13 patients and 27 unilateral tubes in other patients were found.The tubes were botuliform in 32, retort-shaped in 1 6,pouch-shaped in 5.Incomplete separation of the lumen were found in 1 9.In 9 patients with acute salpingitis,1 5 tubes were found with empyema and expansion.In other 31 patients with chronic salpingitis,38 tubes were with hydrops and expansion,14 of whom were with hematocele.The sensibilities of MRI and ultrasound diagnosis for hydrosalpinx were 94.3%(50/53)and 88.7%(47/53)with no statistical differences(P >0.05),however the specificitis were 90.6%(48/53)and 77.6%(41/53)with obvious statistical differences(P <0.05).Conclusion The locating and qualitative diagnosis of MRI for hydrosalpinx is superior to ultrasound.MRI can discriminate the quality of cyst fluid and thus can definitely diagnose the hydrosalpinx caused by acute or chronic salpingitis.

Objective To investigate the application value of MRI in the diagnosing and assessing the severity of acute pancreatitis (AP).Methods 78 cases suspected with AP in our hospital underwent MRI.According to the golden standard of combination with the observation of the patients during hospitalization and the surgical pathological results,the sensitivity,accuracy and specificity of MRI in diagnosing AP were calculated.MRI Balthazar scoring system was used to evaluate the severity grade of AP.The results were compared with Ranson evaluation criterion usually used in clinic to evaluate the severity of AP.Results A total of 64 patients were final diagnosed by means of clinic and pathology.The sensitivity,accuracy and specificity of the MRI were 95.31％(61/64),93.59 ％ (73/78) and 85.71％(12/14),respectively.With the clinical and pathological diagnosis,the patient with mild AP were 45 cases,and the severe AP were 19 cases.The accuracy of MRI Balthazar severity grading was 95.31％ (61/64),which was significantly higher than that of Ranson evaluation accuracy 82.81 ％(53/64),with P =0.023.Conclusion MRI is an effective method for clinical diagnosis of AP,and it is superior to Ranson evaluation criterion for assessment of the severity,of which has a significant role in guiding clinical diagnosis and treatment.

OBJECTIVETo investigate the value of Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and a modification of the POSSUM system (P-P0SSUM) scoring system in predicting the surgical operative risk of pancreaticoduodenectomy for periampullary tumors.

METHODSPOSSUM and P-POSSUM scoring systems were used to retrospectively evaluate the clinical data of 432 patients with periampullar tumors who underwent pancreaticoduodenectomy in the Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from January 1985 to December 2010. The predictive occurrence of postoperative complications and mortality rate were calculated according to the formula. ROC curve analysis and different group of risk factors were used to determine the discrimination ability of the two score systems, and to determine their predictive efficacy by comparing the actual and predictive complications and mortality rates, using Hosmer-Lemeshow test to determine the goodness of fit of the two scoring systems.

RESULTSThe average physiological score of the 432 patients was 16.1 ± 3.5, and the average surgical severity score was 19.6 ± 2.7. ROC curve analysis showed that the area under ROC curve for mortality predicted by POSSUM and P-POSSUM were 0.893 and 0.888, showing a non-significant difference (P > 0.05) between them. The area under ROC curve for operative complications predicted by POSSUM scoring system was 0.575. The POSSUM score system was most accurate for the prediction of complication rates of 20%-40%, showing the O/E value of 0.81. Compared with the POSSUM score system, P-POSSUM had better ability in the prediction of postoperative mortality, when the predicted value of mortality was greater than 15%, the predictive result was more accurate, and the O/E value was 1.00.

CONCLUSIONSPOSSUM and P-POSSUM scoring system have good value in predicting the mortality of patients with periampullary tumors undergoing pancreaticoduodenectomy, but a poorer value of POSSUM score system in prediction of complications. We can establish a more suitable scoring system for pancreaticoduodenectomy by modifying the score constant and weight, to better predict surgical risk and reduce the operative complications and mortality.

Ampulla of Vater ; Common Bile Duct Neoplasms ; mortality ; surgery ; Humans ; Morbidity ; Pancreaticoduodenectomy ; adverse effects ; mortality ; Postoperative Complications ; diagnosis ; mortality ; Postoperative Period ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Risk Factors