Objective To assess value and limitations of non-invasive methods in assessing liver fibrosis.Methods By summarized current situation and advancement of serum fibrotic markers,ultrasound,CT and MRI in assessing liver fibrosis,we investigated their value and limitations.Results In addition to diagnosis,non-invasive methods of assessing liver fibrosis assess severity of liver fibrosis.For liver fibrosis,however,non-invasive methods can not monitor effectively reaction to therapy and progression.Conclusion Non-invasive methods play important roles in diagnosis and assessing severity of liver fibrosis,and reduce the need of liver biopsy.

Objective:To explore the clinical value of dual-source CT direct method lower extremity deep vein CT angiography (DSCTV) and Doppler ultrasound (DUS) in the diagnosis of thrombosis in inferior vena cava and bilateral lower extremities deep venous.Methods: 40 suspected patients with lower extremities deep vein thrombosis (DVT) were enrolled to accept DSCTV, and the every original image data of this detection was analyzed by using multi- mode image reconstruction analysis. One week before and after DSCTV, all of patients need carried out DUS detections for inferior vena cava and bilateral lower extremities deep venous. 22 cases of these patients were detected by lower extremity deep vein X-ray digital subtraction angiography (DSA).Results: There was better consistency for diagnosis results between DUS and DSCTV, and their Kappa value was 0.784. The sensitivity, specificity and accuracy of DUS for lower extremity DVT, respectively, were 93.4%, 86.7% and 91.6%, and each result of DUS was lower than that of DSCTV (sensitivity with 97.2%, specificity with 91.1% and accuracy with 95.6%). By drawing ROC curve, the AUC value of DUS was 0.897, and that of DSCTV was 0.936, while the difference between them was no significant (Z=1.143,P>0.05).Conclusion: DSCTV possesses unique scanning and post-processing technique, which has a good reference value in the diagnosis for DVT

Objective To introduce the current value of multi-detector row CT (MDCT) and magnetic resonance imaging (MRI) techniques on evaluation of diffuse hepatic parenchymal diseases. Methods By literature review,the application and recent advances of various kinds of MDCT and MR imaging techniques in evaluating diffuse hepatic parenchymal diseases were summarized. Results There were three kinds of diffuse liver parenchyma diseases,which were the diseases of storage,vascular and inflammatory. The morphology changes of diffuse liver parenchyma diseases could be demonstrated well by MDCT. MRI,especially MR functional imaging could reflect the morphology changes,and cellular metabolic activity of the liver,which provided qualitative and quantitative information for the diagnosis and evaluation of therapeutic effect on diffuse liver parenchyma diseases. Conclusion MR imaging techniques,especially those functional techniques,developed rapidly and had practical value in both the diagnosis and severity assessment of hepatic fibrosis.

Objective To evaluate the clinical value of selective intra-arterial calcium stimulated venous sampling ( ASVS) for the localization of pancreatic insulinoma preoperatively.Methods The clinical data of 28 insulinoma patients admitted from May 2000 to June 2010 in Ruijin Hospital undergoing selective intra-arterial calcium stimulated venous sampling with diagnosis of insulinomas before surgery were analyzed retrospectively.Results There were 12 males and 16 females.All the patients had Whipple's triad, and with proved insulinomas by postoperative pathology.There were 26 cases of single insulinoma and 2 cases of multiple insulinomas with altogether 32 insulinomas resected.78.1% of insulinomas were less than 20 mm.All patient were examined by selective intra-arterial calcium stimulated venous sampling.The peak ratio of insulin to the baseline after calcium stimulation appeared at the superior mensenteric artery (SMA) in 6 cases, and the peak ratio of insulin to the baseline after calcium stimulation appeared at gastroduodenal artery(GDA), proximal splenic artery (SAP) and distal splenic artery (SAD) in 9 cases, 6 cases and 6 cases respectively; Selective intra-arterial calcium stimulated venous sampling accurately located 25 cases, and selective intra-arterial calcium stimulated venous sampling located 2 cases wrongly.In one patient, the selective intra-arterial calcium stimulated venous sampling was falsely negative.The mean and median peak ratio of insulin to the baseline after calcium stimulation were 8.8 folds and 14.8 folds respectively.Accurate rate of selective intra-arterial calcium stimulated venous sampling was 89.3% (25/28) and it was higher than that of computed tomography (CT) (56.5% ) , magnetic resonance imaging (MRI) (60.0%).Sensitivity of selective intra-arterial calcium stimulated venous sampling was 96.2%, which was higher than that of computed tomography ( 69.6% ) , magnetic resonance imaging (75.0% ).Conclusion Selective intra-arterial calcium stimulated venous sampling is superior to computed tomography, or magnetic resonance imaging as a preoperative localizing tool for insulinomas, since this procedure is invasive it should be used when other preoperative morphologic studies (computed tomography or magnetic resonance imaging) failed.

Objective To probe CT grading criteria of vascular invasion in pancreatic cancer.Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years.Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer.There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels,on the degree of circumferential contiguity of tumor to vessel,on the degree of lumen stenosis,and on the degree of contiguity between tumor and vessels combined vascular caliber.Conclusion CT grading criteria are not uniform,each one has defects.

Objective To investigate the diagnostic value of a double action MR contrast agent——gadobenate dimeglumine (Gd-BOPTA) for focal liver lesion and biliary system disease.Methods Articles about Gd-BOPTA in CNKI and PubMed for the past few years were searched and the value of Gd-BOPTA in the diagnosis of focal liver lesion and biliary system disease was summarized.Results For focal liver lesion,Gd-BOPTA not only can reveal blood supply of the lesion,but also reveal the hepatocellular functional status in the lesion.For biliary system,biliary excretion of Gd-BOPTA can be used to evaluate the anatomic structure of bile duct,function of gallbladder and biliary system disease.Conclusions Gd-BOPTA has an important value in the diagnosis of focal liver lesion and biliary system disease.Gd-BOPTA may have wider applications in the future.

Objective To summarize the diagnosis and surgical therapeutic experience of insulinoma.Methods The clinical data of 130 patients with insulinoma confirmed by pathologic examination from 1966 to 2008 were analyzed retrospectively.Results All the patients had Whipple's triad.37.7％ were once misdiagnosed.Only 43.8 ％ were diagnosed correctly within one year after the onset of symptoms.The average time of evolution was 5.2 years.Ultrasonography,CT,MRI and ASVS were able to localize tumor in 32.9％,70.6％,70.3％ and 88.9％ of the cases,respectively.There were 121 cases (93.1％) of single insulinoma,4 cases (3.1％)of multiple insulinomas,and 5 cases(3.8％)of hyperplasia.127cases(97.7 ％)were benign and 3 cases (2.3 ％)were malignant insulinoma.All the 130 cases underwent surgery,among whom 89 cases were cured by enucleation of tumor.The principal postoperative complications were pancreatic fistula(19.2％) and pancreatitis(3.9％).Conclusions Whipple's triad was with great significance to diagnose insulinoma.Multislice spiral CT is the first choice for preoperative localization of insulinoma and ASVS is an important complementary measure for localizing insulinomas not detected by CT or MRI.Simple enucleation is the most common surgical method.

Objective To investigate mut-slice spiral CT(MSCT) and MRI features and correlated pathological basis of stasis cirrhosis.Methods MSCT and MRI findings of 35 patients with stasis cirrhosis (study group) and 35 patients with posthepatitic cirrhosis (control group) were studied retrospectively. Volume index of liver and spleen, caliber of hepatic vein and the number of regenerative nodules exceeded 5mm in diameter were measured.The contrast-enhanced patterns of liver parenchyma, contrast medium reflux, ascites, the number of varices and correlated abnormalities were reviewed.Results The volume indexes of liver and spleen, calibers of hepatic vein were (4434.95±1283.08) cm~3,(621.92±400.33) cm~3 and (3.61±0.81) cm in the study group,(2569.73±853.06) cm~3,(1275.61±727.51) cm~3 and (1.92±0.46) cm in the control group,respectively.The number of the patients showed waves of borderline, inhomogeneous pattern of parenchymal contrast enhancement, regenerative nodules exceeded 5mm in diameter, contrast medium reflux, varices and ascites were 5, 29, 17, 20, 16 and 6 cases in the study group,29,0,5,0,35 and 26 cases in the control group,respectively,there were statistic differences between the study group and control group(P＜0.05).Conclusion MSCT and MRI play a invaluable role in the diagnosis and differential diagnosis and etiological diagnosis of stasis cirrhosis.

Objective To investigate multi-slice spiral CT (MSCT) and MRI features of stasis cirrhosis and the diagnostic value of MSCT and MRI. Methods MSCT and MRI findings of 35 patients with stasis cirrhosis were studied. The size of liver and spleen, the diameter of hepatic vein (HV), enhancement pattern of liver parenchyma, contrast medium reflux in inferior vena cava (IVC) and (or) HV, ascites, number of varices and correlated abnormalities were reviewed. Results The volume index of liver and spleen of 35 patients was 4 434.95 cm3 and 621.92 cm3 respectively. The mean diameter of HV of 27 patients (77.1%) was 3.61 cm and HV of other 8 patients (22.9%) were too small to show. Number of patients showed waves of borderline, inhomogeneous pattern of parenchymal contrast enhancement, contrast medium reflux in IVC and (or) HV, varices and ascites was 5 (14.3%), 29 (82.9%), 20 (57.1%), 16 (45.7%), and 6 (17.1%), respectively. Correlated abnormalities included cardiac enlargement 4 cases (11.4%), pericardium thickening 11 cases (31.4%), and pericardial effusion 2 cases (5.7%). Conclusions Stasis cirrhosis mainly demonstrate liver enlargement, inhomogeneous pattern of parenchymal contrast enhancement, contrast medium reflux in IVC and (or) HV, and slight portal hypertension. MSCT and MRI play invaluable roles in diagnosis, differential diagnosis and etiological diagnosis of stasis cirrhosis.

Objective To investigate the imaging features of Budd-Chiari syndrome(BCS) on 64 slice spiral computed tomography(64SCT) and the diagnostic value of 64SCT for BCS.Methods Twenty-nine patients diagnosed as BCS by 64SCT were retrospectively included into this study and all the patients were researched by digital substraction angiography(DSA).Two abdominal radiologists analyzed the CT imaging features of BCS,paying attention to the vascular lesion,the morphology abnormality of the liver and the degree of portal hypertension,with review of DSA findings.Results ①The accuracy of 64SCT for BCS was 93.1%(27/29),and there were 2 false positive cases and no false negative case.The accuracy of 64SCT for those patients with thrombosis of inferior vena cava(IVC) and(or) hepatic vein(HV) was high as compared to those with stenosis of IVC and(or) HV.②The morphology abnormality of the liver included hepatomegaly(24 cases),low attenuation(27 cases) and inhomogeneous pattern of parenchymal contrast enhancement(5 patients in arterial phase and 19 patients in portal vein phase).③The images of all the patients showed the features of portal hypertension.Conclusion The accuracy of 64SCT for BCS is satisfactory and the false negative is seldom.The 64SCT could accurately display the morphology abnormality of the liver and the compensatory circulation in BCS patients.For those patients with stenosis of IVC and(or) HV,however,the diagnostic power of 64SCT is limited.