Objective To investigate the correlation between flat IVC (fIVC)and relative clinical,index of prolapse of kidney(K) and lordosis of abdominal aorta (A)with respect to the lumbar on supine.Methods Abdominal CT image data of 100 cases without sign of low blood volume were selected randomly.The K and A were calculated in the plane of the entrance of the renal vein and fIVC was defined according to the ratio of length to short diameter of IVC (R)up and down about 1.5 cm plane,which large to 3 ︰ 1.The index size between different groups tested by t,the association of fIVC with age and gender tested byχ2 .Results Among 100 cases, male 57 cases,female 43 cases,fIVC was 14 and 20 cases respectively (χ2 =5.26,P <0.05);The old,middle-aged and young groups were 56,38 and 6 cases respectively,the constituent ratio of fIVC was 44.64%(25/56),23.68%(9/38)and 0(0/6)respectively;The mean of K plus A was 2.57±0.25,2.1 5 ±0.14 and 2.05 ±0.1 1 respectively.The two former of old group was all significantly more than that of green group (χ2 =6.40,t=5.06,P <0.05).The mean of K plus A of fIVC and non-fIVC set was 2.67±0.25 and 2.03±0.18 (t=3.89,P <0.05)respectively.Conclusion The increased K and A on supine perhaps as causes for the formation of fIVC and its more located nearby the entrance of the renal vein,and is associated with age and gender.

Objective To investigate the effect of MR imaging in rats with series coil. Methods MR scanning was performed on the self-made aqueous solution phantom with the series coil and other three coils respectively, using the same FRFSE- XL pulse sequence. SNR of the same image was obtained in the same position slice for all four coils. Twelve SD rats were divided into three model groups and one normal group. FRFSE-XL FSPGR and Probe-SI pulse sequence were respectively used to show the brain injury,1H-MRS, spinal cord injury (SCI) and abdomen with series coils. Results The SNR of series coil (39. 7)was over six times higher than the SNR of knee joint coil (6. 41 ), which was the best in other three coils.Grey matter and white matte; the brain structure and hematomas were clearly depicted in the rats'brain on T1WI and T2WI. From the second week after injection of 6-OHDA into the rats brain, the ratio of NAA/Cr decreased (before injection 1.24 ,two weeks after injection 0. 781 ). The spinal cord and the configuration of the white matter were clearly showed on T2WI image, and the location and degree of SCI in the rat thoracic spinal cord were also well defined on T2 WI image. The pulse sequence of FSPGR T1 WI was used for rat abdomen scanning. The scan time was only eight seconds. It is helpful to overcome the breathing movement effect and show the structure of rat abdomen. Conclusion It provided a good means for the rat MR in vivo to make use of 3.0T MR combined with series coils.

PurposeTo explore the multislice CT (MSCT) and clinical manifestations of diaphragmatic hiatus hernia with hernial sac effusion, in order to improve its diagnostic rate.Materials and MethodsMSCT data were retrospectively analyzed for morphologies and clinical manifestations in 32 patients with diaphragmatic hiatus hernia and hernial sac effusion.Results32 patients included 21 males and 11 females (χ2=0.64,P>0.05). 25 patients were older than 60 years and 7 cases younger than 60 years (χ2=13.58,P<0.01). There were 27 cases with non-viscera hiatus hernia including 23 cases of combined fat-water hernia and 4 cases of simple effusion. 5 cases were of viscera type hiatus hernia (χ2=5.47,P<0.05). 28 cases showed ascites including 23 cases with non-viscera hiatus hernia and 1 case with viscera type hiatus hernia (χ2=9.56,P<0.01). The axial images from different levels of non-viscera hiatus hernia with liquid hernial sac demonstrated quasi-circular, meniscus, ringlike and teardrop shapes.Viscera type hiatus hernia and liquid hernial sac were found to be irregular shape . All patient sufferered from dysphagia, chest distress and epigastric discomfort.ConclusionThe increased pressure gradient between thorax and abdomen driving ascites into supradiaphragmatic hernial sac and clamping by hiatus may be the main mechanism. Quasi-circular, meniscus, ringlike andteardrop were the characteristic signs of diaphragmatic hiatus hernia with hernial sac effusion.

ObjectiveTo discusses the MSCT multiplanar reconstruction manifestation (MPR) of localized fat collection adjaction to subdiaphragmatic inferior vena cava (IVCfat).MethodsThe thoracic and abdominal MSCT scan data of 8246 patients were browsed,45 patients with presumed IVCfat on axial CT scans were further studied prospectively with MSCT MPR.The predisposing position of IVCfat and its relationship with IVC were observed.It was divided into two kinds of intraluminal type and extraluminal type according to the angle of IVCfat with respect of the wall of IVC.The other 50 patients without IVCfat were randomly selected as the control group.The sagittal inclination angle (SIA) and diameter ratio (DR) between supra- and sub-diaphragmatic IVC between the two groups were compared by using t test.Results The detection rate was 0.55％ (45/8246).Of which hepatic vein lacuna 8 patients,subdiaphragmatic gap medial to IVC 28 patients and IVC groove 9 patients.The shape of IVCfat showed mainly for the round,oval and crescents on axial CT scans,of 15 patients intraluminal type,4 showed target signs .The shape of IVCfat showed mainly for half-moon at MPR.The SIA and DR at IVCfat group were 21.62° ± 8.42°and 2.01 ±0.84 respectively,at control group were 16.75° ±7.82°(t =1.594,P ＞0.05) and 1.31 ±0.28(t =2.341,P ＜ 0.05 ) respectively.ConclusionThe round,oval or half of limited fat density shadow adjaction to subdiaphragmatic inferior vena cava which similar to in the lumen is the characteristic performance of IVCfat,it may be an anatomical variation.

Objective To investigate the diagnostic value of multiplanar reformation (MPR)reconstruction for the detection of traumatic diaphragmatic rupture (TDR) in multi-slice CT examination.Methods Thirty six cases with thoracoabdominal trauma, including 21 cases with and 15 cases without TDR confirmed by surgery, received multi-slice CT examination. They were enrolled in this study. Three experienced radiologists retrospectively analyzed the axial and MPR images. The diagnostic criteria for TDR included abnormally elevated hemidiaphragm, diaphragmatic discontinuity, the "collar sign" or "dependent viscera "sign. Referenced to surgical results, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of axial and MPR images in detection of TDR were calculated. The McNemar was used to investigate the differences between axial and MPR images in the detection of diaphragmatic discontinuity and "collar sign", and the differences between axial and MPR images of these two signs in TDR diagnosis. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of axial images in detection of TDR were 71% ( 15/21 ), 80% ( 12/15 ), 83% ( 15/18 ),67% ( 12/18 ) and 75% ( 27/36 ), respectively; of MPR images, they were 86% ( 18/21 ), 93%(14/15), 95% ( 18/19 ), 82% ( 14/17 ) and 89% ( 32/36), respectively. By axial images, twelve diaphragmatic defects or interrupts were identified in nine cases, and "collar sign" was identified in six cases. By MPR, 20 diaphragmatic defects or interrupts were identified in 15 cases ( P = 0.125 ), and "collar sign" was identified in 14 cases (P =0.021 ). The sensitivity and specificity of diaphragmatic defects or interrupts for TDR diagnosis in axial images were 43% (9/21) and 80% ( 12/15 ), respectively;in MPRimages, they were71% (15/21) (P=0.125)and93% (14/15) (P=0.500), respectively.The sensitivity and specificity of "collar sign" for TDR diagnosis in axial images were 29% (6/21) and 100% ( 15/15), respectively; in MPR images, they were 67% ( 14/21 ) (P =0. 021 ) and 100% (15/15)( P = 1.000), respectively. Conclusions MSCT presented good sensitivity, specificity and accuracy for the diagnosis of TDR. MPR images were useful supplements for axial images in TDR diagnosis which improved the diagnosis.

Objective To investigate the gastrointestinal imaging (GI)performance of herniation of pure abdominal omental fat (PAOF)into the esophagus hiatus(EH).Methods 7 cases of PAOF herniated into EH found by GI and MSCT were collected.The performance of GI was analyzed and compared with MSCT.Results 4 cases with large soft tissue shadow around lower segment esophagus,its density are lower,esophageal mucosa was showed coarse disorderly in the range of 2-4 cm of lower segment esophageal in the mucous membrane phase,of which 1 case with the mucosal line of esophagus at the j unction of esophagus and the superior border of the soft tissue slung up.Mild stenosis lumen of flexible wall was displayed in the filling phase,the upper bound of the lesions was often visible.3 cases with obtuse His angle,of which 1 case its change was shown with position.A more larger cystic fat density shadow was showed in MSCT right side of lower segment esophagus.3 cases were almost normal GI performance,among them 1 case of esophageal diaphragmatic ampulla lasting and a smaller cystic fat density shadow was showed in MSCT right side lower segment esophagus.The connection of the lower part of cystic fat density shadow to abdominal fat was showed all in 7 cases by MSCT MPR,and left gastric artery was shown to point to or protruded into EH by arcuate form.Conclusion A slight change of mucous membrane and lumen of lower segment esophagus which bounded above with larger and fade soft tissue density shadow and His angle obtuse variable were the special GI performance of the herniation of PAOF into EH,and the diagnose depended on MSCT.

Objective To observe the manifestations of MSCT and CT virtual endoscopy (CTVE) images of pleural windows in spontaneous pneumothorax.Methods MSCT data of 73 patients of spontaneous pneumothorax were analyzed.Taking pneumatized sac as the center,thin cross sectional planer (1 mm thickness) MPR and CTVE were reconstructed.Then the size and location of pleural windows,form of pleural surface defect or niche and the relationship with the chest were observed.Results In all 73 patients of spontaneous pneumothorax,27 pleural windows were detected in 15 patients with MSCT thin cross-sectional planer reconstruction image.Pleural windows were observed on the left side in 11 patients,while on the right side in 4 patients.Most of pleural windows located at apex (15/27,55.56％),followed by anterior chest wall (7/27,25.93％) and mediastinum (5/27,18.52％).The connection of pleura window with thorax was shown in 23 (23/27,85.19％).Small defection on parietal pleural with pneumatized sac bulging was seen in all pleural windows,with circular,elliptic,short columnar or hockey shapes.On the front view of CTVE,pleural windows showed niche on parietal pleural surface with round or oval form,and the bottom of the pneumatized sac could be straightly seen in 19 pleural windows.The walls were flat,tunnel shaped in 6 pleural windows,while cavernous shaped in other pleural windows.Conclusion Pleural windows often displayed as small diverticulum like shadows on parietal pleural surfaces,and the pathogenesis might be associated with negative pressure increased in local pleural cavity and pleural damages.

Objective ToexploretherelationshipbetweenSchizasgradeofthenerverootwithintheduralsacandtheduralsac cross-sectionalarea(DSCA)ofthelumbarspineaswellastheclinicalsignificance.Methods 3.0T MRIexaminationofthelumbar spineof89patientswithlunbarspinestenosis(LSS)from May2016toSeptember2017intheaffiliatedhospitalofNantongUniversitywere collected.Twoexperienceddoctorsindependently measuredthekyphosisdegreeofthethoracolumbarspine,theDSCAofthe2-5 lumbarlevels,vDSCA,dDSCA,andevaluatedSchizasgradeofthenerverootforfourdegradsofA,B(gradeB1:DCSA≥100 mm2, gradeB2 :DCSA<100 mm2 ),CandDaccordingtozygopophysisconnectingline,andfinallyconductedthetestof Kappa consistency.DSCA wasdividedintothreegroupsof≤75 mm2,76-99 mm2and≥100 mm2,andχ2 wasadoptedtoexaminetherateineachSchizas grade.Schizasgradewithd/vvalue(dDSCA/vDSCA)andthekyphosisdegreeofthethoracolumbarspinewerecomparatedbyttest. Forthecorrelationcoefficient,S pear m an analysis wasadopted.Results In89cases with173lumbarlevels,schizasgradeofthenerve rootwere52,51,32and38levelsforgradeA-DrespectivelyI.nDSCA≤75mm2group,SchizasCandDwere18.5%and21.9%respectively, whichweresignificantlyhigherthanthoseforgradeAandB(0% and3.5%,P<0.01);InDSCA=76-99mm2group,Schizasgrade AandBwere8.7% and17.9%,whichweresignificantlyhigherthanthoseofgradeCandD (0% and0%,P<0.05and0.01);In DSCA≥100mm2group,therewere0% and0%forSchizasgradeCandD,whichweresignificantlylowerthanthoseforgradeAand B(21.4% and8.1%,P<0.0SchizasgradesofA-Dgroups,d/vaveragevalueswere0.64±0.29,0.48±0.22,0.42±0.20and0.34±0.11 respectively,in whichgradeCand D weresignificantlylower thanthoseofgradeAandB(P<0.01).Thecorrelationcoefficientof SchizasgradewiththeDSCAandd/vvalueswere0.83and0.87 respectively(P<0.01).Thekyphosisdegreeofthethoracolumbar spinewas(158.7±15.9)°inSchizasgradeB1,and (167.8±11.2)°inothergrades(t=4.37,P<0.05).Conclusion Theclassification ofnerverootSchizasgradeishighlyrelatedtoDCSA,andbothofthemaretheindicatorsforjudgingwhetherthelumbarspinalis stenosisornormal.TheSchizasgradeismoreconvenientandquicker;InordertoavoidconflictwithDCSA,SchizasBshouldbedividedintoB1 andB2 Whenitisusedtodeterminewhetherhavestenosis.

BACKGROUND:Currently,there have been a variety of conservative and surgical treatment plans for spontaneous osteonecrosis of the knee,achieving excellent results.However,a broad consensus on indication and guide of surgical treatment has not been announced.In clinical practice,there is still a misunderstanding that unicondylar replacement or total knee arthroplasty should be performed upon the discovery of spontaneous osteonecrosis of the knee,while an urgent need for universal access to the concept of stepwise therapy. OBJECTIVE:To summarize and find the factors leading to the poor effect of conservative treatment in spontaneous osteonecrosis of the knee,which occurred on the medial femoral condyle,from the literature and clinical cases,at the same time,combined with the Koshino stage,to propose the strategy of stepwise spontaneous osteonecrosis of the knee treatment on the medial femoral condyle. METHODS:A systematic search of the literature database was conducted to summarize the factors leading to poor outcomes of conservative treatment in spontaneous osteonecrosis of the medial femoral condyle.Meanwhile,according to the Clinical&Health Records for analytics&Sharing system,the cases receiving conservative and surgical treatment in spontaneous osteonecrosis of the medial femoral condyle in the Department of Orthopedics of Guangdong Provincial Hospital of Chinese Medicine from January 2017 to January 2023 were analyzed retrospectively,then the causes of success and failure in typical cases were summarized and analyzed. RESULTS AND CONCLUSION:(1)Early diagnosis and treatment of spontaneous osteonecrosis of the knee were very important for prognosis.For sudden knee pain in some patients,if no obvious abnormality was found in the X-ray examination,and the symptoms persisted and could not be relieved for more than 1 week,an MRI examination was recommended to detect early spontaneous osteonecrosis of the knee.(2)The X-ray images of Koshino stage 1 and stage 2 of spontaneous osteonecrosis of the medial femoral condyle were difficult to be distinguished,which needed to be probed by MRI.MRI images of Koshino stage 1 were mainly characterized by bone marrow edema,and an osteonecrosis area with a clear boundary was not formed,while MR images of Koshino stage 2 showed a necrotic area with a clear boundary.(3)Five factors leading to the poor effect of conservative treatment on spontaneous osteonecrosis of the medial femoral condyle were summarized:a.The necrotic area was＞5 cm2;b.The necrotic area accounted for more than 40%of the condyle;c.relative compression percentage of medial meniscus≥33%(with or without medial meniscus injury and subchondral bone marrow edema);d.MRI depth of necrotic area(anterior-posterior diameter of sagittal necrotic area)＞20 mm;e.varus deformity of lower limb＞6°.(4)Conservative treatment of spontaneous osteonecrosis of the knee in Koshino stage 1 was good.For spontaneous osteonecrosis of the knee in Koshino stage 2,conservative treatment was preferred or combined with drilling decompression.If there was no relief or improvement of symptoms or in MRI after 3 months,while the patient had any of the previous five factors,then knee preservation surgery should be considered.For spontaneous osteonecrosis of the knee in Koshino stage 3 and stage 4,knee preservation surgery should be selected based on the previous five factors,including age,gender and activity level of the patient.Total knee arthroplasty was used for spontaneous osteonecrosis in Koshino stage 4,which was associated with symptomatic patellofemoral arthritis,valgus alignment,or necrotic area,which greatly affected the stability of unicondyle prosthesis.