Objective To evaluate the diagnosis and emergency surgical treatment of ruptured intracerebral aneurysms (RIAs) accompanied with intracerebral hematomas (ICH).Methods A retrospective study was performed on the clinical data of 23 patients ofICH following RIAs,admitted to our hospital from May 2009 to September 2013.CTA was performed in 17 patients and cranial CT in 6 before the operation.The emergent operations were performed in all the patients within 24 hours of aneurysm rupture; pterion approach was adopted to clip the arterial aneurysm and clear intracerebral hematoma.Results According to Glasgow outcome scale (GOS) scores,4 recovered well,6 were mildly disabled,8 were severely disabled and 5 died.After follow-up for 3.3 years in 15 patients,no further bleeding occurred.Eight aneurysms were re-checked by CTA,7 aneurysms were completely clipped and 1 aneurysm had residual neck.Conclusions Preoperative CTA is essential for the correct diagnosis of ICHs due to RIA.The curative effect of the emergent operation can improve the survival rate and prognosis of patients with RIA accompanied with ICH.

Objective: To analyze the clinical value of SPECT/CT in diagnosis of skull base bone invasion and clinical decision-making for nasopharyngeal carcinoma (NPC), and to compare their diagnostic value with SPECT/CT, CT, MRI, and MRI combined with SPECT (MRI-SPECT) for skull base bone invasion. Methods: Before treatment, among 348 newly diagnosed NPC patients, CT scan was performed in 186 patients (group A) and the remaining 162 patients received MRI scan (group B). Clinical doctors then made clinical management decisions according to the CT or MRI results. After that, all patients underwent ⁹⁹Tc^m-MDP SPECT/CT examination for nasopharyngeal local tomography, and the results were provided to the clinical doctors to make clinical management decisions again. The changes between the two clinical management decisions were scored according to diagnosis, range of lesion, staging, treatment regimens, and auxiliary examination. The diagnostic value of CT scan, MRI scan, SPECT/CT and MRI-SPECT for skull base bone invasion was then evaluated and compared. Results: In terms of changes in scores of clinical management decisions, the score of group A was 1.387 and group B was 0.951, showing a significant difference between the two groups by Wilcoxon test (Z=6.570, P<0.001). By χ² test, there were correlations between CT and SPECT/CT (χ² =98.495, P<0.001), and between MRI and SPECT/CT (χ² =32.662, P<0.001). The consistency of CT and SPECT/CT (Kappa=0.713) was greater than MRI and SPECT (Kappa=0.449). The sensitivity of CT, MRI, SPECT/CT and MRI-SPECT was 67.1%, 84.5%, 90.8% and 100%, the specificity was 73.3%, 92.3%, 85.6% and 84.6%, and the area under the ROC curve was 0.702, 0.884, 0.882 and 0.923, respectively. Conclusions SPECT/CT has important impact on clinical management decision for NPC. In the judgement of skull base invasion, the diagnostic value of SPECT/CT is significantly higher than CT and approximately equal to MRI. SPECT/CT should be one of the routine examination methods of nasopharyngeal carcinoma. In addition, in view of its greater diagnostic value, MRI combined with SPECT should be the focus of future imaging studies.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphoma, Large B-Cell, Diffuse ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Neck ; diagnostic imaging ; pathology ; Positron-Emission Tomography ; Prognosis ; Young Adult

OBJECTIVETo compare the diagnostic value of ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and large-scale diffusion weighted imaging (DWI) for evaluation of non-Hodgkin lymphoma (NHL) bone marrow (BM) infiltration.

METHODSA total of 79 patients with pathologically diagnosed NHL underwent ¹⁸F-FDG PET/CT, large scale DWI and BM pathological examination. BM examination as the "gold standard", the performance (the sensitivity, specificity, accuracy, positive and negative predictive value) of ¹⁸F-FDG PET/CT and large scale DWI for evaluation of BM infiltration was compared and the risk of BM infiltration of different subtypes and sources of NHL was analyzed.

RESULTS25 of 79 cases were diagnosed as BM infiltration by pathological examination with 57 BM sites. Abnormal high BM metabolisms were identified in 22 cases with 56 BM sites by ¹⁸F-FDG PET/CT and 25 cases with 58 BM sites by large-scale DWI. The sensitivity, specificity, accuracy, positive and negative predictive value of ¹⁸F-FDG PET/CT were 80.0%, 96.3%, 91.1%, 90.9%, 91.2%, respectively. And they were 84.0%, 92.6%, 89.9%, 84.0%, and 92.6% by large-scale DWI, respectively. A receiver operating characteristic (ROC) analysis demonstrated that there was no statistical difference in ¹⁸F-FDG PET/CT and large-scale DWI (P>0.05). The area under ROC curve for ¹⁸F-FDG PET/CT and large-scale DWI were 0.911 and 0.883 respectively. The incidences of BM infiltration in aggressive NHL patients by ¹⁸F-FDG PET/CT (21/69, 30.4%) and large-scale DWI (23/69, 33.3%) were higher than those (PET/CT: 10.0%; large-scale DWI: 20.0%; P>0.05) in indolent NHL patients.

CONCLUSION¹⁸F-FDG PET/CT and large-scale DWI had important clinical value in diagnosing BM infiltration of NHL. A combination of ¹⁸F-FDG PET/CT, large-scale DWI and pathological examination could improve the positive rate of BM infiltration in NHL.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Marrow ; pathology ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymphoma, Non-Hodgkin ; diagnosis ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Positron-Emission Tomography ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Young Adult