Objective To evaluate the diagnostic value of multi-slice spiral CT for non-angle caused nutcracker syndrome(NCS). Methods A total of 177 cases of clinical suspected nutcracker syndrome patients recevied multi-slice spiral CT examination,,inclu-ding 33 patients with negative results,144 cases patients with positive results.The analysis was performed by measuring the angle between superior mesenteric artery(SMA)and the abdominal aorta(AA),and the ratio of the diameter of the narrowest and expan-sion in the left renal vein.Results Within 33 cases of nutcracker-negative patients,the angle of SMA and AA was (46.06 ± 24.46)°;the ratio was (2.11±0.76).144 cases was diagnosed as nutcracker-positive patients,the angle of SMA and AA was (23. 10±9.63)°;the ratio was (3.83±1.24).There was positive correlation between angle and ratio in NCS (P<0.0001).Among9 ca-ses of nutcracker syndrome caused by non-angle factors three were oppressed by the uncinate process pancreas,two cases were caused by the malformations of the left renal vein,one case was posterior nutcracker syndrome,one case was oppressed by portal veinOne case of pressured renal vein due to tortuosity renal vein coiled renal artery.One case of the left renal vein compression lumen narrowing,causing significant downward pressure on the left renal vein.Conclusion Spiral CT angiography reconstruction can clear-ly show the cause and the location of the left renal vein compression,which may provide helpful information in diagnosing nutcracker syndrome caused by non-angle factors.

PurposeTo investigate clinical significance of echocardiography combined with Flash CT in diagnosis of partial anomalous pulmonary venous connection (PAPVC). Materials and Methods Twenty-eight cases of PAPVC were recruited in the study. All the subjects underwent both preoperative echocardiography and coarse pitch Flash CT scanning. Imaging findings were compared with the results of surgery, including the type of PAPVC, size of atrial septal defect (ASD), and other combined malformations. Results Among 28 patients, 16 cases and 5 suspicious cases (4 cases of PAPVC and 1 case of pulmonary vein embolism) were diagnosed by echocardiography. Six cases were missed, and 1 case was misdiagnosed. CT misdiagnosed 1 case. The accurate diagnosis rate of echocardiography (71.4%, 20/28) was lower than that of Flash CT (96.4%, 27/28) (P<0.05). There were 44 combined malformations in 28 cases, 43 lesions were diagnosed by echocardiography, and 34 lesions were diagnosed by Flash CT. The accurate diagnosis rate of echocardiography (97.7%, 43/44) was higher than that of Flash CT (77.3%, 34/44) (P<0.05). The average DLP was (15.5±3.2) mGy·cm and average effective dose (ED) was (0.354±0.058) mSv.Conclusion Flash CT has a higher diagnosis accuracy of PAPVC but a lower diagnostic accuracy of combined malformations when compared with echocardiography. Moreover, echocardiography can make comprehensive evaluation in valve disease, pulmonary artery pressure and cardiac function. Flash CT combined with echocardiography may improve preoperative diagnosis.

Objective To analyze the CT features of renal carcinoma associated with Xp11.2 translocations/TFE3 gene fusions (Xp11.2 RCC),and to improve the diagnostic accuracy.Methods Clinical data,CT imaging and pathological features of 12 cases with pathology proved Xp11.2 RCC were analyzed retrospectively.Results All the 12 cases were solid masses.11 cases were oval or quasi-circular,1 case was irregular.Tumors were iso-density or hyperdensity on CT plain scan images.The density was heterogene-ous,combined with necrosis in 11 cases and spotty or patchy calcification in 7 cases.After injection of contrast,moderate or obvious enhancement of tumors was found,1 case had retroperitoneal lymph node metastasis,1 case was found with mass formation in the re-nal hilus,1 case had adrenal metastasis.Another one was found with psoas major muscle and lumbar 5 invaded.Conclusion The Xp11 .2 RCC has certain CT characteristics.This disease should be considered when a renal tumor is iso-density or hyperdensity on the CT plain scan images and has moderate or obvious enhancement,combined with necrosis or calcification.

Objective To study the relationship between spiral CT features and histological differentiation of gastric carcinoma.Methods Triphasic spiral CT scans with water filling method and administration of hypotonic agent were performed in 55 patients with advanced gastric carcinoma.Spiral CT findings were compared with postoperative pathology and histological differentiation.Results(1)The size and enhanced features of the lesions were significantly correlated with tumor histological differentiation(P

Objective To investigate correlation between the amount of interleukin-17 (IL-17) producing cells and the expression of transforming growth factor (31 (TGF-β1) in glioma,and evaluate the clinical values of IL-17 and TGF-pl in predicting the prognosis of glioma. Methods The presence of IL-17 and TGF-pl was measured by immunohistochemistry in 135 human glioma (WHO Ⅰ 18,WHO Ⅱ 45,WHO Ⅲ 53,WHO Ⅳ 19) tissues and 15 normal brain tissues. Results There was no IL-17 positive staining in normal brain tissues. Of 135 glioma specimens showed low TGF-pl expression and 77 (57. 03% ) showed high TGF-pl expression. No TGF-β1 expression was detected in normal brain tissue. Furthermore,TGF-β1 expression was positively correlated with the amount of IL-17 producing cells in glioma tissues ( r=0.285, P<0.01). Compared with the low grade,the levels of IL-17 and TGF-pl positive cells were obviously increased in high grade. The Kaplan-Meier analysis showed that there were significant differences in overall survival (OS) between the IL-17 and TGF-pl high-expression and lowexpression group (P＜0.01, P＜0.05). The 3-year OS rates of IL-17 of high expression and low expression were 33.75% and 76. 36%. Multivariate Cox proportional hazards regression analysis indicated that age,KPS score, IL-17 were independent prognostic factor for OS (P＜0.01). Conclusion Intratumoral IL-17-producing cell density and the expression of TGF-β1 was associated with the malignancy of human glioma.

Objective To analyze the value of multi-slice spiral CT (SCT) scan in staging and subtyping of renal cell carcinoma (RCC). Methods The preoperative kidney SCT data and postoperative pathology results of 64 patients with RCC were retrospectively analyzed. The patients′ ages ranged from 33-78 years (average 54 years). There were 44 males and 20 females in the study group. According to the CUA Guidelines, the staging and subtyping of RCC were performed through the combined information of preoperative SCT attenuation in unenhanced, corticomedullary phase and enhancement pattern. The results were compared with the postoperative histopathological results. Results The SCT results showed 38 cases were clear cell RCC, 14 cases were papillary RCC and 12 cases were chromophobic cell RCC. Histopathological results showed that 40 cases were clear cell RCC, 16 cases were papillary RCC and 8 cases were chromophobic cell RCC. According to the standard of 40 HU of CT attenuation value, the sensitivity, specificity and accuracy were 75%, 79% and 78% for diagnosis of papillary RCC in the unenhanced phase. The sensitivity, specificity and accuracy by the standard of 90 HU of CT attenuation value was 90%, 88% and 89% for diagnosis of clear cell RCC in the corticomedullary phase. In chromophobic RCC, homogeneous enhancement was more common than in papillary RCC and clear cell RCC. There was no significant difference of staging and subtyping of RCC between SCT and pathological results (P>0.05). The accuracy of SCT in staging and subtyping of RCC was 88% in staging, and 89% in subtyping. Conclusions SCT is a useful preoperative tool to stage and subtype RCC

Objective To investigate the value and usefulness of optimized multislice CT enterography (MSCTE) with orally administered isosmotic mannitol (2. 5%) as negative contrast in demonstrating the small bowel and its abnormality. Methods Forty patients suspected of intestinal tumors were randomly divided into two groups and underwent conventional or optimized MSCTE. The expansion degree of bowel lumen and the thickness of bowel wall were evaluated for the six segments of the small intestine. The other 20 patients suspected of gastrointestinal diseases underwent gastrointestinal CT imaging.The expansion degree of bowel lumen and the wall thickness of bowel wall were statistically analyzed with Chi-Square test and t test. Results The wall thickness of the stomach, ileum and colon were (2. 56 ±0.52) ,(1.41 ±0. 15),(1.46 ±0. 13),(1.91 ±0. 25), (1.97 ±0.26),(2.01 ±0. 19), (2. 04 ±0.24)and (2. 05 ±0. 18)mm. Optimized method was superior to conventional method in the expansion degree of the second and third segments of the small intestine (P ＜ 0. 05) . There was no significant differences between two groups in the expansion degree and depiction of mucosa for the other segments of small intestine (P ＞ 0. 05). The gastrointestinal CT imaging was poor in the depiction of the duodenum and jejunum, but stomach, ileum and colon were fully illustrated. Conclusion Optimized MSCTE was superior to conventional method in demonstrating the small bowel, and gastrointestinal CT imaging can expand diagnostic scope because of good observation of whole gastrointestinal tract.

Objective To discuss the spiral CT features of lymph node metastasis in advanced gastric cancer, and to investigate the correlation between spiral CT features and pathologic results. Methods Spiral CT scan and triphasic enhancement spiral CT scan were performed in 59 patients with advanced gastric cancer before operation. Results ①The pathologic metastatic rate of lymph node in gastric cancer was high when the lymph nodes were nubby-mixed, prominently enhanced, unsymmetrical enhanced and ≥9 mm in diameter on spiral CT (P<0.05). ②The detection rate of lymph node metastasis with spiral CT was high when carcinoma tissues were poorly differentiated, Borrmann Ⅲ+Ⅳ, T3-4 staging and TNM Ⅲ+Ⅳ staging. Conclusion The spiral CT features of lymph node (distributing type, size, enhanced degree, enhanced mode and staging) can reflect the pathologic characteristics of lymph node metastasis in gastric carcinoma. Pathologic characteristic of gastric tumor determines the detection rate of lymph node metastasis on spiral CT. The accuracy of CT to diagnose lymph nodes metastasis will be improved by integrating the spiral CT features of both gastric tumor and lymph node.

Objective To access the diagnostic value of volume helical shuttle (VHS)technology of spectrum CT in detection of the pulmonary arteriovenous malformations (PAVM).Methods Thirteen patients with PAVM confirmed by surgery and clinical data underwent CT pulmonary artery angiography with VHS technology,which were regarded as group A.The consecutive images at four different phases were gotten Meanwhile,other thirty patients underwent conventional CT pulmonary artery angiography using bolus tracking scan,regarded as Group B.The enhancement degrees of the pulmonary trunk were measured,and the image quality was also subjectively assessed by two radiologists separately,which were compared between two groups.Results In group A,the proportion of optimal phase in each of the four phases was 15.38% (2/13),46.15% (6/13),30.77% (4/13)and 7.7% (1/13),respectively.The mean CT value in pulmonary trunk was (329.21±41.63)HU in group A and (281.74±49.83)HU in group B,exhibiting no difference (P =0.989). The percentage of enhancement degree of pulmonary trunk more than 300 HU in group A was more than that in group B (P=0.000).However, the image quality of the main pulmonary artery,lobar pulmonary artery or segmental pulmonary artery was not significantly different between two groups (P >0.05).There were no statistically differences in mean DLP between group A of (715.54±195.37)mGy/cm and group B of (558.36±186.81)mGy/cm (t=3.737,P=0.068).Conclusion Spectrum CT VHS with higher image quality and enhancement degree is superior to conventional CT scan,which can be used to reduce the influence of individual circulation difference on image quality.

Objective To assess the effects of image fusion of CT spectral monochromatic imaging on image quality in small hepatocellular carcinoma (HCC).Methods Thirty patients with 40 pathologically proven small HCCs (≤3 cm) underwent upper abdominal plain CT and dual-phase enhanced spectral CT scan were analyzed retrospectively.Conventional 140 kVp polychromatic images (group A) and monochromatic images with energy levels from 40 to 140 keV were reconstructed by using spectral imaging viewer.Monochromatic images with highest CNR (group B)and 70 keV images with lowest noise (group C) were fused to generate fused images (group D) with image fusion software.Objective evaluation of 40 HCCs [contrast-to-noise ratio (CNR) of lesion,image noise in HU] and subjective rating score of 30 patients (image noise score,overall image quality score,and lesion conspicuity score) among the four groups were compared by using One-way ANOVA and Kruskal-Wallis H test.Results CNR (1.3±0.6,2.1±0.6,1.5±0.6 and 2.4± 1.3 respectively) and image noise [(20±7),(32±9),(18±3) and (24±6) HU respectively] among group A,B,C and D all had statistical differences (F =5.724 and 13.619,both P values ＜ 0.01).CNR in group D was higher as compared with group A and C (both P values ＜ 0.05),but was similar to group B (P ＞ 0.05).Image noise in group D was lower than group B and higher than group C,but showed no difference from group A (all P values ＞ 0.05).Image noise scores [(3.5±0.5),(3.3±0.4),(3.6±0.5)and(3.5±0.4)point,respectively],overall image quality scores [(3.2 ± 0.4),(3.3 ± 0.3),(3.1 ± 0.3) and (3.7 ± 0.4) point respectively] and lesion conspicuity scores [(3.3 ±0.4),(3.9±0.4),(3.2±0.4) and (3.7 ±0.4) point,respectively] among the four groups all had statistical differences (Z =9.581,37.495 and 43.436,all P values ＜ 0.05).Scores of the four groups were all greater than 3 and met the clinical diagnostic level.Group D was higher than group B in image noise score,higher than the other three groups in overall image quality score,higher than group A in lesion conspicuity score (all P values ＜ 0.05).Conclusion Combined use of CT spectral monochromatic imaging and image fusion can improve overall image quality while maintaining or increasing CNR in small HCC.