[Objective] To analyze the image findings of MR enterography (MRE) and diffusion weighted imaging (DWI) in Crohn disease (CD) and to discuss the diagnostic value of MRI for evaluating the activity of CD.[Methods] 26 patients proved by clinical,imaging and pathological data were enrolled in this study.The intra-/extra-intestinal image features of CD were retrospectively analyzed,and the intestinal lesions were evaluated by MRE+DWI scoring system.The differences in image features of active and inactive CD were compared.[Results] 26 bowel segments were evaluated and included active (n =20) and inactive CD (n =6).The intestinal performance of CD included wall thickening,T2WI hyperintensity and hyperenhancement.The pathological changes of active CD were more serious when comparing with that of inactive CD.DWI showed hyperintensity in the affected bowel wall.ADC of active C D [(0.9 ± 0.2) × 10-3 mm2/s] was significantly lower than that of inactive CD [(1.5 ± 0.4)× 10-3 mm2/s] (P ＜ 0.001).Extra-enteric performance of active CD included comb sign,lymphadenectasis of mesentery,mesenteric exudation,fistula and abdominal abscess.[Conclusion] MRE combined with DWI can accurately assess CD activity and diagnose extra-enteric complications.

Objective To explore the diagnostic value of magnetization transfer imaging (MTI) and DWI for detecting intestinal wall property of crohn's disease (CD). Methods Forty four patients with CD were prospectively enrolled in the study, and MR enterography (MRE), MTI and DWI were performed. According to MRE findings, patients were divided into three subgroups:acute inflammatory group, chronic fibrotic group and combined inflammatory with fibrotic group. Intestinal wall T2WI signal, magnetization transmisson rate (MTR) and ADC value were measured on MRE, MRI and DWI imagings, respectively. The differences of MTR and ADC among the three groups were analyzed by one-way ANOVA;the differences of T2WI scores were analysed by Kruskal Wallis;the differences of MTR and ADC values between normal and pathological intestinal wall were analyzed by paired t test;ROC curve were used to evaluate the CD fibrosis and inflammation diagnostic efficiency of MTI ana DWI based on MRE signs. Results Among the 44 cases, 11 cases were in the acute inflammatory group, 18 cases were in the chronic fibrotic group and other 15 cases were in the combination group. The T2WI score, MTR and ADC among the three groups showed significant differences (all P<0.01).The mean MTR and ADC of pathological intestinal wall of the 44 cases were (40.77±6.05)%and (1.04±0.18)× 10-3mm2/s, and the adjacent normal bowel were (21.75±4.17)%and (1.97 ± 0.23) × 10- 3mm2/s, respectively. Moreover, the difference of the above values showed significant differences (t=19.12,-21.80 respectively, all P<0.01). There was a negative correlation between MTR and T2WI score (r=-0.71,P<0.01). While ADC value was positively correlated with T2WI score (r=0.80, P<0.01). Using ROC curve analysis to differentiate the CD fibrosis from acute inflammation, the area under the curve (AUC) of MTR and ADC were 0.97 and 0.96 ,respectively. Conclusions Both MTI and DWI can be used to assess the properties of intestinal wall, which has the same diagnostic efficacy to identify the acute inflammation and fibrosis.

BACKGROUND:Many experiments and clinical studies have reported that venous blood, absorbable colagen sponge and rich fibrin clot, without the use of bone graft material, can al promote new bone formation; therefore, whether only transplanting concentrated growth factor in the maxilary sinus lift could effectively promote bone regeneration? OBJECTIVE: To conduct the maxilary sinus lift with concentrated growth factor as the graft material, and to observe the peri-implant bone level change. METHODS: Totaly 26 patients were involved, including 14 males and 12 females, aged 35-73 years. Maxilary sinus lift was conducted and autologous concentrated growth factor was taken as the graft material. Astra Tech implants were implanted simultaneously. Patients were divided into 6-12 months, 13-18 months and > 18 months groups according to the folow-up time. Patients were divided into≤ 5 mm, 5-7 mm, and≥ 7 mm groups according to the preoperative alveolar bone height. Patients were divided into≤ 2 mm, 2.0-3.0 mm, and≥3 mm groups according to the postoperative maxilary sinus lift height. The survival rate of implants and marginal bone level changes were observed during the folow-up. RESULTS AND CONCLUSION: Totaly 44 implants were implanted, of which 43 implants were considered as successful repair during the 6-18 months of postoperative folow-up. The survival rate of implants was 98%. There were no significant differences in the changes of mesial, distal and middle marginal bone levels between different folow-up time groups. The maxilary sinus lift with transplantation of concentrated growth factor resulted in a good osseointegration within 6-18 months post-operation. In addition, no significant differences were found in the changes of mesial, distal and middle marginal bone levels between different residual alveolar bone height groups, as wel as between different maxilary sinus lift height groups. It showed that the residual alveolar bone height and maxilary sinus lifting height had no significant effect on the peri-implant bone formation. Briefly, these findings demonstrate that the maxilary sinus lift with concentrated growth factor transplantation can result in a high survival rate of implants that are simultaneous implanted, and the alveolar bone around the implant is stable. But the long-term effect needs further observation.

[Objective]To explore the efficacy of T2* mapping for evaluating inflammatory activity in the patients with Crohn disease(CD).[Methods]A total of 98 CD patients underwent MR enterographywith T2*WI. T2* values were measured by put-ting regions of interest on the thickening bowel wall on T2*mapping. The activity of bowel segment was scored by magnetic resonance index of activity(MaRIA),to analyze the relationship between T2*values with CD activity.[Results]A total of 160 bowel segments were evaluated and includedinactive(MaRIA<7,n=26),mild(7≤MaRIA<11,n=23),and moderately-severe(MaRIA≥11, n = 111)active lesions. The differences in T2* values amongthese three groups were significant(all P < 0.05). T2* values of 160 bowel segments correlatedclosely withMaRIA(r=0.743,P<0.05). High accuracy of T2*values was shown for differentiating inac-tive from active CD(AUC=0.877)anddifferentiating inactive-mild from moderate-severe CD(AUC=0.848). The threshold T2*value of 20 ms allowed differentiation of mild from moderate-severe CD with74.5%sensitivity and 84%specificity.[Conclusions]T2*values, as thequantitative indexof T2*mapping,correlate well with CD activity and showsatisfiedefficacy for diagnosing inflammatoryactivity.

OBJECTIVETo assess the value of MDCT with vessel probe(VP) in the diagnosis and treatment of isolated superior mesenteric artery dissection (ISMAD).

METHODSClinical and imaging data of 15 patients with ISMAD admitted to the First Affiliated Hospital of Sun Yat-Sen University from June 2008 to May 2013 were retrospectively reviewed. Relationship among radiograpic features, clinical symptoms and therapeutic options of ISMAD was examined based on the imaging of 64-MDCT with VP.

RESULTSThe dissection crevasse of all the 15 patients located in anterior arterial wall, and the distance was(24.3±9.7) mm from the origin of SMA. Meanwhile dissection crevasse of 73.3%(11/15) patients located in the zone within 1 cm of proximal end and 1 cm of distal end of the proximal SMA curvature. There were significant differences between patients without abdominal pain(8 cases) and those with abdominal pain(7 cases) in dissection length, minor diameter ratio of true lumen to false lumen, major diameter ratio of true lumen to false lumen(all P<0.01). According to classification of Yun, there were 5 patients of typeI( and 3 type II(a, whose conservative treatment were successful. In other 7 patients of type II(b, 3 patients received successful conservative treatment, and 4 patients had symptom remission after turning to interventional treatment or surgery.

CONCLUSIONS64-MDCT with VP can clearly depict the image manifestation of ISMAD, which provides evidence for the diagnosis and therapeutic options of ISMAD.

Abdominal Pain ; Humans ; Mesenteric Artery, Superior ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

Yolk sac tumor (YST) is a rare germ cell neoplasm of childhood that usually arises from the testis or ovary. The rare cases of YST in various extragonadal locations have been reported, but the primary intrarenal YST is even more uncommon. Here, we report a case of a primary intrarenal YST with tumor thrombus of the inferior vena cava and left renal vein in a 2-year-old boy, with an emphasis on the CT features. To our knowledge, this is the first reported case of an intrarenal YST with intravascular involvement.
Child, Preschool ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal/*diagnosis/pathology/ultrasonography ; Renal Veins/pathology/*radiography ; Thrombosis/pathology/radiography ; *Tomography, X-Ray Computed ; Vena Cava, Inferior/pathology/*radiography

Objective To explore the diagnostic values of combined detection of serum procalcitonin (PCT) and β2 microglobulin (β2MG) in tsutsugamushi disease.Methods Serum PCT and β2MG were compared in cases of tsutsugamushi disease and fever patients at the same time,who were hospitalized at Fourth Affiliated Hospital of Guangxi Medical University from June 2014 to May 2017.The best diagnosis cut-off value of tsutsugamushi disease was calculated by receiver operating characteristic (ROC) curve.Results A total of 57 cases of tsutsugamushi disease,40 cases of sepsis,17 cases of acquired immunodeficiency syndrome (AIDS),17 cases of severe community-acquired pneumonia (SCAP),63 cases of common community-acquired pneumonia (CCAP),14 cases of pulmonary tuberculosis (PTB),20 cases of upper respiratory tract infection,13 cases of other infectious fever and 28 cases of non-infectious fever patients were selected.The level of serum PCT in tsutsugamushi disease [0.87 (0.68-1.34) μg/L] was higher than those in AIDS [0.47 (0.20-1.12) μg/L],CCAP [0.17 (0.09-0.51) μg/L],PTB [0.13 (0.05-0.18) μg/L],upper respiratory tract infection [0.23 (0.05-0.48) μg/L] and non-infectious fever [0.09 (0.06-0.13) μg/L],but was lower than those in sepsis [5.00 (1.04-18.78) μg/L] and SCAP [3.35 (0.76-14.41) p,g/L,P ＜ 0.05],while the difference was not significant compared with other infectious fever [0.76 (0.13-1.99) μg/L,P ＞ 0.05].The level of serum β2MG in tsutsugamushi disease [(5.67 (4.47-7.90) mg/L] was higher than those in sepsis [2.83 (2.10-4.54) mg/L],AIDS [3.85 (3.19-5.22) mg/L],SCAP [3.83 (2.98-5.58) mg/L],CCAP [1.99 (1.51-2.75) mg/L],PTB [1.92 (1.37-3.00) mg/L],upper respiratory tract infection [2.02 (1.25-2.74) mg/L],other infectious fever [2.45 (1.51-4.12) mg/L] and non-infectious fever [2.99 (2.06-4.30) mg/L,P ＜ 0.05].ROC curve showed that the most suitable diagnosis cut-off value of serum PCT in tsutsugamushi disease was 0.53 μg/L,the sensitivity was 94.7％,and the specificity was 60.4％.The critical value of serum β2MG was 3.74 mg/L in diagnosis of tsutsugamushi disease,its corresponding sensitivity and specificity were 91.2％ and 75.9％,respectively.The sensitivity and specificity of combined serum PCT and β2MG in diagnosis of tsutsugamushi disease was 87.7％ and 86.3％,respectively.Conclusion Combined detection with serum PCT and β2MG can improve early diagnosis of tsutsugamushi disease.

Objective To assess the diagnostic value of magnetization transfer MRI (MTI) for bowel inflammation and fibrosis in humans with Crohn disease (CD). Methods From July 2014 through April 2017, 31 patients with a confirmed diagnosis of CD were prospectively recruited from the First Affiliated Hospital of Sun Yat Sen University. They were scheduled for elective surgery due to bowel obstruction and other complications, and underwent preoperative MR enterography (MRE) and MTI within 15 days of surgery. All cases had available intestinal specimens identified on MRE and resected bowel segments for region by region matching. All patients underwent breath hold conventional MRE and MTI examinations, and then the magnetization transfer ratios (MTRs) of pathological bowel segments were measured. Using region by region correlation between MTI and surgical specimen, the bowel segments were resected to stain with HE for evaluating bowel inflammation, Masson for bowel fibrosis, and typeⅠcollagen staining for the deposition of typeⅠcollagen within the bowel walls. The histologic sections from the most severe areas were scored as 0 (normal), 1 (mild), 2 (moderate) and 3 (severe). The correlations between MTR and histologic scores were analyzed by using Spearman rank correlation or partial correlation. The differences in MTR among different grades of bowel fibrosis were analyzed by one way ANOVA. The efficacy of MTR for predicting bowel fibrosis was evaluated by receiver operating characteristic curves analysis. The difference in MTRs between purely inflammatory bowel walls and mixed fibrotic and inflammatory bowel walls was analyzed by Student s t test. Results Sixty two resected bowel specimens from 31 patients including 9 purely inflammatory bowel walls and 53 mixed fibrotic and inflammatory bowel walls were obtained in this study. There were significant differences in MTR among non fibrotic [(21.45 ± 2.65)%], mildly [(30.88 ± 6.14)%], moderately [(35.14 ± 4.31)%] and severely [(35.14 ± 4.31)%] fibrotic walls (F=38.397,P<0.01). MTRs strongly correlated with fibrosis scores (r=0.681, P<0.01). High accuracy of MTRs was shown (curve under area=0.905, P<0.01) for differentiating moderately severely fibrotic from non fibrotic and mildly fibrotic bowel walls. Using MTR of 31.50% as a cutoff value, the sensitivity and specificity were 93.6% and 80.0%, respectively. The MTRs of purely inflammatory bowel walls [(21.45 ± 2.65)%] were significantly higher than that of mixed fibrotic and inflammatory [(36.28±5.21)%] bowel walls (t=-13.052,P<0.01). MTRs correlated with the scores of type Ⅰ collagen (r=0.325, P=0.044) but did not correlate with inflammation scores (r=-0.024, P=0.857). Conclusions MTI enables quantitative evaluation of bowel fibrosis in patients with CD and can be used to differentiate purely inflammatory CD from mixed fibrotic and inflammatory CD.

Objective:To develop a mesenteric creeping fat index (MCFI) based on CT enterography (CTE) to characterize the degree of creeping fat wrapping around the inflamed gut in Crohn disease (CD), and to assess the relationship between MCFI and the inflammatory intestinal stricture.Methods:From December 2018 to July 2019, the patients with CD who underwent surgery in the First Affiliated Hospital of Sun Yat-Sen University were prospectively collected. The extent of perienteric mesenteric vessels wrapping around the gut was reconstructed to develop MCFI based on CTE images. The intestinal stricture index was obtained by calculating the ratio of the maximal upstream luminal diameter divided by the minimum luminal diameter apparent within the stricturing region. Using region-by-region correlation between CTE and surgical specimen, creeping fat score in intestinal specimen was obtained by assessing the extent of creeping fat wrapping around the resected bowel segment, and HE staining was performed on the bowel specimen corresponding to creeping fat to obtain the pathological inflammatory score. The Spearman correlation analysis was used to evaluate the correlation between MCFI, creeping fat score in intestinal specimen, and inflammatory score, intestinal stricture index. The ROC curve analysis was used to assess the accuracy of MCFI in distinguishing moderate-severe and mild inflammatory bowel walls.Results:Totally 30 CD patients were enrolled. The creeping fat score in intestinal specimen positively correlated with pathological inflammatory score ( r s=0.403, P=0.027) and with intestinal stricture index ( r s=0.642, P<0.001). MCFI positively correlated with creeping fat score in intestinal specimen ( r s=0.840, P<0.001), with pathological inflammatory score ( r s=0.497, P=0.005), and with intestinal stricture index ( r s=0.599, P<0.001). ROC analysis showed that the area under the curve of MCFI for differentiating moderate-severely from mildly inflammatory bowel walls was 0.718 (95%CI 0.522-0.913). Using MCFI≥4 as a cutoff value, the sensitivity and specificity were 81.8% and 47.4%, respectively. Conclusions:There was a correlation between creeping fat and inflammatory intestinal strictures in CD. MCFI can non-invasively depict the degree of creeping fat wrapping around the gut and assess the inflammatory intestinal stricture.

OBJECTIVETo explore the value of comprehensive application of CT and PET/CT in differential diagnosing mucinous and non-mucinous colorectal adenocarcinoma.

METHODSCT and PET/CT image data of 37 patients with mucinous adenocarcinoma and 50 patients with non-mucinous adenocarcinoma confirmed by pathology in our hospital from January 2010 to December 2012 were analyzed retrospectively. Differences of image were compared between two methods.

RESULTSOn CT, lesion density of pre-contrast, pro-contrast phase and enhancement degree were significantly lower in mucinous adenocarcinoma than those in non-mucinous adenocarcinoma(all P<0.01). Enhancement degree of hypointense area, hypointense area proportion of total lesion, and lymphatic or distant metastasis ratio were significantly higher in mucinous adenocarcinoma than those in non-mucinous adenocarcinoma(all P<0.05). On PET/CT, maximal SUV value of mucinous adenocarcinoma was significantly lower as compared to non-mucinous adenocarcinoma[(8.64±4.34) Bq/L vs. (12.38±5.96) Bq/L, P=0.015].

CONCLUSIONSCT combined with PET/CT provides better valuable information in differential diagnosing between mucinous and non-mucinous colorectal adenocarcinoma and clinical practice.

Adenocarcinoma ; diagnostic imaging ; Adenocarcinoma, Mucinous ; diagnostic imaging ; Colorectal Neoplasms ; diagnostic imaging ; Humans ; Multimodal Imaging ; Positron-Emission Tomography ; Retrospective Studies ; Tomography, X-Ray Computed