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Comparative study of MRI patterns of medial patellofemoral ligament injury in adolescents and adults after acute lateral patellar dislocation

Lei ZHENG ; Guangying ZHANG ; Luming LIU ; Baisheng SUN ; Jiquan DU ; Hui JIANG ; Bin ZHAO

Chinese Journal of Radiology.2013;47(10):903-907. doi:10.3760/cma.j.issn.1005-1201.2013.10.008

Objective To compare and analyze MRI characteristics of medical patellofemoral ligament(MPFL) injury patterns in adolescents and adults after acute lateral patellar dislocation.Methods MR images of 42 adolescents and 45 adults after acute lateral patellar dislocation were retrospectively reviewed.Routine MR scanning was performed in axial,sagittal and coronal planes,including T1 WI,T2 WI and fat saturation sequence.The x2-tests were performed to analyze the MPFL injury patterns between adolescent group and adult group.Results The prevalence rate of MPFL injury was 97.6％ (41/42) in adolescent group after acute lateral patellar dislocation,including 57.1％ (24/42) of complete tear and 40.5％ (17/42) of partial tear.The prevalence rate of MPFL injury was 100.0％ (45/45) in adult group,including 64.4％ (29/45) of complete tear and 35.6％ (16/45) of partial tear.There were no statistical difference between adolescents and adults in prevalence rate of MPFL injury,complete MPFL tear,partial MPFL tear (x2 =1.084,0.486,0.223 ; P ＞ 0.05).The prevalence rate of MPFL injury at femoral attachment,patellar attachment and midsubstance were 31.0％ (13/42),78.6％ (33/42) and 26.2％ (11/42) respectively in adolescent group,whereas they were 64.4％ (29/45),40.0％ (18/45) and 15.6％ (7/45) respectively in adult group.It occurred at multiple sites in 33.3％ (14/42) of adolescents,and in 15.6％ (7/45) of adults.There were significant differences between adolescents and adults in the prevalence rate of MPFL tear at femoral attachments and patellar attachments (x2 =9.759,13.324 ; P ＜ 0.05),but there was no statistical difference at its midsubstance (x2 =1.497,P ＞ 0.05).Although not statistically significant (x2 =3.749,P ＞ 0.05),MPFL tear at multiple locations were seen more in adolescents than in adults (33.3％ vs.15.6％).Conclusion The injury degree and distribution of MPFL are similar in adolescents and adults after acute lateral patellar dislocation,but there is significant difference in the site of MPFL injury distribution between adolescents and adults.MPFL is most easily injured at femoral attachment,secondly at patellar attachment in adults,while MPFL is most easily injured at patellar attachment,secondly at femoral attachment in adolescents.Adolescents are more likely to have multiple-site MPFL injury than adults.

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MRI findings in children with vanishing white matter disease

Jianmin HU ; Haihua ZHANG ; Jiangxi XIAO ; Ye WU ; Sheng XIE ; Jingmin WANG

Chinese Journal of Radiology.2013;47(10):908-911. doi:10.3760/cma.j.issn.1005-1201.2013.10.009

Objective To describe the MRI features of vanishing white matter disease (VWM).Methods Ten patients diagnosed as VWM between 2008-2013 were enrolled,with the mean age of(40 ±23)months.The clinical materials and MR images of them were reviewed retrospectively.The findings of MRI were analyzed by two experienced neuroradiologists in this study,including the location (cerebrum,cerebellum,brainstem,corpus callosum and internal/external capsule),size and signal intensity of the lesions,as well as the presence of cystic degeneration,cerebrum atrophy and the abnormal signal of the basal nuclei.Results MRI of brain typically showed extensive abnormal signal in the cerebral central white matter (10/10) and the focal lesion in subcortical white matter (9/10).The involvement of U-fibers was present in 7 cases.Cystic degeneration of the affected white matter was found in 7 cases.Abnormal signal also appeared in the white matter of posterior limb of the internal capsule (8/10),the external capsule (7/10),the inner rim (the callosal-septal interface) of the corpus callosum (8/10).The lesions of the thalamus and globus pallidus were detected in 2 cases.The white matter of the brainstem and cerebellum were involved in 6 and 7 cases respectively.Conclusion VWM typically shows a diffuse and symmetrical abnormal signal in the cerebral white matter with cystic degeneration on MRI,which is usually diagnostic.

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The value of dual-energy CT in diagnosing pulmonary embolism in children

Chunxiang TANG ; Song LUO ; Longjiang ZHANG ; Changsheng ZHOU ; Guangming LU

Chinese Journal of Radiology.2013;47(10):912-916. doi:10.3760/cma.j.issn.1005-1201.2013.10.010

Objective To evaluate the value of dual energy CT with Lung Vessels application in diagnosing pulmonary embolism (PE) of children.Methods Forty-seven patients with nephrotic syndrome and aged ≤ 18 years old (32 male,15 female,mean age 15 years) underwent dual-energy CT pulmonary angiography (CTPA).Two radiologists recorded the presence or absence of emboli and counted the clots on a per-patient and per-lobe basis with Lung Vessels,respectively.With conventional CTPA as reference standard,sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) of Lung Vessels application to detect PE were computed for two readers.Inter-reader agreement was also calculated.Results Conventional CTPA detected 51 clots in 35 lung lobes in 13 patients,giving PE incidence was 27.6％ (13/47) for this cohort.On a per-patient basis,readers 1 and 2 detected 25 and 21 patients with PE with Lung Vessels,corresponding to sensitivities,specificities,PPVs,and NPVs of 100.0％ (13/13),58.6％ (17/29),43.3％ (13/30),100.0％ (17/17) and 100.0％ (13/13),76.5％ (21/29),50.0％ (13/26),100.0％ (21/21),respectively.On a per-lung lobe basis,readers 1 and 2 detected 74 and 63 clots with Lung Vessels,respectively,corresponding to sensitivities,specificities,PPVs,and NPVs of 94.3％ (33/35),79.5％ (159/200),44.6％ (33/74),98.7％ (159/161) and 97.1％ (34/36),85.5％ (171/200),54.0％ (34/63),98.8％ (171/173),respectively.On a per-clot basis,134 and 105 clots were detected with Lung Vessels application,corresponding to sensitivities,specificities,PPVs,and NPVs for DECT of 96.1％ (49/51),64.9％ (159/245),36.3％ (49/135),98.7％ (159/161) and94.1％ (48/51),75.0％ (171/228),45.7％ (48/105),98.3％ (171/174)for readers 1 and 2,respectively.Excellent or good inter-reader agreement was observed on a per-patient,per-lobe and per-clot basis (Kappa =0.828,0.859,0.695 ; all P ＜ 0.01).Conclusions Dual-energyCT with Lung Vessels application has a high sensitivity and negative predictive value for PE detection in children.More clots are detected with Lung Vessels application than conventional CTPA,which deserve further investigation.

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CT manifestations and clinical pathology features of hepatic mesenchymal hamartoma in children

Xuefeng SUN ; Xinyu YUAN ; Mei YANG ; Xiaolun ZHANG ; Jizhen ZOU ; Hongwei GUO ; Xia LIU

Chinese Journal of Radiology.2013;47(10):917-920. doi:10.3760/cma.j.issn.1005-1201.2013.10.011

Objective To investigate the CT features of hepatic mesenchymal hamartoma (HMH)in children.Methods Nine patients with HMH confirmed by postoperative pathology were enrolled,including 4 were males and 5 were females.Their age ranged from 3 days to 9 years 5 months (the median age was 7 months).All patients admitted due to palpable abdominal mass without jaundice.All patients were examed by contrast-enhanced CT before the operation.Results All the 9 cases showed solitary hepatic mass,among which 6 were in the right lobe,2 were in the left lobe and 1 involved in both lobes.The tumor size ranged from 7.0 to 22.5 cm (mean size was 13.5 cm) in diameter.The CT manifestations of HMH was related to the proportion and distribution of component in the masses.The masses were cystic (n =1),cystic-solid mixed (n =6) and solid (n =3).After contrast administration,the solid component and the septa of the mass showed enhancement while cystic component was not enhanced.Calcification was seen inside the tumor in one case.Conclusions The CT features of HMH in children are multitudinous which are related to postoperative pathological findings.With the clinical history,it is easy to distinguish HMH from the other hepatic tumors.

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Influences of different tube voltages on the dose and image quality of a full field digital mammography

Honglan ZHAO ; Hong MA ; Xin LU ; Qiuyun LI ; Gaohong CHEN ; Xiaosong WU ; Kai XU

Chinese Journal of Radiology.2013;47(10):921-925. doi:10.3760/cma.j.issn.1005-1201.2013.10.012

Objective To evaluate the effect of different tube voltages on the radiation dose and image quality of a full field digital mammography system.Methods Both experiments were performed under manual exposure mode.In one experiment,the tube voltages were kept constant at 25,28 and 31 kVp,and the CIRS 015 phantom was exposed at three target/filter combinations molybdenum/molybdenum (Mo/Mo),molybdenum/rhodium (Mo/Rh),and rhodium/rhodium (Rh/Rh) and at tube current-exposure time products of 32-140mAs.The entrance skin exposure (ESE) and average glandular dose (AGD) were recorded,the signal-to-noise ratio(SNR) and contrast-to-noise ratio (CNR) and figure of merit (FOM) were measured to evaluate the influences of different tube voltages on dose and image quality at same target/filter combination.The univariate of randomized completed block-design was used for statistics.In second experiment,the phantom were exposed using Mo/Rh combination when the tube current-exposure time product was kept constant at 56 mAs,and the tube voltage varied between 23 and 33 kVp in 1-kVp increments.The ESE and AGD were recorded,the SNR,CNR and FOM were measured for plotting the curves against tube voltages.Results At Mo/Mo combination,the AGD,ESE,SNR,CNR and FOM of 25,28 and31 kVp were(1.25 ±0.56) mGy,(6.46±2.86) mGy,71.52±8.37,1.91 ±0.26,3.21 ± 0.68; (1.94 ±0.85) mGy,(9.18±4.07) mGy,144.46 ± 11.31,2.41 ±0.28,3.37 ±0.96 and (3.01 ±1.38) mGy,(12.60±5.59) mGy,128.89 ±15.29,2.47 ±0.31,2.31 ±0.76 respectively; at Mo/Rh combination were (1.23 ±0.55) mGy,(5.26 ±2.33) mGy,67.31 ±4.11,1.82 ±0.19,3.01 ± 0.82; (1.86 ±0.84) mGy,(7.57 ±3.34) mGy,139.54 ± 12.16,2.30 ±0.25,3.23 ±0.92 and (2.81 ±1.24) mGy,(10.48 ±4.62) mGy,127.77 ±15.14,2.59 ±0.31,2.67 ±0.68; and at Rh/Rh were(1.09 ±0.48) mGy,(4.89 ±2.16) mGy,67.46 ±2.23,1.48 ±0.72,3.08 ± 1.69; (1.75 ± 0.78) mGy,(6.88 ±3.03) mGy,137.74 ± 14.65,2.37 ±0.26,3.62 ± 1.07 and (2.59 ± 1.13) mGy,(9.32 ± 4.12) mGy,117.91 ± 19.05,2.51 ± 0.31,2.74 ± 0.84.Both experiments indicated that,for a given target/filter combination,the AGD,ESE and CNR increased,but the ESE/AGD decreased with the tube voltage increasing; The first experiment indicated both SNR and FOM of 28 kVp were higher than that of 25 kVp and 31 kVp; the second experiment showed both SNR and FOM decreased with tube voltages increasing.The differences of AGD、ESE、ESE/AGD、SNR、CNR and FOM among the three tube voltages were significant (F =4.391-528.848,P ＜ 0.05) ; but the difference of CNR between 28 and 31 kVp at Mo/Mo and Rh/Rh had no statistical significance (P ＞ 0.05) ; and the differences of FOM between 25 and 28 kVp at the three target/filter combinations were not statistically significant (P ＞ 0.05).Conclusion For a breast with 4.2 cm thickness and 50％ adipose 50％ glandular composition,different tube voltages have significant effects on the radiation dose and image quality.

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Characteristics of Chinese radiology research in 2012 and comparison to western radiology research

Fengdan WANG ; Huadan XUE ; Yingxi CHEN ; Xin ZHANG ; Xiao TAN ; Wenda WANG ; Zhengyu JIN

Chinese Journal of Radiology.2013;47(10):936-939. doi:10.3760/cma.j.issn.1005-1201.2013.10.015

Objective To analyze the characteristics of published radiology original articles in China,and compare radiology research inboard and abroad.Methods According to the Contents of Chinese Science Core Periodicals in 2012,there were 15 comprehensive radiological core periodicals in China.All of them were retrospectively surveyed,and original articles published between October 2011 and October 2012were evaluated.The following information was abstracted from each article:radiologic technique used,radiologic subspeciahy,type of research,sample size and study design.At the same time,all the original articles from two top radiology journals,Radiology and European Radiology (ER) at the same period were evaluated.Chi-square test was used to compare the composition percentage inboard and abroad.Results There were 2784 original articles published in the 15 Chinese top radiological periodicals in total The most commonly used radiologic techniques were CT (1093 of 2784,39.3％),MRI (824 of 2784,29.6％) and intervention (402 of 2784,14.4％).Radiology and ER totally published 560 original articles.MRI (265 of 560,47.3％),CT (170 of 560,30.4％) and mixed techniques (63 of 560,11.3％) were most used.In China,as much as 2572 (92.4％) articles were clinical research,115 (4.1％) was basic research,9 (0.3％) was clinical and basic research,and 83 (3.2％) was non-basic non-clinical research.The sample size of less than 10,between 10 to 50,and more than 50 was 374 (13.4％),1448 (52.0％) and 847 (30.4％) respectively.339 (12.2％) Chinese articles belonged to perspective research,and 1211 (43.5％) were retrospective.For Radiology and ER,515 (92.0％) articles were clinical research,39 (7.0％) was basic research,3(0.5％) was clinical and basic research,and 3(0.5％) was non-basic non-clinical.The sample size of less than I0,between 10 to 50,and more than 50 was 30 (5.4％),225 (40.2％) and 252 (45.0％) respectively.230 (41.1％) articles belonged to perspective research,and 202 (36.1％) ones were retrospective.Radiology and ER articles used MRI more than that published in Chinese radiology journals (x2 =666.690,P ＜ 0.01).Clinical research was the most commonly used research type both inboard and abroad (x2 =0.116,P ＞0.05).Articles of sample size more than 50 abroad were more than that of China (x2 =44.895,P ＜0.01).Perspective research was used more abroad (x2 =275.667,P ＜ 0.01),and the main research type in China was retrospective.Conclusion Chinese radiology workers might need to do more perspective and larger sample size clinical researches.

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The feasibility study of low tube voltage combined with low contrast dose in multi-slice CT skull arteriography

Wei XIA ; Xiaorui YIN ; Jingtao WU ; Yuan ZHOU ; Zhijun WANG

Chinese Journal of Radiology.2013;47(11):984-987. doi:10.3760/cma.j.issn.1005-1201.2013.11.007

Objective To evaluate the feasibility of a low-dose contrast medium protocol for 64-slice CT angiography (CTA) of head using a low-tube-voltage setting.Methods ① Phantom study:64-slice spiral CT respectively sets 80,100,120,140 kV and 100,200,300,400,500 and 600 mA as scanning parameter lines.Analysis of the best Signal-to-noise ratios (SNR) and contrast to noise ratios (CNR).②Clinical study:to prospectively continuous select sixty-six patients with suspected intracranial aneurysm and arteriovenous malformation and so on from April to October of 2012 to perform hand CTA inspection.The random number table method for A,B two groups,33 patients in each group.Group A (conventional group)scanning parameters:120 kV,400 mA and amount of contrast agent:1 ml/kg; Group B(test group) scanning parameters:80 kV,600 mA,amount of contrast agent 0.5 ml/kg.Using independent samples t test for each group radiation dose,SNR,CNR were statistically analyzed.By two experienced radiologists to 5 points on two groups of image quality subjective evaluation.Mann-Whitney U test was used for statistical analysis of subjective evaluation.Results Group A and B group CTDIvol respectively is 59.1,27.5 mGy.Group B than in group A,CTDIvol decreased by 53.5％.A,B groups of the SNR,CNR were 71.5 ± 10.7,92.0 ± 7.4; 58.5 ± 10.5,79.6 ± 7.7,Group B than in group A SNR,CNR were enhanced by 22.3％,26.4％,differences were statistics significance (t =584.0,388.6,P ＜ 0.01).The subjective image evaluation of group B was bigher than group A (Z =31.2,23.4,P ＜ 0.05),differences were statistics significance.Two physicians on CTA images to assess the consistency of uniform height(Kappa =0.904,P ＜0.05).Conclusion In the head CTA examination,use of low tube voltage combined with low contrast dose not only can improve the image quality but also radiation dose were significantly lower.

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MR elastography on 3.0 T scanner: a preliminary study of fiver stiffness measurements and inter-rater consistency in volunteers and patients with chronic fiver disease

Yu SHI ; Qiyong GUO ; Lan ZHANG ; Fei XIA ; Bing YU

Chinese Journal of Radiology.2013;47(11):1005-1008. doi:10.3760/cma.j.issn.1005-1201.2013.11.012

Objective To estimate reliability of magnetic resonance elastography (MRE) in measuring liver stiffness of volunteers and patients with chronic liver disease and to assess inter-rater consistency.Methods MRE was performed on a 3.0 T scanner in all subjects,including 24 volunteers (control group) and 64 patients with liver disease (chronic liver disease group).Liver stiffness was measured blindly by two raters.The pathological fibrosis score was applied as a standard reference for liver fibrosis in 22 patients.The intraclass correlation coefficient (ICC) was used to evaluate inter-rater reliability.The differences of liver stiffness between two groups were evaluated using non-parametric MannWhitney U test.Spearman analysis was used to analyze the correlation between fibrosis stages and liver stiffness.Results The intraclass correlation coefficient of liver stiffness was perfect (ICC =0.99,P ＜ 0.01)between two raters.There was significant difference of mean stiffness between control group and patient group (U =90.5,P ＜0.01) with(2.35 ±0.34) kPa and(4.17 ± 0.47) kPa,respectively.The correlation between fibrosis stage (3,3,5,5 and 6 patients in fibrosis stage S0,S1,S2,S3 and S4) and stiffness (2.13,3.25,3.82,5.45 and 7.35 kPa) was very strong (r =0.96,P ＜0.01).Conclusion MRE is a reliable and promising tool to measure liver stiffness and to assess liver fibrosis.

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Follow-up study of discharged patients infected with novel recombinant avian-origin influenza A H7N9

Ying ZHU ; Zhiyong ZHANG ; Yuxin SHI ; Qingle WANG ; Qian MA

Chinese Journal of Radiology.2013;47(9):786-789. doi:10.3760/cma.j.issn.1005-1201.2013.09.006

Objective To analyze the laboratory results and chest CT appearances of novel recombinant avian-origin influenza A (H7N9) in discharged patients for understanding the imaging changes.Methods The clinical and imaging data of 4 patients with novel recombinant avian-origin influenza A (H7N9) were collected.The imaging changes and laboratory results were analyzed.Results All patients underwent chest CT examination 2 to 5 times from admission to discharge.The lesions primarily presented as ground-glass opacity (GGO) and mainly located in the inferior lobe of the left lung in 3 cases,in the inferior lobe of the right lung in 1 case,alternating between absorption and progress.GGO was absorbed obviously in about 3 days after treatment and consolidation was progressed after treatment.Consolidation absorption was observed with continue treatment in 1 case.The pulmonary lesions were absorbed obviously in 1 case 7 days after discharge.Synchronous reduction of the absolute values of CD3,CD8,CD4,CD45 were observed in 3 cases and the ratio of CD4/CD8 was normal.Conclusions (1) The areas of pulmonary involvement are large and variable in H7N9.The lesion area and imaging patterns are important for disease prognosis.(2) H7N9 virus infection may causes immunosuppression,decrease of CRP value can predict the improvement of the disease.

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Assessment of atrial septal defect size with three-dimensional volumetric measurement of cardiac CT: comparison with size of the postoperative occluder

Huijun SONG ; Shiliang JIANG ; Bin Lü ; Gejun ZHANG ; Zhihui HOU ; Zhongying XU

Chinese Journal of Radiology.2013;47(9):790-795. doi:10.3760/cma.j.issn.1005-1201.2013.09.007

Objective To evaluate two kinds of practical CT three-dimensional volumetric measurement techniques in assessing atrial septal defects (ASDs) for transcatheter device closure.Methods Retrospective assessment of 50 consecutive patients who underwent ASD closure was conducted.Cardiac CT was performed in them before planned transcatheter ASD closure and postoperative chest radiograph was performed in both posteroanterior and lateral view.Coronary CT angiography was made for the detection of coronary artery disease,and three-dimensional reconstruction of ASD was conducted for determination of the defect size in the GE-workstation.Two kinds of practical CT three-dimensional volumetric measurement techniques,one named CT virtual endoscopy assisted volumetric measurement (CTVE) and another called axial sequence assisted volumetric measurement(CTAS),were used to calculate the major axis and the minor axis of the ASD respectively.Thus,the dimensions of the Equivalent Circle were derived,with circunference and area equal to the elliptic ASD according to the formulation (D =√b4/a2 + a2-b2).The ASDs occluder (ASO) dimension was measured in the lateral chest radiograph,and this postoperative occluder-waist size (POS) value was regarded as the gold standard for the measurement of ASD.The results were compared between CTVE and CTAS,and the correlations were evaluated between them and the gold standard.Results The differences in the major dimensions (-9.05 mm,t =-6.60,P ＜ 0.05),minor dimensions (-4.86 mm,t =-4.39,P ＜ 0.05) and Equivalent circle dimensions (-7.65 mm,t =-6.40,P ＜ 0.05) of ASD between CTAS and CTVE were statistically significant.Though the CTAS cannot provide the en face views of ASDs,the Equivalent Circle dimensions measured by CTAS(22.48 ± 5.59) mm was correlated well with POS (27.07 ± 6.83)mm (Y =1.14X + 1.39,r =0.94,P ＜ 0.01),and a good correlation was found between this Equivalent Circle dimensions and ASO size (Y =1.02X + 6.84,R2 =0.78,r =0.88,P ＜ 0.05).The correlation between the Equivalent Circle dimensions measured by using CTVE (30.13 ± 9.27) mm and POS was poor (Y =0.30X + 17.94,r =0.41,P ＜ 0.01),though it can provide the en face views of ASDs.Conclusion CTVE and CTAS are two complementary techniques of assessing ASDs for transcatheter device closure.

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