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Role of Ultrasound Contrast Time-intensity Curves in Hepatic Tumor Characterization and the Evaluation of Radiofrequency Ablation Effect

Yan HE ; Xiaojing LI ; Ling ZHANG

Chinese Journal of Medical Imaging.2013;(11):844-848. doi:10.3969/j.issn.1005-5185.2013.11.014

Purpose To explore the value of ultrasound contrast time-intensity curves in hepatic tumor qualitative diagnosis and evaluation of tumor ablation effect. Materials and Methods Forty-two patients who were clinically diagnosed as hepatic cancer or cirrhosis underwent contrast enhanced ultrasound for the tumor lesions within the liver, dynamic analysis of the lesions were executed with software SonoLiver CAP, the nature of the tumors were determined and the results were compared with those of the enhanced MRI. Ultrasound guided biopsy was followed with radiofrequency ablation treatment, two-dimensional and contrast enhanced ultrasound were executed two weeks after the ablation, and the results were compared with enhanced MRI findings during corresponding period. Results 52 tumor nodules were found with two-dimensional and color Doppler ultrasound, 65 (33 hyperplastic nodules, 32 malignant lesions) with CEUS, 65 (21 hyperplastic nodules, 44 malignant lesions) with ultrasound contrast time-intensity curves, and 61 (20 hyperplastic nodules, 41malignant lesions) with contrast enhanced MRI; pathological examination revealed that 26 of the lesions were benign and 39 were malignant;there was statistically significant difference (χ2=4.561, P<0.05) between the results of ultrasound contrast time-intensity curves and simple contrast enhanced ultrasound for the assessment of the nature of tumor;no statistically significant difference (χ2=0.003, P>0.05) was found between ultrasound contrast time-intensity curves and enhanced MRI for the assessment of the nature of tumor;there was statistically significant difference (χ2=5.298, P<0.05) between ultrasound contrast time-intensity curves and simple contrast enhanced ultrasound for the assessment of whether the tumor was malignant or benign, when taking biopsy results as the reference standard. Conclusion With ultrasound contrast time-intensity curves, dynamical, intuitive, and quantitative evaluation can be obtained for the perfusion differences between the lesion and the surrounding liver parenchyma, which provides more accurate information for qualitative diagnosis of hepatic tumors thus contains great application value in the evaluation of the effects of radiofrequency ablation for hepatic tumors.

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Comparison of ECToolbox Formulae for the Assessment of Left Ventricular Ejection Fraction

Wei XIA ; Jing NI ; Juhua ZHUANG ; Cuihua HU

Chinese Journal of Medical Imaging.2013;(11):829-833. doi:10.3969/j.issn.1005-5185.2013.11.009

Purpose To evaluate the correlation and consistency of left ventricular ejection fraction (LVEF) obtained by ECG-gated myocardial perfusion SPECT (GMPS) using four formulae (R0-R3) of ECToolbox software and findings on equilibrium radionuclide angiography (ERNA), and to determine the optimal diagnostic thresholds by using the four formulae. Materials and Methods A total of 38 patients with myocardial infarction and 65 patients with suspected coronary heart disease underwent both 99Tcm-MIBI rest GMPS and 99Tcm-RBC ERNA within a week. The LVEF values calculated by ECToolbox R0, R1, R2 and R3 were compared with those obtained by ERNA, and compared with ERNA results, the optimal diagnostic thresholds of the four formulae (R0-R3) were assessed by receiver operating characteristic (ROC) curves. Results The results calculated by the formulae (R0-R3) presented a significant positive correlation with that obtained by ERNA [mean LVEF value by ERNA (54.6±17.5)%, mean LVEF value by formulae R0-R3 (64.1±15.7)%, (56.3±15.1)%, (69.9±17.9)% and (56.7±13.6)%, respectively, r=0.899, 0.898, 0.890, 0.895; P<0.01]. All mean LVEF values calculated by the four formulae were higher than that by ERNA, and the difference was significant (P<0.05). LVEF≥50%obtained by ERNA was considered as normal diagnostic value, the optimal diagnostic thresholds of R0-R3 were 56.5%, 51.5%, 64.5% and 52.5%, respectively. Conclusion The results calculated by R0, R1, R2 and R3 in the ECToolbox software and that by ERNA show significant correlation and difference for the assessment of LVEF. Thus it is advisable to stick to one formula in the follow-up of each patient and select correspondent threshold in the clinical diagnosis.

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Direct CT Venography in the Diagnosis of Varicose Veins of Lower Limb

Jianwei JIANG ; Yunjuan YIN ; Jun CHANG ; Haiyan HOU ; Jungan WANG

Chinese Journal of Medical Imaging.2013;(11):825-828. doi:10.3969/j.issn.1005-5185.2013.11.008

Purpose To explore the value of direct CT venography (CTV) for the diagnosis of varicose veins of lower limb. Materials and methods Forty patients diagnosed as varicose veins of lower limbs were enrolled. 40 patients with 56 involved limbs underwent direct CTV examination, and their images were stratified and evaluated according to the severity and the scope of the disease. Main assessment:definition and scope of CT axial scans combined with volume rendering (VR) and maximum intensity projection for the display of the varicose veins; situation for the display of perforating veins, deep veins and iliac veins;diagnostic compliance between CTV and DSA. Results All of the 56 involved limbs underwent laser intra-cavity occlusion surgery, among them 7 cases with 11 limbs underwent venous angiography under DSA at the same time. In the evaluation of the VR, excellent proportion was 92.86%(52/56), moderate proportion was 7.14%(4/56). Among the deep veins, ratio of the imaging that was able to meet the diagnostic standard was 94.34%, 88.46%and 27.27%, respectively for calf vein, femoral vein and external iliac vein. The total demonstration rate of perforating veins was 98.21%(55/56). Diagnostic compliance between CTV and DSA was 100.00%. Conclusion Lower extremity direct CTV imaging is convenient and noninvasive for patients with varicose veins, with high compliance with DSA results, thus is significantly valuable for the guide of clinical treatment.

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Two-dimensional Multiple-echo Recalled Gradient Echo Sequence at Flexion Position in the Diagnosis of Hirayama Disease

Yuanyuan QIN ; Shun ZHANG ; Yan ZHANG ; Wenzhen ZHU

Chinese Journal of Medical Imaging.2013;(10):745-748. doi:10.3969/j.issn.1005-5185.2013.10.007

Purpose To evaluate the diagnostic value of two-dimensional multiple-echo recalled gradient echo (2D MERGE) with flexural position in the hirayama disease. Materials and Methods Conventional MRI and axial MERGE images (7 cases) were analyzed and the anteroposterior diameter was measured at C6 vertebral body, and the structure of spinal, extramedullary and subdural space and extradural space were compared. Results The anteroposterior diameter was (5.7±0.6) cm and (4.7±0.5) cm in the neutral position and flexural position (t=-2.95, P<0.05). The“butterfly”shape of spinal grey matter could not be detected in the 4 cases on MERGE with flexural position, which could not demonstrated on the conventional MR images. 2D MERGE was not sensitive for the CSF flow artefacts and the contrast between spinal and surrounding structures was improved. However, the vascular images could not displayed on 2D MERGE images. Conclusion 2D MERGE sequence is better than T1WI and T2WI on sagittal view and T2WI on axial view in the pathological changes of hirayama disease except flow-empty vein sign, thus it has an important role in diagnosing hirayama disease.

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MRI Diagnosis of Intraventricular Meningioma

Peng HU ; Dong CHEN ; Haoyuan DING

Chinese Journal of Medical Imaging.2013;(10):741-744. doi:10.3969/j.issn.1005-5185.2013.10.006

Purpose To investigate the MRI characteristics and differential diagnosis of intraventricular meningioma. Materials and Methods The clinical manifestation and MRI characteristics was retrospectively analyzed in the 11 patients with confirmed intraventricular meningioma by pathology. Results The intraventricular fibrocellular meningioma (7 cases) showed iso- and slightly short T1 signal and short and heterogeneously iso-T2 signal. The syncytial (1 case) and mixed (1 case) miningioma in the fourth ventricle, the syncytial meningioma in the third ventricle, and endothelial meningioma in the septum pellucidum (1 case) all showed slightly long T1 and slightly long T2 signal. Pathology results showed that 7 cases of fibrocellular meningioma in lateral ventricle, 1 case of syncytial meningioma and mixed type in the fourth ventricle, 1 case of syncytial meningioma in the third ventricle, 1 case of endothelial meningioma in septum pellucidum Conclusion The fibrocellular type was commonly encountered for the lateral ventricle meningioma, and hypointensity on T2WI could be regarded as its typical MRI characteristics, and it is diffcult for the differential diagnosis for the other intraventrical meningiomas.

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Non-contrast-enhanced Magnetic Resonance Angiography of the Hepatic Portal Vein at 3.0 Tesla

Feifei YAO ; Jingliang CHENG ; Zitao YANG ; Ying LI ; Guoguo LU

Chinese Journal of Medical Imaging.2013;(11):853-856. doi:10.3969/j.issn.1005-5185.2013.11.016

Purpose To explore the methods of selectively visualizing hepatic portal vein by using three-dimensional fast imaging employing steady state acquisition combined with in-flow inversion recovery labeling pulse at 3.0 Tesla. Materials and Methods Ten healthy volunteers were examined under different TI (1200, 1400, 1600, 1800 ms), and the vessel-to-liver contrast ratio of the main portal vein, right portal vein, and left portal vein were measured. Results Non-contrast-enhanced MRA images of portal vein were obtained successfully in all ten volunteers. The signal intensity of peripheral portal branches gradually increased when TI increased from 1200 ms to 1600 ms, and the highest vessel-to-liver contrast ratio occurred when TI was 1400 ms. Conclusion Non-contrast enhanced magnetic resonance angiography of the hepatic portal vein can be successfully achieved at 3.0T high field MRI. A fixed TI of 1400 ms is preferable.

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Original Data Iterative Reconstruction and Intelligent Optimum Tube Voltage Scanning Technology in Reducing Radiation Dose of Temporal Bone Scanning

Shiping YANG ; Li WU ; Yong WANG ; Dan HAN

Chinese Journal of Medical Imaging.2013;(11):808-811. doi:10.3969/j.issn.1005-5185.2013.003

Purpose To explore the value of low tube voltage, original data iterative reconstruction (SAFIRE) and intelligent optimum tube voltage scanning (CARE kV) technology in reducing radiation dose of high resolution CT (HRCT) temporal bone scanning and its impact on image quality. Materials and Methods Ninety patients with ear problem underwent clinical HRCT scan. All the patients were randomly divided into group A (conventional scanning), group B (CARE kV) and group C (low tube voltage) according to chronological order, with 30 cases in each group. Image quality was double-blind scored by two qualified radiologists. CT value, noise, contrast to noise ratio (CNR), signal to noise ratio (SNR), CT dose index volume (CTDIvol), dose-length product (DLP) and effective dose (ED) were compared among three groups. Results Image quality and the average CT value had no statistical difference among three groups (F=3.70, 3.61;P>0.05);noise, CNR, SNR, CTDIvol, DLP and ED had statistical difference among three groups (F=1.23, 1.42, 2.05, 2.13, 1.79, 1.32; P<0.05). Compared with group B, noise reduced about 14.1%in group C, while CNR and SNR increased about 32.1%and 26.3%, respectively (q=3.64, 3.45, 4.36; P<0.05). CTDIvol, DLP and ED were significantly different between group B and group C (q=3.13, 4.24, 4.24; P<0.05). Conclusion Scanning with low tube voltage, SAFIRE and CARE kV technology not only effectively reduce radiation dose, but also obtain satisfactory image quality. It should be widely utilized.

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Multislice Spiral CT-based Simulation in Enlarging Exposure Extent of Internal Carotid Artery Siphon Before and After Removing Anterior Clinoid

Jiangjun QIN ; Hongxiu XIAO ; Rong TU ; Xiaolu ZHOU ; Qun QIN ; Wei TANG

Chinese Journal of Medical Imaging.2013;(11):801-803. doi:10.3969/j.issn.1005-5185.2013.11.001

Purpose To study the exposure extent of internal carotid artery siphon (ICAS) before and after removing anterior clinoid process (ACP) using multislice spiral CT (MSCT) simulation, and to improve the tumor resection rate and ensure the operation effect. Materials and Methods MSCT three-dimensional images reconstruction simulating supraorbital keyhole approach of 100 patients (200 sides) were observed, the distance between the crotch of anterior cerebral artery and middle cerebral artery and ICAS before and after removing ACP (exposure extent) was measured. Results In 100 patients (200 sides ACP), the exposure extent before and after removing ACP were (14.3±3.9) mm and (30.5±4.2) mm, respectively on the left side with statistical difference (t=45.278, P<0.001), and were (15.9±3.8) mm and (31.8±3.9) mm, respectively on the right side with statistical difference (t=40.513, P<0.001). The exposure extent increased (16.3±3.6) mm and (15.8±3.9) mm, respectively on the left and right side with no statistical difference (t=0.251, P>0.05). Conclusion MSCT simulating supraorbital keyhole approach in removing ACP can effectively increase the exposure length of ICA, and enlarge the exposure extent of sella region, thus provide reliable imaging information for removing tumor and selecting surgical project in this region.

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Three Vessels and Trachea View in Prenatal Diagnosis of Fetal Aortic Arch Abnormalities

Guannan HE ; Jiaxiang YANG ; Lin LIAO

Chinese Journal of Medical Imaging.2013;(10):783-786. doi:10.3969/j.issn.1005-5185.2013.10.018

Purpose To explore the value of three vessels and trachea view in rapid screening of aortic arch malformations. Materials and Methods 51 fetal subjects who were prenatally diagnosed with aortic arch abnormalities were enrolled, and their diagnoses were confirmed by postnatal echocardiography or autopsy results after induction. Targeted fetal cardiac examinations were conducted under obstetric ultrasound examination conditions, ultrasound images were restored and compared with sonographic features of normal aorta. Results Among the 51 fetus cases with aortic arch anomalies, right-oriented aortic arch with left subclavian artery vagus was shown in 17 cases, left-oriented aortic arch with right subclavian artery vagus in 2 cases, double aortic arch in 2 cases, aortic arch disarticulation in 6 cases, and aortic arch coarctation in 24 cases. Diagnostic accuracy of ultrasound was 94.1%. Sonographic changes were displayed in three-vessel or three vessels and trachea view in all cases. Conclusion Three vessels and trachea view plays an important prompt role in ultrasound diagnosis for fetal aortic arch abnormalities. But when it is manifested as the“1oo”sign, it will be rather difficult for the differential diagnosis of aortic arch disarticulation and severe aortic arch coarctation.

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Bedside Ultrasonography for Emergent Patients in the Diagnosis of Vasa Previa and Umbilical Cord Prolapse

Chaofeng GUO ; Yanqing WANG ; Xiaojing WANG ; Jie XUE ; Bai GAO ; Nianzeng SHI

Chinese Journal of Medical Imaging.2013;(10):780-782. doi:10.3969/j.issn.1005-5185.2013.10.017

Purpose To investigate the value of bedside ultrasonography for emergent patients in the diagnosis of vasa previa and umbilical cord prolapse. Materials and Methods The bedside ultrasonography data of 12 emergent cases of vasa previa and 18 emergent cases of umbilical cord prolapse were retrospectively analyzed for detection rate. Results Nine out of 12 emergent patients with vasa previa were detected by bedside ultrasonography;2 were misdiagnosed as umbilical cord prolapsed;and 1 patient who had missed diagnosis suffered fetal demise during vaginal labour. Fifteen out of 18 emergent patients with umbilical cord prolapse were detected by bedside ultrasonography;2 were misdiagnosed as vasa previa; and 1 missed diagnosis (no death case was reported). The detection rates for both groups of patients had no significant difference (P>0.05). Conclusion Bedside ultrasonography for emergent patients can visualize the traveling of vasa previa and umbilical cord prolapse so as to promptly provide evidence for clinical diagnosis and reduce perinatal mortality.

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