Differentiation of hypovascular pancreatic neuroendocrine tumors and mass-forming pancreatitis by enhanced CT / 医学研究生学报

ObjectiveTo explore the value of MSCT for differentiating the hypovascular pancreatic neuroendocrine tumors (Hypo-PNETs) from mass-forming pancreatitis.Methods21 patients with histological-confirmed MPFs and 19 patients with Hypo-PNETs who underwent preoperative dynamic contrast-enhanced CT were included. The CT images were analyzed including tumor size,density, border, CT values in each phase, dilatation of pancreatic duct and bile duct and metastases. The clinical data included age, sex and clinical symptoms.ResultsMFPs often occurred in male patient compared with Hypo-PNETs (85.7% vs 52.6%, P<0.05), and the difference is statistically significant; Metastases only occurred in Hypo-PNETs (P<0.05), and the difference is drastically significant. The well-defined margin often occurred in Hypo-PNETs (52.4% vs 47.6%, P=0.032). Solid tumor more happened in MFPs(95.2% vs 47.4%, P＜0.05). The CT values in the portal of MFPs were higher than Hypo-PNETs(P<0.05). The combined features showed accepted diagnostic performance for differentiating Hypo-PNETs from MFPs (89.5% of sensitivity and 95.2% of specificity).ConclusionMFPs often occurred in male patient, and CT values of portal phase, density, border and metastases may be valuable for differentiating Hypo-PNETs from MFPs.

Imaging diagnosis of 52 cases of sclerosing pneumocytoma / 医学研究生学报

Objective Sclerosing pneumocytoma (SP) is a rare benign tumor of the lung. This study investigates the CT and PET/CT features of 52 patients with sclerosing pneumocytoma (SP), summarizes their imaging features and provide reference for improving the accuracy of SP imaging diagnosis.Methods The clinical and imaging data of 52 patients with SP confirmed by operation and pathology in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine and the First Affiliated Hospital of Nanjing Medical University from January 2010 to March 2018 were analyzed retrospectively，and the imaging features of the disease were analyzed and summarized. Among 52 SP patients, 46 were female and 6 were male, with an average of 50.7±12.6 years old.Results ①Morphological characteristics: all were round or round-shaped solitary nodules or masses in the lung. The average diameter of the tumor was 22.2±15.4 mm. 39 lesions had smooth edges and 13 had shallow edge lobulation sign; ②Predilection sites: 33 of the cases were closely attached to or adjacent to the pleura, and there was no preponderant distribution of the lobe; ③Density: The density of the lesion was homogeneous. 8 cases had coarse calcifications at the edges or in the lesions; ④Enhancement features: 26 cases showed moderate to marked enhancement, only 6 cases were mild enhancement; ⑤Features around the tumor: "vascular adhering sign" in 21 cases, "tail sign" in 7 cases, "air crescent sign " in 5 cases, "localized emphysema" in 4 cases, "halo sign" in 11 cases, "bird egg-bird nest sign" in 5 cases, 4 cases of secondary bronchiectasis; ⑥Associated tumors: 3 cases of invasive lung adenocarcinoma, 3 cases of lung adenocarcinoma in situ, 2 cases of pulmonary atypical adenomatous hyperplasia, 1 case of pulmonary tiny inflammatory nodule; 2 cases of esophageal cancer associated, 1 case of invasive thymoma, 1 case of large mature ovarian cystic teratoma; ⑦PET/CT characteristics: 18F-FDG standard uptake value in tumor increased to different degrees, the average of SUV max value was 4.4±3.2.Conclusion The innovation of this research: SP is shown as solitary circular or circular-shaped blood-rich nodules in the lung, often under the pleura, especially the mediastinal pleura and lobar pleura. There is no lobar distribution advantage; SP calcification is uncommon, among which the calcification at the margin of the tumor was more common. "Air crescent sign", " Halo sign" and " Bird egg-bird nest sign" have high diagnostic value for SP.

Assessment of the diagnostic value of CT and X-ray enterography for small intestinal Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the value of CT and X-ray enterography in the diagnosis of small intestinal Crohn disease(CD).</p><p><b>METHODS</b>Data of 39 CD cases confirmed by surgery and pathology who underwent CT and X-ray enterography were analyzed retrospectively. All the patients had complete CT data, 28 cases had X-ray intestinal barium meal data, and 18 had sinus tract enterography.</p><p><b>RESULTS</b>CT enterography showed mural thickening(>4 mm) in 34(87.2%) patients, mural gas in 7(17.9%), mural edema in 7(17.9%), mural fat in 4(10.3%), increased enhancement of bowel wall(>10 HU) in 37(94.9%), multiple segmental lesions in 33(84.6%), single segmental lesions in 6(15.4%), mesenteric lymphadenopathy(>5 mm) in 13(33.3%), vascular bundle thickening in 9(23.1%), cellulitis in 12(30.8%), peritoneal abscess in 10(25.6%), phlegmon in 8(20.5%), incomplete intestinal obstruction in 14(35.9%), seroperitoneum in 22(56.4%), and fistulization in 4(10.3%). CT enterography did not demonstrate the change of mucosa such as strip ulcer or cobblestone. Among the 28 cases of small bowel X-ray enterography, 23 cases(82.1%) presented with multiple segmental lesions, 5(17.9%) with single segmental lesions, 18(64.3%) with strip ulcer, 16(57.1%) with cobblestones, 4(14.3%) with intestinal fistula, while no bowel wall and extraintestinal complication of CD disease was observed. Among the 18 cases of sinus tract enterography, 13 cases (72.2%) presented with intestinal fistula, 12(66.7%) with peritoneal abscess, 8(44.4%) with sinus tract.</p><p><b>CONCLUSIONS</b>CT enterography can demonstrate exactly the diseased bowel wall and extraintestinal complication of CD disease, which is important to evaluate the extent of CD and guide the treatment, however strip ulcer and cobblestone sign cannot be demonstrated. The X-ray enterography is available to demonstrate the characteristic changes of CD such as trip ulcers and cobblestones, but is difficult to show the bowel wall and extraintestinal inflammatory mass and abscesses. The sinus tract enterography is easy to demonstrate the intestinal fistula and intra-abdominal abscess. Combination of these methods is more beneficial to guild the diagnosis and treatment.</p>

Dual-energy computed tomography angiography for evaluating the renal vascular variants / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recognizing renal vascular variants preoperatively is important in order to avoid vascular complications during surgery. This study aimed to investigate the renal vascular variants with dual-energy computed tomography (DECT) angiography to provide valuable information for surgery.</p><p><b>METHODS</b>A total of 378 patients underwent DECT. The number, size, course and relationships of the renal vessels were retrospectively observed from the scans. Anomalies of renal arteries and veins were recorded and classified. Multiplanar reformations (MPR), maximum intensity projections (MIP), and volume renderings (VR) were used for analysis.</p><p><b>RESULTS</b>In 378 patients (756 kidneys), renal artery variations were discovered and recorded in 123 kidneys (16.3%, 123/756) of 106 patients (28.0%, 106/378). Type IB (early branches of the only one main renal artery) and IC (accessory renal artery with only one main renal artery) were found most frequently with an incidence of 11.4% (43/378) and 14.5% (55/378). The incidence of renal artery variations in the left kidney was not statistically different than in the right kidney (12.4% vs. 11.1%). The incidence of renal vein variations was detected in 104 patients (27.5%, 104/378). The incidence of venous variants in the right kidney was higher than in the left kidney (20.1% vs. 7.4%), but left renal vein variations were more complex. Variants of the left renal vein were detected in 28 patients including type 1 (circumaortic left renal vein) in eight cases, type 2 (retroaortic left renal vein) in seven cases, type 3 (abnormal reflux) in six cases, type 4 (late venous confluence of left renal vein) in five cases, and type 5 (rare type) in two cases. The frequency of left renal vein variation associated with the left renal accessory artery was significantly higher than with early branches of the left renal artery (P = 0.037).</p><p><b>CONCLUSIONS</b>The renal vascular variants are rather common and complex. DECT angiography can demonstrate the precise anatomy of the renal vessels, which is a benefit for renal transplantation or other renal operations.</p>

A new study on diffusion tensor imaging of the whole visual pathway fiber bundle and clinical application / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>With conventional imaging methods only the morphous of the visual nerve fiber bundles can be demonstrated, while the earlier period functional changes can not be demonstrated. We hypothesized that diffusion tensor imaging (DTI) would demonstrated the whole optic never fiber bundle and visual pathway and the earlier period functional changes. The purpose of the present study was to evaluate the application of DTI technique in the demonstration of the whole optic never fiber bundle and visual pathway, and the influence of orbital tumors on them.</p><p><b>METHODS</b>GE 1.5 T signa HD MR System, and the software package DTV2 were adopted. The total 45 subjects were enrolled, including 15 volunteers and 30 patients. All patients had ocular proptosis from minor to major. Seven patients had visual acuity decrescence.</p><p><b>RESULTS</b>The nerve fiber bundles, e.g. optic chiasma, optic tract and optic radiation in posterior visual pathway were well demonstrated in all cases. Wherein, the intact whole visual pathway fiber bundles were clearly revealed in 10 volunteers and 17 patients, and optic nerve was not wholly revealed in the rest of the subjects. Shift of optic nerve caused by compression and partial deformation were seen in 7 patients with orbital tumor. In 6 of 7 patients, DTI displayed significant abscise and deformation of visual nerve. Chi-square test indicated significant correlation between visual acuity decrescence and DTI visual nerve non-display.</p><p><b>CONCLUSIONS</b>Visual nerve fiber bundles and the whole visual pathway were visualized in most of patients with DTI. It might be an effective method of providing imaging evidence for visual nerve fiber earlier period functional changes, and laid a foundation for the study in other cranial nerves.</p>

Treatment experience of severe acute pancreatitis on 1033 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summary the treatment experience of severe acute pancreatitis (SAP).</p><p><b>METHODS</b>From January 1997 to March 2009, a total of 1033 patients suffered SAP were admitted with a mean APACHE II score 12.0 +/- 4.3. There were 622 males and 411 females, aged from 13 to 98 years old. All patients were cared by the multidisciplinary team with intensivist, endoscopists, gastroenterologists, radiologist, nephrologist and surgeons.Patients treated in SICU in the early phase of the disease. In these 1033 patients, 365 cases received mechanical ventilation, 218 with tracheotomy, 159 cases received high-volume continuous venovenous hemofiltration (CVVH), 179 received nasobiliary drainage, 513 were treated with early enteral nutrition. CT-guided percutaneous catheter drainge for peripancreatic fluid collection was pefromed for 477 times and 438 patients received surgical debridement for infected pancreatic necrosis.</p><p><b>RESULTS</b>In all these 1033 cases, 975 patients (94.4%) survived, and 38 patients died (3.7%). The mortality of patients who received surgical debridement for infected pancreatic necrosis was 7.1% (31/438).</p><p><b>CONCLUSION</b>The muti-discipline management of severe acute pancreatitis can remarkably improve the prognosis of patients.</p>

Beneficial effects of hydrocortisone in induced acute pancreatitis of rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Little is known of the effects of hydrocortisone on cell adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) and its counterreceptors (LFA-1, Mac-1) in acute pancreatitis (AP). We investigated the effects of prior treatment with hydrocortisone on the production of ICAM-1 and its counterreceptors (LFA-1 and Mac-1) in AP of rats to clarify the effect of hydrocortisone on induced acute pancreatitis.</p><p><b>METHODS</b>Acute pancreatitis was induced by infusion of 5% chenodeoxycholic acid into the pancreatic duct, followed by ligation of pancreatic duct. Before induction of acute pancreatitis, rats were treated with hydrocortisone (n = 20) or 0.9% saline (n = 20). Blood and specimens from pancreas and lung were obtained from 5 rats from each treatment euthanized at 1 hour or 3 hours, 6 hours, 12 hours. Expression of ICAM-1 was assessed by immunohistochemistry and Western blot analysis of pancreas and lungs. The expression of LFA-1 and Mac-1 on neutrophils was detected by flow cytometer. The therapeutic effect of hydrocortisone was assessed from injuries to pancreas and lung.</p><p><b>RESULTS</b>ICAM-1 expression in the pancreas of hydrocortisone group was significantly less than in control group at 3 hours and 6 hours. In the lungs of hydrocortisone group, ICAM-1 expression was significantly less than in control group at 3 hours, 6 hours and 12 hours. The expression of LFA-1 and Mac-1 on neutrophils in blood increased significantly in control group over hydrocortisone group. Increased expression of ICAM-1, LFA-1 and Mac-1 preceded leukocyte infiltration. Compared to untreated animals with acute pancreatitis, rats pretreated with hydrocortisone had significantly reduced histological lung injury and output of ascitic fluid.</p><p><b>CONCLUSIONS</b>Prior treatment with hydrocortisone before the induction of acute pancreatitis ameliorates pulmonary injury and the output of ascitic fluid and reduces the expression of ICAM-1 and its counterreceptors (LFA-1, Mac-1) in acute pancreatitis.</p>

MR diffusion-weighted imaging in differential diagnosis of intracranial cystic lesions / 中华放射学杂志

Objective To evaluate the value of diffusion-weighted imaging(DWI)on differential diagnosis of intracranial cystic lesions.Methods Seventy-six patients with surgically and pathologically confirmed intracranial cystic lesions undergone conventional MRI,DWI and contrast enhanced MRI examination.The signal characteristics of intracrania]cystic lesions on DWI were analysed retrospectively, the apparent diffusion coefficient(ADC)values of cystic areas were measured quantitatively.Results Nineteen brain abscesses showed hyperintense signal on DWI.Among 34 brain tumors,3 brain gliomas were hyperintense signal,1 brain glioma was isointense signal and 1 metastasis was hyperintense signal;the other 29 brain tumors showed hypointense signal on DWI.The ADC values of all lesions were:(0.62?0.15)? 10~(-3)mm~2/s in brain abscesses,(2.39?0.78)?10~(-3)mm~2/s in brain gliomas,(2.68?0.40)? 10~(-3)mm~2/s in brain hemangioblastomas,(2.79?0.79)?10~(-3)mm~2/s in brain metastases,respectively. There were significant differences between the ADC values of brain abscess and the cystic or necrotic portions of brain glioma,hemangioblastoma,metastasis(P0.05). Seven intracranial arachnoid cysts showed hypointense signal and 16 epidermoid cysts strikingly hyperintense signal on DWI.The ADC values of arachnoid cysts and epidermoid cysts were(2.96?0.36)?10~(-3)mm~2/s and(0.94?0.13)?10~(-3)mm~2/s respectively.There was significant difference between the ADC values of arachnoid cysts and epidermoid cysts(P