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Objective:To investigate the clinical and imaging characteristics of liver density changes in patients with initial-treated drug-sensitive secondary tuberculosis during standardized treatment and after withdrawal when cured.Methods:A retrospective analysis was conducted of 34 patients with initial-treated drug sensitive pulmonary tuberculosis in Beijing Chest Hospital of Capital Medical University and the First Affiliated Hospital of Xinxiang Medical University from January 2014 to April 2019. The chest computed tomography (CT) examination and sputum culture were performed before treatment. The patients received the standardized treatment and they were divided into three groups according to the course of treatment (three, nine and 12 months). Liver density and liver function were followed up during treatment (three, six, nine and 12 months) and after drug withdrawal (3, 6 and 12 months). The measurement data were analyzed by t-test. Results:The average liver density of these three groups gradually decreased during the treatment period, and gradually increased after drug withdrawal. There were five and nine cases of fatty liver occurred at three and six months of treatment in the six-month treatment group, respectively; and six, two and zero cases of fatty liver occurred at three, six, and 12 months after drug withdrawal, respectively. There were four, eight and 11 cases of fatty liver occurred at three, six, and nine months of treatment in the nine-month treatment group, respectively; and seven, two and zero cases occurred at three, six, and 12 months after drug withdrawal, respectively.There were five, 10, 14 and 14 cases of fatty liver occurred at three, six, nine and 12 months of treatment in the 12-month treatment group, respectively; and 12, 10 and five cases occurred at three, six, and 12 months after drug withdrawal, respectively. During the course of treatment, the density of livers of some cases decreased unevenly, and the density of right lobe of the liver was lower than the left lobe. The density of left lobe of the liver was (49.8±4.0) HU, (45.0±3.9) HU, (37.0±9.9) HU, (45.3±8.1) HU, (48.4±6.6) HU at the treatment of six, nine and 12 months and drug withdrawal of three and six months, and the density of right lobe of the liver was (44.0±6.1) HU, (37.2±7.7) HU, (25.5±15.8) HU, (38.5±11.7) HU, (43.8±9.9) HU, the differences were statistically significant ( t=4.611, 4.512, 2.307, 2.803 and 2.291, respectively, all P<0.05), while those were not statistically significant among three months of treatment and 12 months after drug withdrawal ( t=1.573 and 1.199, respectively, both P>0.05). There were two cases showed alanine aminotransferase (ALT) and aspartate amiotransferase (AST) accompanied elevated (ALT>2×upper limits of normal (ULN), AST<2×ULN) at three and six months of treatment, with no abnormalities detected of alkaline phosphatase (ALP) and total bilirubin (TBil). Conclusions:The liver density gradually decreases and uneven fatty liver could appear during anti-tuberculosis treatment, but it gradually returns to normal or relieves after drug withdrawal. The degree of fatty liver is not synchronized with the changes of liver function indexes (ALT, AST, ALP and TBil), which belongs to chronic reversible injury.
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Objective To explore the features of multi-slice spiral computed tomography (MSCT) examination of indirect,direct and femoral inguinal hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 106 patients with indirect,direct and femoral inguinal hernia who were admitted to the First Affiliated Hospital of Xinxiang Medical University between December 2014 and August 2017 were collected.All the patients were diagnosed as inguinal hernia by MSCT examination and multi-planar reconstruction.Observation indicators:(1) sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT;(2) inguinal anatomic presentation in MSCT examination;(3) relationship between hernial sac and surrounding structures in MSCT examination;(4) hernia contents and quadrants of hernial sac in the quadrant partition with " cross intersect" method and complications.Count data were described as absolute number or percentage.Comparison of count data was done using the chi-square test with row multiplied by column.Results (1) Sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT:of 106 patients,66,22 and 18 were diagnosed as indirect hernia,direct hernia and femoral hernia with 70,27 and 20 hernial sacs respectively.Sensitivity,specificity,positive and negative predictive values of inguinal hernia by MSCT were respectively 95.7％,96.3％,98.5％,89.7％ in indirect hernia patients and 96.3％,95.7％,89.7％,98.5％ in direct hernia patients and 100.0％,100.0％,100.0％,100.0％ in femoral hernia patients,and diagnostic accordance rate of femoral hernia was also 100.0％.Diagnostic accordance rate of inguinal hernia was 95.9％,and correct index was 0.920.(2) Inguinal anatomic presentation in MSCT examination:transverse,coronal and sagittal imagings of inferior epigastric artery,inguinal ligament,musculus rectus abdominis,femoral vein and other anatomic structures can be identified,and internal ring of inguinal canal of 6 patients cannot be observed clearly.For relationship between internal ring of inguinal canal and inferior epigastric artery,coronal view was the best,transverse view was the next,and sagittal view was rarely observed.For relationship between inguinal ligament and hernial sac,sagittal view was the best,coronal view was also observed clearly by continuous planes,and transverse view was poor.The oblique coronal view was the best for the direct hernial triangle and internal ring of inguinal canal,and coronal view of femoral triangle was the best.The lateral crescent sign and quadrant partition of "ross intersect" method needed to be observed in transverse plane.(3) Relationship between hernial sac and surrounding structures in MSCT examination:indirect hernia entered into the inguinal canal through internal ring of inguinal canal,and hernial sac was located at the outside of inferior epigastric artery;direct hernia was out through triangle hernia,and hernial sac was located at the inside of inferior epigastric artery,92.6％ (25/27) patients were accompanied by lateral crescent sign.The indirect hernia and direct hernia went along the upper front of inguinal ligament;femoral hernia was out through femoral triangle hernia,and hernial sac was located at the lower back of inguinal ligament and the outside of the pubic tubercle.(4) The hernia contents and quadrants of hernial sac in the quadrant partition with "cross intersect" method and complications:the most common hernia content was small intestine,including partial patients with hernia content composed of various substances;indirect hernia contents included small intestine (35),mesentery (29),effusion (25),intraabdominal fat (9),colon (8) and ovary (1) in turn;direct hernia contents included small intestine (14),intraabdominal fat (11),effusion (6),mesentery (6),colon (3) and bladder (2) in turn;femoral hernia contents included small intestine (12),intraabdominal fat (8),effusion (3) and mesentery (2) in turn.There was a statistically significant difference in the hernia contents among indirect hernia,direct hernia and femoral hernia (x2=28.389,P＜0.05).The main hernial sac located at antero-external quadrant was respectively occurred in 70 hernial sacs of indirect hernia and 27 hernial sacs of direct hernia and 15 hernial sacs of femoral hernia,and 5 hernial sacs of femoral hernia were located at postero-external quadrant.There was a statistically significant difference in comparison of the quadrant partition with "cross intersect" method (x2 =78.904,P ＜ 0.05).The intestinal obstruction was respectively occurred in 8 patients with indirect hernia and 14 patients with direct hernia and 12 patients with femoral hernia,with a statistically significant difference (x2=26.674,P＜0.05).Conclusions Indirect hernia,direct hernia and femoral hernia have characteristic signs of imaging.MSCT can display precisely the anatomical details of inguinal region,which plays an important role in diagnosis and differential diagnosis of indirect hernia,direct hernia and femoral hernia,especially in display of hernia contents and diagnosis of complications,thus it can provide important information for evaluating risk and making operation plan.
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Objective To investigate the correlation between tumor perfusion parameters and tumor volume and Child-Pugh classification in CT of hepatocellular carcinoma (HCC).Methods Fifty-six patients with hepatocellular carcinoma were selected to perform CT perfusion imaging.The parameters of the total tumor perfusion such as hepatic artery perfusion (HAP),portal vein perfusion (PVP)and hepatic perfusion index (HAPI)were calculated according to the degree of hepatic encephalopathy,albumin,bilirubin, clotting time,ascites for liver Child-Pugh classification.The relationship between the tumor or peritumoral perfusion parameters with tumor volume and Child-Pugh classification were analyzed.Results (1)There was no correlation between tumor or peritumoral perfusion with the tumor volume.(2)The difference of HAP,PVP and HAPI between the different Child-Pugh classification groups was statistically significant (P<0.000 1).(3)With the reduction of Child-Pugh classification,the tumor body HAP and HAPI values gradually decreased, while the PVP value increased gradually.Conclusion There is no correlation between the tumor volume of hepatocellular carcinoma with total tumor perfusion parameters.The differences in perfusion measurements between different Child-Pugh classification can intuitively and quantitatively reflect the reserve function of the liver.
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Objecfive To observe the changes of regional cerebral blood flow (rCBF) in systemic lupus erythematosus (SLE) patients with neuropsychiatrie disorders and evaluate rCBF SPECT imaging in the detection of neuropsychiatric problems in SLE patients.Methods Twenty neuropsychiatrie SLE patients were enrolled in the study and were performed SPECT rCBF imaging anti CT/MRI scans,respectively.Twenty SLE patients without neuropsychiatrie manifestatiuns (SLE) and 20 healthy volunteers also underwent SPECT rCBF imaging as controls.Semiquantitative analysis was conducted as designed by selecting 3 consecutive crosssections and delineating ROI,which generated HQ and the results were compared between with SLE and controls.Results SPECT rCBF findings were almormal in 20 NPSLE.in which 19 of the 20 with abnormal SPECT findings showed focal uptake defects the other patient showed increased foeal uptake.Four N PSLE patients had ahnormal CT/MRI scans findings.Compared with the methods of rCBF and CT/MRI imaging,the difference was significant (P＜0.01).Nineteen SLE patients without neuropsychiatrie manifestations had normal SPECT findings.the other 1 patient showed focal uptake defect.SPECT findings were all normal in 20 healthy volunteers.Temporal cortex was the most commonly involved region,followed by frontal cortex.Specific values generated from semiquantitative analysis (HQ) of temporal and frontal regions in neruopsychiatrie SLE patients were lower than that in SLE patients and healthy volunteers (P＜0.01 and P＜0.05).Conclusion SPECT rCBF imaging has the potential to be a sensitive tool to detect the neuropsyehiatric disordersin SLE patients,and has important value in helping for early diagnosis and therapy.Hypoperfusion on ECD-SPECT under the territory of the middle cerebral artery (MCA) is the most common observation,and which temporal and frontal regions are the most frequently involved regions in neruopsychiatrie SLE patients.
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Objective To determine the diagnostic value of SPECT in lower digestive tract hemorrhage (LDTH). Methods Of the 24 LDTH cases,16 were tested by gastric mucosa imaging ,4 by 99m Tc PHA imaging,and the other 4 by 99m Tc RBC imaging.All the patients' diagnosis were confirmed by surgery and pathology. Results The sensitivity and the specificity of the gastric mucosa imaging were 100%(16/16) and 93.7%(15/16),respectively. The sensitivity of the 99m Tc PHA imaging and the 99m Tc RBC imaging was 75.0%(3/4) and 75.0 %(3/4), respectively, but had no specificity. Conclusions SPECT has very high sensitivity and specificity in the diagnosis of Meckel's diverticulum. 99m Tc PHA imaging and 99m Tc RBC imaging may help to determine the position of bleeding in unkown causes of LDTH.