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Objective To investigate the CT diagnostic value of small bowel wall thickness and density in differentiating simple small bowel obstruction (SI) from strangulative small bowel obstruction (ST).Methods Fifty-three cases with thickened small bowel wall (thickness ＞ 3 mm) confirmed on CT scan were reviewed,including 27 cases of SI and 26 cases of ST,in conjunction with their proven intraoperational,pathological and clinical findings.Of the 53 cases,35 cases also underwent postcontrast CT scan.CT manifestations of relationships between thickened small bowel wall and its density were classified as normal,higher or lower density in tunica mucosa of small bowel wall,higher or lower density in full thickness of small bowel wall for exploring the differential diagnostic features between SI and ST on CT scan.Chi-square or Fisher exact test were used to test the proportion difference of CT scan between SI and ST.Results In cases with normal density in tunica mucosa (NDTM) on precontrast CT,there were 21 cases of SI and 6 cases of ST(x2 =15.859,P ＜0.01).However,in cases with NDTM on postcontrast CT,there were 13 cases of SI and 5 cases of ST,and there was no significant difference (x2 =1.377,P ＞ 0.05).Thus,NDTM showed no convincing value in differentiating SI from ST.In cases with lower density in tunica mucosa (LDTM) on precontrast CT,there were 4 cases of SI and 5 cases of ST (P ＞ 0.05).In cases with LDTM on postcontrast CT,there were 4 cases of SI and 4 cases of ST (P ＞ 0.05).Thus,LDTM also showed no value in differentiating SI from ST.The lower density in full thickness of small bowel wall (LDFTS) was revealed in 0 of SI and 10 cases of ST on precontrast CT (P ＜ 0.01),and 0 of SI and 5 cases of ST on postcontrast CT (P ＜ 0.01),indicating that LDFTS showed significant value in differentiating SI from ST.Conclusion Combining the small bowel wall thickness and density,CT manifestations of early bowel wall pathological changes in small bowel obstruction can be acquired,adding some value in the differential diagnosis between SI and ST.
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Objective To investigate the value of CT and endoscopic ultrasonography (EUS) in the diagnosis of gastrointestinal stromal tumors (GIST). Methods Eleven patients with surgically and pathologically proved GIST were collected and retrospectively analyzed.Plain CT scanning was performed in all 11 cases and enhancement in 10 cases, while additional EUS in 8 cases.Results Of the 11 lesions, 8 were located in stomach, 1 in esophagus, 1 in duodenum, and 1 in rectum, respectively.In benign GIST, the diameter of the tumor was less than 5 cm, with clear margin and homogeneous density.In malignant GIST, the characteristic appearances were as follows: (1) The diameter of the tumor was more than 7 cm; (2) The tumor was lobular in shape; (3) Lesions contained intratumoral small or large patchy necrosis; (4) The tumor had large and deep ulcers; (5) Around the tumor, small vessels arranged in clumps or in line; (6) The tumor contained scattered small calcifications; (7) Invasion of adjacent tissues and metastasis.The positive predictive value of CT for location of GIST was 54.5% (6/11), the positive predictive value of EUS was 87.5% (7/8).By pathology, benign GIST was identified in 3 cases, malignant in 7 cases, and active proliferation in 1 case.The positive predictive value of CT for differentiation of benign and malignant GIST was 72.7% (8/11), the positive predictive value of EUS was 62.5% (5/8).Conclusion CT combined with EUS are helpful in evaluating the gastrointestinal origin of GIST, and in differentiating between benign and malignant GIST, and in instructing clinical treatment and estimating prognosis.
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Objective To study the helical CT dual-phase feature of peripheral enhancement in small hepatocellular carcinoma (SHCC) and to evaluate its correlation with the histopathology. Methods The helical CT dual-phase feature of peripheral enhancement in SHCC was analyzed in 17 cases with 18 lesions, all the lesions were confirmed by operation and histopathology. Results In 17 lesions, peripheral enhancement ring of the lesions wasn′t intact, the thickness of peripheral enhancement ring wasn′t uniform, and small nodular enhancement was found inside the peripheral enhancement ring in hepatic arterial phase (HAP). In 1 lesion, the peripheral enhancement ring of the lesion was intact and the thickness of peripheral enhancement ring was uniform in HAP. The density of the peripheral enhancement ring and the small nodular enhancement decreased to hypodense or isodense than the normal liver parenchyma in portal venous phase. Pathologic pattern: 16 lesions were trabecular type and 2 lesions were scirrhous type. The differentiation of the tumor cell was grade I in 2 lesions, grade Ⅱ in 14 lesions, grade Ⅲ in 1 lesion, and grade Ⅳ in 1 lesion, respectively. In 12 lesions, the vessels were richer in the lesion border than that in the lesion center. In 6 lesions, the vessels were less rich in both center and border. In 3 lesions, the pseudo-capsule was showed in the border of the lesion. In 10 lesions, the flecks of necrosis were demonstrated in the border and/or center of the lesion. Conclusion The helical CT dual-phase feature of peripheral enhancement in SHCC is characteristic, and SHCC might be distinguished from other hepatic diseases with peripheral enhancement.
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Objective To study the helical CT signs of the hepatocellular carcinoma (HCC) after percutaneous microwave coagulation therapy (PMCT) and to evaluate the correlation between the helical CT signs and the therapeutic effect of HCC. Methods The helical CT signs were analyzed in 22 cases with 26 lesions of the hepatocellular carcinoma that were treated with PMCT under ultrasonic guidance. Results In 21 lesions, no enhancement was detected in the lesion border or inside the lesion at hepatic arterial phase (HAP) and portal venous phase (PVP). In 7 lesions, the slight or marked patchy enhancement was revealed in the surrounding liver of the lesions in HAP. In 5 lesions, nodular enhancement was found in the lesion border or inside the lesion in HAP. Conclusion The dual-phase helical CT might be accurate in judging the therapeutic effect of HCC after PMCT. If no enhancement was showed in the lesions in the dual-phase helical CT, it indicated that no tumor survived. If slight or marked patchy pattern enhancement was revealed in the surrounding liver of the lesions in HAP, it was a normal reaction after PMCT. If nodular enhancement was found in the lesion border or inside the lesion in HAP, it indicated that the tumor partially survived.
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Objective To improve imaging diagnosis of Wegener granulomatosis.Methods Ten cases with Wegener granulomatosis were collected and their imaging findings were analyzed retrospectively.Results Eight cases presented sinusitis. CT showed mucosa thicken, accompanied with the destruction of middle-line structure in 3 cases and orbit mass in 2 cases. Seven cases involved lungs. Pulmonary imaging were complicated, showing multiple nodules or masses in 3 cases and multiple variable signs in the others. One case showed left upper bronchus obstruction. Conclusion Imaging of Wegener granulomatosis is complicated. Wegener granulomatosis should be diagnosed accompanied with clinical and pathologic findings.
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Objective To study the helical CT dual-phase enhancement manifestation of the hypodense small hepatocellular carcinoma, and to evaluate its correlation with the histopathology. Methods The CT signs and its histopathologic changes were analyzed in 25 cases with 27 hypodense lesions in helical CT dual-phase enhancement. All the lesions were confirmed as small hepatocellular carcinoma by operation and histopathology. Results (1) On unenhanced scan, 16 lesions were with obscure borders and 11 lesions were with well-delineated borders. On enhanced scan, only 7 lesions were with obscure borders and the other 20 lesions were with well-delineated borders, and their contours were slightly irregular. (2) On unenhanced scan, 18 lesions showed homogeneous hypodensity and 9 lesions showed heterogeneous hypodensity. On enhanced scan, only 6 lesions showed homogeneous hypodensity and the other 21 lesions showed heterogeneous hypodensity with multiple flecks of more hypodense areas. Conclusion The helical CT dual-phase enhancement characteristic manifestations of hypodense small hepatocellular carcinoma were as follows: the border of the lesion was obscure on unenhanced scan, however the border of the lesion became well-delineated and slightly irregular, and there were multiple flecks of more hypodense areas in the lesions after enhancement. This might be an important character in distinguishing hypodense small hepatocellular carcinoma from other hypodense diseases in the liver.