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Objective:To summarize the CT imaging features of obturator hernia.Methods:From July 2009 to May 2019, the clinical and CT imaging features of 26 cases with obturator hernia diagnosed by multi-slice spiral CT(MSCT) were retrospectively analyzed.The locations of hernia sac, contents of hernia and intestinal obstruction were observed by multi-planer reconstructions(MPR).Results:There were 5 cases of bilateral obturator hernia, 9 cases of right obturator hernia and 12 cases of left obturator hernia.The contents of hernia were small intestine in 19 cases, mesentery in 9 cases and bladder in 5 cases.There were 3 cases of bilateral small intestine obturator hernia, 7 cases of right and 9 cases of left small intestine obturator hernia, presented with abruptly collapse and narrowing of small intestinal cavity at the entrance of obturator canal.The small intestine was herniated between the external obturator muscle and the pubic muscle and adductor brevis, between the upper and lower bundles of external obturator muscle and the internal obturator muscle and superior pubic sulcus.There were 15 cases of small intestinal obstruction, including 9 cases of incarcerated small intestinal obstruction and 6 cases of strangulated small intestinal obstruction, of which 15 cases presented with small intestinal effusion, 3 cases with a little accumulation of gas, 14 cases with small intestinal wall edema and 2 cases with intestinal wall defect.The dilatation effusion and pneumatosis could be found in the proximal small intestine, of which 14 cases with gas-liquid level, 12 cases with small intestinal wall edema and mesenteric edema.There were 4 cases of bilateral mesenteric obturator hernia, 2 cases of right mesenteric obturator hernia and 3 cases of left mesenteric obturator hernia.There were 2 cases of right mild bladder obturator hernia and 3 cases of left mild bladder obturator hernia, presented with cystic water-like density at the entrance of obturator canal.Conclusion:MSCT reconstruction can intuitively display imaging features of obturator hernia, which has a rather high diagnostic value for small intestinal ischemic, necrosis and perforation.
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Objective@#To assess the enhancement characteristics of plaques in patients with intracranial atherosclerotic stenosis using three-dimensional high-resolution magnetic resonance imaging (3D HR MRI), and to analyze the correlation between the enhancement characteristics of plaques and the time from onset of stroke symptoms to MRI examination.@*Methods@#The enhancement characteristics of plaques were retrospectively analyzed in 61 patients with cerebral infarction who were scanned in MRI room of the Affiliated Hospital of Yangzhou University from January 2014 to January 2016. According to the elapsed time between symptom onset and MR examination, 61 patients were classified into early stage group (<4 weeks, n=26), middle stage group (4-12 weeks, n=20) and late stage group (>12 weeks, n=15). All cases underwent three-dimensional sampling perfection with application optimized contrast using different angle evolutions (3D-SPACE) T1WI and enhanced 3D-SPACE T1WI sequence scans, as well as routine head MRI examinations. The signal intensities of plaques before and after enhancement scanning were compared on the 3D-SPACE T1WI sequence. The degrees of plaque enhancement were qualitatively analyzed, and the enhancement rates of plaques were quantitatively calculated. The correlation between the enhancement characteristics of plaques and time of symptom onset of stroke was analyzed.@*Results@#Sixty-one intracranial atherosclerotic plaques on the 3D HR MRI showed eccentric thickening or annular thickening of the vessel wall, and slightly higher signals on the T1WI. They showed different degrees of enhancement or no enhancement after enhancement scans. The characteristics of plaque enhancement in 61 patients with cerebral infarction were analyzed. The results showed that 26 plaques in the early stage group were obviously enhanced for 21 cases (80.8%), mildly enhanced for 4 cases (15.4%), no enhancement for 1 case (3.8%), and the enhancement rate was 80.49%±18.64%. Twenty plaques in the middle stage group were obviously enhanced for 2 cases (10.0%), mildly enhanced for 14 cases (70.0%), no enhancement for 4 cases (20.0%), and the enhancement rate was 52.09%±18.17%. Fifteen plaques in the late stage group were mildly enhanced for 2 cases (2/15), no enhancement for 13 cases (13/15), and the enhancement rate was 12.16%±10.44%. There were statistically significant differences in the degrees of plaque enhancement and plaque enhancement rates among the three groups (χ2=22.834, P<0.01; F=78.403, P<0.01). Further analysis showed that there was a statistically significant difference in the degree of enhancement and enhancement rate of plaques between the early stage group and the middle stage group (χ2=-4.177, P<0.01; t=5.179, P<0.01), and there was a statistically significant difference between the middle stage group and the late stage group (χ2=-2.484, P<0.05; t′=8.189, P<0.01), and the difference between the early stage group and the late stage group was also statistically significant (χ2=-3.796, P<0.01; t′=15.044, P<0.01). There was a significant negative correlation between the time from onset of stroke symptoms to MRI examination and the enhancement rate of plaques (r=-0.903, P<0.01).@*Conclusions@#Enhanced HR MRI scanning can clearly show the enhancement of intracranial atherosclerotic plaques. With the prolongation of the onset time interval, the enhancement of intracranial atherosclerotic plaques gradually weakens, which can assess the vulnerability of plaques and has important guiding significance for secondary prevention of ischemic stroke.
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Objective@#To observe distribution and morphological characteristics of symptomatic atherosclerotic plaques in the middle cerebral artery (MCA) using high-resolution magnetic resonance imaging (HR-MRI), and to investigate HR-MRI characteristics of atherosclerotic plaques in the MCA in patients with acute cerebral infarction.@*Methods@#A total of 57 symptomatic patients with MCA atherosclerotic plaques recruited in the Affiliated Hospital of Yangzhou University from January 2014 to January 2016 were imaged with diffusion weighted imaging (DWI), three dimensional time of flight magnetic resonance angiography (3D TOF-MRA) and HR-MRI scanning for plaque on a 3.0 T MRI scanner. According to the results of DWI examination, the 57 patients were divided into transient ischemic attack (TIA) group (27 cases) and acute cerebral infarction group (30 cases). The distribution of the narrowest lumen plaque was evaluated by cross-section division into four equal arcs (superior, inferior, ventral, dorsal arcs). For quantitative analysis, lumen area (LAMLN), vessel area (VAMLN) at maximal lumen narrow (MLN) and LAreference, VAreference were measured, then wall area (WA), plaque area (PA), percentage of plaque burden, rate of lumen stenosis and remodeling index (RI) were calculated. The data of each group were compared and analyzed.@*Results@#The location and morphological analysis of the 57 patients with symptomatic MCA atherosclerotic plaques revealed that plaques were located in the ventral wall in 19 cases (33.3%), the upper wall in 15 cases (26.3%), the dorsal wall in 10 cases (17.5%), and the lower wall in 13 cases (22.8%). For the location variations in ventral wall, upper wall, dorsal wall and lower wall, the TIA group was shown as six cases (22.2%), five cases (18.5%), seven cases (25.9%) and nine cases (33.3%), and the acute cerebral infarction group was shown as 13 cases (43.3%), 10 cases (33.3%), three cases (10.0%) and four cases (13.3%), respectively. There was no statistically significant difference in the distribution of each side wall between the two groups (P>0.05). VAreference, LAreference, VAMLN and RI of the TIA group and the acute cerebral infarction group were (19.89±1.34) mm2, (15.19±2.04) mm2, (20.78±1.78) mm2, 1.09±0.11 and (19.70±1.34) mm2, (14.60±2.33) mm2, (21.53±2.34) mm2, 1.10±0.11, respectively. There was no statistically significant difference between the two groups (P>0.05). The remodeling patterns of both groups were mainly positive remodeling, with a total of 44 cases (77.2%). In the TIA group and the acute cerebral infarction group, the WAMLN, PA, stenosis rate and plaque load percentages were (8.85±1.92) mm2, (4.00±3.00) mm2, 20.92%±9.18%, 19.05%±14.93% and (11.10±1.88) mm2, (6.00±2.25) mm2, 28.56%±8.67%, 27.30%±7.69%, respectively. The differences between the two groups were statistically significant (t=-4.466, t=-2.865, t=-3.231, t=-2.580, P<0.01). There were eight patients (29.6%) with unsmooth plaque surface in the TIA group and 19 patients (63.3%) in the acute cerebral infarction group. The differences between the two groups were statistically significant (χ2=6.475, P<0.05). LAMLN in the TIA group and the acute cerebral infarction group was (11.93±1.59) mm2 and (10.43±2.08) mm2 respectively, and the difference between the two groups was statistically significant (t=3.033, P<0.01).@*Conclusions@#Symptomatic atherosclerotic plaques in MCA in the acute cerebral infarction group have higher plaque load, thicker vascular wall at the maximum stenosis and more unsmooth plaque surface. This indicates the characteristics of high-risk plaques to a certain extent.
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Objective:To explore the clinical application value of CT-guided methylene blue staining and/or Hookwire localization of pulmonary ground-glass nodule (GGN) before video-assisted thoracoscopic surgery (VATS). Methods: Totally 141 patients with 160 GGN underwent VATS after CT-guided methylene blue staining and/or Hookwire implantation for localization of nodules. The success rate of localization, puncture complications and success rate of surgery were calculated. Results: All GGN were successfully located and resected. Among 160 nodules, 18 were located with stained with methylene blue, 12 with Hookwire implantation, while 130 nodules were located with combination of two methods, and the success rates of methylene blue staining, Hookwire implantation and combination of these two methods were all 100%. Small amount of pulmonary hemorrhage and pneumothorax were observed in 25 and 38 cases respectively during puncture, including 13 cases with both pulmonary hemorrhage and pneumothorax. Postoperative pathology showed that 117 nodules were malignant and 43 were benign nodules. Conclusion: CT-guided methylene blue staining and/or Hookwire implantation before VATS can accurately locate GGN, reduce puncture complications and improve the success rate of resection.
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Objective To observe distribution and morphological characteristics of symptomatic atherosclerotic plaques in the middle cerebral artery (MCA) using high?resolution magnetic resonance imaging (HR?MRI), and to investigate HR?MRI characteristics of atherosclerotic plaques in the MCA in patients with acute cerebral infarction. Methods A total of 57 symptomatic patients with MCA atherosclerotic plaques recruited in the Affiliated Hospital of Yangzhou University from January 2014 to January 2016 were imaged with diffusion weighted imaging (DWI), three dimensional time of flight magnetic resonance angiography (3D TOF?MRA) and HR?MRI scanning for plaque on a 3.0 T MRI scanner. According to the results of DWI examination, the 57 patients were divided into transient ischemic attack (TIA) group (27 cases) and acute cerebral infarction group (30 cases). The distribution of the narrowest lumen plaque was evaluated by cross?section division into four equal arcs (superior, inferior, ventral, dorsal arcs). For quantitative analysis, lumen area (LAMLN), vessel area (VAMLN) at maximal lumen narrow (MLN) and LAreference, VAreference were measured, then wall area (WA), plaque area (PA), percentage of plaque burden, rate of lumen stenosis and remodeling index (RI) were calculated. The data of each group were compared and analyzed. Results The location and morphological analysis of the 57 patients with symptomatic MCA atherosclerotic plaques revealed that plaques were located in the ventral wall in 19 cases (33.3%), the upper wall in 15 cases (26.3%), the dorsal wall in 10 cases (17.5%), and the lower wall in 13 cases (22.8%). For the location variations in ventral wall, upper wall, dorsal wall and lower wall, the TIA group was shown as six cases (22.2%), five cases (18.5%), seven cases (25.9%) and nine cases (33.3%), and the acute cerebral infarction group was shown as 13 cases (43.3%), 10 cases (33.3%), three cases (10.0%) and four cases (13.3%), respectively. There was no statistically significant difference in the distribution of each side wall between the two groups (P>0.05). VAreference, LAreference, VAMLN and RI of the TIA group and the acute cerebral infarction group were (19.89 ± 1.34) mm2, (15.19 ± 2.04) mm2, (20.78 ± 1.78) mm2, 1.09 ± 0.11 and (19.70 ± 1.34) mm2, (14.60 ± 2.33) mm2, (21.53 ± 2.34) mm2, 1.10 ± 0.11, respectively. There was no statistically significant difference between the two groups (P>0.05). The remodeling patterns of both groups were mainly positive remodeling, with a total of 44 cases (77.2%). In the TIA group and the acute cerebral infarction group, the WAMLN, PA, stenosis rate and plaque load percentages were (8.85±1.92) mm2, (4.00±3.00) mm2, 20.92%± 9.18%, 19.05% ± 14.93% and (11.10 ± 1.88) mm2, (6.00 ± 2.25) mm2, 28.56% ± 8.67%, 27.30% ± 7.69%, respectively. The differences between the two groups were statistically significant (t=-4.466, t=-2.865, t=-3.231, t=-2.580, P<0.01). There were eight patients (29.6%) with unsmooth plaque surface in the TIA group and 19 patients (63.3%) in the acute cerebral infarction group. The differences between the two groups were statistically significant (χ2=6.475, P<0.05). LAMLN in the TIA group and the acute cerebral infarction group was (11.93±1.59) mm2 and (10.43±2.08) mm2 respectively, and the difference between the two groups was statistically significant (t=3.033, P<0.01). Conclusions Symptomatic atherosclerotic plaques in MCA in the acute cerebral infarction group have higher plaque load, thicker vascular wall at the maximum stenosis and more unsmooth plaque surface. This indicates the characteristics of high?risk plaques to a certain extent.
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Objective To summarize the features of multi-slice spiral computed tomography (MSCT) examination of mesenteric panniculitis (MP).Methods The retrospective cross-sectional study was conducted.The clinical data of 105 patients with MP who were admitted to the Yangzhou NO.1 People's Hospital between September 2009 and September 2015 were collected.All the patients were diagnosed by MSCT and multiplanar reconstruction (MPR).Observation indicators:(1) imaging features of computed tomography (CT):location,number,shape,size,density,mesenteric vessels and surrounding intestine of the lesions,with or without pseudotumor sign,enlarged fibrous nodules or lymph nodes,pseudocapsule sign,fatring sign,cystolization and calcification;(2) follow-up results.Follow-up using outpatient examination was performed by plain and/or enhanced scans of abdominal CT up to April 2017.Results (1) Imaging features of CT:of 105 patients,77,14 and 14 received respectively plain scans of abdominal CT,plain and enhanced scans of abdominal CT and enhanced scans of abdominal CT.Lesions of 105 patients were located at the mesentery.The single lesion was detected in 79 patients and multiple lesions in 26 patients,with number of lesions of 5-12 per case and total number of 213.All the 105 patients had pseudotumor sign,which showed different size of patchy or mass shadows with clear edge extended from mesentery root to mesenteric vessels;most long axes extended from mesentery root to jejunum in the left lumbar region;the homogeneous or heterogeneous mesenteric fat density was increased,and CT value was higher than that of normal retroperitoneal adipose tissues;fog-like mesentery showed less obvious enhancement by enhanced scan and mesenteric vessels were wrapped around.The cord-like,round or oval fibrous tissue nodules and/or enlarged lymph nodes were found in 100 patients.All the 105 patients had pseudocapsule sign.The density ring of soft tissues of different thickness was found,with a clear boundary between leading-and trail-edges and normal abdominal and retroperitoneal adipose tissues;most membranes extended to left lumbar region,thicker and thinner membranes were respectively located at the anterior and posterior areas and right side,and parts of membranes were absence.The fatring sign was detected in 71 patients,there were ring-like hypodense shadows around the mesenteric vessels and fibrous tissue nodules or lymph nodes.Cystolization and calcification were found in 2 and 2 patients.Thirty-eight patients had surrounding intestinal canal translocation.(2) Follow-up results:55 patients were followed up for 1.0-57.0 months,with an average time of 14.7 months.Of 55 patients,26 had stable lesions and no obvious changes;4 returned to normal due to complete absorption of lesions;19 were improved due to partial absorption of lesions;6 had lesions progressions.Conclusion The features of MSCT examination of MP include pseudotumor sign,pseudocapsule sign and fatring sign.
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Objective To explore the efficacy of acupuncture in the treatment of nonalcoholic fatty liver disease by using magnetic resonance iterative decomposition of water and fat with echo asymmetry and least-squares estimation-quantitative FAT/R2 * imaging (IDEAL-IQ) technique.Methods Totally 36 patients with nonalcoholic fatty liver were divided into acupuncture group (25 cases) and control group (11cases).The patients were performed liver magnetic resonance IDEAL-IQ and the liver fatty component value (F value) was measured before and after the treatment,at the same time clinical indicators of liver function and blood lipid were measured.The Spearman correlation analysis was used to compare the consistency of F value and blood lipid in all patients.The t test was used to compare the differences of liver F values,liver function,blood lipids and other clinical indicators of two groups before and after the treatment.Results There were significantly positive correlation between the fat component and triglyceride (TG),total cholesterol (TC) level (r =0.836,0.852,P ＜ 0.05),and significant negative correlation between the fat component and high density lipoprotein (HDL) level in the fatty liver group (r =-0.735,P ＜0.05),The liver F values,alanine aminotransferase (ALT) and aspartate aminotransferase (AST) contents and TG,HDL,low density lipoprotein (LDL) and TC contents of the acupuncture group after treatment were statistically significant (P ＜ 0.05).Comparison of each index in the acupuncture group after treatment with the control group,the differences were statistically significant (P ＜ 0.05).Conclusions Acupuncture is an effective approach to treat nonalcoholic fatty liver disease,as it can improve liver function and down-regulate lipid level.Magnetic resonance IDEAL-IQ technique can quantitatively detect its therapeutic efficacy.
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Objective To investigate the mechanism of motor recovery in hemiplegic patients after ischemic stroke using acupuncture-induced blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) and diffusion tensor imaging (DTI).Methods A total of 20 patients with left hemiplegia after ischemic stroke were enrolled in the study. DTI raw data was used to reconstruct three dimensional image of pyramidal tract through post-processing of workstation,and the damage and recovery of the pyramidal tract were observed. SPM8 and other software were used to compare and analyze the acupuncture-induced BOLD-fMRI data, and the distribution differences in the brain activation areas were compared. Results The muscle strength grade and the Fugl-Meyer scale score at 6 months were significantly higher than those during 3-6 weeks after stroke onset. DTI showed that the right pyramidal tract had different degrees of damage, interrupt, compression, and displacement during 3-6 weeks after onset, and there were different degrees of repair, remodeling at 6 months after onset. Acupuncture-induced BOLD-fMRI showed that compared with 3-6 weeks after onset, the positive activated brain regions were mainly located in the motor related brain regions in bilateral frontal cortex and the left cerebellum, and the negative activated brain regions were mainly located in the limbic system, such as bilateral anterior cingulate cortex and parahippocampal gyrus. Conclusions The mechanism of motor recovery in hemiplegic patients after ischemic stroke may be mainly related to the regulation and compensation of motor related brain regions,as well as the regulation of muscular tension through the extrapyramidal system. The repair and reorganization of the damaged motor pathway may also be the mechanism of motor recovery in hemiplegic patients after ischemic stroke.
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Objective To summarize the features of multi-slice spiral computed tomography (MSCT) examination of acute primary epiploic appendagitis,and investigate the clinical value of MSCT.Methods The clinical data of 19 patients with acute primary epiploic appendagitis who were admitted to the Yangzhou No.1 Hospital from December 2009 to March 2014 were retrospectively analyzed.All the patients received MSCT examination,and the data were transported to the work station for multiplanar reconstruction.The location,shape,size,density,peripheral performance and peritoneal thickening were observed.Results The foci of the 19 patients were located adjacent to the colon.One focus was adjacent to the cecum,4 were adjacent to the ascending colon,1 was adjacent to the hepatic flexure of the colon,6 were adjacent to the descending colon,and 7 were adjacent to the sigmoid colon.The shapes of the foci were similar to the oval or ring in 14 cases and similar to the flame in 5 cases.The diameters of the foci were 0.8-3.7 cm.The results of CT plain scan showed that the density of the foci was similar to that of the fat,and the CT value was-101--34 HU.The central density of the foci was lower,while the limbic density was higher.The results of CT enhanced scan showed a ring-like enhancement region in the foci,and the lesion was surrounded by slightly high-density inflammation.Point or linear slightly high-density shadows were detected at the center of the foci in 9 patients.The peritoneum was locally thickened in 14 patients.The colonic wall was locally thickened in 1 patient,and the pelvic effusion was detected in 5 patients.The results of CT reexamination of 4 patients showed that the inflammatory regions were reduced or disappeared,the mass shrank,nodulized or calcified.Conclusions MSCT examination can provide a specific features of primary epiploic appendagitis.It could accurately diagnose acute primary epiploic appendagitis when combined with multiplanar reconstruction.
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Objective: To observe the clinical efficacy of combined tuina manipulations with Qi Zheng Qing Peng paste for herniation of the lumbar intervertebral disc. Method: All 568 cases were randomly allocated into an observation group (189 cases), control Ⅰ group (187 cases) and control Ⅱ group (192 cases). Combined tuina with Qi Zheng Qing Peng paste, combined tuina with diclofenac diethylamine emulsions and tuina alone were adopted in the above three groups respectively. The efficacies in the three groups were compared after 4 weeks of treatment. Results: The total effective rates in the observation group, control Ⅰ group and control Ⅱ group were 89.9%, 86.6% and 84.9% respectively, showing a significant difference (P ＜0.05) . Conclusion: Combined tuina manipulations with Qi Zheng Qing Peng paste works well for herniation of the lumbar intervertebral disc.
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Objective To investigate the optimum scanning parameters for multi-slice spiral CT aorta imaging so as to emphasize the contrast delay time and the method of image reconstruction.Methods 21 cases of patients were scanned with contrast enhancement by the method of bolus tracking.The contrast medicine was injected through elbow vein.Flow speed was 3.0ml/s,and contrast usage was 1.5 to 2ml/ kg.Scanning was triggered when the density of the enhancement at ROI arose to a prescribed value.After data acquisition and reconstruction,the aorta was displayed.Results The average time for the influx of contrast in aorta was 20 seconds.Data was reformatted with the thickness of 2.5mm and 50% overlapping.VR,CPR,MIP and SSD images were reconstructed.Conclusion With constant tracking of density by Smartprep software,the optimized scanning parameters and the proper image post-processing techniques,aorta can be clearly displayed.[Chinese Medical Equipment Journal,2008,29(2):88-89]