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Objective To explore the imaging features of brucellar spondylitis (BS).Methods The imaging data of 49 cases who were diagnosed as brucellar spondylitis by a positive standard tube agglutination titer test (≥1:100) and (or) the isolation of brucella species from blood or other tissue at our institution between September 2012 and October 2016 were retrospectively reviewed.X-ray,CT scan and MRI examination was performed in 49,28 and 42 cases,respectively,of which 19 cases underwent both CT scan and MRI examination.The imaging manifestations of the spine were analyzed.The x2 test or Fisher's exact test were applied to compare the imaging manifestations of the patients who underwent both CT scan and MRI examination.Results Of the 49 patients,34 patients (69.4％) had involvement of the lumbar vertebra.Forty-five patients (91.8％) had contiguous involvement at adjacent 2 vertebral bodies.There were 10 cases (20.4％) with bony spur or bone bridge,3 cases (6.1％) with spondylolisthesis and 3 cases (6.1％)with slightly kyphosis deformity.There were 8 cases (28.6％) showing bone destruction of more than half of the vertebral body and 6 cases (21.4％) with sequestra on CT.There were 14 cases (33.3％) with psoas abscesses,of which 2 (4.8％) had migrating abscess.Epidural abscesses with dural sac compression were found in 17 cases (40.5％) and 3 cases (7.1％) showed nerve roots compression.There were statistically significant differences in the detection of vertebral bone destruction,bone marrow edema,hyperosteogeny,intervertebral disc changes,abscess formation and sequestrum between CT and MRI (P＜0.05).Conclusion BS has characteristic imaging features.The presence of bone destruction,sequestrum,and migrating abscess should warrant the possibility of BS.
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Objective To investigate the clinical value of eynovial membrane volume measurement by MRI in patients with hemophilic arthropathy receiving radionuclide synoviectomy. Methods Forty two patients,total 63 diseased joint,who hospitalized in the hemophilia diagnosis and treatment center of Henan Province People's Hospital were enrolled in the study after receiving both enhanced an non enhanded MRI, from May 2011 to January 2015.Sixteen patients(21 joints)were treated with 32P radionuclide synoviectomy (PRS)and followed up.The synovial membrane volume were evaluated by enhanced and non enhanded MRI before and after PRS. All data were analyzed by t test. Results The synovial membrane volume had no statistical difference by using the non enhanced(3 104.38±60.19)mm3and enhanced(2 995.19±59.14)mm3 MRI scans (t=-1.369, P=0.191). The synovial membrane volume post PRS (2 479.45 ± 46.48)mm3much lower than that before PRS (2 983.30 ± 42.87) mm3(t=7.831,P=0.000). The magnetic resonance enhanced range after PRS (0.92 ± 0.06) was significantly lower than that before treatment (1.17 ± 0.07) (t=2.108, P=0.048). Conclusion Synovial membrane volume and magnetic resonance enhanced range are important index to predict clinical efficacy of PRS.
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Objective To observe the value of CT spectral imaging in assessment of synovial hemosiderin deposition (SHD) in the knee joint in patients with hemophilic arthropathy (HA).Methods Twenty-five HA patients (40 assessable knees) underwent CT spectral imaging and MR scanning.According to the MRI international prophylaxis study group (IPSG) score of SHD,the knees were divided into mild group and severe group.CT value,iron (water) concentration (FeC),water (iron) concentration (WC),effective atomic number (Eff-Z) and average spectral curve slope (aSCS) of SHD area were measured and calculated,respectively.Meanwhile,the adjacent semi-membrane muscles in the same slice were taken as controls.The spectral parameters of CT were compared with One-Way ANOVA,and ROC curves were plotted to obtain the spectral parameters and the optical diagnostic threshold of SHD.Results CT value,FeC,and aSCS of SHD area were statistically significant among three groups (F=148.08,307.88,7.80,364.62 and 261.50,P＜0.01),and the differences of parameters between any two groups except WC were statistically significant (all P＜0.05).The area under ROC curve of SHD evaluated with aSCS was the largest,and the thresholds for the diagnosis of severe and mild SHD of aSCS was 1.84 and 0.42,respectively.Conclusion Multiple parameter analysis of CT spectral imaging is of great value for assessment of the severity of SHD in the knee joint in HA patients,therefore having important clinical significance.
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Objective To investigate the feasibility of reducing spine metal artifacts with metal artifacts reduction technique (WARP) at 3.0 T MRI.Methods This study included 15 cervical and 14 lumbar spine cases.The image quality of WARP sequences and conventional sequences were compared (5 score evaluation scale) as well as the signal to noise ratio (SNR) and contrast noise ratio (CNR) of the image artifacts.The scanning time was recorded.Paired-t test and Mann-Whitney test were used respectively to compare the SNR and CNR,and qualitative scoring between the two sequences.P＜0.05 was considered to indicate a significant difference.Results The image distortion and blur of the WARP sequences were obviously reduced as compared to the conventional sequences.The SNR and CNR of artifacts of the WARP sequences were lower than that of the conventional sequences (All P＜0.05).The image quality scores of WARP sequences in cervical and lumbar spines[4(3 to 5) and 4(3 to 5)] were higher than that of conventional sequences[3(2 to 4),3(2 to 4)](P＜0.05).The scanning time of cervical spines in WARP sequence(14 min 9 s) was increased by 64 s (8.2％),and the time of lumbar spines (13 min 41 s) decreased by 9 s (1.1％).Conclusion The WARP sequences at 3.0 T could effectively reduce the artifacts of metallic prosthesis in cervical and lumbar spine without prolonging the scanning time at 3.0 T MRI.
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Objective To evaluate the effect on threshold of triggered angiographic acquisition by different iodine flow rate on renal artery CTA using Smart Prep tracking technique.Methods A total of 420 patients were randomly divided into A-D group with iodine flow rate of 0.90 gI/s,1.11 gI/s,1.20 gI/s,1.48 gI/s on average respectively.And each group were divided 7 subgroups with threshold 140-＜150 HU,150-＜ 160 HU,160-＜ 170 HU,170 ＜180 HU,180 ＜190 HU,190-＜200 HU,200-210 HU respectively.The quality of the images were graded from 1 5 by 2 radiologists.The best image quality subgroups were achieved,and the scores were compared among the best image quality subgroups.Results Image quality of renal CTA in each group were best performed with a threshold of 170-＜ 190 HU,160-＜ 190 HU,170-＜ 180 HU,160-＜ 180 HU respectively.When the threshold were 170-＜180 HU,image quality were good with all iodine flow rate groups.There was no significant difference among the scores of the best image quality subgroups (all P＞0.05).Conclusion Different iodine flow rate with appropriate threshold can acquire better image quality of renal CTA.
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Objective@#To observe the therapeutic response of radiosynovectomy with p-32 colloid on hemophilic arthropathy, and to assess the effects of radiosynovectomy with Denver Score on hemophilic arthritis staging.@*Methods@#Radiosynovectomy with p-32 colloid was performed on 326 hemophilic arthritis patients (405 joints) , and recorded bleeding before and after treatment. The MRI performance of 102 joints was evaluated by using Denver scoring system, then was divided into 0-6 and 7-10 groups. Finally, the differences between 2 groups were analyzed.@*Results@#Average pain score of all hemophilic arthritis patients at 6 months, 1, 2 and 3 years post treatment decreased from 3.2±2.4 (n=326) to 1.2±0.6 (n=285, P=0.021) , 1.7±0.5 (n=242, P=0.032) , 2.1±1.1 (n=212, P=0.030) and 2.2±1.6 (n=176, P=0.037) , respectively. The frequency of bleeding in 405 joints at 1, 2 and 3 years post treatment decreased from 15.1±3.6 to 2.1±0.7, 4.3±0.6, and 4.8±0.8 times per year (P<0.01) , respectively; Meanwhile, the proportions of significantly ameliorated joints’ activities were observed as of 68.50% (248/362) , 58.39% (181/310) , 55.67% (162/239) and 42.61% (75/176) , respectively. The frequencies of haemarthrosis at 1 and 2 years post treatment in patients with 0-6 Denver Score (45 target joints) reduced from 13.0±1.9 to 1.3±0.6 (P=0.002) and 3.1±0.9 (P=0.009) times per year, respectively, which also decreased in 7-10 group (57 target joints) from 16.6±2.1 to 3.1±0.9 (P=0.008) and 5.7±1.1 (P=0.004) times per year, respectively. There was no statistical difference between 0-6 and 7-10 groups before treatment in the terms of haemarthrosis frequency (P=0.773) . However, 7-10 group had higher haemarthrosis frequency at 1 and 2 years post treatment compare with 0-6 group (P=0.028 and 0.042, respectively) . Synovial volumes in 29 joints reduced after 6 month when compared with baseline [ (2 362.15±32.41) mm3 vs (3 012.40±39.78) mm3, t=7.621, P<0.001].@*Conclusion@#Radiosynovectomy with p-32 colloid on haemophilic synovitis was a safe and effective procedure. The patients with Denver Score of 0-7 had lower frequency of haemarthrosis.
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Objective To assess the diagnostic value of capsule endoscopy (CE) and CT virtual endoscopy (CTVE) for small intestinal diseases.Methods The data of 31 patients with suspected small bowel diseases who were examined by both CTVE and CE were collected.The diagnostic rates of CE and CTVE was compared by paired data McNemar test,using the diagnosis confirmed by surgery or follow-up as the golden standard.Results The confirmed diagnosis of 31 patients were small intestinal tumor in 16,nontumorous lesion in 10 and no abnormal lesion in 5.CE identified positive findings in 24 patients,including 14 cases of tumorous lesion (with mis-location in 2 and failure in definite diagnosis in 7) and 10 cases of non-tumorous lesion.CTVE identified positive findings in 17 patients,including 14 cases of tumorous lesion (with mis-location in 1 and failure in definite diagnosis in 4) and 3 cases of non-tumorous lesion.The combination of CE and CTVE could identified positive findings in 26 patients,including 16 tumorous and 10 nontumorous lesions.The diagnostic rates of CE and CTVE for tumorous lesions were both 87.5％ (14/16).The overall diagnostic rate of combined CE and CTVE was 83.9％ (26/31),which was significantly higher than that of CTVE alone (54.8％,17/31) but similar to that of CE alone (77.4％,24/31).Conclusion Both CE and CTVE are effective in diagnosis of small intestinal lesions and the combined use of 2 methods can increase diagnosis yield.
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Objective To summarize the experiences in the diagnosis and treatment of the hepatic hereditary hemorrhagic telangiectasia (HHHT).Methods The clinical data of 15 HHHT patients who were admitted to the Qilu Hospital,People's Hospital of Mengyin,People's Hospital of Liaocheng,Henan Provincial People's Hospital,the Second Hospital of Hebei Medical University,First Affiliated Hospital of Zhejiang University were retrospectively analyzed.The clinical manifestation,features of imaging and laboratory examination were summarized,and the diagnosis,treatment and prognosis of the disease were investigated.Results HHHT patients had nonspecific symptoms in the early stage,and some patients presented with right upper quadrant discomfort,shortness of breath,anemia and liver bruit.The condition of HHHT patients could be worsened by liver cirrhosis or portal hypertension rapidly.The results of color doppler ultrasound and computed tomography showed intrahepatic telangiectasia,arteriovenous fistula and hepatic artery aneurysm in the 15 patients.Digital subtraction angiography was not clear enough for 2 HHHT patients with more than 1 enlarged hepatic arteries,but computed tomographic angiography was feasible.According to the degree and stages of the HHHT,all the 15 patients were divided into asymptomatic HHHT,simple HHHT and complex HHHT.Among the 6 patients who underwent surgical treatment,5 received ligation or banding of the enlarged hepatic arteries with subsequent disappearance of symptoms.Three patients received interventional treatment,and the treatment for 1 patient with complex HHHT was failed,and the patient died 30 months after medical treatment.Six patients were treated by conservative treatment,2 patients of them had no symptoms at the beginning,then they suffered from hepatic dysfunction and ascites at 21 and 35 months,respectively,and 1 of them died 6 months later.Four patients received medical treatment,and the results of color doppler ultrasound and computed tomography showed the pathological changes were aggravated gradually.Conclusions Telangiectasia,intrahepatic arteriovenous fistula and hepatic artery aneurysm are the main imaging characteristics of HHHT,and imaging diagnosis has significant value in the diagnosis of HHHT.HHHT is a progressive disease,early,active and individualized treatment is beneficial to the patients.The outcome of ligation or banding of the hepatic arteries is satisfactory.
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ObjectiveTo compare the diagnostic value of magnetic resonance imaging (MRI),computed tomography (CT) and radiography in the early detection of arthropathies of haemophilia.Methods Prospective studies of 21 joints in 11 patients were studied with X-ray,CT and MR examination. The 21 joints with haemophilia arthropathies were divided into three groups according to Pettersson scoring system.0 point were the first group,＜4 points were the second group,≥4 points were the third group.Abnormal imaging findings of osteoporosis,enlarge epiphysis,erosion of cartilage,irregular subchondral surface,narrowing of joints space,joint deformity,subchondral cyst formation,effusion/haemarthrosis of joint,synovial hypertrophy with haemosiderin,deformity of joints were used for all imaging comparison.The results were analysis with Chi-square test.To compare the first group,irregular subchondral surface and the number of subchondral cyst formation of all symptomatic joints were detected by CT and MR,the results were analysis with pair-sample t test.ResultsModerate and severe hemophilic joints were found in 80.95％ (17/21)of twenty-one symptomatic joints,and mild hemophilic joints were found in 19.05％ (4/21).The detected results were the same in enlarge epiphysis,narrowing of joints space,joint deformity in all joints by radiography,CT and MR.Significant difference in detection of irregular subchondral surface,subchondral cyst formation,effusion/haemarthrosis of joint,were found between radiography with either CT (x2 value 19.06,16.70,4.84,P ＜0.05 ) or MRI (x2 value 19.06,16.70,7.76,P ＜0.05),Significant difference in detection of the first group joint irregular subchondral surface and the subchondral cyst formation total number were found between CT and MR ( x2 =3.29,P ＜ 0.05 ). Conclusions MR and CT were superior in detection of the early abnormal changes in evaluating hemophilic arthropathies,however CT could detect more smaller irregular subchondral surface and subchondral cyst formation than MR.
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Objective To investigate the feasibility of achieving consistent image quality with dose reduction technology in lumber spine MSCT examination with Z-axis automatic tube current modulation (ATCM). Methods Forty-eight patients diagnosed as lumber intervertebral disc protrution scanned twice by MSCT before and after interventional operations with the same coverage from third lumbar vertebra to first sacral vertebra. The first scan (FM) was with fixed tube current of 320 mAs. The follow-up scan was with ATCM with noise index (NI) of 12.0 HU. At the levels of L3-4, L4-5 and 15-S1, image quality, image noise and radiation dose were measured and analyzed. Image quality and radiation dose were compared by paired t-test and the image noise was compared by ANOVA test. Results The dosage of the ATCM had a 31.3% reduction compared with FM, the average DLP was(187.9±66.4)mGy·cm and(273.4±45.4) mGy·cm respectively, where t = 8.205, P < 0.05. The average noise and their deviations for the FM group were (9.8±2.4) HU,(9.9±2.4) HU, and (11.5±3.2) HU at level of L3-4, L4-5, 15-S1, respectively. With ATCM, the average noise was(12.0±0.8) HU, (11.7±0.6) HU, and (11.7±1.4) HU, respectively. There was statistical difference between the two groups (F = 23.31, P < 0.05). The image quality scores for the FM group were (4.7±0.3), (4.5±0.2), (4.5±0.2) and showed no statistical difference to ATCM group (4.6±0.3), (4.5±0.2), (4.5±0.2) at level of L3-4, L4-5, L5-S1, respectively, where t = 1.000, P > 0.050 Conclusion ATCM technique with the noise index setting at 12.0 HU can achieved a 31.3% dose reduction while keep the consistent image quality for lumbar spine MSCT study.
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Objective To evaluate the clinical application value of multi-slice helical CT volumetric (VH) scanning in lumber spine. Methods One thousand of patients with back and leg pain who underwent CT examinations were selected as subjects. We simulated the traditional protocol of single-slice(SS) discrete scanning for L3/4, L4/5, and LS/S1 intervertebral discs. The VH scanning mode was performed with 120 kV, 210 mAs,pitch of 1.5 and coverage of 97. 5 mm. The simulated SS scanning mode was performed with 120 kV, 240 mAs and coverage of 45.0 mm. The diagnostic outcomes and the radiation doses were compared between the two scanning modes. Two groups doctors observed ten terms, including the osseous spinal stenosis,narrowed intervertebral space and so on in two scanning modes respectively. Then consistency analysis of the data was carried out. Results The VH scanning mode showed far more features than the SS mode. The detection rates of the VH mode in the osseous spinal stenosis, narrowed intervertebral space,herniated nucleus pulposus, narrowed lateral recess, vertebral lesion, hypertrophy of L5 transverse process,abnormal direction of facet, facet degeneration, lumbar spondyloschisis, and paraspinal soft tissue were 11.8% (n =118), 38. 5% (n =385), 9. 3% (n =93), 46. 8% (n =468), 31.4% (n =314), 5.7% (n =57), 25.4% (n = 254), 49. 7% (n = 497), 9.9% (n = 99), and 0. 6% (n = 6) respectively, while the detection rates of the SS mode in ten terms were 5.6% (n = 56), 0, 0. 6% (n = 6), 27. 9% (n = 279),22.4% (n =224), 1.2% (n = 12), 16.7% (n = 167), 37.2% (n =372), 0.5% (n =5), and 0.2%(n = 2) respectively. The difference between the two groups had statistically significance (average P <0.05), except the paraspinal soft tissue abnormal (P > 0.05). The detection rates of the VH mode were higher than the SS mode in the osseous spinal stenosis, narrowed intervertebral space, herniated nucleus pulposus, lumbar spondyloschisis, being 6.2% (n = 62) , 38. 5% (n = 385) , 8.7% (n = 87), and 9.4%(n =94), respectively. In addition, VH mode only partially showed the articular facets, narrowed lateral recess, hypertrophy of L.5 transverse process, and paraspinal soft tissue. We could not acquire the imaging slices paralleling to intervertebral discs in SS mode in 467 patients (46.7%) with lumbosacral angle greater than 35°. The radiation dose of VH mode (164.9 mGy/em) was slightly higher than SS mode (147.0 mGy/cm) Conclusion MSCT VH scanning mode can significantly improve the diagnostic rate of lumbar spine diseases compared with SS mode, and was not restricted by the lumbosacral angle with slightly increasing radiation dosage.
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Objective To assess the value of clinical application of CT pulmonary angiography(CTPA) in diagnosing pulmonary damage of Behcet’s syndrome.Methods 17 patients with Behcet’s syndrome underwent MSCT(Light Speed Plus, GE)with conventional CT scan and CTPA. The two kinds of imaging materials were comparatively studied by chi-square test , and diagnosed by comprehensive imaging appearances. Results The major feature of conventional CT included:bilateral or unilateral pulmonary density were nonhomogeneous in all cases,solitary or multiple pulmonary aneurysmal ecctasia in 9 cases,pulmonary artery growed in 12 cases,irregular and constrictive vascular wall in 6 cases and segmental infiltration in 5 cases.The features of CTPA included:irregular and constrictive pulmonary vascular wall in 15 cases,pulmonary aneurysms in 15 cases,pulmonary artery expansion in 16 cases,pulmonary artery thrombosis in 8 cases.There were statistical differences between conventional CT and CTPA in pulmonary aneurysm and arterial wall changes(?_1~2=5.10,P_10.05).Conclusion CTPA can diagnose pulmonary damage of Behcet’s syndrome in combination with clinic and conventional CT.
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Objective To evaluate diagnostic value of CT coronal scan to foreign body in bronchus of children.Methods 30 cases appearances of CT coronal scan to foreign body in bronchus of children were analysed.The appearances between CT coronal scan and axial scan,X-ray examination of chest were contrasted in some cases.Results Foreign body in bronchus or granuloma around part of foreign body were shown clearly by CT coronal scan in 30 cases,28 cases obstructive emphysema,13 cases obstructive pneumonia and 3 cases obstructive atelectasis were also shown clearly.Another,CT coronal scan showed the double margin sign of 16 cases diaphragm and 11 cases mediastinum.Conclusion CT coronal scan could show direct and indirect signs of the most foreign body in bronchus of children and it may be acte as primary examintion.