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Objective:To investigate the value of dual-layer detector spectral CT in preoperative evaluation of immunohistochemical expression levels in breast cancer patients.Methods:The clinical, pathological and imaging data of breast cancer patients who received preoperative spectral CT chest scan in Affiliated Hospital of Southwest Medical University from October 2020 to January 2021 were retrospectively analyzed. A total of 70 patients were divided into positive or negative estrogen receptor (ER) group, positive or negative progesterone receptor (PR) group, positive or negative human epithelial growth factor receptor 2 (HER2) group, and positive or negative Ki-67 group according to the immunohistochemistry. Philips workstation and Special Diagnostic Suite software were used for processing and analysis. The CT value and iodine concentration value (IC) of the lesion and the effective atomic number (Z eff) of the lesion in the arterial and venous phases were measured, and the standardized CT value (NCT), standardized iodine concentration value (NIC), slope (K) of the keV-CT value curve in the arterial and venous phases as well as the CT difference and the IC difference in the arteriovenous phase were calculated. Independent sample t test was used to compare the differences in spectral parameters between patients with positive and negative immunohistochemical parameters, and ROC curve was used to analyze the efficacy of spectral parameters in the differential diagnosis of positive and negative different immunohistochemical parameters. Results:Z eff, NIC, K value, CT value, IC value of arterial and venous phase and NCT value of venous phase in negative ER group were higher than those in positive ER group, the difference was statistically significant ( P<0.05). Z eff, NIC, K value, IC, CT difference in arteriovenous phase and IC difference in arteriovenous phase in positive HER2 group were higher than those in negative HER2 patients, the difference was statistically significant (P<0.05). The arterial K value in positive Ki-67 group was higher than that in negative Ki-67 group, the difference was statistically significant ( P<0.05). Taking arterial phase K value of 1.22 as the diagnostic threshold, it had the highest diagnostic efficiency in differential diagnosis of ER positivity versus negativity (area under curve of 0.791, sensitivity of 84.00%, specificity of 65.00%). Taking the arteriovenous phase IC difference of 0.47 mg/ml as the diagnostic threshold, it had the highest performance in differential diagnosis of HER2 positivity versus negativity (area under curve of 0.736, sensitivity of 76.32%, specificity of 65.62%). Conclusion:Dual-layer detector spectral CT has certain diagnostic value for the immunohistochemical expression of breast cancer patients, which can provide reference for clinical diagnosis and treatment.
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Objective To observe the relationship between the integrity of Willis circle and aneurysm with MSCT angiography.Methods CTA data of 580 patients with intracranial vascular lesions were retrospectively analyzed.The morphological structure of Willis circle and the occurrence of aneurysm were observed based on axial thin-layer,VR,MIP and MPR images.According to the integrity,Willis circle were divided into type Ⅰ (Willis circle complete),type Ⅱ (the anterior circulation complete but the posterior circulation incomplete),type Ⅲ (the anterior circulation incomplete but the posterior circulation complete) and type Ⅳ (both the anterior and posterior circulation incomplete) for statistical analysis.Results For the classification of Willis circle,there were 118 cases of type Ⅰ (118/580,20.34％),344 of type Ⅱ (344/580,59.31％),25 of type Ⅲ (25/580,4.31％) and 93 cases of type Ⅳ (93/580,16.03％).The incidence of Ⅰ-Ⅳtypes of Willis circle with aneurysm accounted for 16.10％ (19/118),14.83％ (51/344),32.00％ (8/25) and 23.66％ (22/93),respectively.The incidences of aneurysm in patients with different types of Willis circlewere statistically significant (x2=8.013,P=0.046).There was statistical difference of the type of Willis circle between different genders (x2=12.631,P=0.006),and the incidence of aneurysm in females was higher than that in males (25.00％ [63/252] vs 11.28％ [37/328];x2 =18.80,P＜0.025).Conclusion Most Willis circle were not complete,and incomplete Willis circle aneurysm tended to occur in females with higher aneurysm rate.
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Objective To analyze CT manifestations of inguinal canal lipomas (ICLS).Methods CT datas of 104 pa tients with ICLS was retrospectively analyzed.And the imaging features were observed by MPR.Results The main CT manifestations of the ICLS were fat density in the inguinal canal and were unconnected with the abdominal fat.Among the 104 ICLSpatients,male (90/104,86.54％) was more than famale(14/104,13.46％;x2=55.538,P＜0.001).Thele sions were located at bilateral sides in 8 cases,left side in 66 cases and right side in 30 cases.The lesions in left side were more than those in right side (x2 13.500,P＜0.001).The mean maximum cross-sectional area of ICLS was (3.89 ± 2.12)cm2.There was no statistically significant difference between male and famale in maximum cross-sectional area (t=1.038,P=0.302).Conclusion In ICLS patients,male is more than famale.And more lesions are located at the left side.The CT manifestations of ICLS have certain characteristics,and MPR images are helpful in diagnosing ICLS.
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Objective To evaluate early dynamic contrast enhancement CT on multiple organ failure in acute pancreatitis.Methods 333 cases of acute pancreatitis identified by clinical and early dynamic contrast enhancement CT were collected.Patients were divided into organ failure group(OF group,124 cases) and non-organ failure group (notn-OF group,209 cases).All variables including duration of hospitalization,need for intensive care unit,infection,need for operation,mortality and MCTSI,EPIC score were analyzed by U test and x2 test firstly.The variables with significance (P＜0.05) were analyzed by Stepwise Logistic regression further.Results On U test and x2 test,there were significant differences(P＜0.001) between two groups in duration of hospitalization,need for intensive care unit,infection,need for operation,mortality,MCTSI score and EPIC score and APFC + ANC＞ 100 mL,and bilateral pleural effusion/ pulmonary atelectasis.The Stepwise Logistic regression analysis demonstrated that increased MCTSI and EPIC score,APFC+ANC＞ 100 mL and bilateral pleural effusion/pulmonary atelectasis were 4 independent risk factors of multiple organ failure in acute pancreatitis.Conclusion Multiple organ failure in acute pancreatitis can be judged with early dynamic contrast enhancement CT for improved treatment.
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Objective To explore the application value of ECG tube current modulation technology of dual source CT in coronary angiography,compared with retrospectively ECG-gated technique.Methods 200 patients were randomly divided into ECG tube current modulation group (Group A)and retrospectively ECG-gated group(Group B).In Group A,the main parameters were the exposure time windows of full dose,which were set according to different heart rates.χ2 test was adopted in the subjective score,and t test was used in the objective score and radiation dose.Results There was no statistical significance in image quality between the two groups(χ2 =2.125,tnoise =-0.557,P >0.05 );The effective dose (ED)of Group A and Group B were (3.30±0.40)mSv and(6.90±1.76)mSv,respectively.The difference was statistically significant (t ED =-1 9.954,P <0.05).The radiation dosage of Group A was 52% lower than that of Group B.Conclu-sion Compared with retrospectively ECG-gated technique,the ECG tube current modulation technique ensures the image quality, and at the same time it can significantly reduce the radiation dose,therefore,it can be used as a routine examination technique of cor-onary angiography.
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Objective To observe the imaging features of partiallythreaded screw fixation using in various kinds of C2 pedicel fracture.Methods CT image materials of 160 Chinese Han patients who suffered from atlantoaxial injury without vertebral body and pedicle fracture of C2 was included in this study,including 120 males and 40 females.Pedical trajectory selected according to Ebraheim method in threedimensional CT reconstruction was analyzed in ADW 4.4 workstation.The posterior wall fracture of C2 vertebral body,isthmus fracture and fractures under C2 laminar were simulated according to clinical observation.The trajectory length (partiallythreaded screw length) from entry point to anterior cortical bone of C2,bolt shank length from entry point to fracture line and fillet of screw length from fracture line to anterior cortical bone of C2 were measured.Relations between height,gender and partiallythreaded screw length bolt shank and fillet of screw length was evaluated.Results Male height was 167±7.9 cm on average,and female was 156±6.6 cm.The length of partiallythreaded screw was 29 mm in male and 25 mm in female on average.Height and gender was positively correlated with partiallythreaded screw length.In posterior wall fracture of C2 vertebral body,length of bolt shank was an average of 17 mm in male and 15mm in female,while fillet of screw length was 12 mm in male and 10 mm in female.The mean length of bolt shank was 14mm in male and 13 mm in female,while mean fillet of screw length was 15 mm in male and 12 mm in female in isthmus fracture.In fractures under C2 laminar,length of bolt shank was 10 mm in male and 9 mm in female on average,while mean fillet of screw length was 18 mm in male and 15mm in female.Conclusion The length of partiallythreaded screw used in posterior axial pedicle fracture may have a close correlation to length and height.The length of bolt shank and fillet of screw was different according to the position of the fracture.
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Objective To explore the application value of multi-slice CT angiography (MSCTA)in posterior approach of upper cervical vertebrae.Methods Fifty-one patients with suspected or conformed upper cervical disease were collected and performed cer-vical CTA examination.Twenty three patients underwent internal fixation surgery of posterior upper cervical and reviewed with CTA examination.Volume Render (VR),Maximum Intensity Projection (MIP)and Multi-planar Reformation (MPR)were used to show the courser and anatomical variation of vertebra artery,the shape of vertebrae,the relationship between the vertebra artery and adjacent structure,advantage artery.The distribution of screw placement,including perforation of the anterior wall,the inner wall, the outer wall,the upper wall,the interior wall and the inner wall of occipital were observed by VR,MIP and MPR after surgery, especially the relationship between the screw and vertebra artery,the screw and spinal cord.Comparing the correlation between the screw placement and postoperative symptoms.SPSS1 9.0 statistical packages were used for statistical analysis.Results VR,MIP and MPR can show the courser and nearby space relationship of cervical artery.The number of advantage artery was 25,equilibra-tion was 26,dysplasia variation was 13,course variation was 4.The number of tiny pedicle was 1 6,including 9 cases of ipsilateral advantage artery.The postoperative data analysis of 23 patients showed that:C1 -20,C2 -36,C3 - 1 5,C4 -2,occipital 40.The number of accurate screw placement was 83.Different type of perforation was 30,including 3 screws closing to vertebra artery,1 screw closing to spinal cord.All 23 patients were asymptomatic after surgery.Conclusion MSCTA can reflect the morphology of cervical vertebral,the spatial relationship between cervical vertebral and surrounding structure,which can provide an accurate refer-ence for clinical screw placement and improve the accuracy .The postoperative CTA can show screw placement accurately,which has great reference for the evaluation of clinical success rate of surgery and post-surgery treatment.
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Objective To explore the feasibility and value of MSCT for the evaluation of hypophysoma before and after endonasal transphenoidal microsurgery.Methods 82 patients with hypophysoma intended to be treated by endonasal transphenoidal microsur-gery,were examined by 64-slice head CT angiography (CTA).All the images were transmitted to workstation and reconstructed by MIP、VR and MPR.The hypophysoma were typed according to the relationship between hypophysoma and its surrounding vessels. The shortest and longest diameter between internal carotid arteries of two sides,tumor length and width,the diameter between ex-ternal naris and the rear wall of sphenoid top and the length from external naris to the rear wall of tumor top were measured in VR images.Sphenoid division was observed in coronal plane image.Major vascular injury,bleeding,and residual tumor situation were observed on postoperative CT review.The surgery effect was evaluated by three associate professorwith SPSS 13.0.Results 39 ca-ses were type-A,30 were type-B,13 were type-C,tumor length ranged from 1.7 cm to 3.9 cm,width ranged from 1.3 cm to 2.5 cm,the diameter between external naris and the rear wall of sphenoid top and the length between external naris and the rear wall of tumor top were 6.9 cm~7.6 cm and 9 cm~12.2 cm.There are 1 5 cases of sphenoid without division,34 cases with one divi-sion,26 cases with two division and at least three division in 7 cases.The surgery effect was better in those which tumor size was relatively smaller compared to the diameter of the internal carotid artery.The evaluation of endoscopic endonasal transsphenoidal surgery with three types of pituitary adenomas had a significant difference (P <0.05).Conclusion MSCT can preferably reflect the spatial location relationship between pituitary adenimas and its surrounding structure,and it is effective evaluation methods for pre-operative and postoperative evaluation of transnasal microsurgical resection.
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Objective To evaluate hepatic functional reserve and operational risks of primary hepatic carcinoma in Child A using functional CT.Methods In 128 cases of primary hepatic carcinoma of Child A undergoing hepatoectomy and identified by pathology, CT perfusion scanning and measurement of remannent hepatic volume were done before operation and whole patients were divided in-to acute hepatic failure group(AHF group,33 cases)and non-acute hepatic failure(non-AHF group,95 cases).All variables were ana-lyzed by one way analysis of variance(one-way ANOVA)firstly.The variables with significance (P<0.05)were analyzed with Step-wise Logistic regression further.Results One-way ANOVA result:There were significant difference between two groups in RHVS measured by CT,PVP,HBF,HBV,serum creatinine,thrombinogen activity,total bilirubin and intraoperative blood loss (P<0.05).The StepwiseLogistic regression analysis demonstrated that decreased RHVS and the lowed PVP were the independent risk factors of AHF complicated to hepatoectomy of primary hepatic carcinoma(P<0.01).Conclusion Hepatic functional reserve and operational risks of primary hepatic carcinoma could be j udged with functional CT before operation .
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Purpose To explore the value of 64-slice spiral CT digital subtraction angiography in diagnosis of cerebral arteriovenous malformations (AVM).Materials and Methods 26 patients with AVM were performed with plain CT scan, enhanced arterial phase and venous phase CT scan on a 64-slice spiral CT scanner. The subtracted arterial phase data was obtained through subtracting the plain CT images from arterial phase images, then the subtracted venous phase data was obtained through subtracting arterial phase images from venous phase images, and subtracted mixed arterial-venous phase data through subtracting plain CT images from venous phase images. Then volume rendering (VR) and maximum intensity projection (MIP) were used to reconstruct the cerebral vessel images. Results The inference of cranial bones was completely removed in all subtracted cerebral vessel images, thus clearly demonstrating malformed vascular nest, feeding arteries and draining veins. And 7 malformed temporal vascular nests, 5 parietal vascular nests, 5 frontal vascular nests, 6 occipital vascular nests and 3 cerebellar vascular nests were revealed;39 feeding arteries were detected altogether. Single feeding artery was found in 15 cases, and multiple feeding arteries in 9 cases. Meanwhile 33 draining veins were observed, and single draining vein was found in 10 cases, multiple veins in 16 cases.Conclusion 64-slice subtraction angiography can remove the inference of cranial bones and clearly demonstrate the feeding arteries, malformed vascular nests, draining veins, potentially providing a reliable evidence for therapeutic planning and postoperative follow-up.
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Objective To observe and measure the anatomical structure of approach of vertical facial nerve canal and put forward the normal measurement range and the location relationship among the vertical segment of facial nerve canal, the posterior wall of external acoustic meatus and the rear edge of external ear,and discuss the relationship and clinical significance between the mastoid gasification and the vertical segment of facial nerve canal. Methods 1. Evaluate the accuracy of CT image of related structure, using spiral CT in scanning four skull specimens, get the horizontal distances of the vertical segment of facial nerve canal to the posterior wall of external acoustic meatus and the rear edge of external in the axial position, and get the sagittal diameter of mastoid (the horizontal distance from the lowest point of external auditory inferior canal to the rear edge of mastoid) and the height (the vertical distance between the lowest points of the external auditory canal wall to the mastoid tip) in the sagittal position. And then saw the skull specimens to measure the distance in the same lay with CT image, and discuss the statistics difference of the distance between the values of CT imaging measurements and the dry entities cranial measurements on hand. 2. Study on people: 118 patients (236 sides) with non-ear disorders were randomly selected, among which there were 63 females (126 sides) and 55 males (110 sides). They were subjected to maxillofacial CT scan in the same layer that used above, and the horizontal distances of the facial nerve canal to the posterior wall of external acoustic meatus and the rear edge of external ear were measured. In addition, half of the product of diameter and height of the mastoid was defined as mastoid area, which was used to define the extension of mastoid gasification. Then related analysis and regression analysis were done between the vertical segment of facial nerve canal and the posterior wall of external acoustic meatus, as well as the rear edge of external ear. Results 1.Part of the experiment: There was no significantly different on the indicator values between CT image the entity measurements among the four skull specimens (P>0.05). 2. Study on people: There was no significantly different between left side and right side(P>0.05), but significantly different between genders(P<0.05). Between mastoid area and the distance from the vertical segment of facial nerve canal to the posterior wall of external acoustic meatus there is inverse correlation, and the relevance has the remarkable significance. However, there was no correlation between mastoid area and the vertical segment of facial nerve canal to the rear edge of external ear. Conclusion There was some relationship between the location of the vertical segment of facial nerve canal and external acoustic meatus. Anatomic position of vertical facial nerve cancal and the posterior wall of external acoustic meatus can be showed clearly. CT and in combination with primitive axial images may provide reliable evidence for the diagnosis facial nerve dieases and the choice of ear surgery route.
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Objective To observe and analyze the standards of the normal vivo renal multi-slice spiral CT(MSCT) imaging to provide relevant normal range for clinic and teaching.Methods 123 cases with normal kidneys were undergone abdominal MSCT,then 3D imaging was performed,the position of kidney distance between two poles of kidney and the central line of the spine,renal length and short axis,the angels between the renal length axis and sagittal segment(LS) and the coronal segment(LC),the angel between coronal segment and the longest distance line from the midpoint of the renal gate to the same kidney's out edge(CL) were observed and measured with statistics analysis.Results Mostly the position of left kidney was higher than that of the right.Almost kidney's upper poles located at the T12 level.The number of left kidney was more than the right kidney in the renal upper pole located higher than T11.Almost kidney's inferior poles located at from the L2 inferior edge level to the L3 inferior edge level.In the statistic results,the values measured on CT of left kidney were large or equal to the right except for CL and LC in men,LC in women,total LC and LS.The width in men,total length and width and total upper distance were of significant statistics meaning(P
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Objective To evaluate the clinical value of multislice spiral CT(MSCT) reconstruction in designing the pedicle screw trajectory before operation in atlantoaxial lesions.Methods 37 patients with upper cervical abnormality treated by surgery for atlantoaxial or occipitoaxial interfixation and/or fusion were undergone MSCT scan,and the 3D anatomical data(including the length,width and height of each pedicle,the angle between the pedicle and sagittal plane,and the thickness of internal occipital crest) were measured on volume reconstruction(VR) and multi-plane reconstruction(MPR) images and used for surgeon to select advisable pedicle screws(including the proper length and diameter) and to ensure the comfortable point,depth and direction for screw position at preoperation.The patients were followed up by atlantoaxial X-ray image and/or MSCT reconstruction to estimate the veracity of the screw position.Results All the patients were operated successfully,of them,5 patients were treated by simply atlantoaxial fixation,15 by atlantoaxial fixation and fusion,4 by simply occipitoaxial fixation,11 by occipitoaxial fixation and fusion,2 by atlantoaxial fixation and occipitoaxial fusion.X-ray images and/or MSCT reconstruction revealed that atlantoaxis were reposition entirely and all the screws were at predesigned trajectory.All the patients were followed up and no screw was broken or loosen and no atlantoaxial redislocation was found.Conclusion MSCT reconstruction for designing pedicle screw trajectory in atlantoaxial lesions before operation is satisfactory and valuable for clinical application.
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Objective To study the factors effect on the measurement of CT value.Methods CT water phantom was scanned using the regular condition of scaning first,then changed one of scaning conditions (thick slice, exposure capacity, reconstruction of function, kV, FOV and CT-scanner) to scan the water phantom again. The CT value (mean?SD) of image region of interest (ROI) was compared in two conditions. Results The mean CT value in the opposite ROI in thick slice 5mm and exposure capacity 150 mAs was similar to that in thick slice 10mm and exposure capacity 300mAs, the reconstruction of function Fc80 was lower Fc10 , the 130kV was distinct higher 120Kv in mean of CT value respectively.The SD(noise) in thick slice 5mm was near to the exposure capacity 150mAs, while in contrast to the thick slice 10mm and the exposure capacity 300mAs was obvious increased , but the reconstruction of function Fc80 was distinct higher Fc10, the 130kV was slightly lower 120Kv in SD(noise) respectively . All of mean CT value and the noise in the small field were higher in the middle field ,when CT imaging in the water phantom of the single small field .This result was also received when the old Toshiba CT-scanner was compared with the new GE CT-scanner in the differ water plantom.Conclusion The CT value is not constant and can’t act as a diagnostic standred.