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<p><b>OBJECTIVE</b>To analyze the value of MR imaging in diagnosis of intraductal papillary neoplasm of the bile duct (IPN-B).</p><p><b>METHODS</b>Fourteen patients with intraductal papillary neoplasms of the bile duct confirmed by surgical pathology were included in this study. The patients underwent MR routine plain scanning and enhancement scanning (including T1WI, T2WI with fat suppression, FALSH T1WI, and three-phase enhancement scanning), diffusion weighted imaging(DWI) and magnetic resonance cholangiopancreatography (MRCP) before operation. The imaging data were reviewed and analyzed retrospectively in comparison with the surgical and pathological results.</p><p><b>RESULTS</b>In these patients, 7 cases had tumors located in the left lobe, 2 cases had tumors in both the left and right lobes, 2 cases in the hepatic hilum, 2 cases in the common bile duct, and 1 case in both the right lobe and the common bile duct. Solitary or multiple intraductal masses could be found in 12 cases, with 11 cases appeared as papillary masses and one case as flat mass. In the other two cases the tumor was not visible (one case had too many stones, and in another case the tumor was too small). The tumors in the 12 cases showed hypointensity on T1WI and hyperintensity on T2WI. On the dynamic contrast-enhanced MRI, 11 cases showed mild and one showed moderate enhancement in arterial phase, and all the cases showed mildly and gradually delayed enhancement. On DWI, the lesion areas showed high signal intensity in all the cases, and the ADC value of the tumor area (1.697×10(-3)mm(2)/s) was significantly lower than that of the normal bile (3.973×10(-3)mm(2)/s) (t = -10.94, P < 0.05). Twelve cases demonstrated filling defects on primary MRCP coronary thin section images. On 3D-reconstruction MRCP images, 7 cases exhibited diffuse bile duct dilatation with the tumor areas more prominent, 3 cases exhibited aneurysmal bile dilatation, while the rest 4 cases exhibited segmental or lobar bile duct dilatation ( including 2 with invisible tumors ). In the 3 cases with aneurysmal bile dilatation, the multiple directions of MRCP images helped to find the communication between the aneurysmal dilatation and the bile duct. All the cases showed significant proximal bile duct dilatation (the extent of dilatation >100%), and 9 cases also showed distal bile duct dilatation. Bile duct stones were noted in 6 cases, 4 at the tumor area, and the other 2 away from the tumor area. No adjacent tissue invasion and no distal tissue or lymph node metastasis were observed.</p><p><b>CONCLUSION</b>Intraductal papillary neoplasms of the bile ducts have characteristic imaging appearances on MRI, and MRI is an important method helpful to making correct diagnosis.</p>
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Humans , Bile Duct Neoplasms , Diagnosis , Bile Ducts , Cholangiopancreatography, Magnetic Resonance , Common Bile Duct , Diagnostic Imaging , Diffusion Magnetic Resonance Imaging , Magnetic Resonance Imaging , Retrospective StudiesABSTRACT
Objective To correlate CT findings of secondary hepatic lymphoma with pathology and to evaluate it's clinical value.Methods Nine patients with secondary hepatic lymphoma confirmed by pathology underwent spiral CT scanning and dual-phase dynamic contrast-enhancement scanning before operation, the CT data were reviewed and analysed retrospectively in comparison with surgical and pathological results.Results Twenty-three lesions of secondary hepatic lymphoma in 9 patients were located in the left lobe (9 lesions), the fight lobe (6 lesions),the porta of the liver (5 lesions) and the caudate lobe (3 lesions), respectively.Sixteen of these 23 lesions were distributed over an area near the portal vein, 7 were seattered in the exterior of liver.17 lesions had an ellipsoid contour and 6 showed irregular contour.The diameter of the lesions ranged from 2.7 to 16.5 cm, with a mean diameter of 5.9cm.The tumor demonstrated mild homogeneous dynamic delayed contrasted-enhancement and the CT value of the non-contrast scans, AP phases and PVP phases were 20.7 to 31.5 HU(with a mean value of 25.3 HU), 23.8 to 48.5 HU(with a mean value of 31.9 HU) and 35.3 to 60.2 HU(with a mean value of 47.8 HU) respectively.Intrinsic hepatic vessels could be discerned in 6 lesions.The lesions situated in the perta of the liver encased the portal vessels, but there was no vessel compression or occlusion.Conclusion Recognition of the dynamic CT features of hepatic lymphoma could enhance its diagnostic accuracy.
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Objective To explore and evaluate MRI in diagnosing primary muscle non-Hodgkin lymphoma. Methods Six surgically confirmed primary muscle non-Hod#in lymphoma underwent MR examination including T_1WI, T_2WI and T_1 WI enhanced studies. The acquired images date was reviewed and analysed retrospectively in comparison with surgical and pathological results. Results The locations of 6 cases were cervical part (2), upper extremity (1), lower extremity (3), respectively. All cases involved of more than one anatomical compartment with poorly defined solid masses in 5 cases and well defined in 1 cases, 5 extended to subcutaneous fat and 3 extended along the neurovascular bundle. The mean tumor diameter was 13.9 cm, ranging from 7.3 to 22.5 cm. One was well demarcated and 5 were ill-defined. On T_1 WI, 2 were slighdy high signal intensity and 4 were slighdy low signal intensity. On T_2 WI, 2 were slightly high signal intensity, 3 were intermediate signal intensity and 1 was high signal intensity. Five were inhomogeneous and 1 was homogeneous. The intrinsic structure such as muscle fiber, tendo, spatium intermusculare were detected on 5 cases. Of the 5 dynamic contrast-enhanced cases, it showed moderate enhamcement during arterial phase, 2 were homogeneous and 3 were inhomogeneous. And it showed progressive enhancement during interstitial phase, 3 were homogeneous and 2 were inhomogeneous. Conclusions Primary muscle lymphoma always originated deep to the fascia showing subcutaneous extension and multiple compartment invasion. Typically form poorly defined solid masses with slightly high in signal intensity on MR T_2WI and middle degree dynamic delayed contrasted-enhanced in which intrinsic anatomic structure such as muscle fiber, tendo, spatium intermusculare and so on can be discerned, almost all cases involve more than one muscle compartment and some of tumor extend along the neurovascular bundle.
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Objective To Explore the imaging features relative to pathology of pelvic chondrosarcoma and to evaluate the clinical value.Methods All 12 cases patients with primary pelvic chondrosarcoma confirmed by pathological examination underwent radiography,spiral CT plain scanning,MR SE-T1WI,FSE-T2WI and SE-Tl WI enhancement scanning before operation.The imaging data was reviewed and analyzed retrospectively to compare with surgical and pathological results.Results Eleven conventional chondrosarcoma and one dedifierentiated chondrosarcoma were located in different parts of pelvis.The diameters of the tumors ranged from 4.7 to 17.0 cm with one case less than 5.0 cm,6 cases being 5.O-10.0 am and 5 cases more than 10.0 Cln.The CT valHe of 5 cases was identical or inferior to muscle with mild to moderate"ring-and-arc"mineralization and soft mass.MR imaging depict the high water content of these lesions as very high signal intensity was detected on T2 WI.Six cases showed typical"ring-and-arc"fibrous tissue which enhanced persistently.Aggressive features of deep endosteal scalloping and soft-tissue extension was also found in these cases.Conclusions Radiographic findings Can suggest the diagnosis of pelvic chondrosarcoma when there is typical"ring-and.arc"fibrous tissue,mineralization,aggressive features of deep endosteal scalloping and large soft-tissue extension.MR imaging reflect directly this pathologic structure,superior to that of CT and radiography.CT is optimal to detect the matrix mineralization,particularly when it is subtle or when the lesion is located in anatomically complex pelvic areas.
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Objective To explore the imaging features of primary malignant fibrous histiocytoma(MFH)of bone and correlate them with pathological findings.Methods Thirteen cases patients with primary MFH of bone confirmed by surgical pathology underwent radiography,spiral CT plain scanning and MR SE-T1 WI,T2 WI and SE-T1 WI enhancement scanning before operation.The imaging date was reviewed and analysed retrospectively in comparison with surgical and pathological results.Results Of 13 MFH,11 were located in the end of long bone,and 2 in the diaphysis.The distance between tumors in the end of long bone and adjacent joint surface was 1 to 5 cm.All lesions showed osteolytic destruction with the maximum diameter of the tumors from 5.3 to 12.7 cm.The tumors had eccentric aggressive osteolytic destruction in 10 lesions,internal crest within the lesions in 7,inconsecutive marginal osteosclerosis in 11,little periosteal reaction in 2 and small soft tissue masses in 9,respectively.The CT value of lesions was similar to muscle.MR imaging depicted low signal intensity with aggressive features on T1 WI,iso to slight high signal intensity on T2 WI,and middle or high degree contrast enhancement on enhanced T1 WI images.Macroscopically,MFH was usually located eccentrically within the bone and produced little or no osseous expansion.The soft tissue component appeared multi-nodules and pseudo-encapsulated.Histologically,they consisted of spindle-shaped fibroblasts,which radiated outward in a spiral array from a central focus and produced a nebula or storiform appearance,and cells,which were small and oval with little visible cytoplasm.Conclusions The imaging manifestations of MFH were specific to some extent.Combined utilization of plain X-ray,CT,and MRI is helpful for the diagnosis and differential diagnosis of MFH.
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<p><b>OBJECTIVE</b>To investigate role of exocrine cells in the pancreatic enhancement images at Manganese (II) N, N'-dipyridoxylethlenediamine-N, N'-diacetate 5, 5'-bisc (Mn-DPDP)-enhanced magnetic resonance (MR) imaging.</p><p><b>METHODS</b>Artificial pancreatic leakage was constructed in six dogs using a fistula tube inserted into the duodenum papillae. Pancreatic juice was collected before and after intravenous infusion of 2 ml/kg of Mn-DPDP at a rate of 2 - 3 ml/min. The Mn content of pancreatic juice was measured by atomic absorption spectroscopy. T(1)-weighted spin-echo images and T(1)-weighted spoiled phase gradient-echo (SPGR) images were obtained prior and approximately 30 min after the administration of Mn-DPDP at 1.5T.</p><p><b>RESULTS</b>The Mn content of pancreatic secretion increased 60.47 +/- 21.83 micro g/dl after the administration of Mn-DPDP (t = 6.785, P < 0.01). The signal/noise ratio (S/N) of the pancreas increased 53 percent +/- 49 percent and 62 percent +/- 44% on T(1)W spin echo images and SPGR images, respectively.</p><p><b>CONCLUSIONS</b>Exocrine cells of the pancreas can absorb manganese and excrete it through the pancreatic juice. Exocrine cells play an important role in the enhancement of the pancreas in MR imaging with Mn-DPDP.</p>
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Animals , Dogs , Contrast Media , Edetic Acid , Pharmacokinetics , Image Enhancement , Magnetic Resonance Imaging , Manganese , Pharmacokinetics , Pancreas , Metabolism , Pyridoxal Phosphate , PharmacokineticsABSTRACT
<p><b>OBJECTIVES</b>To study the usefulness of CT virtual colonoscopy (CTVC) in patients with incomplete conventional colonoscopy (CC) and assess the statistical differences between two methods of colorectal segment examination.</p><p><b>METHODS</b>Sixty patients with incomplete CC underwent volume scanning using spiral CT. CT VC images were obtained using a navigator software in workstation. All patients were confirmed by surgical or CC biopsy histology. Statistical analysis was done using t test comparing two sample percentages.</p><p><b>RESULTS</b>CTVC succeeded in 55/60 patients (91.7%) who had incomplete CC. Additional lesions were identified in the proximal colon in 15/55 patients (27.3%), including 1 primary carcinoma, 16 polyps in 13 patients and 1 ulcerative colonitis. The main cause of incomplete CC was occlusive mass; others were redundant, tortuous colon loops, and excessive colonic spasm. There was a statistically significant difference between the two methods in colorectal segment examination.</p><p><b>CONCLUSION</b>CTVC is a feasible and effective adjunctive method for evaluating the entire colorectal segment following an incomplete CC procedure. It offers a new approach for colorectal examination.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Colonoscopy , Methods , Tomography, X-Ray Computed , MethodsABSTRACT
<p><b>OBJECTIVE</b>To investigate intratumoral microvessel density (MVD) and expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (BFGF) in hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and to evaluate their significance.</p><p><b>METHODS</b>MVD and expression of VEGF and BFGF in cancerous tissues were examined in forty specimens resected from patients with HCC using immunohistochemical methods. Among these patients, 20 patients received 1 to 7 treatments of TACE prior to II-phase surgical resection (TACE group), the other 20 patients were treated by operation without receiving any other treatment preoperatively (surgical group). There was no significant difference in clinical features between the two groups. MVD was assessed by counting immunostained endothelial cells within a certain area, and staining intensity of VEGF was assessed quantitatively with computer-assisted image analyzer. The expression of BFGF was determined by cell-positive or cell-negative.</p><p><b>RESULTS</b>The average MVD was 130.51 75.5 in TACE group and 152.35 58.80 in surgical group. There was no significant difference between the two groups (t=-1.021, P=0.341). Staining intensity of VEGF was 645.60 543.27 in TACE group, higher than in surgical group (158.28 188.48, t=281, P<0.001). BFGF-positive rate was 35% in TACE group and 40% in surgical group. There was no significant difference (x(2)=0.107, P=0.744).</p><p><b>CONCLUSIONS</b>The results indicate that survived cancerous tissue has rich vascularity and the expression of VEGF of the cancerous cells can be enhanced by TACE which may play an important role in reestablishment of blood supply to tumor after TACE.</p>
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Humans , Carcinoma, Hepatocellular , Metabolism , Pathology , Therapeutics , Catheterization , Embolization, Therapeutic , Endothelial Growth Factors , Fibroblast Growth Factor 2 , Liver Neoplasms , Metabolism , Pathology , Therapeutics , Lymphokines , Neovascularization, Pathologic , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth FactorsABSTRACT
Objective To analyze the time-density curve of the small HCCs in the arterial phase and to find out its unique features.Methods All lesions were imaged with single-level serial SCT.The attenuations of the lesion,hepatic artery and hepatic parenchyma were measured.The time-density curve was built with these CT values and their corresponding times.Results The time-density curves of the lesion and liver parenchyma were divided into three kinds:the first kind had two intersects(73%).The first one was seen at the time when the curve of the lesion went up over the one of the parenchyma and the second was seen at the point the curve came down below the parenchyma's.There was no second intersecting point in the second type(19.2%) and the curve of the lesion was below that of the parenchyma in the third (7.7%). Conclusion The initial time of the enhancement of small SHCC is (21.6?6) s.The optimal time of the enhancement of SHCC is (36?8) s.
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Objective To investigate the safety and efficacy of placement of self expandable metallic stent within right atrium and inferior vena cava (ICV) in patients with malignant ICV obstruction involving right atrium. Methods There were 5 male patients with advanced hepatocellular carcinoma, aged from 42 to 65 years (mean 56 3 years). The malignancies invaded right atrium and ICV simultaneously, and caused obstruction of ICV. These patients presented symptoms and signs of obstruction of ICV such as hepatomegaly, ascites, edema of lower extremities. “Z” type stainless steel stents (7 5~10.0 cm in length and 2 5 cm in diameter) were selected for these patients. Part (1.0~3.0 cm in length ) of stent was placed in right atrium and the rest was in ICV. Results All of stents were placed successfully and obstructed ICV reopened. The symptoms of obstruction of ICV relieved or disappeared. There were no recurrence of symptoms of obstruction of ICV and any cardiac complication related to placement of stents in follow up period (67~188 days). Conclusion Placement of self expandable metallic stent within right atrium and ICV in treatment of patients with malignant ICV obstruction involving right atrium is one of the safe and effective methods.
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Objective To investigate the MR features of uterine leiomyomas and evaluate its diagnostic value. Methods Twenty six patients with probable uterine leiomyomas underwent preoperative ultrasound, T 1 weighted spin echo and T 2 weighted fast spin echo MR examinations. Among them, 11 cases were performed with dynamic contrast enhancement. Comparative analysis between MRI findings and pathologic results was done. Results MRI diagnosis in all cases was consistent with the results given by surgery and pathology, except 2 being pathologically proven as endometrial polyp or inflammatory pseudoplasma. The diagnostic accuracy of MRI was 92%, while the accuracy of ultrasound was 85%. The difference between the number of lesions detected by two modalities had statistical significance (89% for MRI vs 69% for ultrasound, ? 2=17.86, P
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Objective To evaluate the mult iphase hepatic CT scan for detecting the hypervascular hepatocellular carcinoma (HCC) by using multidetector row helical CT (MDCT). Methods Multiphase hepatic CT scan of the liver in 40 patients with HCC was carried out with Marconi 8000 multidetector row helical CT scanner .The early arterial phase scan, late arterial phase scan, and portal venous phase scan were started at 20 s, 34 s, and 80 s after the injection of contrast medium, respectively. The numbers of the detected lesions were calculated in each phase. The density values of the liver and tumor were measured for HCC ≥1 cm, and the density difference values of the liver and tumor in each phase were statistically calculated and analyzed. Results The study showed that a total of 61 lesions was found in 40 cases, and the lesions ≥ 1 cm were 47. The density difference values between hepatic parenchyma and HCC in the 47 lesions were significantly different at the early arterial phase, the late arterial phase, and the portal venous phase ( P
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Objective The purpose of this study was to compare gadolinium-enhanced multiphase dynamic MR imaging and multirow-detector helical CT (MDCT) multiphase scanning for detection of small hepatocellular carcinoma. Methods Multirow-detector helical CT multiphase scanning and MRI with SE sequence combined with FMPSPGR sequence were performed in 37 patients with 43 small HCCs. ROC curves were established to analyze the results for each modality. Results There was no statistical difference between MDCT and MRI in the areas below the receive operating characteristic curve (Az). The detection of small HCC on MDCT showed lesser false-positive lesions than that on MRI, however the difference was not statistically different. Sensitivity of detecting small HCC on MDCT with multiphase scanning was higher than that on dynamic MRI. The sensitivity of detection for small HCC (≤1 cm) was 90.0%, 95.0% on MDCT and 70.0%, 85.0% on MRI, respectively. The positive predictive values for small HCC were higher on dynamic MDCT (97.5%, 97.6%) than on dynamic MRI (90.7%, 94.7%), respectively. Conclusion For early detection of small HCC, multiphase hepatic CT scan using MDCT is highly recommended for the patients with chronic hepatitis and cirrhosis.
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Objective To evaluate the diagnostic value of dynamic contrast-enhanced MR angiography(DCE MRA)of the renal arteries.Methods 18 patients suspected with renal arterial diseases underwent DCE MR Angiography examinations.After 20 ml(0.15~0.20 mmol/kg)Gd-DTPA being injected quickly via cubital vein,a scaning and data acquisition with coronal three-demensional fast spoiled gradient(FSPGR)sequence was performed in a breath-hold time,the source images were introduced into work station for post processing,including maximum intensity projection(MIP)and multiplanner reconstruction(MPR),finally 3D DCE MRA images were obtained.Results A comparative study on renal artery stenosis and its degree between DCE MR angiography and DSA was done in 25 arteial segments of 12 cases.In 12 normal renal arteries shown by DSA,DCE MRA found 11 normal and one mild stenosis;Four moderate and one severe stenosis was shown by DCE MRA in five renal arteries with moderate stenosis identified by DSA;DCE MRA found five severe stenosis and three occlusion of renal anteries,which had accordance with DSA findings.Conclusion Dynamic contrast-enhanced MR angiography can accurately assess renal arterial diseases,the accuracy was especially higher in patients with severe arterial stenosis and occlusion.
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Objective To compare the ability of CT and MRI in evaluating the residual of tumor of hepatocellular carcinoma (HCC) and its stability after treated by transcatheter arterial chemoembolization (TACE) with Lipiodol.Methods 28 patients with HCC underwent CT, MRI and angiography within 2~6 months after 1~4 procedure(s) of TACE. These three examinations were completed sequentially within one month. CT and MRI findings were thus compared on the basis of the results of arteriography and clinical follow-up at least 6 months.Results 46 lesions were found in 28 patients. 31 lesions with and the other 15 lesions without residual viable tumor were confirmed by arteriography and clinical follow-up. 20 lesions with and 26 lesions without residual viable tumor were found on CT images, and CT displayed 64.5% sensitivity, 100% specificity, and 76.1% accuracy respectively. 29 lesions with and 17 lesions without residual viable tumor were found on MRI images, and its sensitivity, specificity, and accuracy were 93.5%, 100%, and 95.7% respectively. The sensitivity and accuracy between CT and MRI in evaluating the residual viable tumor of HCCs after TACE were significant different(?
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Objective To optimize the oral contrast media in three-dimensional display of gastric lesions. Methods 41 cases were randomly divided into 3 groups according to different oral contrast media administered: No. 1 air contrast group (n=17), No. 2 fat emulsion group (n=7) and No. 3 positive contrast group (n=25). The 3D CT images were reconstructed using MPR, SSD, RaySum display and virtual endoscopic techniques, and compared with gastric endoscopy and/or conventional barium study.Results The detectability of gastric lesions using fat emulsion and air contrast was 42.8%(3/7) and 80.0%(20/25), respectively, both were significantly lower than that using positive contrast (100%, 30/30) (χ2=19.22,P<0.01;χ2=6.60, P<0.05). The capability of showing the details of stomach lesions was significantly affected by the oral contrast media administered(χ2=17.04,P<0.01). Conclusion It is very important to choose the appropriate oral contrast media for 3D display of gastric lesions in spiral CT, the positive contrast agent is the optimal choice.
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Objective To evaluate the value of gradient-echo chemical shift imaging in detection of lipid-containing abdominal lesions. Methods 35 patients with abdominal lesions were divided into 2 groups according to whether or not they contained lipid. Breath-hold in-phase(IP) and opposed-phase(OP) acquisitions were performed. The demonstration of these lesions on IP and OP was compared. The signal intensity of these lesions on both images was measured. The percentage of signal intensity variation on IP and OP was calculated and statistically analyzed with non-parametric method between the 2 groups. Results For lesions containing lipid, the signal intensity dropped significantly from IP to OP, with median value of signal intensity variation attaining 37.1%. On the other hand, for lesions not containing lipid, the signal intensity did not change obviously between IP and OP, whose median value of signal intensity variation was 3.3%. The difference between the 2 groups was statistically significant (u=4.56,P<0.01). Conclusion Gradient-echo chemical shift imaging is an easy and practical way, helpful to detection of lipid component within abdominal lesions.
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Objective To investigate CT and MRI manifestations of uveal melanoma as well as their diagnostic value.Methods 33 cases of uveal melanoma proved by operation and pathology were studied retrospectively.CT and MRI scanning were performed in 15 and 18 patients respectively.Results The round occupying lesions within eyeball were the characteristic imaging finding of uveal melanomas, most of them were found in the location of choroid membrane. These lesions appeared as homogenous density on CT and short T 1 and short T 2 intensity on MRI. MRI was superior to CT because it could provide more accurate information such as location, shape,extension,and differentiation of the complication (retina detachment) from lesion itself. The preoperation diagnostic accuracy of CT was 53% compared with that of 88% of MRI. Conclusion MRI is the optimal examination method in confirming suspected uveal melanoma.
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5 mm) in 4 cases, and polypoid mass in 3.[WT5”HZ] Conclusion[WT5”BZ] CT is a new non invasive technique, evaluable in the diagnosis of chololedochal cyst complicated with carcinoma. [WT5”HZ]
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Objective To investigate the value of volume reconstruction ( VR ) in showing the ear lesions and to compare with otherpost-processed methods.Methods 15 patients with hearing loss underwent MSCT ultra-high resolution scan with collimation 0.5 mm,pitch 0.5~0.875 and increment 0.1mm.An additional enhanced CT was performed in 10 of 15 cases. The various reconstructions including VR , MPR, SSD, VE, Ray Sum and MIP/MinIP were performed for the comparison of their ability in showing the ear lesions and the invasion of the auditory ossicals and the inner ear of the adjacent tumors. Results VR was the most optimal way, in showing the ear lesions,successionally in descending order was VR, MPR, SSD, MIP/MinIP. Ray Sum and VE were only suitable for showing the lesions of the inner ear and auditory ossicles respectively.Conclusion The data acquired from the scan of MSCT using 0.5 mm collimation can be used in various reconstruction methods including VR, MPR, SSD and MIP/MinIP to display the lesions of the ear and the invasion of the ear fine structures from the plane and three-dimensional view. VR is the best way, which can display the relationship between tumor and facial/auditory nerve, labyrinth .