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Objective:To compare the differences in radiation dose and image quality between cone-beam CT (CBCT) and multi-slice spiral CT (MSCT) applied to atlantoaxial spine imaging.Methods:Head and neck phantom was scanned at 30 exposure parameter combinations using Pramerica CBCT scanner and 15 parameter combinations using Toshiba 320-row MSCT. The effective dose ( E) of CBCT was calculated based on the Monte Carlo dose estimation software PCXMC, the E value of MSCT was obtained by multiplying the dose length product (DLP) by the related factor. t-test for two independent samples or Wilcoxon rank sum test were used for comparison of radiation dose and subjective and objective image quality between two modalities. The subjective evaluation was a 5-point subjective scale using double-blind method for edge sharpness, contrast, soft tissue level, and artifacts of the images. The signal and noise in the region of interest (ROI) were measured and the contrast signal-to-noise ratio (CNR) was calculated. Results:For radiation dose, the volumetric dose index and E values of 2.9 mGy and 27.61 μSv for CBCT were lower than those of 8.8 mGy and 433.16 μSv for MSCT, and the differences were statistically significant( z=-3.05, -5.25, P<0.05). For objective evaluation of image quality, the noise and CNR were 27.74 HU and 3.69 in CBCT group, 7.84 HU and 27.1 in MSCT group. The difference between them were statistically significant( z=-5.39, -5.42, P<0.05). The overall image quality, contrast and artifact scores of the CBCT group were 3.5, 3.0 and 5 were higher than those of the MSCT group at 2.0, 2.0, and 4.0, respectively ( z=-2.32, -2.46, -3.31, P<0.05). Conclusions:Both atlantoaxial CBCT and MSCT scans provide image quality that meets diagnostic requirements. Compared to MSCT, CBCT atlantoaxial scans can effectively reduce radiation dose according to the principle of optimization of radiation protection.
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Objective To explore the features of multi-slice spiral computed tomography (MSCT) examination of indirect,direct and femoral inguinal hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 106 patients with indirect,direct and femoral inguinal hernia who were admitted to the First Affiliated Hospital of Xinxiang Medical University between December 2014 and August 2017 were collected.All the patients were diagnosed as inguinal hernia by MSCT examination and multi-planar reconstruction.Observation indicators:(1) sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT;(2) inguinal anatomic presentation in MSCT examination;(3) relationship between hernial sac and surrounding structures in MSCT examination;(4) hernia contents and quadrants of hernial sac in the quadrant partition with " cross intersect" method and complications.Count data were described as absolute number or percentage.Comparison of count data was done using the chi-square test with row multiplied by column.Results (1) Sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT:of 106 patients,66,22 and 18 were diagnosed as indirect hernia,direct hernia and femoral hernia with 70,27 and 20 hernial sacs respectively.Sensitivity,specificity,positive and negative predictive values of inguinal hernia by MSCT were respectively 95.7％,96.3％,98.5％,89.7％ in indirect hernia patients and 96.3％,95.7％,89.7％,98.5％ in direct hernia patients and 100.0％,100.0％,100.0％,100.0％ in femoral hernia patients,and diagnostic accordance rate of femoral hernia was also 100.0％.Diagnostic accordance rate of inguinal hernia was 95.9％,and correct index was 0.920.(2) Inguinal anatomic presentation in MSCT examination:transverse,coronal and sagittal imagings of inferior epigastric artery,inguinal ligament,musculus rectus abdominis,femoral vein and other anatomic structures can be identified,and internal ring of inguinal canal of 6 patients cannot be observed clearly.For relationship between internal ring of inguinal canal and inferior epigastric artery,coronal view was the best,transverse view was the next,and sagittal view was rarely observed.For relationship between inguinal ligament and hernial sac,sagittal view was the best,coronal view was also observed clearly by continuous planes,and transverse view was poor.The oblique coronal view was the best for the direct hernial triangle and internal ring of inguinal canal,and coronal view of femoral triangle was the best.The lateral crescent sign and quadrant partition of "ross intersect" method needed to be observed in transverse plane.(3) Relationship between hernial sac and surrounding structures in MSCT examination:indirect hernia entered into the inguinal canal through internal ring of inguinal canal,and hernial sac was located at the outside of inferior epigastric artery;direct hernia was out through triangle hernia,and hernial sac was located at the inside of inferior epigastric artery,92.6％ (25/27) patients were accompanied by lateral crescent sign.The indirect hernia and direct hernia went along the upper front of inguinal ligament;femoral hernia was out through femoral triangle hernia,and hernial sac was located at the lower back of inguinal ligament and the outside of the pubic tubercle.(4) The hernia contents and quadrants of hernial sac in the quadrant partition with "cross intersect" method and complications:the most common hernia content was small intestine,including partial patients with hernia content composed of various substances;indirect hernia contents included small intestine (35),mesentery (29),effusion (25),intraabdominal fat (9),colon (8) and ovary (1) in turn;direct hernia contents included small intestine (14),intraabdominal fat (11),effusion (6),mesentery (6),colon (3) and bladder (2) in turn;femoral hernia contents included small intestine (12),intraabdominal fat (8),effusion (3) and mesentery (2) in turn.There was a statistically significant difference in the hernia contents among indirect hernia,direct hernia and femoral hernia (x2=28.389,P＜0.05).The main hernial sac located at antero-external quadrant was respectively occurred in 70 hernial sacs of indirect hernia and 27 hernial sacs of direct hernia and 15 hernial sacs of femoral hernia,and 5 hernial sacs of femoral hernia were located at postero-external quadrant.There was a statistically significant difference in comparison of the quadrant partition with "cross intersect" method (x2 =78.904,P ＜ 0.05).The intestinal obstruction was respectively occurred in 8 patients with indirect hernia and 14 patients with direct hernia and 12 patients with femoral hernia,with a statistically significant difference (x2=26.674,P＜0.05).Conclusions Indirect hernia,direct hernia and femoral hernia have characteristic signs of imaging.MSCT can display precisely the anatomical details of inguinal region,which plays an important role in diagnosis and differential diagnosis of indirect hernia,direct hernia and femoral hernia,especially in display of hernia contents and diagnosis of complications,thus it can provide important information for evaluating risk and making operation plan.
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Objective:To explore the clinical value of color Doppler ultrasound and multi-slice spiral computed tomography (MSCT) in the diagnosis of pulmonary thromboembolism (PTE)- deep vein thrombosis (DVT).Methods: A retrospectively study was adopted to analyze 30 patients with suspected PTE-DVT. The patients with suspected PTE were applied by using MSCT and series three-dimensional reconstructions, such as volume reconstruction (VR), multi planar reconstruction (MPR), maximum intensity projection (MIP) and axial image reconstruction, while the patients with suspected DVT were scanned by using color Doppler flow imaging (CDFI). The shape, size and location of embolus in blood vessel were observed, and the situations of pulmonary artery embolism and the phenomenon of deep vein embolism detected by the two methods were compared and analyzed.Results: In 30 cases, there were 15 cases were diagnosed as positive patients, and in the 15 cases, the patients with DVT were 66.7% (10/15), while the patients with PTE were 86.7% (13/15), and the patients with PTE-DVT were 8 cases (53.3%, 8/15). By using MSCT, there were 10 patients with thromboembolism in pulmonary artery were found, and there were 50 pulmonary arteries with thromboembolism were diagnosed. On the other hand, by using color Doppler ultrasound, there were 12 patients with embolism and fluctuation disappearing of vein wall in deep vein were found, and there were 16 deep veins with thromboembolism were diagnosed.Conclusion: Color Doppler ultrasound should combine with MSCT and they should learn each other so as to achieve the diagnosis of PTE-DVT in convenient, fast, simple, safety and accuracy. This combination of them can provide important reference for clinical therapy of PTE-DVT.
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Objective To summarize the characteristics and clinical value of multi-slice spiral computed tomography (MSCT) examination in the biliary gallbladder-duodenal fistula.Methods The imaging data of 28 patients with gallbladder-duodenal fistula who were admitted to the Wuxi No.2 Hospital of Nanjing Medical University between June 2012 and March 2015 were retrospectively analyzed.All the 28 patients received MSCT examinations,and the imaging changes were observed and analyzed,including the location of lesions,figures of fistulous tract,shrinking or enlarging gallbladder,pneumotosis and stones of gallbladder or bile duct.Results Of the 28 patients,fistula located at the duodenal bulb were detected in 14 patients,junction of the bulb and the descending part of the duodenum in 2 patients,ascending duodenum in 7 patients,horizontal part in 5 patients.Indirect signs of biliary gallbladder-duodenal fistula included that gallbladder volume in 28 patients was significantly reduced,cross sectional area of gallbladder was 2 cm × 1 cm-6 cm × 2 cm,and gallbladder wall was thickened with an average thickness of 5 mm (range,4-9 mm).Adhesion of gallbladder and duodenum,unclear boundary,structure disorder and visible effusion surrounding gallbladder were detected.Among 21 patients with biliary gas,19 patients had pneumotosis of gallbladder and 17 had biliary pneumatosis.Biliary stones were detected in 23 patients including cholecystolithiasis in 19 patients,gallbladder neck stones in 6 patients,common bile duct stones in 13 patients and intra-and extra-hepatic cholangiolithiasis in 1 patient.The diverticulum signs appeared in the duodenum of 11 patients.The direct signs of MSCT in the biliary gallbladder-duodenal fistula included that fistulous tract of 13 patients clearly showed and some were dumbbell-shaped.Two and 2 patients were complicated with gallstone ileus and multiple liver abscesses,respectively.The diagnostic results of MSCT in 28 patients were compared with the results of operative exploration,with an diagnostic concordance rate of 78.6％ (22/28),and the diagnostic concordance rate of gallbladder stones was 82.1％ (23/28).Conclusions The indirect signs of MSCT in patients with biliary gallbladder-duodenal fistula include pneumotosis of gallbladder or/ and biliary gas,gallbladder neck stones or common bile duct stones,gallbladder shrank,adhesion of gallbladder and duodenum,unclear boundary,diverticulum signs in the adhesions of duodenum and gallbladder,and clear orificium fistulae of gallbladder-duodenum is a direct sign of MSCT.
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In order to investigate the clinical value of multi-slice computed tomography (MSCT) in the diagnosis of colonic neoplasms,the clinical data of 57 patients who were confirmed as with colonic neoplasms were admitted to the Wuxi No.2 People's Hospital from June 2013 to June 2014.Patients received plain and enhanced scan of MSCT,multiplannar reconstruction (MPR),sliding thin-slab maximum intensity projection (STS-MIP) and curved planar reformation (CPR),and the results of these examinations were compared with the postoperative TNM stage.Of the 57 patients,tumors located at the cecum in 1 patient,ascending colon in 23 patients,hepatic region of the colon in 9 patients,transverse colon in 11 patients,splenic region of the colon in 1 patient,descending colon in 3 patients and sigmoid colon in 9 patients.The results of the CT examination were in accordance with the results of exploratory laparotomy.The wall of the intestine was irregular ring-like thickened in 57 patients.The thickening of the intestine ranged between 0.6-3.2 cm,and patients had intestinal stricture in different degrees.Sixteen patients had gas-fluid level and dilatation of the intestine and were presented with intestinal obstruction signs.Forty-two patients had nodular or mass shadow in sofi tissues,and the nodules or mass protruded into the intestinal cavity or outside of the intestinal cavity,and resulting in intestinal stricture.The junction of the mass and the adjacent intestinal wall was blurred or clear,and the thickness of the intestinal walls was normal.Carcinomatous ulcer was observed in 20 patients.The shape of the ulcer was crateriform.The serosa and (or) adjacent organs were invaded by the tumors in 47 patients.Twenty-seven patients had lymph node metastasis,including 6 had distal metastasis,4 had hepatic metastasis and 2 had pulmonary metastasis.The sensitivity and accuracy of the preoperative CT examination for T stage were 100.0％ (57/57) and 77.2％ (44/57),respectively.The sensitivity,specificity and accuracy of the CT examination for N stage were 67.9％ (19/28),72.4％ (21/29) and 70.2％ (40/57),respectively.The sensitivity,specificity and accuracy of the CT examination for M stage were 100.0％ (6/6),100.0％ (51/51) and 100.0％ (57/57),respectively.The results of CT examination for TNM stage were well correlated with the pathological examination for TNM stage (κ =0.592,0.514,1.000,P ＜0.05).MSCT scanning and post-processing technique are of important clinical value in depicting tumor location,size and morphology,delineating tumor extension,revealing lymph nodes and metastases,and confirming preoperative tumor TNM stage in patients with colonic neoplasms.
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Objective To investigate the application of multi-slice spiral computed tomography(MSCT) in the diagnosis of solid pseudopapollary tumor of the pancreas (SPTP). Methods Clinical data and CT films of 12 patients with SPTP were retrospectively analyzed from January 2003 to December 2008. Results SPTP presented a typical cystic lesion with well-limited silhouette and no intensification in the cyst on enhanced CT scan. However, a slight to moderate enhancement in the solid components and a markedly enhanced envelope could be seen. Three dimensional images of MSCT can reveal clearly an anatomic relationship of the lesions with surrounding organs and blood vessels. Of 12 cases, there was one case showed that the envelope was incomplete, 3 with duodenal invasion, 2 with superior mesenteric vein involvement, and 1 with closed adhesion with spleen. All 12 patients underwent surgery and had only one tumor, tumor diameter ranged from 4 cm to 18 cm. The location of tumor in pancreas, the relation with surrounding tissue and the pathological presentation were helpful to make peroperative diagnosis. Three dimensional imaging technology of MSCT can offer important referrence for the preroperative evaluation and increase the diagnosis accuracy.
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Objective: To evaluate the shape and texture of the alveolar bones before dental implantation using three-dimension reconstruction techniques by multi-slice spiral CT (MSCT). Methods: Seventeen patients, whose alveolar condition was not clear enough to receive dental implantation, were screened out using conventional dental periapical and panoramic X-ray examination. The occlusion cast was made and a radiological guide template with titanium tube was prepared in the implantation area. The mandibular and maxillary bone was scanned with MSCT. The height, width and density of the alveolar were measured through three-dimensional reconstruction, so as to determine whether the alveolar was suitable for dental implant surgery. Implantation using ITI dental implant system was performed in patients whose alveolar condition met the implantation criteria. Results: Pre-operation MSCT examination indicated that two cases were not suitable for the surgery due to a width of alveolar bone less than 5. 3 mm and a height of the residual bone under the maxillary sinus less than 3 mm. Fifteen patients suitable for the surgery underwent successful implantation. Conclusion: The three-dimensional reconstruction of MSCT images of the jaws can provide more comprehensive and reliable information of the non-security areas and mandibular or maxillofacial alveolar bone defects before implantation.
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Objective To evaluate multi-slice spiral computed tomography(MSCT)in the diagnosis and preoperative staging of gastrointestinal cancer.Methods (1)Three hundred and thirty-two gastric cancer patients underwent preoperative MSCT examination.The staging of gastric cancer by MSCT was compared with histological examination.(2)Seventy-three small intestinal cancer patients underwent preoperative MSCT,and 70 healthy adults were selected as normal contr01.The MSCT images of small intestinal lymphoma and small intestinal cancer were compared with those of normal small intestine.(3)Two hundred and twenty-eight colorectal cancer patients underwent preoperative MSCT,and the features of the MSCT images of colorectal cancer were analyzed by chi-square test.Results (1)The overall accuracy of MSCT in the assessment of gastric wall invasion,lymph node metastasis and distal metastasis were 78.2%(244/312),67.3%(210/312)and 93.8%(30/32),respectively.More information such as the location of lesions and the vessels around the stomach couldbe provided by MSCT image.(2)Abdominal masses,diffuse thickening of intestinal wall and intestinal obstruction were the main features of small intestinal cancer,while mesenterie and retroperitoneal lymph nodes metastases were rarely detected.The presentation of small intestinal lymphoma detected by MSCT were completely the opposite.(3)Signs such as"coarse surface"and"heterogeneous enhancement"were important to the diagnosis of colorectal cancer.The measurement of the MSCT value is helpful in the differential diagnosis of colorectal cancer and colonic inflammation.Conclusions MSCT can provide correct imaging information on the diagnosis and preoperative staging of gastrointestinal cancer.The combination of MSCT and endoscopy can improve the accuracy of diagnosis.
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0.05).[Conclusion] Lumbar accessory processes could be displayed clearly by MSCT volume reconstruction,which offers great help in the clinical practice.
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Objective:To study the importance of nursing cooperation in 16-slice spiral CT contrast enhancement scanning,so as to ensure scanning effect and reduce side reaction.Methods:Clinical records of 2 860 cases underwent 16-slice spiral CT contrast enhancement scanning were analyzed retrospectively.Preparation was done well;patients` reactions were closely observed during scanning;and treatment was performed basing on based on patients` condition.Results:Ninety-three per cent(2 660 in 2 860) of cases presented transient sensation of heat all over the body after injection of non-ion contrast agent;120 cases(4.2%) presented sensation of heat all over the body,bitter taste and itching on perineal region;35 cases(1.2%) presented slight allergic reactions such as sensation of heat all over the body,skin itching,nausea,and urticaria;9 cases presented moderate allergic reactions such as sensation of heat all over the body,urticaria,nausea,vomiting,palpitation,and dyspnea;leakage in pricking region was found in 5 cases(0.1%);none presented severe allergic reaction;and no nursing complications such as skin necrosis and air embolism appeared.Conclusion:Good preparation of nursing care could ensure the effect of contrast enhancement scanning,improve accuracy of diagnosis,and reduce or even avoid allergic reactions.