Value of dual-input perfusion of 320 row CT on the efficacy evaluation of small cell lung cancer / 肿瘤研究与临床

Objective To discuss the value of dual-input perfusion of 320 row CT on the efficacy evaluation of small cell lung cancer (SCLC).Methods A total of 18 patients with SCLC confirmed by pathology who received cisplatin plus etoposide chemotherapy between June 2016 and June 2018 in the 8th Medical Center of Chinese PLA General Hospital were collected.All patients received 320 row CT perfusion scan at 3 time points before chemotherapy,after 2 cycles and 4 cycles of chemotherapy.Tumor size,perfusion pseudo color map and bronchial arterial blood flow (BF),pulmonary flow (PF) and perfusion index (PI) were obtained.The efficacy and adverse reactions were evaluated.The single factor analysis was used to make the group comparison.Pearson test was used to make correlation analysis.Results Two patients after 2 cycles of chemotherapy had complete remission (CR),another 2 patients after 4 cycles of chemotherapy had CR,and 3 patients of the above 4 cases with CR had abundant BF;after 4 cycles of chemotherapy,7 cases had partial remission (PR),6 cases had stable disease (SD),1 patient had progression of disease (PD).Dual-input perfusion of 320 row CT showed that 10 cases had the tumor area ＜ 15 cm2 and 8 cased had the tumor area ＞15 cm2 before the treatment.There was a negative correlation between PI and the tumor area (r =-0.694,P =0.026) on patients with the tumor area ＜ 15 cm2 before the treatment,and no correlation was found in patients with tumor area ＞15 cm2 (P ＞ 0.05).One case had Ⅳ degree of bone marrow suppression,and obvious adverse reactions were not seen in the rest of the patients.Conclusion Dual-input perfusion of 320 row CT based on the simple imaging can make an accurate quantitative judgement of the effect of SCLC according to perfusion parameter,which provides a new basis for curative effect evaluation on SCLC.

Development of Coronary Vasospasm during Adenosine-Stress Myocardial Perfusion CT Imaging

Adenosine is a short-acting coronary vasodilator, and it is widely used during pharmacological stress myocardial perfusion imaging. It has a well-established safety profile, and most of its side effects are known to be mild and transient. Until now, coronary vasospasm has been rarely reported as a side effect of adenosine during or after adenosine stress test. This study reports a case of coronary vasospasm which was documented on stress myocardial perfusion CT imaging during adenosine stress test.

Pre- and Post-Angioplasty Perfusion CT with Acetazolamide Challenge in Patients with Unilateral Cerebrovascular Stenotic Disease

OBJECTIVE: Perfusion computed tomography (PCT) has the ability to measure quantitative value and produce maps of mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). We assessed cerebral hemodynamics by using these parameters and acetazolamide (ACZ) challenge for pre- and post-procedural evaluation in patients with unilateral cerebrovascular stenotic disease. METHODS: Thirty patients underwent pre-procedural PCT with ACZ challenge, and 24 patients (80%) was conducted follow up PCT after angioplasty with same protocol. The mean MTT, CBF, and CBV were measured and compared in both middle cerebral arterial (MCA) territories before and after ACZ challenge. Hemispheric ratio and percent change after ACZ challenge were calculated before and after angioplasty. RESULTS: The mean stenosis rate was 76.6%. Significant increases in MTT (32.6%, p=0.000) and significant decreases in CBF (-14.2%, p=0.000) were found in stenotic side MCA territories. After ACZ challenge, there were significant changes in MTT (37.4%, p=0.000), CBF (-13.1%, p=0.000), and CBV (-10.5%, p=0.001) in pre-procedural perfusion study. However, no significant increases were found in MTT, or decreases in CBF and CBV in post-procedural study. There were no significant changes after ACZ challenge also. In addition, the degrees of these changes (before and after ACZ challenge) were highly correlated with the stenotic degrees in pre-procedural perfusion study. CONCLUSION: PCT with ACZ challenge appears to be a useful tool to assess the cerebral perfusion status especially in patients with unilateral symptomatic stenotic disease.

Estimation of Radiation Exposure of 128-Slice 4D-Perfusion CT for the Assessment of Tumor Vascularity

OBJECTIVE: We aimed to estimate the effective dose of 4D-Perfusion-CT protocols of the lung, liver, and pelvis for the assessment of tumor vascularity. MATERIALS AND METHODS: An Alderson-Rando phantom equipped with thermoluminescent dosimeters was used to determine the effective dose values of 4D-Perfusion-CT. Phantom measurements were performed on a 128-slice single-source scanner in adaptive 4D-spiral-mode with bidirectional table movement and a total scan range of 69 mm over a time period of nearly 120 seconds (26 scans). Perfusion measurements were simulated for the lung, liver, and pelvis under the following conditions: lung (80 kV, 60 mAs), liver (80 kV/80 mAs and 80 kV/120 mAs), pelvis (100 kV/80 mAs and 100 kV/120 mAs). RESULTS: Depending on gender, the evaluated body region and scan protocol, an effective whole-body dose between 2.9-12.2 mSv, was determined. The radiation exposure administered to gender-specific organs like the female breast tissue (lung perfusion) or to the ovaries (pelvic perfusion) led to an increase in the female specific dose by 86% and 100% in perfusion scans of the lung and the pelvis, respectively. CONCLUSION: Due to a significant radiation dose of 4D-perfusion-CT protocols, the responsible use of this new promising technique is mandatory. Gender- and organ-specific differences should be considered for indication and planning of tumor perfusion scans.

Combined Application of CT Perfusion and CT Angiography in Cerebrovascular Diseases / 中国康复理论与实践

@#Objective To study the clinical diagnosis value of the combination application of CT perfusion(CTP) and CT angiography (CTA) in cerebrovascular diseases. Methods 20 patients suspected of cerebrovascular diseases（CVD） were examined with CTP and CTA. All the CTA data were send to 3D post processing card for MIP, SSD and VR reconstruction. Perfusion data were analyzed by CT perfusion package. The absolute TTP, MTT, CBV, CBF values and the relative value between normal and pathological sides were calculated.Results Low perfusion which indicated the prophase of ischemia infarction were detected in 15 cases, 12 cases were located in MCA area, and 10 of them the stenosis of responsible arteries were demonstrated. The degree of the vessel stenosis can be evaluated exactly by CTA source images. Other 5 cases were located in the area of PCA and no positive detection in CTA examination.Conclusion Combined application of CTP and CTA can finish two examinations at the same time in the fast and economic way. Both the hemodynamics changing and the morphology of the vessels were demonstrated which providing omnidirectional pathophysiological information for clinical diagnosis and therapy.

Useful parameters utilizing perfusion CT study to evaluate the hemodynamic status in chronic ischemic stroke patients / 대한뇌혈관외과학회지

OBJECTIVE: Perfusion-computed tomography (CT) is useful and quick diagnostic tool for evaluating ischemic stroke patients. We evaluated three measurement maps, cerebral blood flow (CBF), cerebral blood volume (CBV) and time to peak (TTP) for their usefulness in deciding on revascularization surgery using CT parameters after single photon emission computed tomography (SPECT) findings in chronic steno-occlusive disease patients. METHODS: We retrospectively investigated 47 patients with unilateral internal carotid artery (ICA) or middle cerebral artery (MCA) steno-occlusive disease . All patients underwent digital subtraction angiography (DSA) as well as an acetazolamide challenge with SPECT and perfusion CT. Patients who showed decreased reserve capacity with a Diamox challenge were classified in the positive group, whereas patients who had no difference in reserve capacity were placed in the negative group. RESULTS: Thirty-one patients were positive and the remaining 16 were negative. Differences in rCBV and rCBF parameters between normal cerebral hemispheres and cerebral hemispheres with steno-occlusive disease did not correlate with SPECT results, but TTP values did. SPECT results seemed relevant when TTP differences between hemispheres with normal and steno-occlusive disease were more than 1.55 times. CONCLUSION: Perfusion CT is a useful tool for the rapid, adequate diagnosis of large territorial infarcts, and the TTP map of perfusion CT is a sensitive and reliable parameter to show the status of collateral circulation in chronic cerebrovascular ischemic disease.

Qualitative diagnosis and localization of insulinoma before surgery-review of 99 cases / 中国实用内科杂志

Objective To evaluate the value of different methods of hormone measurement and image study before surgery.Methods We retro spectively reviewed 99 patients with insulinoma confirmed by pathological report after surgery in the PUMC Hospital from December 1989 to August 2005.Results The main clinical manifestations were hypoglycemia coma,weight gain,perspiration,disorientation,hypomnesis,and dizziness.The sensitivity of diagnosis of insulinoma with fasting blood-glucose less than 2.78 mmol/L was 66.6%.The ratio of serum insulin to blood-glucose greater than 0.3 when hypoglycemia attacks was 90% sensitive.The sensitivity of perfusion CT was highest which was 100%.Conclusion Typical “Whipple's triad” and the ratio of serum insulin to blood-glucose greater than 0.3 when hypoglycemia attacks are best for the qualitative diagnosis of insulinoma.Perfusion CT has the best sensitivity and specificity among image studies currently used.

Establishment of an acute cerebral ischemia-reperfusion rat model and evaluation by scanning of perfusion CT / 基础医学与临床

Objective To evaluate the reliability of a rat model of acute cerebral ischemia and reperfusion by using cerebral perfusion functional CT.Methods A stable and reversible focal ischemia model with unilateral middle cerebral artery occlusion was established and evaluated by CT perfusion imaging and TTC staining.Results Artificial Occlusion of the MCA resulted in ipsilateral cerebral infarcts in all study animals.Hypoperfusion was definitely recorded in all CT perfusion images obtained after MCA occlusion and was significantly correlated with the final lesion size.Blood flow was restored after pulling the thread out of the artery.Conclusions The method of establishing an acute focal cerebral ischemia and reperfusion model by thread insertion in our study is simple and stable.If we can screen the stroke model with CT perfusion examination,the error caused by variance of model can be reduced.Thereby it provides a platform for researchers to investigate acute cerebral ischemia and recirculation.

Clinical Usefulness of Perfusion CT in Acute Ischemic Stroke

BACKGROUND: In recent years, thrombolytic therapy has been used with success to reduce the infarction area in patients with acute cerebral infarction, It is very important to identify ischemic penumbra in the treatment of stroke. The aim of this study is detect ischemic penumbra and border between ischemic penumbra and infarction area using perfusion CT and diffusion-weighted MR images (DW-MRI) in patient 's with acute ischemic stroke. METHODS: Thirteen inpatients with acute ischemic stroke at the Department of Neurology at Chonnam University Hospital were selected for this study. They had the discrepancy of lesion between perfusion CT and DW-MRI. Perfusion CT was done on admission and DW-MRI within 24 hours after stroke in all patients. Ischemic penumbra was assessed by comparing the defect on perfusion CT with the infarction area on DW-MRI. Clinical outcome was measured with the NIHSS on day 1, 3, and 7. RESULTS: The subjects (perfusion defect on the perfusion CT> infarction area on DW-MRI) achieved significant improvement at NIHSS. There was a significant difference between infarct and non-infarct tissue for both rCBF and rCBV but not for MTT. It could be possible not to define the tissue outcome but to estimate it by this study. CONCLUSIONS: Perfusion CT with DW-MRI is a useful tool for the detection of ischemic penumbra which may be the main target of active treatment.