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BACKGROUND; Some scholars have classified osteoporotic vertebral compression fractures based on X-ray and MRI findings. However, little is reported on the morphological types and distribution rules of fracture areas in osteoporotic vertebral compression fractures. OBJECTIVE; To investigate and summarize the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI. METHODS; Clinical data from 352 patients with osteoporotic vertebral compression fractures, 73.07 years of age, including 69 males and 283 females admitted at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2011 to June 2017 were retrospectively reviewed. After admission, CT multi-planar reconstruction, MRI and bone mineral density measurements were conducted in each patient. Fresh osteoporotic vertebral compression fractures were confirmed in 477 vertebrae according to clinical manifestations and imaging findings. Fracture areas were defined as shade compact or bright line based on CT multi-planar reconstruction or bone marrow edema on the MRI. Morphological type and distribution of fracture areas were recorded by two experienced spinal surgeons and one senior radiologist independently. The study protocol was approved by the Ethic Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine in China with an approval No. ZYYECKYJ[2017]057. RESULTS AND CONCLUSION: Fracture areas of 472 vertebrae were indicated distinctly on the MRI, whereas the fracture areas of 5 vertebrae were unclear. Meanwhile, fracture areas of 469 vertebrae were shown clearly on the CT multi-planar reconstruction, but the areas of 8 vertebrae were obscure on the CT. Fracture areas of 5 vertebrae were unclear in both CT and MRI. There was no significant difference between CT and MRI in the observation of fracture areas (P=0.402). Finally, fracture areas of 8 vertebrae could not be described accurately on CT, MRI or both. In the sagittal plane of CT and MRI, morphological types of fracture areas of 469 vertebrae were divided into impacted fracture area (n=311, 66.31%) and cleft fracture area (n=158, 33.69%). Of the 158 cleft fracture areas, 26 vertebrae contained gas, 28 vertebrae contained liquid, and 7 vertebrae included both gas and liquid. Of the 469 vertebrae, the location of fracture areas was divided into 5 types: Superior (n=238, 50.75%), inferior (n=80,17.06%), anterior (n=21, 4.48%), central (n=110, 23.45%) and mixed (n=20, 4.26%). These findings indicate that the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures can be effectively distinguished by CT multi-planar reconstruction and MRI, which is important for early diagnosis and further treatment of fresh osteoporotic vertebral compression fractures.
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BACKGROUND: Percutanoues pedicle screw internal fixation is widely used for treating lumbar disease. Because the surgery is guided by the C-arm, it is hard to control the position between screws and facet joint to cause the facet joint violation completely. Body mass index > 29.9 kg/m2, facet joint angle > 35°and age < 65 years old are considered as the high risk factors for percutaneous pedicle screw injury of articular processes. Due to the different positional relationship between the pedicle axis of the lumbar spine and the articular process joint, there is no related report on whether the destruction of the articular process joint by screws is different. OBJECTIVE: To investigate the significance of lumbar CT multi-planar reconstruction for preestimating facet joint violation in lumbar percutaneous pedicle screw placement. METHODS: One hundred patients with lumbar fracture and degenerative disease who underwent percutaneous pedicle screw placement were selected. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The position line of the oblique axial view, oblique sagittal view and oblique coronal view was adjusted to reconstruct the section of pedicle. A circle with the 6.5 mm of position line of the oblique coronal view as its center to check the relationship between the circle and facet joint served as preoperation group. CT examination was performed after surgery for evaluating the degree of facet joint violation by screws and served as postoperation group. The amount of screws which damage the facet joint of different vertebrae between two groups and the damage rate among vertebrae in each group were compared. RESULTS AND CONCLUSION: (1) Totally 478 screws were placed, 109 (22.8%) screws violated facet joints in the preoperation group, and the amount of circles which violated facet joint was 6 (6.8%), 9 (10.5%), 19 (18.3%), 30 (30.0%), and 45 (45.0%) from L1-L 5. (2) 115 (24.1%) screws violated facet joints in the postoperation group, the amount of circles which violated facet joint was 10 (11.4%), 7 (8.1%), 15 (14.4%), 26 (26.0%) and 41 (41.0%) from L1-L 5. (3) The P values of McNamara test of different vertebrae were 0.08 (L1), 0.22 (L2), 0.20 (L3), 0.05 (L4) and 0.08 (L5). There was no significant difference between two groups. (4) The results of Kappa test were 0.67 (L1), 0.80 (L2), 0.80 (L3), 0.87 (L4) and 0.92 (L5). The damage rate among vertebrae in each group had significant differences (P=0.000). (5) To conclude, the relationship between percutanoues pedicle screw and facet joint could be recognized by lumbar CT multiple level reconstruction, which provides a reliable method for preestimating the possibility of facet joint damage caused by the percutanoues pedicle screw.
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Objective@#To evaluate the clinical value of CT axial scan combined with multiplanar reconstruction(MPR) imaging in preoperative diagnosis of elderly patients with intestinal perforation.@*Methods@#From March 2017 to March 2019, 127 patients with suspected intestinal perforation in Dajiangdong Hospital were enrolled.The patients were examined by CT axial scan and MPR, 119 patients confirmed intestinal perforation by postoperative pathological diagnosis.According to the requirements of this study, one radiologist analyzed the CT axial scan image independently, and the other analyzed the CT axial scan combined with the MPR image also.The positive rate of CT axial scan analysis and the positive rate of CT axial scan combined with MPR image analysis were calculated.The pathological diagnosis was used as the gold standard, the positive rate of CT axial scan and the real perforation rate were compared, the positive rate of CT axial scan combined with MPR and the real perforation rate were compared, the positive rates of CT axial scan and CT axial scan combined with MPR were compared.The positive predictive values, negative predictive values, sensitivity, specificity and accuracy of CT axial scan and CT axial scan combined with MPR were calculated.@*Results@#Of 127 patients with suspected intestinal perforation, 86 cases were diagnosed and located by CT axial scan, with the positive rate 67.72%, 113 cases were diagnosed and located by CT axial scan and MPR, with the positive rate 88.98%.Finally, 119 cases were confirmed by pathological diagnosis, with the positive rate 93.70%.The difference between the positive rate of CT axial scan and the perforation rate of pathological diagnosis was statistically significant (67.72% vs.93.70%, χ2=27.537, P<0.001). There was no statistically significant difference between the positive rate of CT axial scan combined with MPR and the perforation rate of pathological diagnosis(88.98% vs.93.70%, χ2=1.792, P=0.181). The positive rate of CT axial scan was 67.72%, and the positive rate of CT axial scan combined with MPR was 88.98%, the difference was statistically significant (χ2=16.918, P<0.001). The positive predictive rate of CT axial scan was 95.35%, the negative predictive rate was 9.76%, the sensitivity was 68.91%, the specificity was 50.00%, and the accuracy was 67.72%.The positive predictive rate of CT axial scan combined with MPR was 99.12%, the negative predictive rate was 50.00%, the sensitivity was 94.12%, the specificity was 87.50%%, and the accuracy rate was 93.70%.@*Conclusion@#The combination of CT axial scan and MPR can improve the accuracy of preoperative diagnosis in elderly patients with intestinal perforation, which is worthy of clinical application.
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Objective To explore the diagnostic values of X-ray and CT examinations for the traumatic diaphragmatic rupture. Methods Totally 17 patients with traumatic diaphragmatic rupture were retrospectively analyzed, who underwent X-ray chest radiograph and 64-slice spiral CT examinations as well as coronal and sagittal imaging by multi-planar reconstruction with GE ADW 4.6 workstation. Results Of the 17 patients, there were 15 ones had the rupture occurred on the left side (93.7%), one case on the right side (6.3%) and the remained one had no diaphragmatic injury;there were 10 ones of diaphragmatic contour discontinuity, 6 ones of intrathoracic hernia, 2 ones of cervical stenosis, one case of hanging sign and two cases of falling viscera sign. Conclusion Routine chest X-ray radiography has difficulty in diagnosing diaphragmatic rupture, while CT multiplanar imaging contributes to determining traumatic diaphragmatic rupture. Diaphragmatic rupture may occur after multiple trauma, and CT with multiplanar reformations has to be used as the routine examination for diagnosing diaphragmatic rupture.
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Objective To evaluate the application value of MSCT in the diagnosis of carotid cavernous fistula(CCF).Methods The data of 10 patients who had been confirmed with CCF by DSA were retrospectively analyzed to compare the imaging features of MSCT plain scan,CTA,post reconstruction imaging and other examination ways.Results 10 patients with CCF which were manifested by superior ophthalmic vein enlargement in CT plain scan,early appearance of superior ophthalmic vein and cavernous sinus enlargement in CTA were studied.The orificium fistulae can be displayed through the multi planar reconstruction (MPR)and the curved planar reconstruction (CPR).The focal region can be well displayed through the volume rendering (VR)and the maximum intensity projection (MIP). CT,MRI,DSA and color doppler ultrasonography have both advantages and limitations in the diagnosis of CCF.Conclusion MSCT can achieve characteristic imaging findings through scan,CTA technology and various post reconstruction methods,it has significant value in the early diagnosis and treatment of CCF.
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Objective: To explore the application value of multi-slice spiral CT based on low dose technique in diagnosis of rib fracture. Methods: 58 patients with highly suspected rib fracture patients were examined by DR and multi-slice spiral CT. 3D reconstruction were finished after MSCT examination at the workstation, including MPR(multi-planar reconstruction), and volume rendering technique(VR). And the results were compared between DR and CT. Results:58 patients all successfully completed the chest X-ray film and multi-slice spiral CT examination. Multi-slice spiral CT image quality fully met the requirements of clinic. It can not only diagnose, but also display the number, location and morphology of rib fracture. 45 cases were diagnosed with chest DR rib fracture and suspected fracture, and the positive rate was 77.59%(45/58). 56 cases were definitely diagnosed with multi-slice spiral CT scanning and three-dimensional reconstruction rib fracture, and the positive rate was 96.55%. Conclusion: The patients can receive lower dose and the tube can be used for a longer time by low dose technique. 3D reconstruction techniques of multi-slice spiral CT not only improve the accuracy of diagnosis, but also display rib fracture morphology clearly, so its clinical value is much higher than DR.
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Objective To investigate the value in the diagnosis of tumor of the stomach by hypotonic water filling method com-bined with CT multi planar reconstruction (MPR).Methods CT image data of 21 5 cases with gastric tumor confirmed by operation and pathology in our hospital were analysed retrospectively.Conventional CT enhanced scan was obtained in patients with the stom-ach hypotonic water filling condition,and MPR CT characteristics of lesions were observed.Results In the 21 5 cases of gastric be-nign or malignant lesions,MPR showed 5 pathological types in 210 cases.In the conventional CT examination,the tumor diagnosis rate had obvious improvement in different gastric parts and types of the stomach tumors through CT MPR.Conclusion There is high detection rate in the diagnosis of gastric tumors using hypotonic water filling method with MPR,which can accurately display invasion and metastasis,and reduce the misdiagnosis and missed diagnosis in gastric tumor.
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Purpose:To evaluate the role of multi - detector row CT(MDCT) using reconstruction techniques in the assessment of patients with obstructed diseases of biliary tract.Materials and Methods: 47 Patients with obstructed diseases of biliary tract confirmed clinically underwent MDCT and their reconstructed images of biliary tract including multi-planar reconstruction (MPR) images and curved planar reconstruction(CPR) images were compared with those of 50 patients without obstruction and dilatation of biliary tract.The display effect of biliary duct structure and biliary duct wall and the display ability of biliary tract by MPR and CPR images between the 2 groups were compared and analysed.The reconstruction images of biliary tract were analysed retrospectively to evaluate the location and possible causes of biliary obstruction.Results: The display effect of biliary duct structure and biliary duct wall in MPR and CPR images of the group with biliary obstruction is better than that of control group,and the display ability of biliary tract in CPR images of the group with biliary obstruction is also better than that of control group.The accuracy of localization and cause evaluation of obstruction by MPR and CPR images is 100% and 89.4% respectively.Conclusions: The MPR and CPR images of MDCT provide a good display of biliary duct structure,biliary duct wall and an accurate evaluation of obstruction localization.The reconstruction technique of MDCT such as MPR and CPR should be widely applied in the evaluation of biliary obstruction.