Magnetization Transfer MR Imaging for Predicting Intestinal Fistula in Patients with Crohn Disease / 中山大学学报(医学科学版)

@#【Objective】To evaluate the feasibility of magnetization transfer（MT）magnetic resonance（MR）imaging for predicting the risk of intestinal fistula in patients with Crohn disease （CD）. 【Methods】 The study prospectively enrolled 12 consecutive patients with CD and abdominal MT imaging were performed before elective surgery. The bowel wall MT ratio normalized to skeletal muscle was calculated；region- by- region correlations with the surgical specimen were performed. Histopathologic evaluation of fibrosis was executed by using Masson trichrome. Wilcoxon rank test ， Spearman rank correlation， and receiver operating characteristic curve （ROC） were used for statistical analysis.【Results】Among 15 surgical intestinal segments from 12 patients，5 lesions were found with intestinal fistula and of them 12 bowel specimens were obtained. The other 10 intestinal segments were without complications and 23 bowel specimens were enrolled. The intestinal fistula bowel showed a significant higher （P=0.045） normalized MT ratio. ROC analysis revealed an area under the curve of 0.674（95%CI：0.537-0.811）for differentiating intestinal fistula bowel from the non- fistula one. The sensitivity，specificity was 93.3% and 51.1% with a cut-off value of 76.8%，respectively. For the Masson score，significant difference（P=0.012）was found between the complicated intestinal specimens and the non-complicated ones. Additionally， the normalized MT ration was statistical correlated with Masson score （r=0.708，P<0.001）.【Conclusion】MT imaging could be a potential method to predict the risk of intestinal fistula in patients with CD.

Value of computed tomography features for prognosis evaluation of gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the association between CT features and survival rate of GIST, and to elucidate the significance of CT features for prognosis.</p><p><b>METHODS</b>Clinical data of 38 patients with pathologically and immunohistochemically proven GISTs, including 11 patients at high biological risk, 13 at moderate risk, 10 at low risk and 4 at very low risk. Patients who underwent CT examination for primary tumors were included. Association between CT features and survival rate was examined.</p><p><b>RESULTS</b>The mean follow-up period of 38 cases was 42.6 months and the 3-year survival rate was 86.8%. Univariate analysis revealed that tumor growth pattern, diameter, lobulated shape, irregular margin, necrosis, ulceration, adjacent invasion, and liver metastasis were associated factors of 3-year survival rate. Circumference invasion and hepatic metastases predicted poor 3-year survival rate (P<0.05). Calcification and intensity were not associated with prognosis (P>0.05).</p><p><b>CONCLUSIONS</b>CT can demonstrate the tumor growth pattern, size, shape, boundary, density, necrosis, hemorrhage, calcification, ulcer, enhance features and metastasis. CT can play an important role in estimating the survival rate of GIST.</p>

Assessment of 64-slice spiral computed tomography angiography with image fusion for perigastric arteries anatomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and clinical significance of 64-multislice spiral computed tomography angiography(MSCTA) with image fusion for the anatomy of perigastric arteries.</p><p><b>METHODS</b>A total of 53 patients underwent abdominal 64-MSCTA, among whom 26 patients with gastric cancer underwent gastrectomy. Using volume rendering techniques, computed tomography angiography(CTA) of perigastric arteries and the stomach were reconstructed respectively, and then the images were fused together. The branching pattern of the celiac trunk and the origins and courses along the stomach of the 10 perigastric arteries were assessed. The accuracy, sensitivity, and specificity of 64-MSCTA were determined based on intraoperative findings.</p><p><b>RESULTS</b>CTA clearly showed the celiac trunk. The most common branching pattern of the celiac trunk was Michels type I( in 46 patients(86.8%). The anatomy of perigastric arteries and stomach could be clearly demonstrated from any angle according to image fusion. The left gastric artery and the right gastroepiploic artery were shown in 100%, the left gastroepiploic artery 94.3%(50/53), the right gastric artery 83.0%(44/53), short gastric artery 58.5%(31/53), posterior gastric artery 49.1%(26/53), the replaced left hepatic artery 15.1%(8/53). The accessory left hepatic artery, accessory left gastric artery and replaced right hepatic artery were all identified in 7.5%(4/53) patients. The accuracy of preoperative CTA in term of correctly identifying perigastric arteries ranged from 84.6% to 100%, the sensitivity 82.6% to 100%, and the specificity was 100% for all the perigastric arteries.</p><p><b>CONCLUSIONS</b>64-MSCTA can clearly reveal individual perigastric arteries. The anatomy of the stomach and perigastric arteries can be shown in vivo by fused image, and can provide guidance for gastrectomy.</p>

Pilot study on MRI of human colon adenocarcinoma cells labeled with superparamagnetic iron oxide in vitro / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the feasibility of MRI of human colon adenocarcinoma cell line (Lovo) labeled with superparamagnetic iron oxide(SPIO) nanoparticles in vitro.</p><p><b>METHODS</b>Lovo cells (5 × 10(5) and 1 × 10(6)) were cultured in medium containing different SPIO nanoparticles (50 microl and 500 microl). Transmission electron microscopy was used to observe cellular ultrastructure and to determine the uptake and distribution of particles in Lovo cells at 1-, 3-, 6-hours. MRI of Lovo cells was performed with T1WI, T2WI sequences. Unlabeled cells were used as controls.</p><p><b>RESULTS</b>Uptake of SPIO nanoparticles occurred within 6 hours. On T1 weighted imaging, there was no significant difference in signal intensity between the experimental groups and the control group. On T2 weighted imaging, there was no significant difference in signal intensity between the experimental groups and the control group after culture of 1 h. Signal intensity began to decrease in 1 × 10(6) Lovo cells labeled with 500 microl SPIO nanoparticle after 3 hours culture. Signal intensity decreased in all the experimental groups after 6 hours culture.</p><p><b>CONCLUSION</b>Human colon adenocarcinoma cell line (Lovo) can be labeled with SPIO nanoparticles, and the labeled cells can be imaged with MRI equipment.</p>

Application of 64MDCT multislice perfusion imaging in colorectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the correlation of time-density curves (TDC), parameters revealed by 64-multidetector-row CT (64MDCT) perfusion imaging with clinicopathological factors (staging, serosal invasion, lymph node metastasis, distant metastasis and CEA) in colorectal carcinoma (CRC).</p><p><b>METHODS</b>64 MDCT perfusion imaging was performed in 33 patients with pathologically verified CRC. TDC was created from the region of interest (ROI) drawn over the tumor, target artery and vein by 64MDCT with perfusion functional software. The parameters of individual perfusion maps included blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability-surface area product (PS). Tumors were staged according to TMN classification. TDC was classified according to their shapes. The correlation between CT perfusion parameters and clinicopathological factors was studied.</p><p><b>RESULTS</b>TDC of 64MDCT perfusion imaging could be classified into five types. TDC in different stages could demonstrate one or more types of the five types. There was no significant difference of CT perfusion parameters among different stages. BV and MTT were significantly higher in the patients with serosal invasion than in those without serosal invasion (t=-2.63,-2.24, P=0.0137, 0.0331, respectively). BV was significantly correlated with tumor size (r=0.41, P=0.02). BF and PS were not correlated with staging, serosal invasion, lymph node metastasis, distant place metastasis and CEA (all P>0.05).</p><p><b>CONCLUSIONS</b>64MDCT multislice perfusion imaging can reveal the blood perfusion of CRC and has potential value of clinical application.</p>

CT diagnosis of midgut malrotation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the diagnostic value of CT in midgut malrotation.</p><p><b>METHODS</b>The CT appearances of 16 patients with midgut malrotation were analyzed retrospectively.</p><p><b>RESULTS</b>The features of CT manifestation in 16 cases were as follows: (1) Horizontal part of duodenum could not reach medioventral line or could reach it but encircled right-down behind the superior mesenteric artery(SMA). (2) Ectopic ileocecal junction. (3) Jejunum located in right-middle abdomen while ileum in left abdomen. (4) A clockwise or counterclockwise rotation of the superior mesenteric vein (SMV) around the SMA. (5) Mid-gut volvulus.(6)Accompanied by other malformations.</p><p><b>CONCLUSION</b>Ambulation of duodenum, location of the small intestine and colon as well as anatomical position of mesenteric vessels should be intensively observed in order to exclude midgut malrotation.</p>

Evaluation of microvessel density and vascular endothelial growth factor in colorectal carcinoma with 64-multidetector-row CT perfusion imaging / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the correlation of 64-multidetector-row CT (64MDCT) perfusion imaging with microvessel density(MVD) and vascular endothelial growth factor(VEGF) in colorectal carcinoma.</p><p><b>METHODS</b>64MDCT perfusion imaging was performed in 33 patients with pathologically verified colorectal carcinoma. Time-density curves (TDC) were created from the region of interest (ROI) drawn over the tumor, target artery and vein by 64MDCT with perfusion functional software. The individual perfusion maps generated were for blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability-surface area product (PS). MVD and VEGF expression of surgical specimens were examined by immunohistochemical staining with anti-CD34, anti-VEGF monoclonal antibody. MVD and VEGF were compared among the different types of TDC in colorectal carcinoma. The correlation of CT perfusion parameters with MVD and VEGF was also examined.</p><p><b>RESULTS</b>TDC of colorectal carcinoma was divided into five types according to their shapes. MVD in the colorectal carcinoma was 22.61+/-9.01. VEGF staining was found in 25 of 29 tumors (86.2%). The score of VEGF expression was 4.15+/-1.09. No significant differences of MVD and VEGF expression among TDC types were found (F=2.59, 1.11, P>0.05). There were also no correlations of MVD and VEGF expression with any dynamic CT parameters (P>0.05).</p><p><b>CONCLUSION</b>64MDCT perfusion imaging, MVD and VEGF may reflect angiogenic activity, but no significant correlations are found among them.</p>

Primary carcinoid tumors of the pancreas:CT findings / 中华放射学杂志

Objective To evaluate the CT findings of pancreatic carcinoid tumors.Methods The CT imaging data of five patients with pancreatic carcinoid tumors confirmed by pathology were retrospectively analyzed.Results The tumors ranged in maximum diameter from 2.0 to 11.0 cm with a mean of 6.4 cm. On unenhanced CT,the tumors were slightly hypodense relative to the pancreatic parenchyma,homogenous in 2 cases,and heterogenous in 3 cases.One tumor showed calcification.After contrast material injection, the solid component of the tumor showed marked heterogenous enhancement on the arterial phase scanning in 3 cases,and mild heterogenous enhancement in 2 cases.The degree of tumor enhancement was less intense than the surrounding pancreatic parenchyma due to necrosis of various degree,which led to the cystic appearance of the tumor in 1 ease.On the portal phase scanning,all tumors showed marked enhancement similar to that of the pancreatic parenchyma.On the delayed phase scanning,the degree of enhancement was more intense than the surrounding pancreatic parenchyma in 1 case.Liver metastases with retroperitoneal lymphadenopathy and peripancreatic vessels invasion were seen in 1 case.No dilatation of the biliary tract or pancreatic duct was present.Conclusion The CT features of pancreatic carcinoid tumors included infrequent dilatation of the biliary tract or pancreatic duct and unusual vascular involvement,calcification within the mass,marked enhancement similar to that of the surrounding pancreatic parenchyma during the portal phase scanning and more intense during the delayed phase scanning.