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Objective To evaluate the necessity and clinical significance of multi-slice spiral CTA (MSCTA) in preoperative examination of complex craniocervical junction (CCJ) malformation.Methods Totally 30 patients of complex CCJ malformation were enrolled,among them 16 underwent routine CT and MRI before surgery (routine group),and the other 14 underwent MSCTA of head and neck after routine CT and MRI (CTA group).The anatomical relationship between the V3 segment of VA and the bone in CCJ was observed,and then individualized operation scheme was formulated,MSCTA data in preoperative CTA group was reconstructed.The operation time,intraoperative blood loss and complications were compared between the two groups.Results CCJ malformation and VA V3 segment variation showed obvious individual characteristics in CTA group.The average operation time was (182.86 ± 27.37)min,and the loss of intraoperative blood was (165.71 ± 42.19)ml.No obvious complications occurred,and the therapeutic effect was satisfactory during follow-up period.In routine group,the average operation time was (205.31± 29.86)min,the loss of intraoperative blood was (246.25 ± 155.22)ml.Vertebral artery injury occurred in 1 case during operation,then bleeding was controlled,and improvement was achieved during follow-up period.There was no significant difference of operation time between the two groups (t=1.878,P=0.057),while the loss of intraoperative blood in CTA group was less than that of routine group (t =2.136,P=0.042).Conclusion MSCTA is a reliable method to investigate the anatomy and variation of bone and blood vessels in CCJ.It is necessary to carry out MSCTA examination before operation in patients with complex CCJ malformation,so as to reduce the complications and avoid the risk of surgery.
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Objective To explore the value of MSCT in diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Methods 24 patients with CTEPH and 8 patients with pulmonary hypertension by other causes were collected retrospectively.To analyzed the characteristics of CTPA images in patients with CTEPH,summarized the direct and indirect signs,and to compared with non-CTEPH.Statistical analysis was performed with SPSS1 7.0 software.Results According to the CTPA images,744 arteries of 24 patients with CTEPH were evaluated.The direct sign of CTEPH was mural thrombus firstly,accounted for 55.35% of the involved arteries,and then was followed by holo-obstruction,partial filling defect,central filling defect,irregular vessel wall thickening and eccentricity filling defect.There were narrowed lumens in 35.01%,dilated ones in 0.89% and no changes in 45.24%.The common indirect signs of CTEPH were pulmonary broadening (100%),enlargement of right heart (95.83%),mosaic attenuation,pericardial or pleural effusion,ground-glass opacity,infarction and atelectasis or consolidation in order.All patients had different degrees of pulmonary hypertension,and the most common findings of CTPA were widened pulmonary artery and enlarged right ventricle,and then were followed by enhancement of the inferior vena cava and hepatic vein,the expansion of bronchial artery and abnormal septal position.Conclusion CTPA can show the types and direct or indirect signs of CTEPH clearly.The morphological changes of the heart in CT are not enough to differentiate the CTEPH and non-CTEPH,and the severity of CTEPH is not alone decided by the degree of chronic pulmonary embolism.
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Objective To analyze CT morphologic features and pathologic changes of pulmonary sclerosing pneumocytoma (PSP) and to improve preoperative diagnostic accuracy of PSP.Methods The clinical and CT data of 12 cases with PSP (with total 13 lesions)confirmed by surgery and pathology were collected and analyzed retrospectively.All cases performed CT plain scan,9 cases had contrast CT scan.Results 1 1 cases had isolated lesions,and 1 case multiple lesions.The long-axis diameter ranged from 1.10 cm to 8.03 cm, with an average of (3.53±0.78)cm.Of 13 lesions,3 located in left lung (23.1%,1 in the upper lobes,2 in lower lobe),and 10 in right lung (76.9%,2 in upper lobe,2 in the middle lobe and 6 in lower lobe);8 lesions located in the lower lobe (61.5%),and 5 in upper and middle lobe (38.5%).There were center type of 4 lesions (30.8%),and peripheral type of 9 lesions (69.2%);The shapes of 8 lesions wereovoid or similar round (61.5%),irregular type of 1 case (7.7%),shallow lobe of 4 cases (30.8%);Smooth edge of 10 cases (76.9%), burr edge in 3 cases (23.1%).With contrast CT scan,7 cases (53.8%)had vascular welt sign,6 cases (46.2%)had air crescent sign,6 cases (46.2%)had halo sign,and 6 cases (46.2%)had tail sign.3 lesions (23.1%)had scattered spot calcification,and the other lesions had uniform density.The CT value ranged from 28 HU to 47 HU,with the average of 35 HU;Of 9 cases (with 10 lesions)with contrast CT scan,2 lesions had mild enhancement,5 cases had obvious enhancement,and 3 case had non-uniform enhancement.Enhanced CT value was 60-1 10 HU,with the average of 77.2 HU,and with the maximum of 75 HU.Conclusion If the pulmonary nodules or masses in middle-aged females had single round or ovoid shape,with about 3 cm diameters,soft-tissue density,smooth edge,and with obvious enhancement after contrast CT scan,and accompanied by vascular welt sign,air crescent sign,halo sign,or tail sign, the diagnosis of PSP should be considered.
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Objective To investigate the value of mammography (MAM),ultrasound (US)and MRI in the diagnosis of breast tumors using a Meta-analysis.Methods A systematic search of relevant literatures was done from CNKI,CBM,VIP,EMBASE OvidSP,PubMed and The Cochrane Library databases.Some related literatures about MAM,US and MRI in the diagnosis of breast tumors and the quality was evaluated,and the available information was extracted.The Meta-analysis was then performed by a Meta-disc 1.4 software,and a Review Manager 5.3 software was used to calculate the summary receiver operating characteristic curves and the area under the curve.Results The diagnostic effect of the MAM+US+MRI was significantly higher than that of mammography or ultrasound (P <0.05).The MAM study heterogeneity among sources was affected by whether it based on BI-RADS diagnostic criteria,and US study heterogeneity was affected by average age of patients.However,the MRI heterogeneity between studies displayed by regression analysis was not affected by each covariate.The diagnostic sensitivity and specificity were 76% (95%CI:0.73-0.79)and 72% (95%CI:0.69-0.75)for MAM,85% (95%CI:0.82-0.87)and 70% (95%CI:0.67-0.73)for US,and 95% (95%CI:0.93-0.96)and 72% (95%CI:0.69-0.75)for MRI,respectively.And the area under curve (AUC)of summary receiver operating characteristic (SROC)curve was 82.0%,88.5% or 97.4%, respectively.Moreover,the AUC of combined three methods together was 98.3%.Conclusion The value of MAM,US and MRI in diagnosis of breast tumor is higher,and the highest one exists when the combined three methods together are used.
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Objective To study feasibility of differentiation of benign and malignant by using eccentric rate of calcification in pulmonary spherical lesions.Methods Two hundred and forty cases with pulmonary spherical lesions(malignant in 170 and benign in 70) confirmed by pathology or clinical follow-up were collected in this study.All cases were underwent chest CT examinations.Nodule CAD software was used to demarcation of pulmonary spherical lesions and internal calcification.Calcification was defined as an area more than 3 pixel with calcification density(CT value＞120 HU).Furthermore,the ratio of calcification center distanceand calcification edge distance was calculated as Ecc.Mann-Whitney U test was used to compare the eccentric calcification rates between the malignant and the benign pulmonary spherical lesions.Taking pathological results as golden standard,the diagnostic efficacy of Ecc was analyzed using ROC curves.Results In 240 lesions,65 calcifications were detected,of which 18 were malignant calcification distributed in 10 lesions,and 47 were benign calcifications distributed in 16 lesions.The median of Ecc in benign and in malignant lesions were 0.80(0.28-1.29) and 3.01(1.52-4.47).The Ecc of calcification in benign lesions were lower than those in malignant lesions (U=183.000,P＜0.01).Under the cut-off value of 1.00,benign calcifications were more likely to lie inner 1/2 part of lesion [61.70％(29/47)],while malignant calcifications were more likely to lie outer 1/2 part of lesion [77.78％(14/18)].The difference was statistically significant(x2=8.117,P＜0.01).Under the cut-off value of 1.72,the resultant sensitivity,specificity,accurate rate were 83.1％,77.8％,81.5％ respectively.The area under the ROC was 0.804.Conclusions Ecc exhibits the location characteristics of calcification and may be an ideal parameter in quantitative diagnostic modeling for providing evidence of quantitative diagnosis.
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Objective To assess the non-invasive and quantitative value of diffusion tensor imaging (DTI)in the diagnosis,differ-ential diagnosis and classification of renal occupying lesions.Methods 30 healthy volunteers and 126 suspected cases with renal space-occupying lesions underwent conventional magnetic resonance imaging (MRI)and DTI scans.A total of 144 lesions were found in 126 patients.DTI was performed in 6 directions with b values of 0 and 500 s/mm2 .Fractional anisotropy (FA)and appar-ent diffusion coefficient(ADC)values were measured.Results With b values at 500 s/mm2 ,FA and ADC values between the nor-mal renal cortex and medulla in renal carcinoma,renal angiomyolipomas,renal cysts were pairwisely compared and there were all statistical difference (P <0.05).Difference of FA and ADC values between clear renal cell carcinoma and non-clear cell carcinoma was also significant (P <0.05).Conclusion FA and ADC values could distinguish benign from malignant renal tumour which may be helpful in the speculation of renal carcinoma pathological types.
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Objective To probe the changes of CT values in liver parenchyma in order to evaluate the therapeutic effect of acute pancreatitis.Methods 104 patients with acute pancreatitis which were diagnosed and treated by department of gastroenterology.Ac-cording to pathological results,the patients were divided into mild acute pancreatitis (MAP)group and severe acute pancreatitis (SAP)one.The CT values of liver parenchyma were measured before and after treatment,and the correlations between CT values changes and the amylase in blood and urine were analyzed.Results The CT values of liver parenchyma showed a negative correlation with the pathological severity of acute pancreatitis (r=-0.089,P <0.05).The accuracy using the changes of CT values to evaluate the therapeutic effect was significantly different between the MAP and the SAP group with different sensitivity of 92.2% and 85.7%and specificity of 33.3% and 94.1% respectively.In addition,the changed trend of CT values in liver parenchyma showed negative correlations with triglycerides and blood amylase.Conclusion CT scan is a useful imaging method in evaluating the liver damage and the therapeutic effect in patients with acute pancreatitis in emergency.
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Objective To study feasibility in extraction of calcific sign within pulmonary nodules with pattern classification.Meth-ods 49 cases with pulmonary nodules (benign in 16 and malignant in 33)confirmed by pathology or clinical follow-up were included in this study and all cases underwent chest CT examinations.CT images were interpreted double-blind by two associate chief radiolo-gists to draw a conclusion that there were any calcification within pulmonary nodules.Meanwhile,the calcifications in the regions of interest(ROI)on CT images were estimated with extraction of the sign of gray value,geometric and lung markings in ROI,and based on pattern classification algorithm at supporting vector machine(SVM).Results According to the results assessed by senior radiologists for classification within pulmonary nodules,the area under ROC curve was 0.95 which was extracted by automatic pat-tern classification algorithm,the extraction performance was stable(k=1),and was goodness fit with visual observation by doctors (k=0.939).Conclusion The ability of automatic pattern classification in detecting calcification within pulmonary nodules is about the same as that of visual assessment by senior doctors.
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Objective To investigate the imaging manifestations, clinical features and treatment of primary aggressive osteoblastoma (PAO)of the calcaneus.Methods The clinical data,imaging findings and treatment of PAO of the calcaneus in a young man retrospectively analyzed with literature review.The lesion was confirmed by pathology one and half years ago,and recurred after operation 10 months follow-up.Results X-ray and CT revealed expansive destruction of right calcaneus with little calcification or ossification,the bone destruction in the medial part of the calcaneus was obvious,the bone cortex was thin and incontinuous,there was no soft tissue mass or periosteal reaction.The talocalcaneal joint was not involved by the tumor.Neither other bones nor the root of Achilles' tendon showed direct tumor invasion or metastasis but neighboring swelling existed.Conclusion There are no significant differences about imaging manifestations, clinical features and laboratory analyses between primary aggressive and benign osteoblastoma of the calcaneus.The accurate diagnosis of PAO is only depending on pathology.The therapeutic effect with pure curettage and bone grafting for the lesion is not fine and tends to recur and malignant change.
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Objective: To develop a classification tree algorithm to improve diagnostic performances of 99mTc-MIBI SPECT/CT fusion imaging in differentiating solitary pulmonary nodules (SPNs). Methods: Forty-four SPNs, including 30 malignant cases and 14 benign ones that were eventually pathologically identified, were included in this prospective study. All patients received 99Tcm-MIBI SPECT/CT scanning at an early stage and a delayed stage before operation. Thirty predictor variables, including 11 clinical variables, 4 variables of emission and 15 variables of transmission information from SPECT/CT scanning, were analyzed independently by the classification tree algorithm and radiological residents. Diagnostic rules were demonstrated in tree-topology, and diagnostic performances were compared with Area under Curve (AUC) of Receiver Operating Characteristic Curve (ROC). Results: A classification decision tree with lowest relative cost of 0.340 was developed for 99Tcm-MIBI SPECT/CT scanning in which the value of Target/Normal region of 99Tcm-MIBI uptake in the delayed stage and in the early stage, age, cough and specula sign were five most important contributors. The sensitivity and specificity were 93.33% and 78.57%, respectively, a little higher than those of the expert. The sensitivity and specificity by residents of Grade one were 76.67% and 28.57%, respectively, and AUC of CART and expert was 0.886±0.055 and 0.829±0.062, respectively, and the corresponding AUC of residents was 0.566±0.092. Comparisons of AUCs suggest that performance of CART was similar to that of expert (P = 0.204), but greater than that of residents (P<0.001). Conclusion: Our data mining technique using classification decision tree has a much higher accuracy than residents. It suggests that the application of this algorithm will significantly improve the diagnostic performance of residents.
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Objective To develop a classification tree algorithm to improve diagnostic performances of 99mTc-MIBI SPECT/CT fusion imaging in differentiating solitary pulmonary nodules (SPNs). Methods Forty-four SPNs, including 30 malignant cases and 14 benign ones that were eventually pathologically identified, were included in this prospective study. All patients received 99Tcm-MIBI SPECT/CT scanning at an early stage and a delayed stage before operation. Thirty predictor variables, including 11 clinical variables, 4 variables of emission and 15 variables of transmission information from SPECT/CT scanning, were analyzed independently by the classification tree algorithm and radiological residents. Diagnostic rules were demonstrated in tree-topology, and diagnostic performances were compared with Area under Curve (AUC) of Receiver Operating Characteristic Curve (ROC). Results A classification decision tree with lowest relative cost of 0.340 was developed for 99Tcm-MIBI SPECT/CT scanning in which the value of Target/Normal region of 99Tcm-MIBI uptake in the delayed stage and in the early stage, age, cough and specula sign were five most important contributors. The sensitivity and specificity were 93.33% and 78. 57e, respectively, a little higher than those of the expert. The sensitivity and specificity by residents of Grade one were 76.67% and 28.57%, respectively, and AUC of CART and expert was 0.886±0.055 and 0.829±0.062, respectively, and the corresponding AUC of residents was 0.566±0.092. Comparisons of AUCs suggest that performance of CART was similar to that of expert (P=0.204), but greater than that of residents (P<0.001). Conclusion Our data mining technique using classification decision tree has a much higher accuracy than residents. It suggests that the application of this algorithm will significantly improve the diagnostic performance of residents.
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Objective To establish classification and regression tree (CART) for differentiating benign from malignant solitary pulmonary nudules (SPN).Methods One hundred and sixteen consecutive cases with 116 solitary pulmonary nodules,which finally were pathologically proven 54 malignant nodules and 62 benign nodules,were prospectively registered in this research.Twelve clinical presentations and 22 CT findings were collected as predictors.A classification tree was established to distinguish benign SPNs from malignant ones.In the observer test,two groups (one made of junior radiologists and one of senior radiologists) were independently presented with clinical information and CT images without knowing the pathologic and machine-learning results.Performance of observers and CART were compared by receiver operating characteristic analysis.Results Receiver operating characteristic analysis showed areas under the curve of CART,senior radiologists and junior radiologists respectively were 0.910±0.029,0.827±0.038,0.612±0.052. Difference between areas (DBF) between CART and junior radiologists was 0.297 (P＜0.01).DBF between CART and senior radiologists was 0.083(P＜0.05).DBF between senior and junior radiologists was 0.214(P＜0.01).CART showed a best diagnostic efficiency,followed by junior radiologists,and then senior radiologists.Conclusion Our data mining techniques using CART prove a high accuracy in differentiating benign from malignant pulmonary nodules based on clinical variables and CT findings.It will be a potentially useful tool in further application of artificial intelligence in the imaging diagnosis.
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Objective To explore the characteristics and applied value of diffusion-weighted MR imaging of kidney in healthy people.Methods Using Philips Gyroscan Intera 1.5T MR System,DWI of kidney was performed in 40 healthy adult volunteers,the ADCs of renal cortex and medulla were measured.Results The cortex and medulla of the normal kidney could be clearly showed by DWI.The ADCs of the cortex medulla and average were 3.08?0.52,2.74?0.68 and 2.91?0.58;2.79?0.51,2.53?0.65 and 2.63?0.62;2.64?0.43,2.32?0.47 and 2.48?0.44 when the b values were 300,500 and 800 s/mm2,respectively.The ADC was higher in the cortex than that in the medulla.Conclusion DWI can be used in kidney,it may be helpful for the diagnosis of renal diseases.
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Objective To study the procedure of imaging examination for the patients with colon cancer.Methods The comparative study on ultrosonograph, pneumobarium double contrast examination, colonscopy and CT in 82 cases with colon carcinoma comfired by operation and pathalogy were carried out.Results The detective rate of colon cancer was 90.1%,89.5%,53.8% and 53.3% by pneumobarium double contrast examination,colonscopy ultrosonography and CT respectively.The detective rate of metastasis in liver was 100% by ultrosonograph and CT.Conclusion Pneumobarium double contrast examination and colonoscopy are the main methods for diagnosis of colon cancer. Ultrosonography and CT are the important methods in evaluating the stage of colon carcinoma before operation.
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Objective To study the clinical and X-ray manifestations of primary non-Hodgkin's lymphoma(PNHL)of bone so that to suppy the valuable informations for clinical diagnosis and treatment of this disease.Methods 14 cases with PNHL of bone confirmed by clinic and pathology were analyzed retrospectively.There were 9 male and 5 femal,age ranged from 20 to 60 years with average of 35 years,and average history of disease was 11 months in all cases.Results Of all cases single bone involved in 11 cases,multiple bone involved in 3 cases,most of them the flat bone and the distal end of long bone were involved.The appearances of the lesion on X-ray were bony destruction with slight sclerosis at the margin of destructive area,there were periosteal reaction,soft tissue masses and destruction of joint manifestations,PNHL of bone can be classified as four typers:osteolytic(n=8),sclerotic(n=2),mixed(n=3)and cystic(n=1)lesions by the form and feature of bone destruction.Conclusion PNHL of bone has characteristic X-ray manifestations comparatively.The correct diagnostic rate can be improved if we concern about clinical data.
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Objective To improve recognition and diagnosis of primary non-obstructive megaureter.Methods The authors analyzed the X-ray findings of intravenous urography and B-ultrasonographic manifestations of 28 cases with primary non-obstructive megaureter proved by varied examinations and operations.Results The X-ray and B-ultrasonographic manifestations as follows:in the terminal ureter,there was a short segment,less than 3 cm in length,with normal caliber but adynamic to micturition and the ureter proximal to the adynamic segment was secondarily dilated remarkably.The terminal end of the dilated ureter appeared as drumstick shaped,spindle-shaped,snakehead shaped or rattail shaped.On right time fluoroscopy and B-ultrasonographic observation,a decrease of peristalsis frequency,increase of peristalsis range,interrupted downward convey of peristalsis wave could be noted.Conclusion The contrast urography is the main method,B-ultrasonography and cyctocopy are helpful for the diagnosis of primary non-obstructive megaureter.
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Objective To evaluate the clinical diagnostic value of magnetic resonance cholangiopancreatography ( MRCP ).Methods MPCP data of 42 cases with pancreatic and bile duct lesion proved by operation and pathology were analyzed retrospectively.MRCP was performed using single-shot-radio SE sequence (SSH/RAD). Of all cases included bile duct lithiasis in 19 , inflammation in 3,congenital cyst in 6 , carcinoma in 12,jaundice caused by diverticulitis of duodenum in 1 and Mirizzi syndrome in 1 .Results MRCP was succeeded at one time in all cases . On MRCP , the visual rate of intrinsic and extrinsic hepatic bile duct was 100% and that of common pancreas duct was 80.58%.The localized and qualitative diagnosis of lesions were up to 100%,88.2% respectively.Conclusion SSH/MRCP/RAD plays an important role in diagnosis of the pancreatic and bile duct lesion in clinical practice.
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Objective To explore CT and MR manifestations and its diagnostic value of liver cystic lesions.Methods The clinical and imaging data of 78 cases with liver cystic lesions were collected,including 21 cases of inflammatory cystic lesions,30 cases of tumor cystic degeneration and 27 cass of congenital growth cysts.Results The detected rate of liver cystic lesions with CT and MRI was all 100%.For inflammatory cystic lesions,tumor cystic degeneration and growth cyst,CT diagnostic accurate rate was 76%,90% and 93%,respectively,and MR was 83%,93% and 100% respectively.CT and MR manifestations:Of all inflammatory cystic lesions,hepatic abscess and liver echinococcosis cyst appeared as cystic occupying lesion,the cysts were of tension,low-density band on CT or water-like signal intensity on MR around the lesions in hepatic abscesses.Liver echinococcosis cysts were of big cyst with small cyst sign and enhanced moderately in cystic wall post contrast-enhanced scan.The metastasis cystic tumors showed single or multiple cystic lesions and mild or moderate circular enhancement.The primary liver tumor's cystc degenerative lesions showed cyst-solid lesions on CT and MR,and were of enhanced manifestations of the primary tumors.Growth cysts were single or multiple low-density or water-like signal intensity,generally there was not enhanced.Conclusion CT and MR have great diagnostic value for the location and nature of cystic lesions.
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Objective To analyse the CT features of hepatic abscess in different stages of pathology so that to improve the accuracy of CT diagnosis.Methods The plain CT and triphase contrast-enhanced CT findings of hepatic abscesses in 50 cases proved by surgery or other clinical methods were retrospectively analysed and compared with CT findings of hepatic carcinoma,hepatic metastases and hepatic hemangiomas.Results CT features of hepatic abscesses were divided into three types according to different stages of pathology.Early pyogenic hepatic abscess(10 cases)had two types:small cavitation(9 cases)and mass(1 case).Typical pyogenic hepatic abscess(38 cases)and granulomatous hepatic abscess(2 cases).Conclusion CT findings of liver abscesses are different in different stage of pathologic changes,triphase contrast-enhanced CT is specific in diagnosing hepatic abscess.
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Objective To select the proper enhanced methods of histogram egualization for the medical digital image. Methods By means of the full-frame histogram equalization(FFHE),local-area histogram equalization(LAHE) and adaptive-meighborhood histogram equalization(ANHE),medical digital images were enhanced,and the characteristics of these three methods were compared. Results Through the gray-level histogram equalization,the detail and the edge of medical digital images could be enhanced. Conclusion Toenhance the detail of local issue,it is better to use ANHE method.To enhance the edge of full image,which the full information must been taken into account,it is better to use FFHE method.