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Purpose To investigate the value of low dose CT combined with iterative model reconstruction (IMR) technique for evaluation of both breast lesion and pulmonary metastasis in patients with breast cancer,and compare the effects of IMR,hybrid iterative reconstruction (HIR) and filtered back projection (FBP) techniques on image quality.Materials and Methods Twenty-one patients with solitary tumor confirmed by mammography and/or ultrasonography at Navy General Hospital from January to May in 2016 were enrolled,and the related breast imaging reporting and data system reached to level 4 and above.All patients underwent dynamic contrast-enhanced CT with different tube current for breast (scanning 6 times within 6 minutes) and chest scans;the conventional tube current (61 mAs) was used at the 2 minutes phase after injection,and the low tube current (10 mAs) was used at the other 5 phases.CT images were reconstructed with FBP,HIR and IMR techniques,respectively.The images of breast lesions and chest in 2 minutes scans were evaluated objectively and subjectively.Results The mean effective radiation dose was (2.15 ± 0.39) mSv.The images of 3 reconstruction techniques at the 2 minutes phase were compared,and the IMR images showed the lowest image noise and the optimal contrast to noise ratio (P＜0.05).The images quality of 3 kinds of reconstruction techniques was acceptable,of which IMR was better than HIR and FBP (P＜0.05).Conclusion Low dose CT scan combined with IMR technique can remain low radiation with dose of 2 mSv,while maintaining good image quality,which can be used for preoperative evaluation of both breast lesion and pulmonary metastasis in patients with breast cancer.
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Objective To analyze the clinical,imaging and pathological features of cortical vein thrombosis (CoVT).Methods Three cases of cortical vein thrombosis were diagnosed in our hospital from February 2010 to October 2012.We reviewed and summarized their clinical manifestation,radiological feature and pathological characteristics.Results All patients were young with acute onset.The main clinical manifestations included headache,epilepsy or limbs weakness.Two cases had intracranial hypertension.One case had decreased activity of protein S.One had increased plasma homocysteine.Brain computed tomography scan showed hypodensity lesion with some hyperdensity inside.Cranial routine magnetic resonance imaging showed long signal in T1-weighed image and T2-weighed image,with occasional short T1 signal inside.Contrast-enhanced magnetic resonance imaging revealed heterogeneous enhancement.All of 3 cases underwent brain biopsy because of the suspected diagnosis of brain tumor.Brain pathology showed the local necrosis and hemorrhage,dilated small vein with congestion or thrombosis.Neuronal degeneration,hyperplasia of gliocyte,hyperplasia of endotheliocyte in small blood vessels with reaction of histiocytes was also displayed.Duration from initial visit to final diagnosis was from 14 days to 2 months.Conclusions CoVT has various clinical and radiological manifestations and it is easy to misdiagnose as brain tumor.Careful analysis of clinical and imaging data could improve its diagnostic accuracy.Brain biopsy would also be helpful for diagnosis.
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Objective To improve the diagnostic ability of leukoencephalopathy with cerebral calcifications and cysts (LCC),a rare central nervous system disease.Methods The clinical manifestations,neuroimages and neuropathological features of a 19-year-old male patient were analyzed.A total of 20 cases from 14 literatures were reviewed.Results The patient was admitted with right limb weakness,cognitive decline,headache and blurred eyesight.Head CT scan showed multiple calcifications,cysts formation and leukoencephalopathy.Brain MRI showed several cysts in bilateral hemisphere,basal ganglia,thalamus and paraventricular areas.A mural nodule was noted inside one of the cyst,which was enhanced on the contrasted MRI.The wall of the cysts was partially enhanced,but not with the fluid inside the cysts.The corresponding CT calcifications foci showed on T1 and T2 with either both hyperintensity or both hypointensity,which was also partial enhanced.Extensive leukoencephalopathy was formed around the cysts and the ventricles.But neither Cho nor NAA changed a lot on MRS.Amplitude diagram of SWI series exhibited multiple round small dark signals all over the affected areas with mixed signals showed in the phase diagram,which indicated both calcifications and microbleedings at the lesions.Neuropathological examinations found no tumor cells in the operated cyst,and showed angiomatous small blood cells were dominant in the cyst wall.Hyaline degenerations,microcalcifications and hemosiderin deposition were observed.No obvious demyelination was discovered,while gliosis,numerous Rosenthal fibers and fibrinoid vascular necrosis were found around the lesions.The clinical,neuroimaging and pathological features of this patient were in accordance with the cases reported in the literatures.Conclusions Neuroimaging is the most important method for the diagnosis of LCC.As small vessel lesions are probably closely related to the pathophysiology of LCC,SWI could be recommended to further reveal the etiology of LCC.
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Objective To compare the imaging characteristics of multiple sclerosis (MS) and neuromyelitis optica (NMO) for better diagnosis and differential diagnosis.Methods The brain and spinal MRI images of 60 MS and 48 NMO cases were retrospectively reviewed.The imaging characteristics including the predilection site,morphological features,enhancement manifestations were summarized.All data was analyzed by using t test and Chi square test with SPSS 13.0.Results (1) The three top predilection sites of brain in head MRI of MS patients were periventricular white matter (34 cases in 60),subcortical white matter (27 cases in 60),brain stem (23 cases in 60).MS lesions also were found in basal ganglia,cerebellum,corpus callosum and thalamus,as well as cortex (9 cases in 60).By contrast,brain lesions were observed in 59.4％ (19/32) of NMO patients,and the three top predilection sites of NMO by turns were brain stem (13 cases in 19),periventricular white matter (12 cases in 19),subcortical white matter (7 cases in 19).Furthermore,the lesions surrounding third ventricle (6 cases in 19) and the tegmentum of brain stem near peri-aqueduct (8 cases in 19) in NMO were not found in patients of MS.The involvement of brain stem and thalamus was more frequent in NMO than in MS (x2 =5.267,6.004,P ＜0.05,respectively).(2) The lesions of spinal cord in MS patients were typically oval,peripheral,and asymmetric,but in NMO patients they were longitudinally extensive and centrally located.The mean number of involved vertebral segments in NMO patients was significantly more than that in MS patients (7.3 vs 2.2,t =-9.288,P ＜ 0.01).Furthermore,the number of spinal cord lesions in MS patients was remarkably more than that in NMO (2.0 vs 1.3,t =4.565,P ＜0.01).The ratios of occurrence of spinal cord swelling and distension of NMO patients was 58.3％ (28/48),which was significantly higher than 21.9％ in MS (7/32,x2 =10.370,P ＜0.01).(3)The enhancement pattern in MS was circular (7 cases in 42),oval (6 cases in 42) and irregular (4 cases in 42),while in NMO was mainly sheet-shaped with mild enhancement (5/11).The lesions of spinal cord showed in MS mainly manifested as oval enhancement (16 cases in 26) and linear enhancement (8 cases in 26),while in NMO lesions manifested as strand or mild linear enhancement (26 cases in 35).Conclusions NMO has several distinct imaging characteristics,which are helpful for differentiation from MS.
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Objective To investigate the association of cognitive impairment with the brain structure changes in multiple sclerosis (MS). Methods 70 patients with MS were tested with the Wechsler Intelligence Scale and brain MRI. Analysis was performed to the brain MRI in 50 patients and diffusion tensor imaging (DTI) in 7 patients. Results The rate of the patients whose full intelligence quotient (FIQ) were less than 90 scores was 40% (28/70), which were higher than that of the normal group (P