DiagnosticvalueofDWIwithultrahighbvalueinpredictionofaggressiveprostatecancer / 实用放射学杂志

Objective ToinvestigatethediagnosticvalueofADC withhigherbvaluefortheaggressivenessofprostatecancer. Methods 52patientswithpathologicallyprovedprostatecarcinomawerestudiedretrospectively.AllpatientsunderwentroutineMRI andDWIwithbvalueof1000and2000s/mm2.Accordingtothelocationoflesionfrombiopsyreport,aROIwasdrawnonADC mapatcancerousfociwithlowT2WIandhighDWIsignalintensityrespectivelyandtheADCvalueswerecalculated.Fociwereclassifiedinto highriskgroup(Gleasonscore≥8)andlow-intermediateriskgroup(Gleasonscore≤7).TheADCvaluesatb=1000or2000s/mm2between thetwogroupswerecomparedbyttest.ROCcurvewasusedtodeterminetheabilityofdifferentb-values.Relationshipsbetween meanADCvaluesinfociatb=1000or2000s/mm2andtumorGleasonscorewereassessedusingthe S pear m an test.Results Thereweresignificantdifferencesbetweenthehigh-riskgroupandthelow-intermediategroup(P<0.05)undertwob-values(b=1000s/mm2 andb=2000s/mm2).TheareaundertheROCcurveofb=1000s/mm2andb=2000s/mm2 ADCvaluesindifferentiatingthetwo groupswas0.858(P<0.05)and0.902(P<0.05)respectively,andnosignificantdifferencewasobservedintheAUCofbothgroups(P=0.222). ADCvaluesoftumorregionswerenegativecorrelatedwithtumorGleasonscoreat1000s/mm2(r=-0.709,P<0.05)and2000s/mm2 (r=-0.814,P<0.05)respectively.Although,nosignificantdifferencewasobservedinthecorrelationcoefficient(ρ)betweentwo groups(P=02.09).Conclusion ADCvaluesofbothb=1000and2000s/mm2havecorrelationwithGleasonscores.Thediagnosticperformanceof highb-value(2000s/mm2)ADCissuperiortonormalb-value(b=1000s/mm2)ADCinassessmentoftumoraggressiveness.

Clinical characteristics of posterior communicating artery aneurysm-induced oculomotor nerve paresis before and after endovascular coiling / 中华神经医学杂志

Objective To investigate the clinical characteristics of posterior communicating artery (PcomA) aneurysm-induced oculomotor nerve paresis (ONP) before and after endovascular coiling,and provide a reference for diagnosis,treatment and prognosis of PcomA aneurysm-induced ONP.Methods A total of 55 patients with ONP attributable to PcomA,admitted to our hospital from July 2007 to January 2013,were chosen in our study;their clinical data and postoperative recovery were retrospectively analyzed to investigate clinical characteristics of ONP attributable to PcomA.Results The average preoperative paralysis time was 12.24±5.33 days in patients with complete preoperative paralysis and 8.90±3.51 days in patients with incomplete preoperative paralysis with significant difference (P=0.014).Of the 55 patients,31 (56.36％) had complete recovery ofoculomotor nerve function,19 incomplete recovery (34.55％),and 5 (9.09％) remained unchanged after endovascular treatment.Most patients (41/50) began to improve in 3 months after endovascular treatment.The complete recovery ratio between patients encountered improvement of ONP within 30 days and over 30 days had statistical differences (P=0.032).Of 31 patients received complete resolution of ONP at the end of the follow-up,25 (80.65％) fully recovered 6 months after endovascular treatment.Thirty patients (96.77％) fully recovered within one year of endovascular treatment.One (3.23％) received complete resolution of ONP over one year of operation.Within 31 patients encountered complete resolution of ONP,there were 24 patients (77.42％) whose duration of recovery was less than 3 months and 7 patients (22.58％) more than 3 months.Functional recovery was noted firstly in the levator palpebrae muscle,followed by the medial rectus muscle,superior rectus muscle,constrictor muscles of the iris,and ciliary muscle.Patients with incomplete recovery often had residual diplopia in upward gaze and pupillary dysfunction.Conclusions The degrees of oculomotor nerve palsy before endovascular coiling are significantly associated with the paralysis time.Endovascular treatment can promote the recovery of PcomA-induced ONP.The earlier the ONP starting improvement,the better the ONP recoverary after endovascular treatment.The muscles which functional damage occurs early will encounter improvement lately.

Assessment of the diagnostic value of CT and X-ray enterography for small intestinal Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the value of CT and X-ray enterography in the diagnosis of small intestinal Crohn disease(CD).</p><p><b>METHODS</b>Data of 39 CD cases confirmed by surgery and pathology who underwent CT and X-ray enterography were analyzed retrospectively. All the patients had complete CT data, 28 cases had X-ray intestinal barium meal data, and 18 had sinus tract enterography.</p><p><b>RESULTS</b>CT enterography showed mural thickening(>4 mm) in 34(87.2%) patients, mural gas in 7(17.9%), mural edema in 7(17.9%), mural fat in 4(10.3%), increased enhancement of bowel wall(>10 HU) in 37(94.9%), multiple segmental lesions in 33(84.6%), single segmental lesions in 6(15.4%), mesenteric lymphadenopathy(>5 mm) in 13(33.3%), vascular bundle thickening in 9(23.1%), cellulitis in 12(30.8%), peritoneal abscess in 10(25.6%), phlegmon in 8(20.5%), incomplete intestinal obstruction in 14(35.9%), seroperitoneum in 22(56.4%), and fistulization in 4(10.3%). CT enterography did not demonstrate the change of mucosa such as strip ulcer or cobblestone. Among the 28 cases of small bowel X-ray enterography, 23 cases(82.1%) presented with multiple segmental lesions, 5(17.9%) with single segmental lesions, 18(64.3%) with strip ulcer, 16(57.1%) with cobblestones, 4(14.3%) with intestinal fistula, while no bowel wall and extraintestinal complication of CD disease was observed. Among the 18 cases of sinus tract enterography, 13 cases (72.2%) presented with intestinal fistula, 12(66.7%) with peritoneal abscess, 8(44.4%) with sinus tract.</p><p><b>CONCLUSIONS</b>CT enterography can demonstrate exactly the diseased bowel wall and extraintestinal complication of CD disease, which is important to evaluate the extent of CD and guide the treatment, however strip ulcer and cobblestone sign cannot be demonstrated. The X-ray enterography is available to demonstrate the characteristic changes of CD such as trip ulcers and cobblestones, but is difficult to show the bowel wall and extraintestinal inflammatory mass and abscesses. The sinus tract enterography is easy to demonstrate the intestinal fistula and intra-abdominal abscess. Combination of these methods is more beneficial to guild the diagnosis and treatment.</p>

Differential diagnosis of intestinal tuberculosis and primary small intestinal lymphoma using endoscopy and computerized tomography / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of intestinal tuberculosis(ITB) and primary small intestinal lymphoma(PSIL) in order to provide clue for the differential diagnosis.</p><p><b>METHODS</b>Data of 24 cases of ITB and 23 cases of PSIL confirmed by surgery and pathology were retrospectively analyzed. The clinical features, endoscopic and CT scan were compared. All the patients had complete clinical and CT data. Twenty cases of ITB and 20 PSIL had complete endoscopic data.</p><p><b>RESULTS</b>ITB was associated with significantly higher proportion of patients with fever(58.3% vs. 4.3%), night sweating(50.0% vs. 8.6%), pulmonary tuberculosis(54.2% vs. 4.3%) and ascites(54.2% vs. 21.7%) than PSIL(all P<0.05), and lower proportion of patients with abdominal mass (4.2% vs. 39.1%), hematochezia (8.3% vs. 47.8%), and perforation (0 vs. 39.1%)(all P<0.01). Endoscopic examination showed circumferential ulcer and rodent ulcer in 40% and 35% of the patients with ITB, and massive lesion and polypoid lesion in 55% of the patients with PSIL(P<0.05). Multi-segmental lesions, layered thickening, pneumatosis intestinalis, edematous ring, bowel lumen narrowing, hollow lymph nodes, and comb sign were more common in ITB(P<0.05), while single segmental lesions, eccentric thickening, and intussusception were more common in PSIL(P<0.05). The enhancement of intestinal wall of ITB were higher than that of PSIL(P<0.05), while the thickening and lymph nodes enlargement of PSIL were higher than that of ITB(P<0.05).</p><p><b>CONCLUSION</b>The clinical characteristics differ between ITB and PSIL and the differential diagnosis can be made by combining endoscopy and CT.</p>