Differentiation of renal oncocytoma and renal clear cell carcinoma using relative CT enhancement ratio / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The difference between renal oncocytomas (RO) and renal clear cell carcinomas (RCCs) presents the greatest diagnostic challenge. The aim of this study was to retrospectively determine if RO and RCCs could be differentiated on computed tomography (CT) images on the basis of their enhancement patterns with a new enhancement correcting method.</p><p><b>METHODS</b>Forty-six patients with a solitary renal mass who underwent total or partial nephrectomy were included in this study. Fourteen of those were RO and 32 were RCCs. All patients were examined with contrast-enhanced CT. The pattern and degree of enhancement were evaluated. We selected the area that demonstrated the greatest degree of enhancement of the renal lesion in the corticomedullary nephrographic and excretory phase images. Regions of interest (ROI) were also placed in adjacent normal renal cortex for normalization. We used the values of the normal renal cortex that were measured at the same time as divisors. The ratios of lesion-to-renal cortex enhancement were calculated for all three phases. The Student's t-test and Pearson's Chi-square test were used for statistical analyses.</p><p><b>RESULTS</b>All RCCs masses showed contrast that appeared to be better enhanced than RO on all contrast-enhanced phases of CT imaging, but there was no significant difference in absolute attenuation values between these two diseases (P > 0.05). The ratio of lesion-to-cortex attenuation in the corticomedullary phase showed significantly different values between RO and RCCs. The degree of contrast enhancement in RCCs was equal to or greater than that of the normal renal cortex, but it was less than that of the normal cortex in RO in the corticomedullary phase. The ratio of lesion-to-cortex attenuation in the corticomedullary phase was higher than the cut off value of 1.0 in most RCCs (84%, 27/32) and lower than 1.0 in most RO (93%, 13/14) (P < 0.05). In the nephrographic phase, the ratio of lesion-to-cortex attenuation was higher than that in the corticomedullary phase in most RO (71%, 10/14), showing a prolonged enhancement pattern; and was lower than that in most RCCs (97%, 31/32), showing an early washout pattern (P < 0.05). In the differentiation of RO from RCCs, the sensitivity was 93%, specificity 84%, positive predictive value 72%, negative predictive value 84%, and accuracy for RO was 87, if the ratio of lesion-to-cortex attenuation in a cortex phase was lower than the cutoff value of 1.0. The sensitivity was 71%, specificity was 97%, positive predictive value was 91%, negative predictive value was 91%, and accuracy for RO was 89%, if the ratio of lesion-to-cortex attenuation in nephrographic phase was higher than that in the corticomedullary phase.</p><p><b>CONCLUSIONS</b>The ratios of renal lesion-to-cortex attenuation ratios may be helpful in differentiating RO from RCCs.</p>

Vascularized iliac bone grafting for avascular necrosis of the femoral head / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the indications for vascularized iliac bone grafting in the treatment of osteonecrosis of the femoral head and operative results.</p><p><b>METHODS</b>From October 1993 to August 2000, Twenty-six hips of 18 patients with osteonecrosis of the femoral head underwent vascularized iliac bone grafting. Clinical evaluation was made according to Harris Hip Score and ARCO staging system.</p><p><b>RESULTS</b>Twenty-three hips of 16 patients were followed up for 31.5 months (6 - 74 months) on average. The mean Harris hip score was 76 patients (mean 61.7). Thirteen hips (medial 8 hips, central 3 hips, lateral 2 hips) were graded > 80 points by Harris hip score were. The incidence of radiographic collapse 20% was (medial), 40% (central) and 75% (lateral) respectively.</p><p><b>CONCLUSIONS</b>Vascularized iliac bone grafting is effective for the treatment of osteonecrosis of the femoral head in short and middle term. We recommend this procedure for the patients with ONFH in ARCO stage I, stage IIA, IIB medial and central, and stage IIC medial.</p>

CT-guided percutaneous biopsy of musculoskeletal lesions / 中华放射学杂志

3 cm)and small lesions(diameter≤3 cm)were 80.6%(79/98)and 67.2% (45/67),respectively(P

The study of selective water excitation in the MR imaging of articular cartilage / 中华放射学杂志

Objective To investigate the value of selective water excitation technique for the assessment of articular cartilage.Methods MR sagittal scanning of knee joints was performed in the fifteen healthy volunteers.MR scan sequences were 3D-FFE-SPIR and 3D-FFE-WATS.The signal noise ratio (SNR)of the cartilage,the contrast noise ratio(CNR)between cartilage and adjacent tissue and their efficiency were calculated and analyzed statistically.Tweenty-nine patients who were suspected having cartilage injury were performed MR examination anti the image characteristics and the detecting ability of each sequence on cartilage lesions were analyzed.Results In the healthy volunteers,the cartilage SNR was 3D-FFE-SPIR:197.93?18.58,3D-FFE-WATS:187.32?21.50(P=0.159).CNR(cartilage/bone)was 3D-FFE-SPIR:185.50?18.34,3D-FFE-WATS:169.55?24.57(P=0.054).CNR(cartilage/muscle)was 3D-FFE-SPIR:61.40?19.04,3D-FFE-WATS:47.27?21.05(P=0.064).The cartilage SNR and CNR between cartilage and bone,muscle of 3D-FFE-SPIR weren't significantly higher than that of 3D-FFE- WATS.CNR(cartilage/liquid)was 3D-FFE-SPIR:91.53?14.46,3D-FFE-WATS:149.28?32.30(P= 0.000).CNR(cartilage/marrow)was 3D-FFE-SPIR:159.26?18.83,3D-FFE-WATS:176.87? 22.50(P=0.028).CNR(cartilage/fat)was 3 D-FFE-SPIR:134.56?15.80,3D-FFE-WATS:154.01? 22.42(P =0.010).The CNR between cartilage and liquid,marrow,fat were higher in 3D-FFE-WATS and significantly different than that of 3D-FFE-SPIR.Thirty detected cartilage injuries of patients were 3D-FFE- WATS:39,3D-FFE-SPIR:45 and there was no statistical difference between them(P=0.37). Conclusion 3D-FFE-WATS can show the articular cartilage clearly.It has high scan speed and suppress the fat signal evenly.Its ability for finding cartilage damage is equal to that of 3D-FFE-SPIR.So WATS can be used in the routine clinical cartilage examination.