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Objective:To explore the application value of 256-layer spiral CT left atrial pulmonary vein dual phase scanning imaging (called simply CT dual phase scanning imaging) in radiofrequency ablation of nonvalvular atrial fibrillation.Methods:The clinical data of 74 patients with nonvalvular atrial fibrillation from October 2018 to September 2020 in Tiantan Hospital, Capital Medical University were retrospectively analyzed. All patients were examined by CT dual phase scanning imaging and transesophageal echocardiography (TEE). The result of TEE was as "gold standard", the value of CT dual phase scanning imaging in the diagnosis of left atrial pre-thrombotic state (PTS) and thrombus were assessed, and the variation of the pulmonary vein was observed.Results:CT dual phase scanning imaging in diagnosis of left atrial PTS had a sensitivity of 52.94% (9/17), a specificity of 92.45%(49/53), a negative predictive value of 85.96%(49/57), and a positive predictive value of 69.23%(9/13); it in diagnosis of left atrial thrombus had a sensitivity of 100.00% (4/4), a specificity of 90.74%(49/54), a negative predictive value of 100.00%(49/49), and a positive predictive value of 44.44%(4/9). The variation rate of the pulmonary vein was 21.62%(16/74).Conclusions:CT dual phase scanning imaging has relatively high values of sensitivity, specificity and negative predictive value in detecting left atrial PTS and thrombus. It can also evaluate the abnormal anatomical characteristics of the pulmonary vein, and find pulmonary vein variation. It provides a reliable basis for radiofrequency ablation of nonvalvular atrial fibrillation.
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Objective To evaluate the additional role of 99mTc-MIBI SPECT-CT imaging before parathyroidectomy (PTX) for secondary hyperparathyroidism (SHPT) patients.Methods A total of 359 SHPT patients from the First Affiliated Hospital of Nanjing Medical University were enrolled in the study from April 2011 to January 2016.Patients were divided into two groups according to the difference of 99mTc-MIBI imaging techniques preoperatively.Patients in group A had dual-phase 99mTc-sestamibi parathyroid scintigraphy performed only.Patients in group B had SPECT-CT parathyroid scintigraphy added in the early phase.With the parathyroid glands confirmed by pathology after operation being the referencc,scnsitivity,specificity,consistency and surgical success rates of the patients in two groups were compared.Results 359 patients (166 men and 193 women) were enrolled,among which 339 on hemodialysis and 20 on peritoneal dialysis.The average age of those patients was (45.90± 11.20) years and median dialysis age was 84 (60.0,120.0) months.Total detection sensitivity,specificity,consistency in group A (169 patients) were 65.54％,56.52％,65.24％ and in group B (190 patients) were 73.84％,84.62％,74.21％ respectively.Total sensitivity and consistency were higher in group B than those in group A (P ＜ 0.01),while no difference in total specificity was observed between two groups (P=0.055).In group A,detection sensitivity of parathyroid glands were 47.56％,77.44％,57.14％ and 79.88％ in right upper gland (RU),right lower gland (RL),left upper gland (LU) and left lower gland (LL) respectively.Consistency in group A were 48.52％,77.51％,56.21％ and 78.70％ respectively.In group B,sensitivity were 58.33％,83.78％,69.78％ and 82.89％ in RU,RL,LU and LL respectively.Consistency in group B were 59.47％,84.21％,70.53％ and 82.63％ respectively.Sensitivity and consistency of upper glands were lower than lower glands in both groups (P ＜ 0.01).When SPECT-CT was added,sensitivity and consistency of upper glands for both sides were higher in group B than those in group A,while no difference of surgical success rates was found between two groups (87.57％ vs 92.63％,P=0.107).Conclusion 99mTc-MIBI SPECT-CT can be combined with anatomic image effectively and increase the sensitivity and consistency of total and upper parathyroid glands.It can also make the accurate location of the lesions,which improves the efficiency of the operation.
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Objective To evaluate the clinical value of cardiovascular dual-phase scan of 256-slice spiral CT in diagnosis of left atrial appendage (LAA) thrombus before radiofrequency ablation in patients with atrial fibrillation. Methods A prospective study was conducted. Thirty-six patients with atrial fibrillation being prepared to undergo radiofrequency ablation admitted to the Fifth Central Hospital of Tianjin from October 2015 toJuly 2016 were enrolled, they were scanned using dual-phase cardiovascular protocol of 256-slice spiral CT, and then trans-esophageal echocardiography (TEE) was performed for the definite diagnose of thrombus. In the first phase of cardiac CT, the intelligent tracking method was used to determine the delayed time; in the second phase cardiac CT scan, 85 seconds was confirmed as the delayed time; TEE as the golden standard was used to evaluate the value of dual-phase CT in definite diagnosis of LAA thrombus.Results LAA low density filling defect was discovered in 5 patients in the first phase CT scan, the CT scan in the second phase, the filling defect still existed, and the diagnosis of LAA thrombus in 3 patients was made (of them 2 cases after TEE examination were diagnosed definitely as LAA thrombus, and the echo in 1 case was smoke-like on TEE, being at pre-thrombus status), 2 cases were confirmed as pseudo-filling defects (afterwards, their diagnosis was confirmed as pre-thrombus status because the echo shown on TEE was smoke-like). Two patients were confirmed as true thrombi on TEE, and there were 3 patients diagnosed as pre-thrombus state by TEE because of their echo smoke-like. TEE was used as the golden standard for diagnosis of thrombus, the following indexes could be calculated: in the first phase, the sensitivity of using CT scan to diagnose LAA thrombus was 100.0%, the specificity 91.2%, positive predictive value (PPV) 40.0%, and negative predictive value (NPV) 100.0%; while in the second phase of using CT scan for diagnosis of LAA thrombus, the above indexes were 100.0%, 97.1%, 66.7%, 100.0% respectively; the CT Kappa coefficient of the second-phase was larger than that of the first-phase CT (0.898 vs. 0.739), the difference being statistically significant (P < 0.05).Conclusions Dual-phase cardiovascular protocol of CT can detecte of LAA thrombus/pre-thrombus state, the PPV is significantly elevated after the second phase of CT scan for diagnosis of thrombus, and the consistency between the second phase CT diagnosis of thrombus and TEE diagnosis is higher than that between the first phase CT and TEE, therefore, using dual-phase cardiovascular protocol of 256-slice spiral CT in diagnosis of LAA thrombus in patients with atrial fibrillation before radiofrequency ablation has relatively high application value.
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Background and purpose:Although FDG tumor imaging has been applied in clinic widely, dual-phase imaging can provide much more information about the FDG uptaking of pulmonary lesions. The purpose of the study was to evaluate the usefulness of dual-phase18F-FDG coincidence detection SPECT/CT imaging in the differential diagnosis of the pulmonary lesions.Methods:There were 28 patients with pulmonary lesions which were detected by CT. All the patients undertook the SPECT/CT imaging at 2 time-phases respectively: early imaging at 40-60 min and delayed imaging at 2-3 h after the intravenous injection of FDG. Data processing: calculating the radio of T and N in early and delayed imaging respectively; T: The radioactive count of the lesions; N: The radioactive count of the normal tissue; and the change rate:ΔT/N. ROC was used to ifnd out the threshold of T1/N1, T2/N2及ΔT/N in the differential diagnosis between benign and malignant lesions. AUC was used to evaluate the diagnosis value of the dual-phase and single-phase imaging.Results:The threshold of T1/N1 in early imaging was 2.65, whereas AUC was 0.767. The sensitivity, speciifcity and accuracy were 83.3%, 30% and 64.3%, respectively. The threshold of T2/N2 in delayed imaging was 3.14, whereas AUC was 0.847. The sensitivity, speciifcity and accuracy were 94.4%, 60.0% and 82.1%, respectively. The threshold ofΔT/N in delayed imaging was 16.9%, whereas AUC is 0.950. The sensitivity, speciifcity and accuracy were 88.5%, 71.4% and 86.2%, respectively.Conclusion:Dual-phase18F-FDG coincidence detection SPECT/CT imaging has much higher accuracy and speciifcity. However it still has false positivity, and should be analyzed with CT and clinical history.
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OBJECTIVE:To explore the effects of dual-phase insulin aspart with different dosing regimens on the related indica-tors of type 2 diabetic (T2DM) patients with poor glycemic control. METHODS:70 T2DM patients with poor glycemic control were randomly divided into group A and group B. All patients were given metformin and stopped other antidiabetic drugs;based on it,group A was additionally given Dual-phase insulin aspart injection,0.5 U/(kg·d),in the morning and evening before a meal by subcutaneous injection;group B was given Dual-phase insulin aspart injection,0.5 U/(kg·d),once before lunch time for 6-10 U and other twice in the morning and evening before a meal by subcutaneous injection. Both groups were treated for 12 weeks. Glu-cose control rate,glucose control time,and glucose indicators,daily fluctuations of glucose before and after treatment and incidenc-es of hypoglycemia and adverse reactions in 2 groups were observed. RESULTS:Glucose control rate in group B was significantly higher than group A,glucose control time was significantly shorter than group A,incidence of hypoglycemia was significantly low-er than group A(P<0.05). After treatment,glucose indicators and daily fluctuations of glucose in 2 groups were significantly lower than before,and group B was lower than group A(P<0.05). There were no obvious adverse reactions during treatment. CONCLU-SIONS:Conpared with 2 times a day,Dual-phase insulin aspart with 3 times a day for administration can effectively improve the glucose control rate and glucose levels in the treatment of T2DM patients with poor glycemic control,with good safety.
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Objective:To compare the results of dual-phase enhanced CT scan and pathological diagnosis of ovarian corpus luteum cyst rupture.Methods: Thirty four cases of ovarian corpus luteum cyst rupture were treated in our hospital from April 2012 to April 2015 were retrospectively analyzed.Results: Among the 34 cases of patients, 28 cases before surgery CT accurate diagnosis of ovarian corpus luteum cyst, 6 cases before surgery CT did not accurately diagnose ectopic pregnancy bleeding was first diagnosed. In terms of the lesion, 22 cases of the right ovary and 12 cases were left ovary. Ruptured corpus luteum cyst diameter in 4.3-7.3cm, averaging (5.1±1.4)cm, the lack of complete cyst wall, visible break, there exists in the blood clot and the surrounding cyst; 20 cases with contrast extravasation, sheet or strip was present in high density around the cyst was the main clinical manifestations; a lot of low density liquid accumulated in the abdominal cavity; 28 cases with cystic density increased, the presence of a blood clot within the cyst was the main clinical manifestations. Surgical results were consistent with observed preoperative CT diagnosis. All patients were pathologically confirmed corpus luteum cyst rupture.Conclusion: Dual-phase enhanced CT scann has higher value in the diagnosis of ovarian corpus luteum cyst rupture bleeding, so is worthy of promotion.
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Objective To compare the clinical usefulness of CT and DSA in evaluating the residual lesion and recurrence of tumor for primary hepatocellular carcinoma (PHC) after transcatheter arterial chemoembolization (TACE) with Lipiodol and to compare the effectiveness between CT and DSA. Methods Forty-five patients with HPC underwent CT and DSA within 1 - 6 months after 1 - 4 procedure(s) of TACE.The interval between two examinations was 3 - 5 days. The detection and demonstration of the residual lesions and the recurrence of tumor on CT and DSA were compared and the results were analyzed. Results The Lipiodol deposition appearance was classified into three patterns: complete compact pattern (n = 9,20% ), defect pattern (n = 32, 71.1% ) and discrete pattern (n = 4, 8.9% ). In patients with complete eompact pattern, no signs of recurrence were found on CT and DSA six months after the procedure. Of 32 patients with defect pattern, signs of recurrence on DSA and on dual-phase CT scans were found in 27 and in 19 respectively. During arterial phase, marked enhancement of the lesion was demonstrated in 16 cases,further enhancement in portal venous phase was manifested in 3 cases, which indicated that the portal vein participated in the tumor feeding. On DSA, the above enhancement areas showed pronounced opacification and vascularization. In another 8 cases, the CT signs and DSA findings were not in accord with each other, the lesions showed no enhancement on dual-phase CT scans but the lesions made their appearance as tumor's vessels and opacification. In patients of discrete pattern, only mild enhancement was seen on dual-phase CT scans, indicating that the tumor was of hypo-vascularization. Conclusion Both plain and dual-phase CT scanning can well demonstrate the residual lesions and the recurrence of hepatocellular carcinoma after TACE. Therefore, in evaluating the therapeutic results of TACE, CT study should be.considered as the examination of choice. DSA is the most sensitive and specific method for observing and assessing the therapeutic response. A combination of CT and DSA can more effectively guide the clinical treatment.
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Eight Beagle dogs were anesthetized and were imaged using a single channel helical CT scanner. The contrast medium used in this study was iohexol (300 mg I/ml) and doses were 0.5 ml/kg for a cine scan, 3 ml/kg for an enhanced scan. The flow rate for contrast material administration was 2 ml/sec for all scans. This study was divided into three steps, with unenhanced, cine and enhanced scans. The enhanced scan was subdivided into the arterial phase and the venous phase. All of the enhanced scans were reconstructed in 1 mm intervals and the scans were interpreted by the use of reformatted images, a cross sectional histogram, maximum intensity projection and shaded surface display. For the cine scans, optimal times were a 9-sec delay time post IV injection in the arterial phase, and an 18-sec delay time post IV injection in the venous phase. A nine-sec delay time was acceptable for the imaging of the canine hepatic arteries by CT angiography. After completion of arterial phase scanning, venous structures of the liver were well visualized as seen on the venous phase.
Sujets)
Animaux , Angiographie/méthodes , Produits de contraste/pharmacologie , Chiens/anatomie et histologie , Iohexol/pharmacologie , Foie/vascularisation , Tomodensitométrie/méthodesRésumé
Objective To compare the clinical usefulness of CT and DSA in evaluating the residual lesion and recurrence of tumor for primary hepatocellular carcinoma(PHC)after transcatheter arterial chemoembolization(TACE)with Lipiodol and to compare the effectiveness between CT and DSA.Methods Forty-five patients with HPC underwent CT and DSA within 1-6 months after 1-4 procedure(s)of TACE. The interval between two examinations was 3-5 days.The detection and demonstration of the residual lesions and the recurrence of tumor on CT and DSA were compared and the results were analyzed.Results The Lipiodol deposition appearance was classified into three patterns:complete compact pattern(n=9, 20%),defect pattern(n=32,71.1%)and discrete pattern(n=4,8.9%).In patients with complete compact pattern,no signs of recurrence were found on CT and DSA six months after the procedure.Of 32 patients with defect pattern,signs of recurrence on DSA and on dual-phase CT scans were found in 27 and in 19 respectively.During arterial phase,marked enhancement of the lesion was demonstrated in 16 cases, further enhancement in portal venous phase was manifested in 3 cases,which indicated that the portal vein participated in the tumor feeding.On DSA,the above enhancement areas showed pronounced opacification and vascularization.In another 8 cases,the CT signs and DSA findings were not in accord with each other,the lesions showed no enhancement on dual-phase CT scans but the lesions made their appearance as tumor's vessels and opacification.In patients of discrete pattern,only mild enhancement was seen on dual-phase CT scans,indicating that the tumor was of hypo-vascularization.Conclusion Both plain and dual-phase CT scanning can well demonstrate the residual lesions and the recurrence of hepatocellular carcinoma after TACE.Therefore,in evaluating the therapeutic results of TACE,CT study should be considered as the examination of choice.DSA is the most sensitive and specific method for observing and assessing the therapeutic response.A combination of CT and DSA can more effectively guide the clinical treatment.
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The effects of different carbon sources added to aerobic medium on cell growth,enzyme activity and metabolite distribution was investigated in dual-phase fermentations.The results showed that both cell density and enzyme activity were enhanced by adding 4mmol/L glucose or 12,54,80mmol/L sodium acetate to aerobic medium,respectively.Then centrifugated cells that had grown aerobically in different conditions were transferred to anaerobic fermentation,the enzyme activity and metabolite distribution changed.To analyze the anaerobic enzyme activity and metabolite distribution,it was concluded that during the anaerobic fermentation of Escherichia coli NZN111 overexpressed malic enzyme,PEP carboxykinase(PCK)was the key enzyme of succinate production,pyruvate kinase(PYK)was associated to the accumulation of by-product pyruvate,and isocitrate lyase(ICL)have some influence on the concentration of succinate.The yield of succinate in anaerobic stage could reach 89.0%,which was 16.6% higher than that of the control by adding 80mmol/L sodium acetate as carbon source in aerobic medium.