Application of three-dimensional CT and image classification in percutaneous vertebraplasty for osteoporotic vertebral compression fractures / 中国骨伤

OBJECTIVE@#To explore the application of three-dimensional CT and image classification in the treatment of osteoporotic vertebral compression fracture(OVCFs) by percutaneous vertebroplasty(PVP).@*METHODS@#A total of 90 patients with OVCFs who were treated with PVP in Linqu People's Hospital of Shandong Province from April 2016 to March 2018 were selected as subjects. There were 31 males and 59 females, aged from 63 to 84 years old. Bone mineral density measurements were performed in all patients to confirm the presence of osteoporosis and imaging examinations were performed to confirm the presence of vertebral fractures. The fracture area was determined by MRI fat surpressed image before operation and three-dimensional modeling was performed to calculate the volume of fracture area. Three dimensional CT imaging of bone cement in fracture area was performed after PVP and the volume ratio of bone cement in fracture area was calculated by computer aided design software, by which patients were divided into groups for study. Forty-one patients whose volume ratio of bone cement in fracture area less than 50% are control group and the rest of 90 patients are observation group. Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were collected in two groups before operation and 1 day, 3 months after operation. The amount of bone cement was recorded after operation.@*RESULTS@#All operations were successful. There were 3 cases of cement leakage in control group and 4 cases in observation group. All patients had no obvious clinical symptoms. After continuous observation and follow-up for 3 months, no complications such as adjacent vertebral fracture, infection, bone cement displacement were found. There was no significant difference in bone cement doses and bone cement leakage between two groups(>0.05). There was no significant difference in preoperative VAS and ODI between two groups(>0.05). All VAS and ODI obviously decreased(<0.05) at 1 day after operation and in observation group the decrease was more significant (<0.05). At 3 months after operation there was no significant difference between two groups. This may have been due to basically healing of vertebral fractures at 3 months after surgery and the pain was no longer significantly related.@*CONCLUSIONS@#PVP can significantly improve clinical symptoms of OVCFs and bone cement filling in fracture area is the key to the short-term effect of PVP.

Differentiation of recurrence rectal cancer and benign pelvic lesions after curative rectal operation with 3.0 T magnetic resonance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of T2WI, DWI and 3D-VBIE at 3.0 T MR in the differentiation of recurrent rectal cancer and benign pelvic lesions after curative rectal operation.</p><p><b>METHODS</b>A total of 28 patients with abnormal pelvic lesions confirmed by CT or MR from April 2007 to October 2010 were evaluated with MR imaging. All the patients received examinations of both T2WI and DWI, and 24 of them received additional examination of 3D-VIBE. Thirteen patients with MR imaging in the same period who were confirmed to have no diseases of the rectum were used as control group. The mean apparent diffusion coefficient(ADC) value and the ratio of the signal intensity(SI) of the lesions to the gluteus maximus in T2WI(SI(L)/SI(M)) and the ratio of the net added signal intensity of the lesions to the net added signal intensity of the iliac artery(SI(L)/SI(A)) at the time of 35 seconds after the iliac artery achieved its highest intensity were measured and calculated. The type of the time-intensity curve(TIC) was over viewed and classified as the benign type when the TIC was rising slowly or constantly and lasted for more than 90 s; however the malignant type when the TIC was rising significantly but lasted less than 90 s kept as a horizontal line for a period or was descending slowly or rising slowly.</p><p><b>RESULTS</b>There were 29 lesions of different final diagnosis, including 17 recurrence rectal cancers, 4 fibrous masses, 6 stoma inflammations, 1 sinus and 1 abscess. Fourteen of them were confirmed by pathological examination. The ratio of SI(L)/SI(M) was 2.84±1.52 in the benign group, 2.58±0.80 in the malignant group, and 2.13±0.58 in the control group, the differences between the 3 groups were not statistically significant(F=1.620, P=0.211). When the ADC value of 1.21×10(-3) mm(2)/s was set as a diagnostic threshold, the sensitivity, specificity, accuracy and coherence for the diagnosis of the malignant lesions were 100%(17/17), 91.7%(11/12), 96.6%(28/29) and 0.928, respectively. When the SI(L)/SI(A) value of 0.28 was set as a diagnostic threshold, the sensitivity, specificity, accuracy and coherence for the diagnosis of the malignant lesions were 100%(13/13), 66.7%(8/12), 84.0%(21/25) and 0.675. When considering the TIC as the diagnostic standard, the sensitivity, specificity and accuracy for the diagnosis of the malignant lesions were 100%(13/13), 83.3%(10/12) and 92.0%(23/25), respectively.</p><p><b>CONCLUSION</b>The signal intensity of T2WI has no specificity in the differentiation of malignant lesions and benign lesions while the DWI and the 3D-VIBE have high values in it.</p>

Application of 3.0T MRI 3D-VIBE dynamic contrast-enhanced in the diagnosis of small hepatocellular carcinomas / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To investigate the detection rate of small hepatocellular carcinomas using 3.0T MRI 3D-volumetric interpolated breath-hold examination (VIBE) sequence dynamic contrast-enhanced scan, and to evaluate its application in the diagnosis of small hepatocellular carcinomas.</p><p><b>METHODS</b>Imaging data of 61 cases of small hepatocellular carcinomas obtained using a 3.0 T Siemens Magnetom Trio Tim magnetic resonance scanner for plain scan and multi-phase dynamic contrast-enhanced scans of three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) were retrospectively analyzed with reference to their pathological diagnoses. The signal and enhanced features and the detection rates of the tumors in different phases of examination were analyzed.</p><p><b>RESULTS</b>Sixty-six lesions were detected in the livers of the 61 patients by pathological examinations, of which 49 had pseudocapsule formation. In their T1WI plain scanning, 43 (65.15%) lesions were found, of which pseudocapsules were found in 19 (38.78%). In their T2WI imaging, 53 (80.30%) lesions were found. In dynamic enhanced 3D-VIBE sequence, 65 (98.48%) lesions were found, of which 35 (71.43%) were found with pseudocapsules. The sizes of the carcinomas ranged from 0.8 to 3.0 cm, 2.1cm on the average. The results of statistical analysis for the detection rates of the cancers of the three different sequences were significantly different (chi2=24.197, P less than 0.05). The differences of qualitative accuracy obtained by plain scan (T1WI + T2WI) and 3D-VIBE sequence were significantly different (chi2=66, P less than 0.05).</p><p><b>CONCLUSION</b>3.0 T MRI 3D-VIBE sequence dynamic contrast-enhanced scan is high-speed and can clearly demonstrate the arterial phase, the portal venous phase and the parenchymal phase images. It not only can find small lesions which can not be found with a plain scan, but also can assist diagnosis through a time-intensity curve. It is of great value for detection and differential diagnosis of small hepatocellular carcinomas.</p>