Spontaneous intracranial hypotension complicated with cerebral venous thrombosis and spinal epidural hematoma: a case report / 中华神经科杂志

Spontaneous intracranial hypotension patients may have complications, such as cerebral venous thrombosis and intracranial subdural hematoma, while complicating with spinal epidural hematoma is rarely reported. A spontaneous intracranial hypotension patient, who started with orthostatic headache, followed by cerebral venous thrombosis , manifested as seizure, status epilepticus, and parenchymal hemorrhage, was admitted to Sir Run Run Shaw Hospital. Spinal evaluation showed lumbar epidural hematoma, without spinal cord compression symptoms. The patient improved with bed rest, fluid infusion, antiepileptic drug, and anticoagulation therapy. Three weeks after discharge, headache recurred without complete remission after lying flat. Cranial neuroimaging showed bilateral subdural hematoma. Anticoagulation was ceased. Subdural hematoma absorbed after treated with two epidural blood patches. The patient was headache-free during follow-up.

Dual-energy CT myelography on detection of spontaneous spinal cerebrospinal fluid leaks: initial study / 中华放射学杂志

Objective To assess the value of dual-energy computed tomography myelography (CTM) on detecting leaks of cerebrospinal fluid (CSF) in patients with spontaneous intracranial hypotension (SIH). Methods Six patients with SIH underwent spinal CTM on a 2nd generation dual-source CT with tube voltage set at 100 and 140 kVp(with tin filter). The virtual non-contrast (VNC) and iodine map images were calculated from dual-energy images. The average weighted (AW) CTM images were mixed from two kVp images with mix factor of 0. 5. Two radiologists evaluated CSF leak using two sets of images respectively: VNC + iodine map images and AW-CTM images. The results from two reading methods were compared. The level of CSF leaks along the nerve roots, C1-2 retrospinal CSF collections, epidural CSF collections and spinal epidural venous plexus were marked. The consensus about leak sites and CSF collections was made by two radiologists in the third session Kappa statistics were used to measure the agreement between the two methods. Results Forty-one leaks were detected using VNC + iodine map images. Forty-three leaks were detected on AW images. The agreement between two methods was excellent (Kappa =0. 997 ,P ＜0. 01). There were no differences in the detection of C1-2 retrospinal CSF collections (n = 2), epidural CSF collections(n = 3) or spinal epidural venous plexus (n = 1). VNC and iodine map images demonstrated superior visual effects than AW images. Conclusion Dual-energy CTM can be used to diagnose spontaneous spinal cerebrospinal fluid leaks in SIH patient.

Virtual non-contrast of liver from dual energy CT: a clinical application / 中华放射学杂志

Objective To assess the virtual non-contrast liver CT from dual-energy CT for the clinical application. Methods In total, 51 patients were included in the study, and all patients underwent multi-phase liver CT on a dual-source CT. The True non-contrast liver CT (TNCT) was performed in a single-energy acquisition mode, but the arterial and portovenous liver CT (VNCT) were performed in a dual-energy mode of 110 kV and 140 kV respectively. The virtual non-contrast CT images were derived from the arterial data using liver virtual non-contrast software. Between the true non-contrast CT and the virtual non-contrast CT, the image quality, mean CT HU values in the liver and muscle, signal to noise (SNR), the radiation dose of volume CT dose index (CTDIvol) and dose length product (DLP) in a single phase and total examination were compared with t test. Results There was no significant difference in the detection of liver lesions between TNCT and VNCT. The CT Hu values of muscle on both TNCT and VNCT images were almost equal. The CT HU values of liver on VNCT images were higher than that on TNCT images and the difference was significant [61.32 ±6. 04 vs. (56. 85 ±4. 80) HU, t = -3. 927,P＜0.01]. There was also significant differenc of SNR between TNCT (11.28±2. 78) and VNCT (8.65 ± 1.56) images( t =-5.590,P＜0.01). The CTDIvol and DLP of single phase were (7.07 ±0.85) mGy and (155.11 ±respectively, but in TNCT the total CTDIvol and DLP reached (21.43 ± 2. 46 ) mGy and (469. 02 ±significance, but the total CTDIvol and DLP were significantly different (t = 16. 168 and 13. 132, P ＜0. 01). Conclusion With the consequent reduction in radiation dose, the VNCT can replace TNCT as an imaging protocol in multi-phase abdominal CT examination in clinic.

CT myelography: application in detecting the site of spontaneous cerebrospinal fluid leaks / 中华神经科杂志

Objective To evaluate the application of CT myelography (CTM) in detecting the site of spontaneous cerebrospinal fluid (CSF) leaks and analyze it's imaging features.Methods Six patients (3 women and 3 men) with spontaneous intracranial hypotension (SIH) were included, who met the criteria of the International Headache Classification (2nd edition, 2004). Five patients subsequently underwent whole spine MRI and all 6 patients underwent CTM. Autologous blood mixed with omnipaque (300 mg/ml) was injected followed by selective puncture at the leak site indicated by CTM. Results MRI was failed to find leak site in the 5 patients, whereas CTM successfully found leak sites in all 6 patients. There were 1 to 7 leak sites respectively with an average of 4.2 sites (totally 25 points). Leak sites at cervical (12 sites) and thoracic (12 sites) were more frequent than at lumbar (1 site). CTM was featured by linear leakage of the contrast medium along the spinal nerve roots, paraspinal collections of hyper-density contrast medium and beak-like enlargement of the nerve sleeves. All patients responded well to the treatment, with complete resolution of symptoms. Conclusion CTM has been shown to be a study of choice to accurately define the location and extent of a CSF leak.

Spiral CT urography and CT virtual endoscopy in detecting urological diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate spiral CT urography (SCTU) and CT virtual endoscopy (CTVE) in detecting urologic diseases.</p><p><b>METHODS</b>SCTU was performed in 46 patients with urological diseases including renal neoplasms (2), paropelvic cysts (2), ureteral calculi (6), ureteral stenosis (4), ureteral neoplasms (2), double kidneys and ureter malformation (1), bladder neoplasms (28) and bladder endometreosis (1). The 6 patients with ureteral diseases and 29 patients with bladder diseases underwent CTVE based on spiral CT scan. All CTVE findings were compared with those of B-mode ultrosonography, intravenous urography (IVU), retrograde pyelography (RGP), conventional CT or cystoscopy.</p><p><b>RESULTS</b>All upper urinary tract diseases and bladder diseases (28 cases) were detected by SCTU and CTVE scans and they were confirmed operatively or pathologically except one case of bladder neoplasm (diameter less than 5 mm) was missed.</p><p><b>CONCLUSION</b>SCTU and CTVE have proved to be non-invasive and reliable in the diagnosis of urological diseases and are superior to IVU or conventional CT. CTVE can serve as a supplementary method to fiberoptic cystoscopy or ureteroscopy.</p>

CT features of xanthogranulomatous cholecystitis / 中华放射学杂志

Objective To investigate the diagnostic values of CT in xanthogranulomatous cholecystitis (XGC).Methods Retrospective analysis was performed in 4 patients with pathology confirmed XGC. Abdomen CT scans with and without contrast enhancement were performed in all patients. Results Only 1 case was correctly diagnosed before surgery. CT findings included gallbladder enlargement (3 patients), gallbladder wall thickening ( 4 patients), gallstone (1 patient), and common bile duct stone (1 patient). The maximum wall thickness was between 4 mm and 30 mm, with irregular low-density layer inside. Mucosal line was normal in 2 and pericholecystic infiltration in 1. After contrast administration, hypodense band sign was revealed in 2 and rim enhancement sign around the nodules was shown in 1 at arterial phase. Conclusion CT features of hypodense band sign and rim enhancement sign around the nodules in the arterial phase of contrast enhanced CT are strongly suggestive of XGC.

The value of MR enteroclysis with air infusion in the diagnosis of small bowel disease / 中华放射学杂志

Objective To investigate the value of MR enteroclysis with air infusion in the diagnosis of small bowel disease.Methods Sixteen patients with suspected small bowel disease, but without acute inflammatory disease or bowel obstruction, received MR enteroclysis with air infusion.There were 12 males and 4 females, and their age ranged from 17 to 75 years.10 patients had abdominal pain, 4 with melena or blood stool, and 2 with diarrhea.The longest course was 7 years, and the shortest 1 week.Before MR imaging, a nasoenteric catheter was inserted into the distal part of duodenum, and about 1000 ml of air was infused through the tube to distend the small bowel.20 mg of IV anisodamine was given to reduce small-bowel peristalsis.All patients were imaged with fat-saturated Gd-DTPA enhanced coronal and axial T 1-weighted spin-echo (SE) sequence and fast spoiled gradient echo (FSPGR) sequence.Comparison between the diagnosis of MRI and the results of surgery, pathology or clinic was performed to assess the sensitivity and specificity of MRI.Results 5 cases were normal, 6 with Crohn disease, 2 with gastric intestinal stromal tumor (GIST), and 1 each of lymphoma, tuberculosis and irritable bowel syndrome.The lumen of normal small bowel in MR enteroclysis was no signal, the wall was outlined as middle signal by intraluminal air and surrounding air-distended bowel and was between 1-3 mm thick, and the diameter of the lumen was between 17-28 mm.Crohn disease showed segmental mural thickening, increased enhancement, luminal stricture, and even extraluminal inflammatory mass or fistula.Intestinal tuberculosis invaded the distal section of ileum, cecum, and the proximal ascending colon, the wall thickened and enhanced apparently, and cecum and proximal ascending colon shortened.GIST showed a mass that was iso-signal on T 1WI, high signal on T 2WI, and enhanced significantly after IV Gd-DTPA.1 recurrent lymphoma of ileum showed mural thickening and increased enhancement but no stenosis.1 irritable bowel syndrome is disfunction, so its shape and signal is normal.Except 1 Crohn disease, which showed a large mass, was misdiagnosed as lymphoma and no abnormality was found in 1 irritable bowel syndrome, the other diagnosis of MRI was correct.The sensitivity in diagnosing small intestinal disease was 100%, and the specificity was 83%.Conclusion MR enteroclysis with air infusion is a sensitive method in diagnosing the small bowel disease, especially in Crohn disease and tumor.It can clearly display the mural thickening and the extraluminal inflammatory mass.