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Abstract Objective: Oral Squamous Cell Carcinoma (OSCC) is conventionally treated by surgical resection, and positive surgical margins strongly increase local recurrence and decrease survival. This study aimed to evaluate whether a Three-Dimensional Segmentation (3DS) image of OSCC confers advantage over Multiplanar Reconstruction (MPR) of OSCC using images of computed tomography scan in surgical planning of tumor resection. Methods: Twenty-six patients with locally advanced OSCC had tumor morphology and dimensions evaluated by MPR images, 3DS images, and Surgical Pathology Specimen (SPS) analyses (gold standard). OSCC resection was performed with curative intent using only MPR images. Results: OSCC morphology was more accurately assessed by 3DS than by MPR images. Similar OSCC volumes and dimensions were obtained when MPR images, 3DS images and SPS measurements were considered. Nevertheless, there was a strong correlation between the OSCC longest axis measured by 3DS and SPS analyses (ICC = 0.82; 95% CI 0.59-0.92), whereas only a moderate correlation was observed between the longest axis of OSCC measured by MPR images and SPS analyses (ICC = 0.51; 95% CI 0.09-0.78). Taking only SPS with positive margins into account, MPR images and 3DS images underestimated the tumor's longest axis in eight out of 11 (72.7%) and 5 out of the 11 (45.5%) cases, respectively. Conclusion: Our data present preliminary evidence that 3DS model represents a useful tool for surgical planning of OSCC resection, but confirmation in a larger cohort of patients is required. Level of evidence: Laboratory study.
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Objective:To investigate the clinical value of computer tomography (CT)-based three-section formula in identification of Siewert types of adenocarcinoma of esophagogastric junction (AEG).Methods:The retrospective and descriptive study was conducted. The clinicopatho-logical data of 62 AEG patients who were admitted to two medical centers, including 33 patients from Peking University Cancer Hospital and 29 patients from the First Affiliated Hospital of Amy Medical University, between January 2019 and January 2021 were collected. There were 53 males and 9 females, aged (66±9)years. All patients underwent CT examination to obtain the coronal and axial images and determine the upper and lower edges of the tumor and the esophagogastric junction, which were imported into the formula for Siewert classification. Observation indicators: (1) results of CT examination and pathological examination; (2) consistence of judgements for CT examination between doctors; (3) consistence of judgements between CT examination and patholo-gical examination. Results of pathological examination came from intraoperative surgical observa-tion and postoperative histopathological examination. Measurement data with normal distribution were represented as Mean± SD, and count data were described as absolute numbers or percentages. The consistency coefficient Kappa ( κ) was used to evaluate the consistency of diagnosis between resear-chers. The κ≥0.75 was regarded as excellent consistency, 0.40< κ<0.75 as good consistency, κ ≤0.40 as poor consistency. Wilcoxon rank sum test was used to evaluate the statistical difference between results of the CT-based three-section formula method and the pathological examination. Taking the results of histopathological examination as standard, the sensitivity, specifi-city, accuracy and 95% confidence interval of the CT-based three-section formula method were calculated. Results:(1) Results of CT examination and pathological examination: all the 62 patients underwent CT examination successfully to obtain the coronal and axial images and determine the upper and lower edges of the tumor and the esophagogastric junction, which were used for Siewert classifica-tion. There were 3 cases with AEG of Siewert type Ⅰ, 47 cases with AEG of Siewert type Ⅱ and 12 cases with AEG of Siewert type Ⅲ according to doctor's judgement from the Peking University Cancer Hospital, and there were 3 cases with AEG of Siewert type Ⅰ, 49 cases with AEG of Siewert type Ⅱ and 10 cases with AEG of Siewert type Ⅲ according to doctor's judgement from the First Affiliated Hospital of Amy Medical University, respectively. After arbitration, there were 2 cases with AEG of Siewert type Ⅰ, 48 cases with AEG of Siewert type Ⅱ and 12 cases with AEG of Siewert type Ⅲ determined by the CT based three-section formula. There were 7 cases of stage T1, 10 cases of stage T2, 24 cases of stage T3, 14 of stage T4a and 7 cases of stage T4b of pathological T staging. There were 2 cases with AEG of Siewert type Ⅰ, 48 cases with AEG of Siewert type Ⅱ and 12 cases with AEG of Siewert type Ⅲ determined by pathological examination. (2) Consistence of judgements for CT examination between doctors: the consistency of Siewert classification determined by CT-based three-section formula between 2 doctors was good ( κ=0.74, P<0.001). (3) Consistence of judgements between pathological examination and CT examination: with Siewert classification determined by pathological examination as reference, the accuracy of Siewert classification determined by CT based three-section formula was 90.3%( κ=0.73, P<0.001). The sensitivity and specificity of CT-based three-section formula were 66.7%(95% confidence interval as 20.8%-93.9%) and 100.0%(95% confidence interval as 93.9%-100.0%) for AEG of Siewert type Ⅰ, 97.7%(95% confidence interval as 88.2%-99.6%) and 72.2%(95% confidence interval as 49.1%-87.5%) for AEG of Siewert type Ⅱ, 73.3%(95% confidence interval as 48.0%-89.1%) and 97.9%(95% confidence interval as 88.9%-99.9%) for AEG of Siewert type Ⅲ, respectively. Conclusion:The CT-based three-section formula can be used for identification of Siewert types of AEG, with a high accuracy.
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BACKGROUND: Percutaneous kyphoplasty (PKP) is an effective method for treating osteoporotic vertebral compression fracture. Although satisfactory clinical outcomes can be achieved, bone cement leakage is still one of the main complications of PKP. Based on previous studies, there are many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphology of different vertebral bodies may be an important reason for bone cement leakage into spinal canal. OBJECTIVE: To investigate the effect of thoracic and lumbar vertebral posterior wall morphology in the patients with osteoporotic vertebral compression fracture on bone cement leakage into the spinal canal during the PKP. METHODS: The clinical data of osteoporotic vertebral compression fracture patients with PKP were selected. There were 98 osteoporotic vertebral compression fracture patients with CT scan and three-dimensional reconstruction image data from T6 to L5. The three-dimensional reconstruction of CT and multiplanar reconstruction were used to measure the depth of the concave vertebral posterior wall (OC) and the corresponding middle-sagittal diameter of the vertebra (PC) of the non-fractured vertebral body, the ratio of OC to PC was calculated. All subjects were divided into thoracic group (T6-T12) and lumbar group (L1-L5) based on the location of measured vertebral, and the differences of the OC between groups were compared. 357 patients (548 vertebrae) with osteoporotic vertebral compression fracture without CT three-dimensional reconstruction underwent PKP within the same period. They were also divided into thoracic vertebra and lumbar vertebra groups. The degree of bone cement leakage into the spinal canal was compared between thoracic and lumbar vertebra groups. RESULTS AND CONCLUSION: (1)The morphological parameters of posterior vertebral wall in 98 patients showed that the depth of the concave vertebral posterior wall gradually (OC) deepened from T6toT12, with an average of 4.6 mm. The depth became gradually shallow from L1 to L5, with an average of 0.6 mm. The ratio of the depth of the concave vertebral posterior wall to the corresponding middle-sagittal diameter of the vertebra was approximately 16% (1/6) from T6toT12. The average value of ratios from Li to U was 3%. The ratios in lumbar vertebra were significantly decreased compared with thoracic vertebra (16%, 1/6). (2) Results form 357 patients who underwent PKP at the same time showed that the rate of bone cement leakage into spinal canal was 10.2% (31/304) in the thoracic vertebra group during the PKP, and the rate of lumbar vertebra group was 3.7% (9/244). In the thoracic group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (3.1 ±0.2) mm, the average maximal area of the bone cement intruded spinal canal was (30.8±0.3) mm2, and the spinal canal encroachment rate was (22.5±0.2)%. In the lumbar group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (1.4±0.1) mm, the average maximal area of the bone cement intruded spinal canal was (14.9±0.2) mm2, and the spinal canal encroachment rate was (11,4±0.3)%. There was significant difference between thoracic and lumbar groups (P<0.05). (3) The above results imply that due to the presence of OC structure in the middle and lower thoracic vertebra, it is possible to reduce the occurrence of bone cement leakage into spinal canal through avoiding bone cement distribution over the posterior 1/6 (16%) of vertebral body in PKP. The effect of the difference between thoracic and lumbar vertebral posterior wall morphology in osteoporotic vertebral compression fracture patients on bone cement leakage into the spinal canal during the PKP may be one of the reasons why the rate of bone cement leakage into spinal canal in thoracic vertebra significantly higher than that in lumbar vertebra. The study protocol was approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (approval No. K2018008).
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@#Objective To investigate the diagnostic value and the best criteria of multiplanar reconstruction (MPR) of spiral CT in recurrent laryngeal nerve lymph node metastasis. Methods We performed multiplanar reconstruction of the spiral CT data of 138 esophageal carcinoma patients admitted to our hospital between December 2016 and June 2019, including 113 males and 25 females with an average age of 47-85 (63.03±15.58) years. The short and long diameters of recurrent laryngeal nerve lymph nodes were measured respectively, and then ratio of short to long diameter was calculated. The three parameters were contrasted with the pathological results and the receiver operating characteristic (ROC) curves for the parameters were drawn. Results Of the 138 patients, 291 left recurrent laryngeal nerve lymph nodes were dissected with an average number of 0-14 (2.11±0.41) per patient and the metastasis rate was 16.70%; while 436 right ones were dissected with the average number of 0-17 (3.16±0.45) per patient and the metastasis rate was 21.00%. The total metastasis rate was 29.70%. In the diagnosis of lymph node metastasis, the areas under ROC curve for short and long diameters as well as the ratio of short to long diameter of left recurrent laryngeal nerve lymph nodes were 0.808, 0.779, 0.621, respectively, while those for the right ones were 0.865, 0.807, 0.637, respectively. Conclusion The metastasis rate of recurrent laryngeal nerve lymph nodes is high and the short diameter has a higher diagnostic value for recurrent laryngeal nerve lymph node metastasis.
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Background: Change in tracheal bifurcation angle (subcarinal angle) is an indirect marker of various cardiac, pulmonary and mediastinal pathologies. Helical computed tomography (CT) allows acquisition of volumetric set of data of the chest and can be used for accurate measurements of subcarinal angle using reconstructed images on a workstation using minimum intensity projection (MinIP).The objective of this study was to estimate normal subcarinal angle (SCA) of trachea by computed tomography and to assess its relationship with gender.Methods: This was an observational study comprising a study cohort of 552 patients comprising of 312 males and 240 females who were subjected to CT chest for various indications in our department. Patients with no underlying cardiac, mediastinal or pulmonary disease were included in the study. Spiral CT scan of chest was performed on 64-slice seimens CT SOMATOM and images were reconstructed with thickness of 1.5mm and the images were viewed in coronal reformatted minimum intensity projection (MinIP) for determination of subcarinal angle using the angle measuring tool provided in the workstationResults: The mean subcarinal angle (SCA) in males was (67.60±14.55). The mean subcarinal angle (SCA) in females was (78.90±11.04). Females had a higher mean SCA compared to males with a statistically significant difference (p-value <0.05).Conclusions: The mean SCA in females was higher compared to males with a statistically significant difference between the two. This study holds practical relevance with regard to the performance of invasive trachea-bronchial procedures like bronchoscopy and tracheal/bronchial intubation.
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Objective To measure the lateral atlanto-dental interval (LADI)of normal atlanto-axial joint in children by MSCT and its MPR techniques,to explore its clinical significance.Methods We performed MPR coronal reconstruction for 207 original images of paranasal sinus scanned in neutral position,measure and compare the bilateral LADI and the variance of bilateral lateral atlanto-dental interval (VBLADI).Results There were 1 25 males and 82 females,the LADI of the former was larger than that of the latter,and there was significant difference between them (P＜0.05),the VBLADI of the former was larger than that of the latter,and there was no significant difference between them (P＞0.05).There were 126 cases younger than 7 years-old,while 81 cases older than or equal to 7 years-old,the bilateral LADI of the former was larger than that of the latter (P＞0.05),while the VBLADI of the former was larger than that of the latter (P＜0.05).Conclusion The asymmetry of bilateral LADI is common in normal children.Subluxation is generally considered suspicious if the VBLADI is larger than or equal to 3 mm,when this occurs,the clinician need to combine the clinical feature and do further examination to make a clarify diagnosis.
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Objective To investigate the diagnostic value of three-dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA)in combination with three-dimensional fast imaging employing steady-state acquisition with phase cycling (3D-FIESTA-C),using multiplanar reconstruction and image fusion technology in preoperative evaluation of vascular compressive trigeminal neuralgia (TN) and to improve the diagnostic accuracy.Methods 3D-TOF-MRA and 3D-FIESTA-C images using MPR and image fusion technology of 70 patients with TN confirmed by surgery were reviewed retrospectively,and compared with intraoperative findings separately and together.Results Microvascular decompression (MVD)surgery was performed in all 70 patients.Compared with surgical results, 3D-TOF-MRA showed presence of the offending vessel around the cisternal segment of trigeminal nerve in 55 cases with a positive rate of 79%.3D-FIESTA-C showed the presence of the offending vessel in 60 cases with a positive rate of 85%.65 cases were found when combining both 3D-TOF-MRA and 3D-FIESTA-C images,with a positive rate of 93%.No positive imaging findings were seen in 5 cases.Operation showed that offending vessels were small arteries in 3 cases and were petrosal veins in 2 cases.The main offending vessels were superior cerebellar artery and basilar artery.Conclusion Combining images of 3D-TOF-MRA and 3D-FIESTA-C using MPR and image fusion technology can show the relationship between offending vessels and the trigeminal nerve clearly in patients,and provide guidance for MVD surgery.There are still some deficiencies in the display of venules,and other sequences of MRI (such as CE-3D-FIESTA sequences)may be helpful.
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Objective To analyze the MSCT characteristics in patients with acute primary epiploic appendagitis(PEA)and to explore the clinical diagnostic value.Methods The complete MSCT examination data,surgical pathology and follow-up results of 1 2 patients with acute PEA in our hospital were analyzed retrospectively.Results In 1 2 cases of acute PEA,the locations of lesion were:beside the sigmoid colon in 5 cases,beside the descending colon in 4 cases,beside the ascending colon in 2 cases and beside the cecum in 1 case;the lesion morphologies were:round or oval in 9 cases,lobulated changes in 3 cases;the lesions were all lipid density;1 2 cases showed a ring-shaped high-density shadow on the edge;1 1 cases of lesions showed high-density shadow in the center,1 case of lesion showed no high density shadow in the center;in 8 cases,there were stripe-shaped high-density exudation shadow around the fat space;only 2 lesions showed thickening of the adjacent colon wall;and in two cases,the edges of lesions in the enhanced scanning showed annular enhancement.Conclusion Acute PEA has characteristic features in the examination of MSCT (oval or ring-like fat density mass,central punctate high-density shadow,high-density marginal ring sign with or without peripheral inflammatory exudation changes). Combining the multiplanar reconstruction(MPR),it can clarify the diagnosis and show conditions of the surrounding tissue,providing important value for clinical treatment.
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Objective To explore the application value of the preoperative multi-slice spiral computed tomography (MSCT) for the repair of huge abdominal incisional hernia.Methods The retrospective crosssectional study was conducted.The clinical data of 61 patients with huge abdominal incisional hernia who were admitted to the Xinjiang Uygur Autonomous Region People's Hospital from January 2012 to February 2016 were collected.All patients underwent preoperative MSCT and three-dimensional reconstruction to measure the percentage of volumes of the hernia sac and abdominal cavity and then selected the individualized surgical methods according to the percentage,and length of small intestine resected was calculated in patients undergoing initiative volume reduction combined with onlay repair.Observation indicators:(1) pre-and post-operative situations:percentage of volumes of the hernia sac and abdominal cavity,duration of preoperative hospital stay,surgical procedure,length of small intestine resected in patients undergoing initiative volume reduction combined with onlay repair,operation time and volume of intraoperative blood loss;(2) postoperative recovery situation:intraabdominal pressure at postoperative 48 hours,recovery time of postoperative gastrointestinal function,removal time of postoperative abdominal drainage-tube,postoperative complications and duration of postoperative hospital stay;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative hernia recurrence and long-term complications up to March 2017.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (range).Results (1) Pre-and post-operative situations:percentage of volumes of the hernia sac and abdominal cavity in 61 patients was 19％ ± 4％,and duration of preoperative hospital stay was (7 ± 5) days.All the 61 patients underwent successful operation,including 48 receiving onlay repair and 13 receiving initiative volume reduction combined with onlay repair,without conversion to other surgery.Length of small intestine resected in 13 patients undergoing initiative volume reduction combined with onlay repair was (48±8)cm.Operation time and volume of intraoperative blood loss in 61 patients were (2.6 ± 0.8) hours and (82± 50) mL.(2) Postoperative recovery situation:intra-abdominal pressure at postoperative 48 hours,recovery time of postoperative gastrointestinal function and removal time of postoperative abdominal drainage-tube in 61 patients were (9.6 ± 2.9) mmHg (1 mmHg=0.133kPa),(2.1 ± 0.9) days and (3.5 ± 1.1) days,respectively.Twelve patients had postoperative complications,and grade Ⅰ intra-abdominal hypertension,grade Ⅱ intra-abdominal hypertension,incisional effusion,incisional infection,incisional sinus,mesh infection and urinary retention were respectively detected in 4,2,4,2,1,1,1 in patients undergoing the onlay repair and 2,1,1,0,0,0,0 in patients undergoing initiative volume reduction combined with onlay repair.Some patients had 2 or more of complications.There was no occurrence of abdominal compartment syndrome and perioperative death.Patients with complications were cured or improved by symptomatic treatment.Duration of postoperative hospital stay in 61 patients was (8±4)days.(3) Follow-up:all the patients were followed up for 6-36 months,with a median time of 19 months.During follow-up,2 patients with recurrence of huge abdominal incisional hernia received tentative follow-up,and were suggested to treat risk factors of recurrence firstly and then undergo reoperations.Other patients didn't have long-term complications.Conclusion MSCT can provide the accurate data of percentage of volumes of the hernia sac and abdominal cavity before repair of huge abdominal incisional hernia,it also has the important clinical value of choosing the individualized surgical method,preserving the maximum out of normal organs in initiative volume reduction combined with onlay repair and increasing surgical outcomes.
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Objective To summarize the features of multi-slice spiral computed tomography (MSCT) examination of mesenteric panniculitis (MP).Methods The retrospective cross-sectional study was conducted.The clinical data of 105 patients with MP who were admitted to the Yangzhou NO.1 People's Hospital between September 2009 and September 2015 were collected.All the patients were diagnosed by MSCT and multiplanar reconstruction (MPR).Observation indicators:(1) imaging features of computed tomography (CT):location,number,shape,size,density,mesenteric vessels and surrounding intestine of the lesions,with or without pseudotumor sign,enlarged fibrous nodules or lymph nodes,pseudocapsule sign,fatring sign,cystolization and calcification;(2) follow-up results.Follow-up using outpatient examination was performed by plain and/or enhanced scans of abdominal CT up to April 2017.Results (1) Imaging features of CT:of 105 patients,77,14 and 14 received respectively plain scans of abdominal CT,plain and enhanced scans of abdominal CT and enhanced scans of abdominal CT.Lesions of 105 patients were located at the mesentery.The single lesion was detected in 79 patients and multiple lesions in 26 patients,with number of lesions of 5-12 per case and total number of 213.All the 105 patients had pseudotumor sign,which showed different size of patchy or mass shadows with clear edge extended from mesentery root to mesenteric vessels;most long axes extended from mesentery root to jejunum in the left lumbar region;the homogeneous or heterogeneous mesenteric fat density was increased,and CT value was higher than that of normal retroperitoneal adipose tissues;fog-like mesentery showed less obvious enhancement by enhanced scan and mesenteric vessels were wrapped around.The cord-like,round or oval fibrous tissue nodules and/or enlarged lymph nodes were found in 100 patients.All the 105 patients had pseudocapsule sign.The density ring of soft tissues of different thickness was found,with a clear boundary between leading-and trail-edges and normal abdominal and retroperitoneal adipose tissues;most membranes extended to left lumbar region,thicker and thinner membranes were respectively located at the anterior and posterior areas and right side,and parts of membranes were absence.The fatring sign was detected in 71 patients,there were ring-like hypodense shadows around the mesenteric vessels and fibrous tissue nodules or lymph nodes.Cystolization and calcification were found in 2 and 2 patients.Thirty-eight patients had surrounding intestinal canal translocation.(2) Follow-up results:55 patients were followed up for 1.0-57.0 months,with an average time of 14.7 months.Of 55 patients,26 had stable lesions and no obvious changes;4 returned to normal due to complete absorption of lesions;19 were improved due to partial absorption of lesions;6 had lesions progressions.Conclusion The features of MSCT examination of MP include pseudotumor sign,pseudocapsule sign and fatring sign.
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Objective To summarize the features of multi-slice spiral computed tomography (MSCT) examination of acute primary epiploic appendagitis,and investigate the clinical value of MSCT.Methods The clinical data of 19 patients with acute primary epiploic appendagitis who were admitted to the Yangzhou No.1 Hospital from December 2009 to March 2014 were retrospectively analyzed.All the patients received MSCT examination,and the data were transported to the work station for multiplanar reconstruction.The location,shape,size,density,peripheral performance and peritoneal thickening were observed.Results The foci of the 19 patients were located adjacent to the colon.One focus was adjacent to the cecum,4 were adjacent to the ascending colon,1 was adjacent to the hepatic flexure of the colon,6 were adjacent to the descending colon,and 7 were adjacent to the sigmoid colon.The shapes of the foci were similar to the oval or ring in 14 cases and similar to the flame in 5 cases.The diameters of the foci were 0.8-3.7 cm.The results of CT plain scan showed that the density of the foci was similar to that of the fat,and the CT value was-101--34 HU.The central density of the foci was lower,while the limbic density was higher.The results of CT enhanced scan showed a ring-like enhancement region in the foci,and the lesion was surrounded by slightly high-density inflammation.Point or linear slightly high-density shadows were detected at the center of the foci in 9 patients.The peritoneum was locally thickened in 14 patients.The colonic wall was locally thickened in 1 patient,and the pelvic effusion was detected in 5 patients.The results of CT reexamination of 4 patients showed that the inflammatory regions were reduced or disappeared,the mass shrank,nodulized or calcified.Conclusions MSCT examination can provide a specific features of primary epiploic appendagitis.It could accurately diagnose acute primary epiploic appendagitis when combined with multiplanar reconstruction.
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Objective To explore the diagnostic value of multi-slice spiral CT MIP-MPR image in regional lymph node metastasis of colonic carcinoma.Methods CT findings of 33 cases with pathological confirmed colonic carcinoma were analyzed retrospectively . All patients were underwent three-phase 256-slice CT dynamic enhancement scanning.All data were processed in workstation,to obtain routine MPR and MIP-MPR image.The regional lymph nodes of colon cancer were counted,and divided into 3 groups accord-ing to the short diameter of lymph node:group I (3.0-5.0 mm),group Ⅱ(5.1-10 mm),and group Ⅲ(10.1 mm up).The diag-nostic sensitivity of CT MPR and MIP-MPR image in checking out lymph nodes of different groups was compared by paired test.Re-sults The average value(x ±s )of lymph node number of three groups with routine MPR and MIP-MPR image were:group I, 3.66±1.99,6.09±2.44 (t=1 1.6,P 0.05).There were statistical differences in group I and group Ⅱ.Sensitivity of MIP-MPR image in chec-king out regional small and middle lymph nodes of colonic carcinoma was higher than routine MPR image.Conclusion Multi-slice spiral CT MIP-MPR image is a good way to checking out regional small and middle lymph nodes of colonic carcinoma.
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Objective To investigate the clinical application and diagnostic value of three.dimensional and muhiplanar reconstruction of spiral CT in fracture of shoulder blade.Methods The image of three-dimensional and muhiplanar reconstruction of spiral CT in fracture of shoulder blade cases were analyzed retrospectively.Results The 54 bone fractures were found in 31 fracture of shoulder blade cases;the multiplanar reconstruction discovered 54 bone fractures,and could show the fracture line and small bone chips clearly,especially for the bone chips in articular cavity,but it could not display the three-dimension of bone fracture;three-dimensional reconstruction discovered 51 bone fractures,and could display the change about three-dimension of bone fracture,but it could not show the fracture line of the bone fracture with small and non-dislocated clearly.Conclusion Three-dimensional and multiplanar reconstruction of spiral CT were applied conjunctively can increase the accurate rate,and strengthen the sense of three-dimensional in fracture of shoulder blade;in addition,it also could show the articular corresponding relationship and surrounding soft tissue injury,and offer the considerable value for the establishment of therapeutic regimen.
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We experienced 3 cases of incomplete intertrochanteric fracture that were detected by multiplanar reconstruction computerized tomography (MPR CT). On the plain radiographs, two cases had only greater trochanteric fracture and the other case had a localized intertrochanteric fracture. There were linear hot uptakes in the intertrochanteric area in all cases on the bone scintigrams. On MPR CT, cortical breakage was found only in the anterior cortex, and the medial, lateral and posterior cortices were intact in all cases. Two cases were treated surgically with using compression hip screws and the other case was managed conservatively because of the patient's poor general condition. The findings of MPR CT were definitely different from those MRI findings of the previously reported incomplete intertrochanteric fractures.
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Fêmur , Quadril , Fraturas do QuadrilRESUMO
ay of the anatomical features of the SN and clinical diagnosis of diseases related to the nerve.
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Objective To evaluate the role of Muhislice computed tomography(MSCT) in the diagnosis of acute ileus.Methods 50,cases with suspected of intestinal obstruction were scanned using MSCT.The diagnostic resuits of MSCT were compared with operation and pathology.Results The existence of ileus was diagnosed in 96% (48 of 50 cases) on MSCT scans,the sensitivity was 95% (41 of 43 cases),the specificity was 92% (46 of 50 cases).The accurate rate of X-Ray plain film in the diagnosis of ileus in this study was 66% (33 of 50 cases),the sensitivity was 76% (33 of 43 cages),the specificity was 68% (34 of 50 cases).The accuracy of etiological diagnosis of ileas made by MSCT in 17 cases proved by operation or clinical follow-up was 82% (14 of 17 cases),and the accuracy of location was 88% (15 of 17cases).The rate of diagnosis accord of CT and surgery in intestinal were no significant differenco(X~2=2.78,P＞0.05);The rate of in line with diagnosis of CT and surgery in intestinal were no significant difference;The rate of in line with diagnosis of CT and surgery in colon were significant(X~2=23.95,P＜0.05).Conclusion Intestinal obstruction is more clearly revealed by MPR of MSCT,which improves the diagnostic ability of acute intestinal obstruction.
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Objective To explore the diagnostic value of thin image and multiplanar reconstruction (MPR) for preoperative T staging on different regions and various pathological staging of colorectal cancer. Methods A total of 163 colorectal cancer patients underwent 64-slice CT examination, then cross section image with thickness of 5 mm (5 mm interval) and 0.5 mm (0.4 mm interval) were reconstructed. The lesions were evaluated and T staged with 5 mm, 0.5 mm and MPR image, respectively. Patients were divided according to the region of lesions: groupⅠ: the anterior wall of lower rectal or near dentate line; groupⅡ: the posterior or lateral wall of lower rectal; group Ⅲ: upper middle rectal or clone. Patients in group Ⅲ were divided into 4 subgroups according to postoperative pathological staging: group A: Tis and T1; group B: T2 (B1: T2a; B2: T2b); group C: T3; group D: T4. The accurate diagnostic rates of different regions, different imaging techniques and different pathological staging were analyzed compared with postoperative pathological results. Results CT accurate T staging diagnostic rate for group Ⅰ, Ⅱ, Ⅲ was 44.44%, 61.54% and 66.67% respectively with 5 mm; 51.85%, 61.54% and 69.92% respectively with 0.5 mm; 51.85%, 76.92% and 78.86% with MPR. There was significant difference of CT accurate diagnostic rates only between group Ⅰ and group Ⅲ (5 mm P=0.031, MPR P=0.004). MRP was better then 5 mm and 0.5 mm only in group Ⅲ (P=0.008, P=0.019). The sensibility of diagnostic T staging of A, B, C and D subgroup in group Ⅲ was as follows: 53.85%, 30.00%(B1: 57.14%, B2: 6.25%), 84.00% and 60.00% with 5 mm; 76.92%, 33.33%(B1: 76.92%, B2: 18.75%),84.00% and 60.00% with 0.5 mm; 92.31%, 53.33%(B1: 78.57%, B2: 31.25%), 86.67% and 80.00% with MPR. CT accurate T staging diagnostic rate of subgroup B2 was significantly lower than those of other groups, and most of the errors were over valuated. Conclusion CT has good sensitivity, specificity and accuracy for diagnostic T staging for early colorectal cancer. MPR can raise the accurate diagnostic rate of upper middle rectal and colon tumor. CT diagnostic value for T staging of lesions at the anterior wall of lower rectal or near dentate line tumor is limited, and the primary cause is over diagnosis of T2b lesions.
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Objective To assess the value of coronal MPR of 64-slice spiral CT in investigation of the cause of bowel obstruction. Methods Thirty-eight patients with different kinds of bowel obstruction underwent 64-slice spiral CT examination, and the data of axial and coronal image were reconstructed. Then the images were analyzed respectively by 4 readers in group A and B. Doctors in one group viewed the axial images first, then the coronal images, while in the other group viewed the coronal images first and then the axial images. The CT findings were compared with the surgical and pathologic results. Results The accuracy of coronal MPR of 64-slice spiral CT for investigating the cause of bowel obstruction was similar to that of axial MPR (86.84% vs 89.47%), and both had high accuracy. Diagnostic accuracy and confidence of doctors were improved obviously with the combination of axial images and coronal images (both 94.73%). Conclusion Coronal MPR of 64-slice spiral CT has very high clinical application value for diagnosing bowel obstruction. Diagnostic accuracy and doctors' confidence are improved with the help of axial images.
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Objective To study the image features and clinical significance of 3-dimensional (3-D)and multiplanar reconstruction with spiral CT(SCT) in cervical spinal fractures.MethodPlain film radiography and spiral CT scanning were taken for 26 cases of cervical spinal fractures.The type of fractures, diagnositic successful rate, parameter of scanning and late stage managing methods were investigated retrospectively to find out the effective difference between the diagnosis of plain X-ray and SCT. The imagin location of fractures,sequence of cenrum, heighth of centrum, fracture line, auxillary structure and rotation/dislocation of the fractures were emphasized to evaluate the advantages of 3-D imaging.ResultIn the 26 cases, there were 4 Jefferson fractures, (in which 1 combined with articular dislocations), 17 C2 spinous process fractures, (in which 1 had failure of plain X-ray diagnostic), 1 Hangman fracture, 2 C1～2 imbalance, (in which 1 had failure of plain X-ray diagnostic).There were 2 cases of axoid longitudinal fractures without obvious dislocation. The diagnositic successful rate were 100% in SCT group, while 65% in X-ray group in which 6 cases had diagnostic failure and 3 cases had fracture mis-diagnozing as dislocation.The anatomical structure of upper cervical spine was complicated and was significantly different from other cervical spine constructions. Spiral CT could reveal high resolution images of the upper cervical spine, morphosis of vertibral canal, dislocation information of fracture mass and its relation with neighbouring tissues. Especially in C1 burst fracture,C2 dens fracture and C1～2 dislocation, SCT could provide clear 3-D information of the size of collateral mass and the dislocation degree, furthermore, images could be rotated freely to observe the fracture in any proper section. That provides important information for the decision of operation, selection of operation types and evaluation of operation dager.ConclusionThe spiral CT scan and 3D reconstruction can reveal fracture better.The advantages of SCT are suggested that this diagnostic modality may be the standard method for the initial evaluation of the upper cervical spine injury.
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PURPOSE: The purpose of this study was to assess the usefulness of multiplanar reconstruction (MPR) images in the preoperative evaluation of advanced gastric cancer. METHODS: Multidetector-row CT (MDCT) was performed on 61 patients with advanced gastric cancer, and the coronal and sagittal multiplanar images reconstructed from the transaxial data. The combined axial and MPR images were compared to the axial images alone to determine if the image quality and diagnostic accuracy had been improved. RESULTS: The observed image quality of the combined axial and MPR images, graded relative to the axial image alone, was fair in 22 (36.1%), good in 27 (44.2%), and excellent in 12 cases (19.7%). For the T staging, the diagnostic accuracy of combining the axial and MPR images (75.4%) was higher than that of the axial image alone (70.7%). However, there was no significant difference in the accuracies between the two methods (McNeamar test, P>0.05). For specific regions, the diagnostic accuracies of combining the axial and MPR images and the axial image alone were as follows: 90.2, and 73.8% with antral lesser curvature involvement; 93.4, and 75.4% with antral greater curvature involvement; 83.6, and 73.8% with gastric angle involvement; 96.7, and 88.5% with liver left lobe invasion; 90.2, and 83.6% with pancreas head invasion and 96.7, and 85.2% with colon or mesocolon invasion, respectively. CONCLUSION: Combining the axial and MPR images does not improve the depiction of the T staging compared to the axial image alone in advanced gastric cancer. However, combining the axial and MPR images improved the imaging quality and diagnostic accuracy of specific regions where the delineation of the conventional axial image was insufficient. Therefore, combining the axial and MPR images may be very useful in the preoperative evaluation of advanced gastric cancers.