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Objective:To investigate the feasibility of multi-slice spiral CT (MSCT) imaging feature of gastric stromal tumor (GST) in evaluating Ki-67 index expression .Methods:The clinical and CT imaging data of 501 patients with GST confirmed by surgery and pathology were retrospectively studied in Zhongshan Hospital affiliated to Fudan University and the Affiliated TCM Hospital of Southwest Medical University from Nov 2014 to Nov 2021. By immunohistochemical results, tumors were divided into Ki-67 low expression group (Ki-67≤6%, 335 lesions) and high expression group (Ki-67>6%, 168 lesions). Multivariate logistic regression analysis was conducted.Results:Between the two groups,there were statistical differences in the longest and shortest diameter of tumor, CT value on venous phase, CT attenuation value ( Z=4.80, 4.91, 3.21, 3.29, all P<0.01) and tumor location,morphology, necrosis, ulcer, feeding artery, vascular enhancement, positive fat sign around disease, gastrointestinal bleeding ( χ2=10.77, 13.49, 8.59, 22.87, 7.59, 7.23, 7.76, 8.58, all P<0.05). Tumor ulceration positive ( OR=1.88, 95%CI: 1.17-3.03) was independent risk factor of Ki-67 high expression ( P=0.009). Gastric antrum was used as the reference for tumor location, cardia ( OR=5.41, 95% CI:1.25-23.46) was independent risk factor of Ki-67 high expression ( P=0.024). Conclusion:MSCT has a definite predictive value for the expression in Ki-67 index of GST cases.
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Objective ToevaluatetheefficacyandsafetyofCT-guidedmicrowaveablation (MWA)forstageIVlungcanceraccompanied withcontrolledsingleintracranialmetastasis.Methods From November2011toOctober2016,78patientsinourhospitaldiagnosed withstageIVnon-smallcelllungcanceraccompaniedwithcontrolledsingleintracranialmetastasiswerestudied.Patientsweredividedintotwo groupsaccordingtowhethertheywerewillingtoacceptlocalMWAtreatmentornot:thegeneralgroup (groupA)with42cases, and MWAgroup(groupB)with36cases.Aftertheintracranialmetastasiswascontrolled,patientsingroupAweretreatedwithGP regimenforsimplechemotherapy,whilepatientsingroupB weretreatedwithlocalMWAcombinedwithGPregimen(gemcitabine combinedwithcisplatin).Allthepatientswerefollowed-upevery3monthsafterthesurgerytoassesstheefficacyandsafetyofthe correspondingtreatment.Thedeadlineofthefollow-upwasJune2017orwhenthetumorrestarteditsdevelopment.Results Thesuccessrateof theMWAofthe39lesionsinthe36patientsingroupBwas100%.TheKaplan-Meiersurvivalanalysisofthefollow-updataofthe twogroupsshowedthattheaverageprogressionfreesurvival(PFS)ofgroupA was(9.9 ± 0.8)monthsandthemedianPFSwas (8.0±0.5)months,whilethePFSofgroupB was (14.1±1.1)monthsandthe medianPFS was (15.0±1.5)months.The Log Rank testshowedthatχ2=8.780andP=0.03<0.05,whichreflectedthatthereweresignificantdifferencesinsurvivaltimebetweenthe twogroups.Theoverallsurvival(OS)ofgroupA was(20.5±1.1)months,andthemedianOSwas(21.0±1.3)months.TheOSof group B was (24.1±1.5)months,andthe median OS was (25.0±3.6)months.The Log Rank testshowedthat χ2=10.57and P=0.02<0.05, whichprovedthattheOSdifferencesbetweenthetwogroupshadstatisticalsignificance.ThemainadverseeffectsofMWA werepain,pleural effusion,pneumothorax,hemoptysis,infectionandsoon.There werenoseriouslife-threateningcomplicationsingroupB.Conclusion LocalMWAtreatmentforstageⅣnon-smallcelllungcancer withcontrolledsingleintracranialmetastasisisasafeandeffective method.Itisworthyofporularizing.
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Objective To discuss the feasibility of the establishment of a Y-shaped channel with windowing technique in treating the stent shunt obstruction occurring after transjugular intrahepatic portosystemic shunt (TIPS).Methods From February 2012 to December 2016,puncture windowing technique was employed in 7 patients to establish a Y-shaped channel in order to treat the stent shunt obstruction complicated by gastric varices bleeding or ascites due to recurrent portal hypertension.The preoperative Child-Pugh scores of liver function ranged from 5 to 10 points,with a mean of (6.85±1.56) points.The blood flow in both the portal vein and the shunt was determined before operation as well as at 5 days and 1,3,6months after operation;the post operative results were compared with preoperative ones.Results Y-shaped channel was successfully reconstructed in all 7 patients.The patients were followed up for a mean of 11months.Neither death nor hepatic encephalopathy occurred.Conclusion For the treatment of post-TIPS stent shunt obstruction,Y-shaped channel reconstruction within the occluded stent by using windowing technique is safe and effective,the operation is simple and easy.Therefore,this technique has certain clinical value.
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Objective To explore the techniques and strategies for the retrieval of the retractable inferior vena cava filter (IVCF).Methods Celect IVCF retrieval was not removed successfully with Gtünther Celect recovery device in 9 cases and exchange-wire-loop removal of inferior vena cava filter method were applicated.Results The longest implanted time of 9 patients was 142 days,the shortest implanted time was 37 days,and the average time was (88.67±33.85)days.Eight fil ters were successfully removed and one failed due to severe bending of inferior vena cava.Filter retrieval rate was 88.89％ (8/9).The average retrieval time was (69.89± 12.12)min (57-162 min).No perforation of the wall and contrast agent were found in all patients after the inferior vena cava angiography.Conclusion For the retrieval of the hook heavily atta ched to the IVCF,the retrieval technique of using the exchange wire into the loop method can effectively improve the retrieval rate and has a certain clinical value.
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Objective To evaluate diagnostic value and analyze the complications of the lung nodules by 64 slice CT guided percutaneous thoracic biopsy(PTB)with coaxial technique.Methods The clinical data of 63 patients with lung placeholder in coaxial line casing biopsy under CT guidance were retrospectively analyzed.After CT positioning,16G coaxial trocar rapidly passed through the pleura,the tip to the edge of the tumor or pathological lesions,pulled out the needle core,the coaxial sleeve in 18G semi automatic biopsy needle,the materials were multi-angle cuted and sent to the pathology examination,the positive rate and the incidence of complications were analyzed.Results In 63 cases of lesions under CT guidance,the success rate of drawing materials was 100.0%,the pathological diagnosis rate was 88.9%.Intraoperative and postoperative complications occurred in 18 cases,the incidence rate was 28.6%,among them 9 cases of pneumothorax(14.3%),pulmonary hemorrhage in 8 cases(12.7%),hemoptysis in 1 case(1.6%),no severe adverse reaction was observed.Conclusion Multi slice CT guided percutaneous coaxial biopsy has the advantages of simple operation,high diagnosis rate,less complications,low risk,it can be promoted in hospitals.
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Objective To analyse the CT appearance of ependymomas and to improve the accuracy of diagnosis. Methods To review the CT appearance of 15 cases of ependymoma that confirmed by surgery and pathology. Results 12 cases were superior, 8 cases were brain parenchyma among of them; 3 cases were subtentorial, among them the fourth ventricle 2 cases. The age of 6 cases vary from 20 to 35 years. Ependymomas superior to the tentorium in the brain parenchyma were the most common, and in malignant parts there were cystoid changes and edema around the tumor. In the other parts were largely solid neoplasm. On unenhanced CT, the solid parts were indense and caicificable and were easy to dicern on enhanced CT . Conclusion The CT appearances of ependymoma were specific, we can dram an accurate conclusion according where the tumor taking place, the age etc.
