摘要:目的: 探讨64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(serum amyloid A protein, SAA)联合术前评估直肠癌在肿瘤分期诊断中的作用。 方法 :纳入经根治术治疗的直肠癌患者通过MSCT扫描进行评估,同时取患者静脉血测量术前SAA水平,行MSCT分期与MSCT和SAA联合分期以比较二者的诊断价值。 结果 :本研究纳入患者121例。MSCT检测T分期的准确度为851%。在评估淋巴结转移方面,MSCT和SAA联合分期的准确度为760%,明显高于MSCT分期(595%, 〖WTBX〗P lt;0001)。MSCT正确判断所有远处转移。同单一的MSCT检测相比,MSCT和SAA联合评估能显著的提高术前TNM分期的准确率(785% vs. 636%,〖WTBX〗P =0011)。 结论 :MSCT联合SAA检测比单一的MSCT检测显著提高了直肠癌术前肿瘤分期和淋巴结转移方面的准确度。这种新的术前评估方法的为肿瘤进展评估和术前治疗决策提供了更加可靠的信息。Abstract: Objective: To determine the role of combinative assessment of 64 multislice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in preoperative rectal cancer staging. Methods : Enrolled consecutive rectal cancer patients undergoing curative surgery were evaluated by MSCT scan. Meanwhile venous blood specimens were taken to measure preoperative SAA concentration. Both MSCT staging and MSCT plus SAA staging were performed to compare with each other. Results : The study population consisted of 121 patients. The accuracy of T staging was 851% for MSCT. The accuracy in evaluating lymph nodes metastases was 760% for MSCT plus SAA compared with 595% for MSCT alone (〖WTBX〗P lt;0001). All the distant metastases were correctly detected by MSCT. The method combining MSCT with SAA led to significant improvement on preoperative TNM staging compared with MSCT alone (785% vs. 636%, 〖WTBX〗P =0011). Conclusion : MSCT plus SAA showed greater accuracy than MSCT alone in rectal cancer staging and lymph node metastases. This novel strategy of preoperative evaluation appears to provide more accurate information on tumor progression and preoperative therapy decisionmaking.
摘要:目的:研究胸腺瘤与前纵隔(血管前间隙)淋巴瘤的MSCT表现,提高对二者的诊断与鉴别诊断能力。方法:回顾性分析经手术病理证实的30例胸腺瘤与18例血管前间隙淋巴瘤MSCT表现,着重观察肿瘤的密度、形态及其与周围结构的关系。结果:30例胸腺瘤中,24例良性胸腺瘤与邻近大血管分界清晰,肿块表现 “D”字或反“D”字状,平扫CT值16~59 Hu,增强CT值20~110 Hu;6例侵袭性胸腺瘤边界不清,呈分叶状、不规则形,密度不均,平扫CT值23~42 Hu,增强CT值23~60 Hu。18例淋巴瘤中,单发于前上纵隔者6例,其余12例呈多结节、肿块状,侵入血管间隙生长,致大血管受压,增强扫描呈轻度强化,常伴有其它部位淋巴结增大。结论:MSCT能清晰显示胸腺瘤与前纵隔淋巴瘤的影像学表现特征,并能有效提高对二者的鉴别诊断。Abstract: Objective: To diagnosis and differentiate thymoma and malignant lymphoma in the anterior mediastinum on the basis of multislice CT (MSCT) imaging features. Methods:We retrospectively reviewed 30 cases with thymoma and 18 cases with malignant lymphoma proven by surgery and pathology.More attention was put on the density, morphology and relation with the surrounding structures of the tumors. Results: The CT manifestations of 30 cases of thymoma were shown as: For 24 cases of benign thymoma, the boundaries were clear, the shapes were “D” signs or contra“D” signs, CT attenuation value were 1659Hu and 20110Hu on unenhanced and contrastenhanced scanning. For 6 cases of malignant thymoma, the boundaries were unclear, the shapes were lobulated or irregular, the density was heterogeneous, CT attenuation value were 2342Hu and 2360Hu on unenhanced and contrastenhanced scanning. For 18 cases of malignant lymphoma, 6 cases were located at anterior mediastinum, 12 cases were nodes or multiple mass, enveloped the neighboring vessel structures, mildly enhanced on contrastenhanced scanning, and associated with enlargement of lymph nodes in other place. Conclusion: MSCT can display the imaging features of thymoma and anterior mediastinal lymphoma, and effectively differentiate thymoma and mediastinal lymphoma.
Objective To evaluate the application value of spiral CT virtual endoscopy and three dimensional imaging in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis. Methods Thirty-three cases of benign tracheobronchial stenosis from June 2004 to November 2008 were checked by spiral CT with airway tracheobronchial reconstruction. For the patients with indications, balloon dilatation was performed under fiberoptic bronchoscope. The three-dimensional reconstruction images were compared with the findings under bronchoscopy. And the preoperative and postoperative three-dimensional reconstruction images were compared for airway diameter. Results Three cases were found stenosis of middle lobe by CT virtual endoscopy and did not undergo balloon dilatation. The remaining 30 cases were confirmed by bronchoscopy findings similar to the images by tracheobronchial reconstruction with CT, with consistent rate of 100% . Immediate postoperative three-dimensional CTreconstruction of tracheal bronchus revealed that diameter of stenotic bronchus increased from ( 2. 7 ±1. 3) mm to ( 6. 9 ±1. 6) mmafter operation. Conclusion Multislice spiral CT virtual endoscopy is helpful in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis and postoperative follow-up.
ObjectiveTo investigate the vaules of multi-slice spiral CT (MSCT) in diagnosing metastatic lymph nodes and judging N stage of resectable gastric cancer. MethodsFifty-nine patients with gastric cancer performed preoperative MSCT plain scan and triple enhanced scans from February 2019 to March 2021 in the First People’s Hospital of Wuhu City were collected. The results of postoperative pathology were taken as the gold standard, the short diameter, long diameter, short to long diameter ratio, CT values of triple enhanced scans and lymphatic hilar blur were compared between the metastatic lymph nodes and the non-metastatic lymph nodes. ResultsThe preoperative MSCT showed that there were 50 cases of metastatic lymph nodes and 9 cases of non-metastatic lymph nodes in 59 patients with gastric cancer. A total of 1 467 lymph nodes were harvested, including 562 metastatic lymph nodes and 905 non-metastatic lymph nodes. The short diameter, long diameter, short to long diameter ratio, and the CT values of plain scan, arterial phase, portal vein phase, and delayed phase of metastatic lymph nodes were higher than those of non-metastatic lymph nodes (P<0.05), and the incidence of lymphatic hilar blur was also higher than that of non-metastatic lymph nodes (P<0.05). Referring to the results of postoperative pathological examination, the accuracies of MSCT in judging of N0, N1, N2, N3a, and N3b stages were 88.9% (8/9), 83.3% (5/6), 85.7% (12/14), 92.3% (12/13), 88.2% (15/17), respectively, and the total accuracy was 88.1% (52/59), the specificity was 96.6% (57/59), and the sensitivity was 91.2% (52/57). ConclusionAccording to this study results, preoperative MSCT has higher specificity, sensitivity, and accuracy in diagnosing metastatic lymph nodes and judging N stage of resectable gastric cancer.
Objective To explore the value of multi-slice spiral CT (MSCT) 3D imaging in evaluating the efficacy of neoadjuvant chemotherapy for advanced gastric cancer. MethodsSixty-one patients with gastric cancer diagnosed by gastroscopy and pathological examination at the First Hospital of Lanzhou University from January 2019 to March 2022 were divided into chemotherapy effective group (n=39) and ineffective group (n=22) according to postoperative pathological regression grade (tumor regression grade, TRG) standards. MSCT was performed before neoadjuvant chemotherapy and before undergoing surgical treatment after neoadjuvant chemotherapy. The independent predictors related to the efficacy of chemotherapy were screened by binary logistics regression analysis of CT conventional observation indexes (including maximum tumor thickness, gastric wall motility, enhancement mode, lymph node metastasis, distant metastasis, peritoneal thickening or peritoneal nodules). Tumor volume and maximum tumor thickness were measured with the imaging histology software ITK-snap, and the diagnostic efficacy of tumor volume and CT conventional observation indexes was analyzed. Results In the evaluation of chemotherapy efficacy, tumor volume reduction rate and tumor maximum thickness reduction rate can evaluate the efficacy of chemotherapy to a certain extent (P< 0.01). The statistically significant indicators (tumor maximum thickness reduction rate, gastric wall motility, lesion intensification mode and peritoneal thickening and nodules) were analyzed by univariate analysis and binary logistic regression. The results showed that gastric wall motility [OR=0.294, 95%CI (0.093, 0.928), P=0.037] and maximum tumor thickness reduction rate [OR=0.282, 95%CI (0.083, 0.957), P=0.042] were independent predictors of the efficacy of neoadjuvant chemotherapy for progressive gastric cancer. Receiver operating characteristic (ROC) curve were plotted based on the predicted probability variable obtained from both and the results showed that the area under curve (AUC=0.900) , sensitivity (83.3%), and specificity (99.8%) of the tumor volume reduction rate were all higher than those of CT clinical index prediction probability variables (AUC=0.802, sensitivity was 58.3%, specificity was 85.7%). ConclusionThe measurement of tumor volume by MSCT combined with the imaging omics software ITK-snap provides an objective basis for the prediction of the efficacy of neoadjuvant chemotherapy, and its diagnostic efficacy is better.
【摘要】 目的 探讨正常成人肺静脉开口径线（pulmonary vein ostia，PVO）的测量方法，并获得我院PVO径线值的95%参考值范围。 方法 2005年6月-2006年1月收集无明显心肺疾病的正常成人236例，对其进行多层螺旋CT扫描，利用斜冠面重建和三维标定的方法测量PVO径线。 结果 四条PVO径线的95%参考值范围如下：右上肺静脉长径线为男性1.49~2.63 cm，女性1.31~2.37 cm，短径线为男性0.87~2.05 cm，女性0.91~1.81 cm；右下肺静脉长径线为男性1.12~2.06 cm，女性1.05~1.95 cm，短径线为男性0.77~1.83 cm，女性0.79~1.69 cm；左上肺静脉长径线为男性1.18~2.20 cm，女性1.09~2.11 cm，短径线为男性0.82~1.72 cm，女性为0.80~1.62 cm；左下肺静脉长径线为男性0.96~1.98 cm，女性1.03~1.81 cm，短径线为男性0.56~1.26 cm，女性0.51~1.33 cm。除左下肺静脉短径男女差异无统计学意义外，其余径线值男性均大于女性。 结论 采用CT三维重建像改进测量方法测量PVO径线值既简便又准确。【Abstract】 Objective To measure and calculate the diameters of pulmonary vein ostia (PVO) by multi-slice spiral computed tomography (MSCT) in healthy people. Methods From June 2005 to January 2006, 236 healthy people were adopted to undergo MSCT. Their diameters of PVO were measured and calculated by oblique coronal planes reconstruction and 3D position-setting. Results Right superior vein: the 95% reference ranges of the long diameters were 1.49-2.63 cm in the male and 1.31-2.37 cm in the female;the ranges of the short diameters were 0.87-2.05 cm in the male and 0.91-1.81 cm in the female. Right inferior vein: the ranges of the long diameters were 1.12-2.06 cm in the male and 1.05-1.95 cm in the female;the ranges of the short diameters were 0.77-1.83 cm in the male and 0.79-1.69 cm in the female. Left superior vein: the ranges of the long diameters were 1.18-2.20 cm in the male and 1.09-2.11 cm in the female;the ranges of the short diameters were 0.82-1.72 cm in the male and 0.80-1.62 cm in the female. Left inferior vein: the ranges of the long diameters were 0.96-1.98 cm in the male and 1.03-1.81 cm in the female;the ranges of the short diameters were 0.56-1.26 cm in the male and 0.51-1.33 cm in the female. The diameters in the male were all longer than those in the female, except the short diameter of left inferior vein. Conclusions It is a convenient and accurate method to measure the diameters of PVO by blique coronal planes reconstruction and 3D position-setting.
【Abstract】 Objective Using 16-slice multi-detector row helical CT (16-slice MDCT) to investigate the value of multiplanar reformation technique (MPR) in the diagnosis of bowel obstruction. Methods Thirty patients with surgically (27 cases) or clinically (3 cases) proofed diagnosis of bowel obstruction underwent 16-slice MDCT examination of the entire abdomen. All cases had plain CT scan, while 20 cases had additional contrast-enhanced CT scan at portal venous phase. In addition to the conventional axial images, the original CT raw data were then reconstructed into both coronal and sagittal images using MPR technique. Imaging findings were analyzed on axial, MPR coronal and sagittal images. Results Among the 30 patients with bowel obstruction, there were 8 cases caused by adhesion, 7 by simple intestinal tumor, 5 by intussusception (including caused by instestinal tumor), 4 by abdominal hernia, 2 by volvulus, 1 by ileocecal abscess, 1 by stenosis of mesenteric artery，1 by retroperitoneal cyst, and 1 by carcinoma in pancreatic tail. Six patients developed intestinal ischemia or strangulation. Both axial and MPR images correctly depicted the presence of bowel obstruction. Based on CT axial view （AV）, the site and the underlying etiology of bowel obstruction were determined in 26 (86.7%) and 22 (73.3%) patients respectively, while the combination with MPR coronal and sagittal images improved the diagnostic performance to 29 (96.7%) and 27 (90.0%) patients respectively. Both axial and MPR images correctly revealed the presence of intestinal ischemia or strangulation in 5 （83.3%）patients. Conclusion MPR technique of MDCT is very useful for evaluating the site and etiology of bowel obstruction, as well as the circulation status of involved bowel loop.
Objective To probe CT grading criteria of vascular invasion in pancreatic cancer. Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years. Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer. There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels, on the degree of circumferential contiguity of tumor to vessel, on the degree of lumen stenosis, and on the degree of contiguity between tumor and vessels combined vascular caliber. Conclusion CT grading criteria are not uniform, each one has defects.
Objective To compare the bronchial arteriography through multidetector-row CT (MDCT) with the digital subtraction angiography (DSA) via femoral artery, and evaluate the application value of bronchial arteriography through MDCT in the diagnosis and treatment of hemoptysis. Methods 133 cases complained of hemoptysis were examined by MDCT and DSA via femoral artery respectively to perform bronchial arteriography, and the differences of image results by two methods were compared. Results 129 cases with abnormal bronchial arteries were confirmed by DSA via femoral artery, 117 cases were checked by MDCT [ the positive rate was 90.7% (117/129 ) ] . 117 cases with abnormal bronchial arteries were confirmed by both MDCT and DSA via femoral artery and 4 cases did not detected any abnormal arteries by both methods. The coincidence rate of two methods was 91.0% (121 /133) . MDCT and DSA via femoral artery showed the similar origins of abnormal bronchial arteries. The coincidence rate of two methods was 100% . Conclusions There is a high coincidence rate betweenMDCT and DSA in detecting bronchial artery abnormalities. MDCT shows the origins of abnormal vessels clearly which could be a fist-choice of routine imagination for interventive operation.