ObjectiveTo evaluate the effectiveness of Cross-Union surgery for the treatment of pseudarthrosis of the tibia (PT) with neurofibromatosis type 1 (NF1). MethodsThe clinical data of 8 children of PT with NF1 who met the selection criteria between January 2018 and December 2023 was retrospectively analyzed. There were 5 boys and 3 girls, and the operative age ranged from 1.8 to 13.3 years with a median age of 3.5 years. According to Paley classification, there were 2 cases of type 2a, 2 cases of type 3, 2 cases of type 4a, and 2 cases of type 4c. There were 5 cases of first operation and 3 cases of re-fracture after previous operation. Six cases had leg length discrepancy before operation, and 2 of them had shortening over 2.0 cm. Except for 1 case of ankle fusion, the other 7 cases had ankle valgus. Preoperative coronal/sagittal angulation was recorded. Postoperative pseudarthrosis healing and refracture were observed. Leg length discrepancy and tibiotalar angle were measured and recorded before operation and at last follow-up. Inan imaging evaluation criteria was used to evaluate the imaging effect. ResultsAll patients were followed up 12-37 months (mean, 23.5 months). One pseudarthrosis failed to heal at 12 months after operation and healed at 3 months after reoperation, while the other pseudarthrosis healed with a healing rate of 87.5% and a healing time of 4-8 months (mean, 5.3 months). No refracture occurred during the follow-up. At last follow-up, there were 2 new cases with leg length discrepancy, which were 0.7 cm and 1.3 cm, respectively. In 2 cases with the leg length discrepancy more than 2.0 cm before operation, the improvement was from 4.1 cm and 12.6 cm to 2.1 cm and 9.0 cm, respectively. There was no significant difference in leg length discrepancy between pre- and post-operation in 8 cases (P>0.05). At last follow-up, 6 patients still had ankle valgus, and there was no significant difference in the tibiotalar angle between pre- and post-operation (P>0.05); the tibial coronal/sagittal angulation significantly improved when compared with that before operation (P<0.05). According to Inan imaging evaluation criteria, 1 case was good, 6 cases were fair, and 1 case was poor. Conclusion Cross-Union surgery is an effective method for the treatment of PT with NF1 in children, can achieve good bone healing results with a low risk of re-fracture. The surgery may not have significant effects on leg length discrepancy and ankle valgus, and further treatment may be required.
Objective To review the value of imaging assessment for perioperative period of liver transplantation. Methods The related literatures in recent years were reviewed, and the applications of various kinds of radiological techniques in perioperative period of liver transplantation and radiological strategies of major complications after liver transplantation were summarized. Results Transplantation has become an effective option for treatment of patients with irreversible severe liver dysfunction. Radiological assessment supplies prompt and accurate information for clinic to increase the success rate and reduce the complications. So it plays an irreplaceable role. Conclusions Radiology assessment is important for screening donors and recipients before liver transplantation， following up and monitoring the complications. The doctor of imaging department could grasp the different imaging appearance in perioperative period of liver transplantation.
Objective To analyze the imaging features of solitary pulmonary nodules ( SPNs) , and compare the two types of lung cancer prediction models in distinguishing malignancy of SPNs.Methods A retrospective study was performed on the patients admitted to Ruijin Hospital between 2002 and 2009 with newly discovered SPNs. The patients all received pathological diagnosis. The clinical and imaging characteristics were analyzed. Then the diagnostic accuracy of two lung cancer prediction models for distinguishing malignancy of SPNs was evaluated and compared.Results A total of 90 patients were enrolled, of which 32 cases were with benign SPNs, 58 cases were with malignant SPNs. The SPNs could be identified between benign and maligant by the SPN edge features of lobulation ( P lt;0. 05) . The area under ROC curve of VA model was 0. 712 ( 95% CI 0. 606 to 0. 821) . The area under ROC curve of Mayo Clinic model was 0. 753 ( 95% CI 0. 652 to 0. 843) , which was superior to VA model. Conclusions It is meaningful for the identification of benign and maligant SPNs by the obulation sign in CT scan. We can integrate the clinical features and the lung cancer predicting models to guide clinical work.
Objective To evaluate the value of 16slice spiral computed tomography (SCT) and its threedimensional reconstruction in diagnosis of aortic dissection (AD). Methods Fortyfive cases with AD underwent 16slice SCT, performed with unenhanced, contrastenhanced scanning and threedimensional reconstructions. Emphasis was placed on the true and false lumen, intimal flap, the entry and reentry tear and the involvement of branches of AD. Eleven cases were confimed by operation. Results True and false lumen and intimal flap of AD could be shown in all 45 cases (100%), the entry and reentry tears were revealed in 44 cases (97.8%) and 33 cases (73.3%), respectively. The right common iliac arteries were most easily involved by AD, 21 cases (46.7%). The thrombi in false lumen were shown in 29 cases (64.4%). Compared with surgery, the location and size of initial entry sites of 11 cases were consistent with the former. Conclusion 16slice SCT can exactly and completely diagnose AD, and provide detailed imaging information for clinical therapy. It’s very important for the selection of treatment methods and the observation of curative effect of patients.
目的 探讨脾占位性病变的临床诊断特点和治疗对策。方法 回顾性分析68例脾占位性病变患者的临床资料。结果 超声和CT是诊断脾占位性病变的主要方法。68例脾占位性病变中良性48例，恶性20例。手术治疗47例，其中脾切除37例，脾切除加胰尾切除2例，脾部分切除3例，脾切除加脾窝引流4例，单纯脾囊肿去顶减压1例。1例脾脓肿行脾切除术后发生肺部感染，经抗感染治疗后痊愈； 1例脾脓肿行脾切除术后，发生脾窝脓肿，感染严重，被迫再次开腹行脓肿引流术，其余良性病变经手术治疗后效果好； 恶性病变术后效果差。结论 脾占位性病变良性多见，恶性少见； 影像学检查是诊断脾占位性病变的主要手段。脾切除对成年人是一种有效的治疗方法，良性预后好，恶性预后差； 对儿童、青少年脾良性病变，脾部分切除是一种很好的选择。
Objective To review the value of imaging assessment of stem cell transplantation in treatment for liver cirrhosis.Methods The related literatures in recent years were collected,and the applications of different radiological techniques and strategies of stem cell transplantation in treatment for liver cirrhosis were summarized.Results Stem cell transplantation in treatment for liver cirrhosis was feasible and effective. Radiological assessment could supply the prompt and accurate information for clinic to choose the proper therapeutic method.The curative effect could also be accurately assessed by radiological techniques.Conclusion Radiological examination is important for the assessment of stem cell transplantation in treatment for liver cirrhosis.
ObjectiveTo analyze the pathological manifestations and imaging characteristics of bronchiolar adenoma (BA).MethodsThe clinical data of 11 patients with BA who received surgeries in our hospital from January 2019 to September 2020 were retrospectively analyzed, including 5 males and 6 females aged 40-73 (62.40±10.50) years. The intraoperative rapid freezing pathological diagnosis, postoperative pathological classification, cell growth pattern, nuclear proliferation index Ki-67 and other immunohistochemical staining combined with preoperative chest CT imaging characteristics were analyzed.ResultsThe average preoperative observation time was 381.10±278.28 d. The maximum diameter of imaging lesions was 5-27 (10.27±6.34) mm. Eight (72.7%) patients presented with irregular morphology of heterogeneous ground-glass lesions, and 3 (27.3%) patients presented with pure ground-glass lesions. There were 10 (90.9%) patients with vascular signs, 8 (72.7%) patients with vacuolar signs, 1 (9.1%) patient with bronchus sign, 3 (27.3%) patients with pleural traction and 9 (81.8%) patients with burr/lobular sign. The surgical methods included sub-lobectomy in 10 patients and lobectomy in 1 patient. Five (45.5%) patients were reported BA by intraoperative frozen pathology. The postoperative pathological classification included 8 patients with distal-type and 3 patients with proximal-type, and the maximum diameter of the lesions was 4-20 (8.18±5.06) mm. Eight (72.7%) patients showed characteristic bilayer cell structure under microscope, and 10 (90.9%) patients showed thyroid transcription factor 1 expression in pathological tissues. The expression of NapsinA in intracavity cells was found in 9 (81.8%) patients. The Ki-67 index of the lesion tissue was 1%-5% (3.22%±1.72%).ConclusionThe pathological features and imaging findings of BA confirm the premise that BA is a neoplastic lesion. However, to identify BA as a benign or inert tumor needs more clinical data and evidence of molecular pathological studies.
Objective To explore the clinical and imaging features of patients with acute dizziness and assess their associations with 3-month prognosis. Methods We enrolled adult patients with a chief complaint of acute dizziness, who were admitted to the Neurological Clinic at the Emergency Department of West China Hospital, Sichuan University between January 1st and May 31st 2022. We collected clinical and imaging features at baseline for each patient. The primary outcome was recurrent dizziness within 3 months after index dizziness. Secondary outcome was stroke within 3 months after index dizziness. Results A total of 1 322 patients who visited the Neurological Clinic were included, of which 617 (46.7%) had a chief complaint of acute dizziness. Among 222 patients who performed emergent brain and neck CT angiography, 1 patient presented with intracerebral haemorrhage. Among the remaining 221 patients, 206 patients completed 3-month follow-up, with 76 patients reported recurrent dizziness and 7 patients had stroke (6 ischaemic, 1 hemorrhagic). The multivariate logistic regression showed that chronic dizziness duration and parenchymal hypodensity on brain CT were each associated with a higher risk of recurrent dizziness. Compared with those who did not report stroke, the stroke patients were more likely to present with hypertension, headache symptoms, and exhibit parenchymal hypodensity on baseline CT (P<0.05). Conclusions In patients with acute dizziness, those with chronic dizziness duration and parenchymal hypodensity on baseline CT were associated with a higher risk of 3-month recurrent dizziness. Acute dizziness patients experiencing 3-month stroke often have hypertension, headache symptoms, and parenchymal hypodensity on baseline CT.
Objective To discuss the imaging characteristics and clinical treatment methods of congenital biliary dilation. Methods Clinical data of 70 cases of congenital biliary dilation who treated in The Third Affiliated Hospital of Henan University of TCM and Henan Provincial People’s Hospital from Jan. 2010 to Jan. 2015 was collected and analyzed. Methods Along the bile duct region (all cases received ultrasound), the ultrasound of 57 cases (81.4%) showed irregular spherical, spindle, or prismatic area without echo connected to the proximal part of the bile duct, the intracavity wall of it was skin pass rolling, and part of it had the spotty detailed or slightly strong stones sound shadow, 1 case combined spindle or capsular area without echo connected to the intrahepatic bile duct partly and along with it. CT of 45 cases (64.3%, 43 cases were diagnosed as congenital biliary dilation) without and with enhancement scanning showed low-density and irregular oblate, cystiform, columniform or fusiform expansion shadow, slight mass effect, no difference before and after the enhancement of partial intrahepatic bile duct and choledoch, and that the structure of surrounding tissues were compressed, lapsed, and deformed. The MRI and magnetic resonance cholangiopancreatography (MRCP) inspection of 65 cases (92.8%, all of 65 cases were diagnosed as congenital biliary dilation) showed tadpole-shaped, irregular cystiform, columniform or fusiform expansion with long T2 and high MRCP signal shadow image of partial intrahepatic bile duct and choledoch, the dilated bile duct also being connected to biliary tree. Of the 70 cases, there were 66 cases (94.3%) of type Ⅰ, 1 case (1.4%) of type Ⅱ, 1 case (1.4%) of type Ⅳa, 2 cases (2.9%) of type Ⅳb. Sixty eight cases (65 cases of type Ⅰ, 1 case of type Ⅱ, 2 cases of type Ⅳb) underwent cholecystectomy+dilated bile ducts resection+common hepatic duct jejunum anastomosis (Roux-en-Y), 1 case underwent cholecystectomy+dilated bile ducts resection+pancreatic duodenal resection, another 1 case underwent cholecystectomy+dilated bile ducts resection+common hepatic duct jejunum anastomosis (Roux-en-Y)+resection of left hepatic lobe. All the cases were successfully recovered without severe complications and had no dead case, but 13 cases (18.6%) suffered from minor complications, including 6 cases of short-term abdominal pain and abdominal distension, 1 case of bile leak, 2 cases of incision infection, 3 cases of pulmonary infection, and 1 case of alteration of intestinal flora. All of the 70 cases were followed-up for 6-56 months (average of 36 months). During the follow up period, 2 cases died in reason of other incidence, 4 cases suffered from simple cholangitis, 3 cases suffered from cholangitis combined with intrahepatic bile duct stone, 2 cases suffered from cholangitis combined with intrahepatic bile duct stone, slight anastomotic stoma stenosis, and mild jaundice, 2 cases suffered from cholangitis. Conclusion Congenital biliary dilation has no typical clinical feature, but it has identifiable imaging manifestation, which can provide a theoretical foundation for congenital biliary dilation in diagnosing, preoperative evaluation, and chosing operative methods. Ultrasound is the first choice, MRI and MRCP are propitious to diagnose, locate, and classfy. The treatment of congenital biliary dilation is resecting the dilated bile ducts fully and performing the common hepatic duct jejunum anastomosis.
Objective To review study of various imaging examination methods for evaluating of gastric cancer. Method The recent and relevant literatures about the imaging examination methods for evaluating of gastric cancer were scrutinized and analyzed retrospectively. Results The imaging examination methods such as the barium meal, endoscopic ultrasonography, computed tomography (CT), magnetic resonance imaging, positron emission tomography-CT, were used to evaluate the gastric cancer, but with certain limitations. The new methods such as the dual-energy CT, radiomics, and so on, had become the focus of the clinical research. The imaging methods are of great significances in the evaluation of the gastric cancer before the surgery, peritoneal metastasis, chemoradiotherapy and neoadjuvant chemotherapy later. Conclusions Various imaging examination methods, used in evaluating of gastric cancer, play some important roles in clinical application. New methods such as dual-energy CT, radiomics, and so on, are with bright potentiality for clinical application.