ObjectiveTo investigate the CT and MR imaging features and distribution characteristics of lymphatic nodal involvement in patients with gallbladder carcinoma. MethodsThirtyseven histopathologically proven cases of gallbladder carcinoma with regional lymphatic nodal enlargement in upper abdomen were included into the study. The lymph nodal short diameter of equal to or larger than 10 mm was used as the criteria for positive lymphadenopathy. Thirtyone cases underwent contrastenhanced spiral CT scanning, 6 cases had MR imaging studies. CT and MR images were jointly evaluated by three radiologists with especial attention to the size and location of enlarged lymph nodes in upper abdomen.ResultsThe enlarged lymph nodes were observed in four anatomic locations in the upper abdominal region. ①The retroportal and retropancreatic group in which lymph nodes were located along the cystic duct and common bile duct, in the portocaval space and behind the pancreatic head. ②The celiac group in which enlarged nodes distributed along the common hepatic artery and surrounded the celiac trunk. ③The mesenteric group in which lymph nodes assembled at the mesenteric root and around the superior mesenteric vessels. ④The abdominal aorta group in which lymph nodes scattered at the left side of abdominal aorta and in the aortocaval space at the level of the left renal vein. The spiral CT visualization rates for the above 4 groups of lymphadenopathy were 89.1%(33/37), 78.3%(29/37), 29.8%(11/37) and 51.3%(19/37) respectively.ConclusionCT and MR can clearly depict the four location sites of lymphadenopathy in patients with gallbladder carcinoma, which closely reflects the three major lymphatic spreading pathways of gallbladder carcinoma, namely, the cholecystoretropancreatic, cholecystoceliac and cholecystomesenteric routes.
【Abstract】Objective To investigate the features of gallbladder carcinoma in two-phase spiral CT, and to analysis the values of two-phase spiral CT for the differential diagnosis between gallbladder carcinoma and chronic cholecystitis. Methods The two-phase spiral CT manifestations of 30 cases of gallbladder carcinoma, proved by surgery and pathology, and 30 cases of chronic cholecystitis were analyzed. Results According to the CT findings, the gallbladder carcinoma was categorized into 3 types: intraluminal mass of gallbladder in 6 out of 30 (20.0%）， thickening of the gallbladder wall in 11 (33.7%), and mass replacing the normal gallbladder in 13(43.4%). The most common enhancement patterns of the wall in gallbladder carcinoma were hyperattenuation during the arterial phase, while isoattenuation with the adjacent hepatic parenchyma during the venous phase; or hyperattenuation during both phases. The most common enhancement pattern of the wall in chronic cholecystitis was isoattenuation during both phases, with clear hypoattenuation linear shadow in the gallbladder fossa. Other ancillary features of gallbladder carcinomas included: infiltration of the adjacent parenchyma, local lymphadenopathy and intrahepatic metastasis. Conclusion Two-phase spiral CT scan can identify the features of the gallbladder carcinoma and is helpful for the differential diagnosis of these two different disease entities.
【摘要】 目的 评价螺旋CT对原发性膀胱移行细胞癌（TCC）分期的准确性。 方法 对2000年9月-2009年9月诊治的73例原发性TCC患者，手术前行螺旋CT临床分期与手术后病理分期进行比较。 结果 TCC患者手术前螺旋CT临床分期与手术后病理分期相符率为90.5%。7例分期不符的患者中，4例螺旋CT分期低于病理分期，3例高于病理分期。 结论 螺旋CT对TCC的手术前临床分期较准确；螺旋CT分期误差产生的主要原因是不能确定肿大的淋巴结是否是癌转移。【Abstract】 Objective To investigate the value of contrast helical CT in Neopl-asm staging in patients with transitional cell carcinoma (TCC) of bladder. Methods Total 73 patients with TCC of bladder treated from september 2000 to September 2009 was analysed to compare preoperative helical CT examination with postoperative pathological diagnosis. Results The coincident staging of helical CT and pathological finding of TCC of bladder was found to be 90.5%. In the remaining seven patients, four patients were of overstaging and three patients were of understaging respectively. Conclusion The early enhancing phase of helical CT is helpful in the evaluation of the staging in patients with TCC of bladder.The cause of incorrecting staging by preoperative CT was usualy due to the difficulty in determing if lymph nodemetastasis occurs.
【摘要】 目的 评价多排螺旋CT（MDCT）在腹股沟区疝诊断中的价值。 方法 回顾性分析2009年6-12月96例经临床证实为腹股沟区疝患者的CT图像资料。通过多平面重建技术获得冠状位及矢状位图像，评价不同平面图像在腹股沟区疝诊断及分类中的应用价值。 结果 63例斜疝患者（66疝）疝囊于腹壁下动脉外侧经腹股沟深环进入腹股沟管，疝囊位于精索或圆韧带前侧（43/66，65.2%）或前内侧（15/66，22.7%）；30例直疝患者（37疝）疝囊位于腹壁下动脉内侧，位于精索内侧（27/37，73.0%）；斜疝及直疝疝囊均走行于腹股沟韧带前上方；3例股疝患者（3疝）疝囊位于腹股沟韧带后下方，冠状位“影像学股三角”内。 结论 MDCT对腹股沟区疝的诊断与鉴别诊断具有重要价值，可为手术前评估及手术中操作提供重要参考信息。【Abstract】 Objective To assess the value of multi-detector row CT (MDCT) in diagnosis of the inguinal region hernia. Methods The CT images of 96 patients with inguinal region hernia from June to December 2009 were retrospectively analyzed. The diagnosis and application of coronal and sagittal views in inguinal region hernia were assessed by multi-planer reconstruction. Results Hernia sac in 63 indirect hernia patients (66 hernias) originated lateral to the inferior epigastric artery enter the inguinal canal through the deep ring, anterior (43/63,68.3%) or anteromedial (15/63,23.8%) to the spermatic cord or round ligament;sac in 30 direct hernia patients (37 hernias) originated medial to the inferior epigastric artery, medial to the spermatic cord;both indirect and direct hernia sac located anterosuperior to the inguinal ligament;sac in three femoral hernia patients (three hernias) located posterior to the inguinal ligament and inside the “radiological femoral triangle” of coronal views. Conclusion MDCT plays on important role in diagnosing the inguinal region hernia, and provides critical information for preoperative and intraoperative.
ObjectiveTo investigate the value of postoperative CT examination for evaluation of local complications in patients with low rectal carcinoma after total mesorectal excision with anal sphincter preservation. MethodsThe patients with low rectal carcinoma who received total mesorectal excision (TME) with anal sphincter preservation were examined using contrastenhanced CT in one year period from May 2009 to May 2010. Particular attention was paid to the presence of anastomotic leakage, local recurrence and status of lymph nodes. ResultsTotal of 82 patients (52 men, 30 women； mean age 57.8 years old； range 25.74 years old) were included in the study. Over a mean 10-month follow-up， 8 cases （9.8%） had clinically or surgically confirmed anastomotic leak, 6 cases （7.3%） had local recurrence around the anastomotic site， and 4 cases （4.9%） showed pelvic and distant metastatic lymphadenopathy. ConclusionPostoperative CT examination, including baseline and follow-up CT studies, is very useful for diagnosing anastomotic leakage, local tumor recurrence and lymphadenopathy.
Objective To investigate the application of multi-detector row spiral CT （MDCT） and multi-planer reconstruction （MPR） in identify the anatomy detail of normal adult groin region. Methods We retrospectively collected the CT images of 50 adult subjects with normal groin anatomic structure underwent groin region thin-slice MDCT scans between July and December 2009, 30 males and 20 females, obtained the coronal and sagittal views by MPR, investigated the value of different plans in identifying anatomic detail. Results Bilateral inferior epigastric artery (100/100, 100%), spermatic cord (60/60, 100%), and round ligament of uterus (40/40, 100%) were well identified on all plans in all subjects. The bilateral “radiological femoral triangle” could be demonstrated on coronal views in all subjects (100/100, 100%). The bilateral inguinal ligament were visible on coronal view in all subjects (100/100, 100%) and on sagittal views in 34 subjects (68/100, 68%), but on axial views was identified in 3 male subjects (6/100, 6%). The bilateral inguinal canal and deep inguinal ring were reliably visible on coronal views in all subjects (100/100, 100%), and on sagittal views in 46 subjects (92/100, 92%). On coronal views, the widths of inguinal canal was (0.97±0.35) cm in left, (0.89±0.23) cm in right for males, and (0.62±0.11) cm in left, (0.71±0.11) cm in right for females. No significant difference was found between two sides (P=0.059 in males， P=0.067 in females), but there were significant differences between males and females (P=0.007 in left， P=0.009 in right). Transverse diameter of deep inguinal ring was (1.32±0.31) cm in left, (1.31±0.36) cm in right for males, and (1.07±0.35) cm in left, (1.07±0.30) cm in right for females. No significant difference was found between two sides (P=0.344 in males， P=0.638 in females), but there were significant differences between males and females (P=0.001 in left， P=0.002 in right). Conclusion MDCT with different plans plays an important role in identify the anatomic details of groin region, the coronal views especially.
Objective To investigate the CT imaging features of hepatic angiomyolipoma and its clinical characteristics. Methods The clinical, radiological, and pathological data of 3 hepatic angiomyolipoma (HAML) patients were retrospectively collected, and the imaging and diagnostic features were analyzed.Results All 3 cases were females, 2 complained of abdominal pain and one was absent of symptom. Both the laboratory examinations were normal in 2 cases, and hepatitis B virus markers were positive in one case. For CT features, the mass located in the superior anterior segment of the right hepatic lobe, in the posterior inferior segment of the right hepatic lobe, and in the left medial lobe, respectively. There were components of fat and soft tissue attenuation in these masses, and in which the CT value of the fat component was from -80 HU to -20 HU (mean -50 HU). There were enhancement in different degree and enhanced vascular imaging could be seen within the lesions. During surgery, all 3 masses were outgrowed from the hepatic lobes. Immunostainning showed HMB45 (+), αSMA (+), S100 (+)，which were bly suggestive of HAML.Conclusion HAML is a rare benign tumor with characteristic CT appearance, and its definite diagnosis relies on the immunohistochemical staining of HMB-45.
Objective To investigate the value of the multi-detector row spiral CT (MDCT) and 3-dimensional reconstruction technique for adult intussusception. Methods Twenty-one patients with surgically and clinical following-up confirmed intussusception were retrospectively included into this study. Three patients had plain MDCT scan, 18 received contrast enhanced MDCT scan. The original images were reconstructed with multi-planar reconstruction (MPR) technique and all the images of 21 patients were divided into original image group and original image add MPR image group. Two abdominal radiologists analyzed the MDCT imaging and recorded respectively the accuracy rate and the confidence index of the doctor about following indexes: whether or not having intussusception, the location of intussusception, finding reason caused intussusception, whether or not having bowel wall ischemia and whether or not having bowel obstruction. The accuracy rate and the confidence index of the doctor were compared using a SPSS statistics software. Results The accuracy rates about above indexes between original image group and original image add MPR image group were 90.5% (19/21) vs. 100% (21/21), 81.0% (17/21) vs. 95.2% (20/21), 85.7% (18/21) vs. 90.5% (19/21), 90.9% (10/11) vs. 90.9% (10/11) and 100% (11/11) vs. 100% (11/11) respectively, and there was no significant difference between original image group and original image add MPR image group (Pgt;0.05). For following indexes: whether or not having intussusception, the location of intussusception, finding reason caused intussusception, the confidence index of the doctor between original image add MPR image group and original image group had significant difference (5.00 vs. 4.24, 4.76 vs. 4.29, 4.29 vs. 3.71), and the confidence index of the doctor of original image add MPR image group exceeded that of original image group (Plt;0.05). Conclusions MDCT plays a valuable role in diagnosis and location of intussusception, finding the reason caused intussusception and evaluation the hemodynamic impairment of being involved in bowel wall. Compared to simple axial image, axial image combine 3-dimensional reconstructed image can increase the diagnostic confidence of the doctor.
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 investigate the mult-slice spiral CT(MSCT)imaging manifestations of bowel wall thickening due to nontumorous causes,and to address the value of MSCT scanning in assessing nontumorous bowel wall thickening.MethodsThe MSCT findings of 284 patients with bowel wall thickening due to nontumorous causes confirmed by surgery,biopsy,or clinical follow-up were retrospectively analyzed.The location, range,symmetric or asymmetric,degree,attenuation,presence or absence of enhancement and associated perienteric abnormalities of thickened bowel wall were involved.ResultsAll nontumorous disease caused bowel wall thickening include liver cirrhosis(109 cases),acute pancreatitis(54 cases),bowel obstruction(36 cases),inflammatory bowel disease(14 cases),ischemic bowel disease(12 cases),radiation enterocolitis(13 cases),tuberculosis(12 cases),immune reaction(10 cases),infective enteritis(3 cases),acute appendicitis(3 cases),hypoproteinemia(5 cases),non-common disease(8 cases)and normal variants(5 cases).The attenuation pattern of the thickened bowel wall include high attenuation(1 case),iso-attenuation(144 cases),low attenuation(127 cases),fat deposition(5 cases)and pneumatosis(7 cases).The enhancement pattern of the thickened bowel wall included gentle enhancement(249 cases),notable enhancement(32 cases)and unenhancement(3 cases).Degree of bowel wall thickening included mild thinckening(279 cases)and marked thickening(5 cases).The range of bowel wall thickening was focal(8 cases),segmental(64 cases)and diffuse(212 cases).The associated perienteric abnormalities of thickened bowel wall included swelling of fat(218 cases),ascites(189 cases),lymphadenopathy(5 cases),peirenteirc abscess(2 cases),mesenteric vascular lesion(25 cases)and involvement of solid abdominal organs(169 cases). ConclusionMSCT has an invaluable role in the diagnostic evaluation of nontumorous bowel wall thickening.A wide variety of nontumorous diseases may manifest with bowel wall thickening at MSCT.Paying attention to the characteristics of thickening of bowel wall will benefit the diagnosis and differential diagnosis of various intestinal diseases.