ObjectiveTo introduce the technique of threedimensional portal venography of multidetector row spiral CT and its clinical application in the evaluation of the portosystemic collateral shunts of liver cirrhosis. MethodsAll relevant literatures were retrospectively reviewed on the application of twodimensional and threedimensional reconstruction techniques such as MIP, SSD, VRT of multidetector row spiral CT to demonstrate the collateral vessels of liver cirrhosis.ResultsThe distribution, pathway and anatomy of portosystemic collateral vessels were well shown by multidetector row spiral CT portal venography. Conclusion Multidetector row spiral CT portal venography provides excellent depiction of the anatomic characteristics of the collateral shunts and enables the continuous tracing of vascular structures, thus it is very helpful in the imaging evaluation of the collateral vessels of liver cirrhosis.
ObjectiveTo introduce the new nomenclature scheme of the International Working Group (1995) on hepatic nodules, and summarize the imaging features of various hepatic nodules in light of their pathological characteristics, and evaluate the diagnostic values of various imaging facilities.MethodsUltrasound, computed tomography(CT), magnetic resonance imaging(MRI), and angiographic CT were reviewed and introduced.ResultsMany of these types of hepatic nodules play a role in the de novo and stepwise carcinogenesis of hepatocellular carcinoma(HCC) in the following steps: regenerative nodule, lowgrade dysplastic nodule, highgrade dysplastic nodule, small HCC, and large HCC. Accompanying such transformations, there are significant alterations in the blood supply and perfusion of these hepatic nodules.ConclusionModern stateoftheart medical imaging facilities can not only delineate and depict these hepatic nodules, but also provide important clues for the characterization of focal hepatic lesions in most cases, thus facilitating the early detection, diagnosis and management of HCC in its early stage.
Objective To review the current status of magnetic resonance imaging (MRI) techniques in the evaluation of hepatic fibrosis. Methods The application and recent advances of various kinds of MRI techniques in evaluating hepatic fibrosis were summarized by literature review. Results The state-of-the-art of MRI evaluating of hepatic fibrosis included common contrast-enhanced MRI, double contrast-enhanced MRI, and various functional MRI techniques. Common contrast-enhanced MRI could detect morphological changes of the liver, but little value in phasing. Double contrast-enhanced MRI markedly increased the contrast to noise ratio. Except diagnosis liver fibrosis, functional MRI also could phase it by its serverity. Conclusion MRI techniques, especially those functional MRI techniques, are advancing very fast and have very great potentiality in both the diagnosis and severity assessment of hepatic fibrosis.
Objective To evaluate the sensitivity， specificity, and accuracy of magnetic resonance imaging （MRI） in characterizing adnexal masses. Methods The databases such as the Cochrane Library, PubMed， EMbase， CNKI， and WanFang Data were searched on computer from 1991 to 2011. The reviewers screened the trials according to inclusion and exclusion criteria strictly, extracted the data， and assessed the methodology quality. Meta-analysis were performed using the Metadisc 1.40 software. The acquired pooled sensitivity, specificity， and summary receiver operating characteristic curve （SROC） were used to describe the diagnostic value. The pooled likelihood ratios were calculated based on the pooled sensitivity and specificity. Results Ten case-control studies involving 649 women who were suspected to have pelvic masses were included and 729 masses were confirmed by the postoperative histopathology. The pooled statistical results of meta-analysis showed that：the sensitivity and specificity of MRI were 〔89%（84%-92%）， P=0.046 6〕 and 〔87% （83%-90%）， P=0.000 2〕 respectively, the positive and negative likelihood ratios of MRI were 6.25（P=0.008 5） and 0.14（P=0.029 1） respectively, and the area under the SROC curve （AUC） was 0.941. The sensitivity and specificity of ultrasound were 〔87%（82%-91%）， P=0.000 0〕 and 〔73%（69%-77%）, P=0.000 0〕 respectively, the positive and negative likelihood ratios of MRI were 3.07（P=0.000 0） and 0.18（P=0.000 1） respectively， and the AUC was 0.897. The speci?city and accuracy of MRI in characterizing female pelvic masses were higher than ultrasound obviously. Conclusion According these evidences， the MRI should be recommended to the women who are suspected to have pelvic masses as a preferred.
Objective To introduce the current value of multi-detector row CT (MDCT) and magnetic resonance imaging (MRI) techniques on evaluation of diffuse hepatic parenchymal diseases.Methods By literature review, the application and recent advances of various kinds of MDCT and MR imaging techniques in evaluating diffuse hepatic parenchymal diseases were summarized. Results There were three kinds of diffuse liver parenchyma diseases, which were the diseases of storage, vascular and inflammatory. The morphology changes of diffuse liver parenchyma diseases could be demonstrated well by MDCT. MRI, especially MR functional imaging could reflect the morphology changes, and cellular metabolic activity of the liver, which provided qualitative and quantitative information for the diagnosis and evaluation of therapeutic effect on diffuse liver parenchyma diseases. Conclusion MR imaging techniques, especially those functional techniques, developed rapidly and had practical value in both the diagnosis and severity assessment of hepatic fibrosis.
Objective To evaluate the imaging features of pancreatic neuroendocrine carcinoma （PNEC）. Methods The imaging data of 7 patients with PNECs proved by surgery and pathology in West China Hospital of Sichuan University from Jul. 2007 to Dec. 2012 were retrospectively analyzed. The boundary， density， and strengthening features of tumor were observed. Results Seven tumors were found in all patients with 2 in pancreatic head， body， and tail， respectively. There was 1 tumor in pancreatic body and tail too. Five tumors were with unclear boundary. Five tumors had hypodense enhancement and 2 had isodense enhancement. Two cases had distal pancreatic duct dilation. None of them had liver metastases or lymph node involvement. Conclusion PNEC has certain characteristics on imaging. It is difficult to distinguish diagnosis from pancreatic cancer.
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 reveal the significance of D2-40/CK19 dual immunohistochemistry for micrometastasis of peripancreatic neural plexus in patients with pancreatic cancer. Methods Between January 2006 and January 2007, 44 patients with pancreatic duct adenocarcinoma underwent extended radical resection. Conventional hematoxylin/eosin staining and double immunohistochemical staining using CK19 and D2-40 were used to determine peripancreatic neural invasion and lymphatic vessel invasion (LVI) in peripancreatic neural plexus tissues. Results D2-40 immunohistochemistry showed brown-yellow tube-like lymph vessels. The lymph vessel of peripancreatic nerve plexus followed vascular and perineurium, and the lymph vessel adjacent to peripheral nerve fascicles owned tube-like structure. CK19 immunohistochemistry showed cytoplasm of pancreatic cancer cell was red. The LVI was observed in lymphatic capillaries. Peripancreatic neural plexus invasion was found in 30 cases (68.2%), tumor cell invading presented in lymph vessels of peripancreatic neural plexus in 21 patients (47.7%) with pancreatic cancer. The peripancreatic neural plexus invasion was associated with LVI (P=0.003). The plexus of pancreatic capitalis and celiac plexus were respectively confirmed to be the spot with the highest lymphatic vessel density and the maximal incidence of neural plexus invasion simultaneously. Conclusions Patients with pancreatic cancer should be given the opportunity of radical operation combining related peripancreatic neural plexus as far as possible. The dual immunohistochemical staining with anti-CK19 and anti-D2-40 monoclonal antibodies should be a new method in research of perineural invasion of pancreatic cancer, exhibiting both the pancreatic cancer cells and lymph vessels clearly and distinctly.