ObjectiveTo investigate the specific CT findings of high-risk gastrointestinal stromal tumors (GISTs). MethodsCT findings of 24 patients with high-risk GISTs from August 2009 to March 2014 proved by surgery and pathology were retrospectively reviewed. ResultsTwelve of the high-risk GISTs were from the stomach, 11 from the small intestine (5 from duodenum, 4 from jejunum, and 2 from ileum), and 1 from the rectum. The biggest transverse diameter of the tumor was between 2.5 and 15.0 cm, and 2 were less than 5 cm and 22 of them were over 5 cm. The tumors appeared as irregular in 20 cases, and with indefinite boundary in 21 cases. Twenty-four tumors showed different levels of necrosis and cystic change, 15 showed ulcer, 2 showed perforation with effusion and pneumatosis, and 3 showed calcification. The enhancement of lesion was mostly moderately to markedly inhomogeneous. High-risk small intestinal stromal tumors had more significant enhancement and vessels. Hepatic metastasis in 3 cases was detected. ConclusionCT features of HRGISTs can be found with certain characteristics, which may contribute to the diagnosis.
ObjectiveTo discuss the CT characteristics of pleural lung cancer, and analyze the reason for misdiagnosis. MethodsThe CT data of 8 patients with pleural lung cancer confirmed by postoperative pathology and treated in Renshou People's Hospital and Fist Affiliated Hospital of Chongqing Medical University between January 2010 and December 2013 were retrospectively analyzed. ResultsAmong the 8 cases of pleural lung cancer, 6 occurred on the left and 2 on the right; there were 3 nodular and 5 irregular masses; 6 had uniform density and 2 had irregular focus and relatively lower density; 4 had osteolytic destruction of adjacent ribs; 6 had pleural effusion; and 5 had mediastinal lymph nodes enlargement, in which 1 had multiple lymph node metastasis of left lung hilum, left supraclavicular region and left axillary. All the 8 cases were enhanced moderately. ConclusionPleural lung cancer has certain featured manifestations on CT. Analyzing the features carefully, considering clinical symptoms, and cytological examination of hydrothorax can reduce the incidence of misdiagnosis.
ObjectiveTo discuss the CT characteristics of combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC), and analyze the reasons for its misdiagnosis. MethodWe retrospectively analyzed the CT data of 7 patients diagnosed to have combined hepatocellular carcinoma and cholangiocarcinoma by postoperative pathological analysis between January 2009 and February 2015. We analyzed such characteristics as location, shape, density, enhanced features, surrounding invasion, mediastinal lymph node metastasis, cirrhosis and pyoperitoneum of the disease. ResultsThere were 7 tumors among the 7 patients. Plain scan showed slightly lower density nodules or masses. After the enhancement of arterial phase, 5 tumors showed obvious inhomogeneous enhancement but 2 mild marginal enhancement. During the portal venous phase and the delay stage, the regional degree of tumor foci was significantly decreased, but some regions sustained annular or nodular and patchy enhancement. Among the 7 cases, the portal vein was invaded in 2, bile duct in 1, lymph node metastasis in 2, cirrhosis in 1, and peritoneal effusion in 1. Preoperative diagnosis was correct in only 2 cases and the other 5 cases were misdiagnosed by CT. ConclusionsThe cHCC-CC possesses some characteristic appearances on CT. Analyzing the characteristics carefully combining with symptom and cytological examination of hydrothorax can reduce the incidence of misdiagnosis.
ObjectiveTo evaluate the CT features of coronary artery aneurysm by coronary artery imaging on 128 slice CT and dual source CT (CTCA). MethodsA total of 1 108 cases were prospectively examined using CTCA between March 2011 and April 2014. With volume rendering, maximum intensity projection, multiplanar reconstruction and surface reconstruction, we observed the coronary artery morphology and vascular wall condition. ResultsThree cases of coronary artery aneurysm were found. In case one, the anterior descending branch (LAD) had grape-like prominency segmentally; in case two, LAD and left coronary circumflex branch (LCX) and right coronary artery (RCA) had diffuse dilation with local shuttle expansion; in case three, left main, LAD and LCX and RCA had diffuse expansion. ConclusionCTCA is a noninvasive, simple and effective method for the diagnosis of coronary artery aneurysm, and it can be the first choice for the high risk population with coronary artery aneurysm.
ObjectiveTo assess the value of multi-slice spiral CT (MSCT) in the diagnosis and resectability judgement of hepatic alveolar echinococcosis (HAE). MethodsThe CT findings of 28 patients who were confirmed HAE by surgical pathological examination were retrospectively analyzed. Comparative analysis were made between the CT findings and surgical pathology. ResultsAltogether 45 lesions in hepatic were detected. Lesions mainly revealed an infiltrating tumor-like hepatic mass with irregular margins and heterogeneous contents with varied attenuation, including scattered hyper-attenuating calcifications and hypo-attenuating areas corresponding to necrosis, no substantial enhancement, however, the fibro-inflammatory component surrounding the parasitic tissue was enhanced faintly in the delayed phase, and clearly demarcated from surrounding parenchyma. MSCT angiography (CTA) depicted signs of infiltration of hepatic vessels such as pushed, compression, displacement, stenosis, encasement and interruption. Compared with findings of operation, the sensitivity and specificity value of MSCT for evaluating the hepatic artery system disorders were 67%, 97%; and for portal venous system were 83%, 93%; and for hepatic venous system were 84%, 91%; while for inferior vena cava were 85%, 100%. Twelve cases which were evaluated as resectable by MSCT were in accordance with surgical findings. In the rest 16 patients which were judged as non-resectable by MSCT, only 2 patients were radical treatment through partial excision, repair and reconstruction for the involvement of large vessels and bile ducts. ConclusionMSCT is accuracy in the diagnosis and assessment of vessels complication of HAE. It has an important value to evaluate the resectability of HAE and the planning of treatment.
ObjectiveTo assess the use of 18-Fluorine-labelled 2-deoxy-2-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the diagnosis of uveal melanoma. MethodsTwenty-three patients with uveal melanoma confirmed by histopathologic examination or imaging examination were enrolled. There were 16 male, 7 female, and the mean age was (49.8±12.3) years. All the lesions were unilateral, with 11 cases in OD, 12 cases in OS. Diagnosis was confirmed by histopathological examination of enucleated eyeballs in 15 cases, by ophthalmoscope, fundus fluorescein angiography, ocular B-mode ultrasound and magnetic resonance imaging and other imaging technology in 8 cases. 15 patients diagnosed by histopathologic examination of enucleated eyeballs were divided into three types including mixed (7 patients), spindle cell (6 patients) and epithelioid cell (2 patients) types. The mixed cell type and epithelioid cell type are considered as high-risk; spindle cell type is low-risk. All the patients were evaluated by whole body PET/CT. The location, size, shape, boundary of the lesions, and the relationship with adjacent structures were observed in CT images. 18F-FDG uptake was quantitative expression by standardized uptake value (SUV) in PET image; positive diagnosis should be made when the maximum standardized uptake value (SUVmax) was not less than 2.5. The correlation between SUVmax and maximum diameter of tumor base, tumor height was analyzed by Spearman rank correlation test. The detection rate of high-risk and low-risk patients between 18F-FDG PET and CT methods was comparative analyzed. ResultsAll the CT images showed abnormal high density ocular lesions. The shape of the lesions included 8 patients of semi sphere-like, 7 patients of flat-like, 4 patients of mushroom-like, 3 patients of round-like and 1 patient of diffuse lesions. The tumors were located in the posterior pole (9 patients), temporal equator (5 patients), nasal equator (4 patients), superior equator (1 patient), temporal ciliary body (1 patient), inferior ciliary body (1 patient), temporal iris (1 patient), and nasal iris and ciliary body (1 patient). SUVmax≥2.5 were found in 9 patients (39.13%), the largest basal diameter and height were (17.53±3.48), (11.37±3.85) mm respectively. SUVmax < 2.5 were found in 14 patients (60.87%), the largest basal diameter and height were (10.66±3.25), (5.33±2.23) mm respectively. The former's largest basal diameter and height were greater than the latter's and the difference was statistically significant (t=4.815, 4.786; P < 0.01). SUVmax was positively correlated with the largest basal diameter and height respectively (r=0.881, 0.809; P < 0.01). 15 patients (39.13%) were diagnosed by histopathological diagnosis after enucleation, of which SUVmax≥2.5 were found in 8 patients which included 6 patients of mixed type, 1 patient of epithelioid cell type, and 1 patient of spindle cell type. The detection rate of high-risk type (77.78%, 7/9) was higher than that of low-risk type (16.67%, 1/6), the difference was statistically significant (χ2=5.402, P < 0.05). Conclusions18F-FDG PET-CT examination can show large uveal melanoma tumor from cell metabolism, and may help to evaluate the prognosis of the preoperative patients. But, for small tumor, it has little value. We don't recommend 18F-FDG PET-CT is used as a routine examination for uveal melanoma.
Objective To investigate the CT features and anatomic basis of peritoneal and retroperitoneal spread of primary acute duodenal inflammation. Methods Twenty-six cases of peritoneal and retroperitoneal spreading acute duodenum inflammation confirmed by gastroscopy and clinical diagnosis during January 2010 to December 2014 were collected. Then we analyzed the CT manifestations of their inflammatory features, and abdominal cavity and retroperitoneal diffusion rules. Results According to the inflammation location, in the 26 cases, there were 1 case of inflammation in the descending part of duodenum, 1 in the horizontal part of duodenum, 15 in both the descending and horizontal parts of duodenum, 7 in both the horizontal and ascending parts of duodenum, and 2 in all the descending, horizontal and ascending parts of duodenum. According to the peritoneal and retroperitoneal spreading locations of acute duodenum inflammation, there were 20 cases of transverse mesocolon and mesenteric root swelling, 17 cases of enlargement of the head of pancreas, 6 cases of ascending colon and ileocecal swelling, 5 cases of anterior and posterior renal fascia of right kidney and perinephric fascia of right kidney swelling, 3 cases of effusion between the anterior and posterior renal fascia and lateral cone fascia of right kidney, 1 case of transverse mesocolon, mesenteric root, and the right pelvic swelling, and 1 cases of abdominal pelvic effusion. Conclusions Acute duodenum inflammation is mainly located in the descending and horizontal parts of duodenum. Different duodenal segments have different degrees of inflammation, while the horizontal segment is the most obvious. Inflammation involving two segments and above can be combined with ulcers. The inflammation infiltrates through transverse mesocolon, mesenteric root, anterior and posterior renal fascia of the right kidney, and spreads to the abdominal and retroperitoneal space, which causes the ascending colon and ileocecal swelling. The effusion can be observed in retroperitoneal space, anterior and posterior renal fascia and abdominal cavity.
Objective To analyze the ability of spectral CT imaging in displaying breast cancer lesions and explore the value of spectral CT imaging in detecting breast cancer. Methods The spectral CT images with different parameters of sixty-eight breast cancer lesions confirmed by pathology between July 2013 and February 2016 were retrospectively analyzed. The contrast noise ratio (CNR) and signal to noise ratio (SNR) as well as the ability in detecting breast cancer of the images with different parameters were compared. Results Fat-water material decomposition images showed breast cancer lesions best. Iodine-water material decomposition images had the lowest CNR. 70 keV monochromatic images and the monochromatic of best CNR images had better SNR. Fat-water material decomposition images detected all of the breast cancer lesions. Conventional CT plain scan detected least lesions. Conclusion Spectral CT imaging, especially fat-water material decomposition images, can show breast cancer lesions well, which has the potential application for detection of breast cancer lesions.
Objective To clarify the thin-layer 16-slice spiral CT features of coal worker’s pneumoconiosis and the superior distribution of comorbidities in their staging and lobes and lung field anatomy. Methods Sixty-six patients with coal worker's pneumoconiosis diagnosed by the pneumoconiosis diagnosis and identification group from October 2014 to March 2015 were enrolled. All patients underwent 16-slice spiral CT and thin-layer CT reconstruction with a thickness of 1.5 mm. The thin-slice CT signs and comorbidities of coal workers’ pneumoconiosis were observed, and the superior distribution of CT signs in patients at different stage and different lobes and lung field anatomy were evaluated. Results There were 16 cases of irregular small nodules in the lungs, 22 cases of large shadow fusion, 18 cases of intraocular shadow calcification, 41 cases of emphysema, 21 cases of pulmonary bullae, 21 cases of pulmonary hypertension, and 31 cases of enlarged lymph nodes in the mediastinum and calcified. The above signs were mostly distributed in stage Ⅲ pneumoconiosis (P<0.05). There were 32 cases of regular small nodules, which were mostly distributed in stage Ⅰ pneumoconiosis. In the 16 cases of irregular small nodules, the advantage was distributed in the middle and outer lobes of the double lungs. In the 22 cases of large shadow fusion, the advantage was distributed in the upper and lower lobe of the lungs. In the 16 cases of tuberculosis, the advantage was distributed in the upper lobe of the lungs. In the 21 cases of bullous bullae, the advantage was distributed in the upper lobe of the two lungs, mostly in the right upper lung. Conclusion The thin 16-slice spiral CT signs of coal worker’s pneumoconiosis can reflect the pathological changes, and have a certain correlation with the stage of pneumoconiosis, and have obvious characteristics in the anatomical distribution of lung and lung fields.
ObjectiveTo investigate the CT and pathological findings of adrenal leiomyosarcoma, so as to improve the accuracy of diagnosis.MethodsThe clinical data of patients with adrenal leiomyosarcoma who were confirmed with surgery and pathology in West China Hospital, Sichuan University between August 2009 and January 2019 were retrospectively analyzed. Patients without pre-operation CT examination were excluded. The CT imaging features of the disease, including the location, size, shape, enhanced features, surrounding structures and metastasis of adrenal leiomyosarcoma were evaluated on CT images, respectively.ResultsFinally 5 patients were included. All of them had left single lesion. Enhanced CT features delineated large masses with well-defined but irregular boundaries, multicentric necrosis involving both the center and edge, continuous increased enhancement of the non-necrotic area, and cross-section of neovascularization or needle-tip vessels in the tumors. Among the 5 patients, 2 had postoperative recurrence and 3 lost follow-up.ConclusionsPrimary adrenal leiomyosarcoma is rare. Adrenal leiomyosarcoma could be correctly diagnosed with CT enhanced examination, which are helpful for making surgical strategies.