Objective To evaluate the value of medical imaging technology in qualitative and quantitative diagnosis of liver steatosis. Methods To describe the current status and advancement s of medical imaging technology such as sonography , CT and MRI in qualitative and quantitative diagnosis of liver steatosis , and to cont rast their advantages and shortages. Results Sonography could be used as the primary screening and evaluate measures in qualitative and quantitative diagnosis of liver steatosis , and CT was more reliable in quantitative diagnosis , MRI had significant improving with its high sensitivity and specificity. Conclusion Medical imaging technology has significant clinical value in qualitative and quantitative diagnosis of liver steatosis , especially with the help of functional MR imaging techniques such as spect roscopy and chemical shif t Gradient-Echo technic.
【Abstract】 Objective To review the study of noninvasive imaging methods for evaluating liver fibrosis. Methods The current literatures on the use of the ultrasonography， CT and MRI for the evaluation of liver fibrosis were reviewed. The principles, applications and advancement of each imaging methods were described and summarized respectively. The features of the newly developed imaging techniques were also discussed. Results In addition to the morphologic information， the imaging examinations can also provide functional information about the circulation status， diffusion and metabolism features of liver. The potential diagnostic value of MR elastography for liver fibrosis has been addressed. Conclusion The imaging examinations, especially the functional MRI techniques, are reliable noninvasive alternatives for the evaluation of hepatic fibrosis, with bright potentiality for clinical application.
Objective To investigate the diagnostic value of CT scanning and MR imaging on acute cholecystitis. Methods The CT or MR imaging data of 21 patients with proved acute cholecystitis were retrospectively reviewed. Eleven patients were examined with contrast-enhanced multi-detector-row spiral CT scanning and other 10 cases underwent contrast-enhanced MR imaging. Results Nineteen patients showed obscure gallbladder outlines （90.5%）. The gallbladder wall demonstrated even thickening in 15 patients （71.4%） and irregular thickening in 6 cases （28.6%）. All patients showed inhomogeneous enhancement of the gallbladder wall （100%）. The bile was hyper-dense or hyper-intense on T1W image in 11 cases （52.4%）. Ten cases had free peri-cholecystic effusion （47.6%）, and 16 cases had peri-cholecystic adhesive changes or fat swelling （76.2%）. Patchy or linear-like transient enhancement of the adjacent hepatic bed in the arterial phase was seen in 16 cases （76.2%）. Twelve patients developed pleural effusion, or ascites, or both （57.1%）. Gallbladder perforation complicated with peritonitis was seen in one case, micro-abscess formation and pneumocholecystitis was observed in another case, and one case had gallbladder diverticulum. Conclusion Wall blurring, pericholecystic adhesion or fat edema, and transient enhancement of adjacent hepatic bed in the arterial phase are the imaging findings specifically associated with acute cholecystitis, which are readily appreciated on contrast-enhanced multi-phasic CT and MR scanning.
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.
Objective To investigate multi-slice spiral CT (MSCT) and MRI features of stasis cirrhosis and the diagnostic value of MSCT and MRI. Methods MSCT and MRI findings of 35 patients with stasis cirrhosis were studied. The size of liver and spleen, the diameter of hepatic vein (HV), enhancement pattern of liver parenchyma, contrast medium reflux in inferior vena cava (IVC) and (or) HV, ascites, number of varices and correlated abnormalities were reviewed. Results The volume index of liver and spleen of 35 patients was 4434.95 cm3 and 621.92 cm3 respectively. The mean diameter of HV of 27 patients (77.1%) was 3.61 cm and HV of other 8 patients (22.9%) were too small to show. Number of patients showed waves of borderline, inhomogeneous pattern of parenchymal contrast enhancement, contrast medium reflux in IVC and (or) HV, varices and ascites was 5 (14.3%), 29 (82.9%), 20 (57.1%), 16 (45.7%), and 6 (17.1%), respectively. Correlated abnormalities included cardiac enlargement 〔4 cases (11.4%)〕, pericardium thickening 〔11 cases (31.4%)〕, and pericardial effusion 〔2 cases (5.7%)〕. Conclusions Stasis cirrhosis mainly demonstrate liver enlargement, inhomogeneous pattern of parenchymal contrast enhancement, contrast medium reflux in IVC and (or) HV, and slight portal hypertension. MSCT and MRI play invaluable roles in diagnosis, differential diagnosis and etiological diagnosis of stasis cirrhosis.
ObjectiveTo investigate the value of proton magnetic resonance spectroscopy (1H-MRS), gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR.MethodsThirty patients with fatty liver diagnosed by CT or ultrasound who admitted in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital between August 2017 and May 2018, were enrolled and undergone gradient dual-echo, triple-echo, and 1H-MRS examination before and 3 months after treatment. The fat index (FI) and relative lipid content (RLC) were measured. Fatty liver index (FLI) was calculated from blood biochemical indicators, waist circumference, and BMI at the same time. With the reference standard of FLI, the results before and after treatment measured from MRI were analyzed.ResultsThere were significantly differences of FLI, FIdual, FItriple, and RLC before and after treatment (t=5.281, P<0.001; Z=–3.651, P<0.001; Z=–3.630, P<0.001; Z=–4.762, P<0.001), all indexes decreased after treatment. FIdual and FItriple were positively correlated with FLI before (rs=0.413, P=0.023; rs=0.396, P=0.030) and after treatment (rs=0.395, P=0.031; rs=0.519, P=0.003), the highest correlation factor was FItriple to FLI after treatment. There were no significant correlation between RLC and FLI before and after treatment (P>0.05).ConclusionsIt is feasible to quantitatively evaluate the treatment effect of fatty liver by using 1H-MRS, gradient dual-echo, and triple-echo sequences. Gradient triple-echo sequences has better accuracy, which is technically easy to implement and more suitable for clinical development.
Objective To investigate the diagnostic value of proton magnetic resonance spectroscopy （1 H-MRS） on the quantification of hepatic steatosis at 3.0 T MR united.Methods Twenty-two patients who were candidated for liver surgery (living liver transplantation donor candidates, lobectomy or segmental resection for focal liver diseases, etc.) were enrolled in this study. 1 H-MRS was conducted with point resolved selective spectroscopy （PRESS） sequence, using SAGE software packages. The values of water peak (PW), lipid peak (PL) were measured, the area under water peak (AW) and lipid peak (AL), and then the relative lipid content of liver cells (RLC1, RLC2) was calculated. All subjects underwent surgical resection of liver shortly after MR scanning, fresh frozen specimens were obtained for Sudan Ⅲ staining, and staging was conducted.Results In all 22 patients, 7 patients without fatty liver, 11 patients with mild fatty liver, 4 patients with moderate or severe fatty liver. Intercomparison between different histopathological grades showed following findings: the values of PL, AL, RLC1 and RLC2 had statistical significance (Plt;0.05). The values of PL， AL， RLC1 and RLC2 were positively correlated with the proportion of fatty degenerative cells (PFDC), Plt;0.05, and the highest correlation factor was 0.771 (RLC1 to the PFDC).Conclusion 1 H-MRS can accurately quantify liver fat content and reflect the severity of hepatic steatosis. It has the potential to replace invasive liver biopsy.
目的 探讨中老年人群血清尿酸水平与代谢综合征（MS）及其各组分的关系。 方法 采用横断面研究，对2007年49～80岁成都成华区711例人群进行调查，并测量身高、体重、血压、空腹血糖、三酰甘油、高密度脂蛋白、低密度脂蛋白、血清尿酸等指标，采用SPSS 16.0软件分析尿酸与MS及MS各组分之间的关系。 结果 在中老年人群中，MS的发生率为25.60%，高尿酸血症的发生率为21.24%。女性MS、腹型肥胖、高三酰甘油血症和低高密度脂蛋白胆固醇血症的发生率均明显高于男性。尿酸与腰围、收缩压、三酰甘油、舒张压、高密度脂蛋白水平的相关系数分别为0.311、0.140、0.118、0.106和?0.147，均有统计学意义（P＜0.05）。男、女性尿酸与腰围的相关系数分别为0.173和?0.321，均有统计学意义（P＜0.05）。男、女性尿酸与空腹血糖的相关系数分别为?0.049和0.183，均有统计学意义（P＜0.05）。 结论 血清尿酸水平与MS及其各组分关系密切，血清尿酸水平和MS及其各组分间的关系存在性别差异。
ObjectiveTo explore the effect of Ketogenic diet (KD) in patients with Dravet syndrome (DS).MethodsThe seizures, electroencephalogram (EEG) and cognitive function of 26 DS patients receiving treatment of KD from June 2015 to October 2019 in the Epilepsy Centre of Guangdong 999 Brain Hospital were analyzed retrospectively. Modified Johns Hopkins protocol was used to initiate KD, blood glucose and urinary ketone bodies were monitored in the patients. The effect was evaluated by Engel outcome scale. And the EEG, cognition, language and motor function of the patients were assessed.Results26 DS patients (20 boys, 6 girls) received treatment of KD more than 4 weeks, the seizure of epilepsy were reduced above 50% in 15 patients (57.7%), 2 patients were seizure free. Among them, the effcet of KD can be observed in 7 patients within one week and 3 patients within two weeks, accounting for 66.7% (10/15). 26 cases (100%), 24 cases (92.3%), 20 cases (76.9%), 11 cases (42.3%) were reserved in 4, 12, 24, 28 weeks respectively. 26 patients achieved Engel Ⅰ ,Ⅱ,Ⅲ,Ⅳgrade effect, accounting for 38.5% (10/25), 54.2% (13/23), 65.0% (12/19), 81.8% (9/11) respectively according to Engel scale. The back ground rhythm of EEG showed obvious improvement in 14 patients wthin 16 patients who revieved EEG after KD. 17 patients assessed cognitive, language and motor function after KD, cognitive function was improved in 10 patients, language was enhanced in 11 patients, motor function of 8 patients was enhanced. The main adverse reactions of KD in the treatment process were mainly gastrointestinal symptoms and metabolic disorders.ConclusionKD treatment in DS has many advantages, such as fast acting, being effective in more than half of the DS patients and tolerable adverse reactions. Cognitive, language and motor function were improved in some patients. Drug resistant DS patients are suggested to receive KD treatment early.
Objective To explore the effect of antihypertensive therapy for hypertension patients from plateau area. Method A retrospective analysis of medical records for Tibetan patients with hypertension from October to December 2013 in Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region. Results The study recruited 165 patients. The rate of treatment, control, and compliance of hypertension patients were 86.7% (143/165), 23.8% (34/143), 43.4% (62/143), respectively. The main characteristics of hypertension treatment were higher proportions of single-drug therapy (81.1%, 116/143); among those the Tibetan drug (24.1%), calcium channel blockers (21.6%), diuretics (19.0%), and traditional compound preparation (18.1%) were most commonly used in the antihypertensive therapy. Conclusions The rate of treatment was high, but the rate of control and compliance were low in Tibetan patients with hypertension. It was necessary to carry out hypertension education to patients and strengthen the training of doctors at the plateau.