Objective To study the clinical significance of multi-slice spiral CT in portal vein imaging. Methods One hundred and thirty seven cases underwent enhanced scan with GE Light SpeedQX/i4 CT scanner were collected, including 41 cases of liver cancer, 20 cases of hepatic cirrhosis, 21 cases of cavernous hemangioma of liver, 9 cases of hepatic abscess, 6 cases of carcinoma of gallbladder, 14 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 5 cases in normal. The results of portal vein images were reconstructed with three-dimensional software and analyzed. Results In 109 cases, portal vein, cranial mesenteric vein, and splenic vein were demonstrated successfully in the stage of portal vein: volume rendering images were clear in 84 cases, and maximum intensity projection images and multiplanar reconstruction images were clear in 109 cases. Forty-five cases of portal hypertension, 18 cases of opened collateral circulation, 15 cases of portal vein tumor thrombus, 1 case of splenic vein tumor thrombus, and 6 cases of large cavernous hemangioma were demonstrated successfully. Conclusion The portal vein imaging with multi-slice spiral CT can show the dissection and lesions of portal vein and its branches clearly, and can provide the clinical evidence for clinicians to formulate a treatment plan correctly.
【Abstract】ObjectiveTo describe the imaging manifestations of acute necrotizing pancreatitis (ANP) on multidetectorrow spiral CT (MDCT). To investigate the relationship between pancreatic glandular necrosis and retroperitoneal inflammatory spreading and the clinical severity of ANP. MethodsA 16detector row spiral CT was used to perform contrastenhanced abdominal scanning in 90 patients diagnosed as ANP， who were prospectively enrolled into this study. Scoring of the extent of pancreatic glandular necrosis and Balthazar grading based on retroperitoneal inflammatory spreading were done at the same time. For 44 patients who met the criteria of Ranson scoring, both scoring by CT severity index (CTSI) and Ranson criteria. Multiplanar reformation technique was used for image postprocessing. Results①In 40 out of 90 patients, the pancreatic glandular necrosis was less than 30%, in 23 the necrosis was between 30%-50%, and in 27 the necrosis was more than 50%. Peripancreatic fat swelling and thickening of anterior renal fascia were observed in all cases of ANP; Peripancreatic and retroperitoneal phlegmonous fluid collection occurred in 78 patients (86.7%); 12 had fluid collection in lesser sac (13.3%); Thickening and swelling of posterior gastric wall in 71 patients (78.9%); 87 developed intestinal ileus (96.7%) and 35 patients had peritoneal effusion (38.9%); Splenic infarction in 4 patients (4.4%); 82 had pleural effusion (91.1%). ②Twelve patients were classified as Balthazar grade C， 42 as grade D and 36 as grade E. There was a statistically significant positive correlation between the extent of pancreatic glandular necrosis and Balthazar CT grade. ③In 44 ANP patients suitable for Ranson criteria, 12 cases were classified as mild (27.3%), 23 as moderate (52.3%), 9 as severe (20.5%). CTSI grading of these patients was as follows： Mild cases 0, moderate cases 25 (56.8%), severe cases 19 (43.2%). Correlation between the CTSI grades and the clinical severity of ANP was of statistical significance. ConclusionANP can demonstrate a series of imaging manifestations on MDCT. To some extent, the degree of pancreatic glandular necrosis and the extent of retroperitoneal spreading is positively correlated, and CTSI grading based on MDCT imaging features is also positively correlated with the clinical severity of ANP.
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.
Objective To evaluate the directional significance of SurgiCase software in free fibula mandibular reconstruction. Methods Between September 2010 and March 2012, 10 patients with mandibular defect underwent free fibula mandibular reconstruction. There were 7 males and 3 females, with an age range of 19-43 years (mean, 27 years). The extent of lesions was 7 cm × 5 cm to 16 cm × 8 cm. In each case, three-dimensional spiral CT scan of the maxilla, mandible, and fibula was obtained before surgery. The CT data were imported into the SurgiCase software and the virtual surgery planning was performed. After that, the mandibular rapid prototyping was made according to customized design. The reconstruction surgery was then carried out using these preoperative data. During actual surgery, the extent of mandibular defect was from 6 cm × 3 cm to 16 cm × 5 cm; the length of fibula which was used to reconstruct mandible was 6-17 cm; and the area of flap was from 6 cm × 5 cm to 16 cm × 6 cm. Results Preoperative data could not be applied because the intraoperative size of tumor was larger than preoperative design in 1 case of mandibular ameloblastoma, and the fibula was shaped according to the actual osteotomy location; operations were performed successfully according to preoperative design in the other 9 patients. The operation time was 5-7 hours (mean, 6 hours). Primary healing of incision was obtained, without early complications. Ten patients were followed up 1 year. At last follow-up, 8 patients were satisfactory with the appearance and 2 patients complained with unsatisfied wide facial pattern. The panoramic radiograghs showed good bone healing. The range of mouth opening was 2.5-3.5 cm. Conclusion SurgiCase software can provide precise data for free fibula mandibular reconstruction during surgery. It can be applied widely in clinic.
Objective To evaluate the accuracy of the related parameters measured by spinal virtual surgery system (SVSS) three-dimensional (3D) techniques by comparing with the parameters measured by multi-spiral CT (MSCT) workstation. Methods Seven vertebrae specimens of adult men were scanned with MSCT, and the messages were sent toMSCT workstation and SVSS. The 3D image of spine was reconstructed by using volume rendering and multi-planar reformation; based on the parameter requirement of lower cervical pedicle fixation, 10 related parameters were measured. Then SPSS11.0 analyzer software was used to analyze the parameters measured by 2 systems. Between June 2009 and March 2010, 6 patients who received screw insertion in lower cervical spines were given MSCT scanning, then the messages were sent to SVSS 3D reconstruction to evaluate the situation and to collect the parameters of pedicle screw insertion. Results SVSS measurement showed that 1 pedicle was clausura (C3) and the diameters of 4 pedicles in coronal view were lee than 3 mm (C4 in 1, C5 in 2, C6 in 1), which did not fit for screw insertion; the results were similar to those by MSCT measurement. A total of 66 lower cervical pedicle were measured successfully. Significant differences were found in 14 parameters as follows between 2 systems (P lt; 0.05): the left pedicle height of C3, the both sides pedicle width of C4, the right pedicle spongy width of C4, the left X-direction entrance of C6, the both sides Y-direction entrance of C3, total pedicle length of sagittal view in both sides pedicle of C3 and the left pedicle of C5, total pedicle length of axial view in C3 pedicles, the left pedicle of C5, and the right pedicle of C6. There was no significantdifference in the other parameters (P gt; 0.05). In 6 cl inical cases, 34 screws were inserted, the postoperative MSCT scanning showed that 30 screws were placed successfully. The rate of accuracy was 88.24%. According to the Richter’s perforation classification, perforation at grade I and at grade II occurred in 2 cases (5.88%), respectively. Conclusion The accuracy of the parameters measured by SVSS is similar to that by MSCT.
Objective To study the feasibil ity and rel iabil ity of the multi-plannar reformation (MPR) of multispiral CT (MSCT) in measuring the kyphosis angle (KA) after thoracolumbar fracture. Methods From December 2007 to December 2009, 45 thoracolumbar fracture patients who underwent computed radiology (CR) and MSCT were recruited. There were 32 males and 13 females with a mean age of 48 years (range, 24-63 years), including 36 simple compression fractures and 9 burst fractures. The fracture locations were T11 in 6 cases , T12 in 11 cases, L1 in 20 cases, and L2 in 8 cases. Fracture was caused by trafffic accident in 25 cases, by fall ing from height in 12 cases, and by others in 8 cases. The imaging examination was performed after 2 hours to 7 days of injury in 22 cases and after more than 7 days in 23 cases. The KA was measured on the lateral X-ray films of CR and MPR by two observers, then the measurements were done again after three weeks. The data were statistically analyzed. Results The average KA values on CR by two observers were (20.75 ± 8.31)° and (22.49 ± 9.07)°, respectively; showing significant difference (P lt; 0.05), and the correlation was good (r=0.882, P lt; 0.05). The average KA values on MPR by two observers were (16.65 ± 8.62)° and (17.08 ± 7.88)°, respectively, showing no significant difference (P gt; 0.05), the correlation was excellent (r=0.976, P lt; 0.05). The average KA values on CR and MPR were (21.61 ± 8.43)° and (16.87 ± 8.20)°, respectively; showing significant difference (P lt; 0.05), the correlation was good (r=0.852, P lt; 0.05). Conclusion It is more feasible and rel iable in measuring the KA on MRP of MSCT than CR, but the value is larger on CR.
Objective To assess the cl inical significance of transpedicular screw insertion in lower cervical vertebra assisted by multi-spiral CT (MSCT) three dimentional (3D) image reconstruction techniques. Methods Eight cervical vertebra specimens were examined by MSCT, and the messages were sent to SGI02 Workstation; according to the parameter requirements of lower cervical pedicle fixation, by using post-process of volume rendering (VR) the condition was judged and multi-plannar reformation (MPR) was used to do individual analysis; and the ideal path of screw insertion was obtained andthe related parameters were measured. After preoperative plan being finished, referring to these measured parameters, 3.5 mm screws were inserted into C3-7 pedicles of these 8 specimens. After insertion of screws, MSCT scanning and 3D reconstruction were performed again to evaluate the accuracy of lower cervical pedicle screw inserting. From May 2007 to November 2009, 28 patients who received screw insertion in lower cervical spines were given MSCT scanning and 3D reconstruction to evaluate the illness situation, to confirm shortest fixation volumes, and to collect the parameters of aim pedicle screw insertion. Results The time of insertion for each screw was (392 ± 62) seconds. It was found that one pedicle was clausura (1.25%, 1/80) and five pedicle diameters in coronal view were less than 3 mm (6.25%, 5/80), which all were not fit for screw insertion. A total of 74 screws were placed successfully. One-time success rate of screw insertion was 95.95% (71/74). The total accuracy rate was 91.89% (68/74). Six screws penetrated (8.11%). According to the Richter penetrating classification: grade one was 6.76% (5/74) and grade two was 1.35% (1/74). There were significant differences (P lt; 0.05) in penetrated rate between our study and anatomic landmark local ization (47.37%), Miller methods (25.00%), and there was no significant difference (P gt; 0.05) when compared with Abumi method (6.70%), hopper method (7.10%), pipel ine deoppilation method (5.20%) and navigation technique (11.30%). In cl inical 28 cases, 121 screws were inserted; one pedicle was clausura and one was fissure fracture, which all were unfit for insert screw in preoperative plan, the surgery project was adjusted. After operation, 17 patients (76 screws) were given MSCT scanning again. A total of 67 screws (88.16%) were placed successfully. Nine screws (11.84%) penetrated, grade one was 7.89% (6/76) and grade two was 3.95% (3/76). Conclusion It is accurate to apply MSCT 3D reconstruction techniques to measure the ideal screw canal in preoperative individual ized plan. Strictly following individual quantitative data, the safety and accuracy of the surgery can be improved. And it is feasible and available to use MSCT MPR imaging to evaluate the accuracy of pedicle screw insertion.
Objective To evaluate the accuracy of pedicle guide device for the placement of the pedicle screws. Methods Pedicle guide device was designed and made for the anatomical trait of pedicle. The 3-Danatomical data of the thoracic pedicles were measured by multislice spiral CT in two embalmed human cadaveric thoracic pedicles spine(T1 -T10). Depending on transverse section angle(TSA) and sagittal section angle(SSA) of pedicle axis, the degree of horizontal dial and sagittal dial were adjusted in the guide device. The screws wereinserted bilaterally in the thoracic pedicles by using the device. After pulling the screws out, the pathways were filled with contrast media. The TSA and SSA of developed pathways were measured. Results Analysis of the difference between pedicle axis and developed pathway was of no statistical significance(P＞0.05). Conclusion The guide device could be easilyoperated and guarantee high accuracy of the pathways of screws and the incidence of pedicle penetration could be significantly reduced.
Objective To explore the manifestations and features of multi-slice spiral CT （MSCT） in the diagnosisof papillary thyroid carcinoma （PTC）. Methods Preoperative MSCT data of 35 cases of PTC proved by operation and pathology in our hospital form May. to Jun. in 2013 were observed retrospectively， to analyze the manifestations and characteristics of MSCT for it. Results Of 35 patients with PTC， MSCT totally showed 48 lesions， 68.6% （24/35） of patients with single lesion， 31.4% （11/35） of patients with 2-3 lesions， and 62.9% （22/35） of patients with lymph node metastasis. Of the 48 lesions， 29.2% （14/48） of lesions located in the left lobe， 70.8% （34/48） of lesions located in the right lobe；the lesions’ maximum diameter were 0.4-5.8cm， with the average maximum diameter of 1.3cm. There were 39.6% （19/48） of lesions with uneven density， 25.0% （12/48） of lesions with irregular shape， 47.9% （23/48） of lesions with blurred edges， 18.8% （9/48） of lesions had papillary enhanced tumor nodules， 10.4% （5/48） of lesions had peritumoral incomplete enhanced ring sign， 22.9% （11/48） of lesions invaded surrounding tissue or organs. There were 35.4% （17/48） of lesions had calcification， in which 76.4% （13/17） of lesions were fine granular calcification， 11.8% （2/17） of lesions were mixed calcification， and 11.8% （2/17） of lesions were coarse calcification. Conclusion MSCT manifestations of PTC have certain characteristics， which can provide imaging basis for clinical treatment options.
ObjectiveTo explore the differences and similarities of the featurs of lymph node metatasis of abdominal esophageal carcinoma and cardiac cancer. MethodsPreoperative CT images of abdominal esophageal carcinomas and cardiac cancers were reviewed and analysed on lymph node size and preponderant distribution. ResultsShort diameter ≥10 mm of lymph node at CT was adopted as metastasis criterion. The detection rates of abdominal esophageal carcinomas and cardiac cancers were 73.5%（144/196） and 83.7% （170/203）, respectively. Thoracic lymph node metastasis rate of abdominal esophageal carcinomas was 11.1% （4/36） in 7 area, 27.8% （10/36） in 8 area, 8.3% （3/36） in 9 area, while celiac lymph node metastasis rate was 36.1% (13/36 ） in No.7 group, 19.4% （7/36） in No.1 group, and 11.1% （4/36） in No.2 group primarily. Lymph node metastasis rate of cardiac cancers was 17.9% （5/28） in No.1 group, 28.6% （8/28） in No.2 group, 39.3% （11/28 ） in No.3 group, and 25.0% （7/28） in No.4 group for the first stop lymph nodes, and 35.7% （10/28 ） in No.7 group for the second stop primarily. ConclusionAs metastasis criterion, short diameter ≥10 mm of lymph node at CT is feasible, but there exist certain falsepositive rate. Thoracic lymph node metastasis of abdominal esophageal carcinomas is mainly in the 7, 8, and 9 area, while celiac metastasis is mainly in No.7, No.1, and No.2 groups. Lymph node metastasis of cardiac cancers is in No.1, No.2, No.3, No.4, and No.7 group primarily.