CT scan is regarded as the imaging modality of choice in patients with pancreaticobiliary ductal abnormalities. However, the axial orientation of the CT images provides only limited anatomical view of pancreaticobilia...CT scan is regarded as the imaging modality of choice in patients with pancreaticobiliary ductal abnormalities. However, the axial orientation of the CT images provides only limited anatomical view of pancreaticobiliary ductal abnormalities. The technological advances of multi-de-tector row CT and three-dimensional image processing in workstations allows rapid image acquisition and a short postprocessing time. In particular, multiplanar reforma-tions (MPR) and minimum intensity projections (MinIP) offer rapid and accurate images of the anatomy and ab-normalities of the pancreaticobiliary tree. Moreover, MPR and MinIP help determine the relationship between the pancreaticobiliary ductal anatomy and the surrounding structures. This pictorial review illustrates the wide spec-trum of images obtained by the MPR and MinIP of the anomalies and disorders of the pancreaticobiliary tree.展开更多
Purpose: To present an application of the anisotropic diffusion (AD) method to improve the accuracy of the functional images of perfusion parameters such as cerebral blood flow (CBF), cerebral blood volume (CBV) and m...Purpose: To present an application of the anisotropic diffusion (AD) method to improve the accuracy of the functional images of perfusion parameters such as cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) generated from cerebral CT perfusion studies using multi-detector row CT (MDCT). Materials and Methods: Continuous scans (1 sec/rotation ×60 sec) consisting of four 5-mm-thick contiguous slices were acquired after an intravenous injection of iodinated contrast material in 6 patients with cerebrovascular disease using an MDCT scanner with a tube voltage of 80 kVp and a tube current of 200 mA. New image data were generated by thinning out the above original images at an interval of 2 sec or 3 sec. The thinned-out images were then interpolated by linear interpolation to generate the same number of images as originally acquired. The CBF, CBV and MTT images were generated using deconvolution analysis based on singular value decomposition. Results: When using the AD method, the correlation coefficient between the MTT values obtained from the original and thinned-out images was significantly improved. Furthermore, the coefficients of variation of the CBF, CBV and MTT values in the white matter significantly decreased as compared to not using the AD method. Conclusion: Our results suggest that the AD method is useful for improving the accuracy of the functional images of perfusion parameters and for reducing radiation exposure in cerebral CT perfusion studies using MDCT.展开更多
Estimated LBW could be used to determine the contrast material dose and rate during MDCT. The aim of this study is to test the accuracy of a technique for estimation of lean body weight (LBW) from a single multi-detec...Estimated LBW could be used to determine the contrast material dose and rate during MDCT. The aim of this study is to test the accuracy of a technique for estimation of lean body weight (LBW) from a single multi-detector row computed tomographic (MDCT) abdominal image, using a bioelectrical body composition analyzer scale as the reference standard. CT images of 21 patients with previously measured LBW (mLBW) were processed using computer-assisted, vendor-specific software (Advantage Windows 4.2;GE Healthcare, Inc). For each transverse image, a fat-fraction was automatically measured as the number of fat pixels (-200 to -50 HU) divided by the total number of pixels having an attenuation value ≥-200 HU. Estimated LBW (eLBW) of five single contiguous sections was calculated in each of three abdominal regions (upper abdomen, mid abdomen and pelvis) by multiplying TBW by (1 – fat-fraction). Bland-Altman plot with limits of agreement was used to assess agreement between mLBW and eLBW. The mean mLBW for all patients was 56 kg (range, 39 - 75 kg). Mean differences and limits of agreement between mLBW and eLBW measurements for the upper abdomen, mid abdomen and pelvis reported were -8.9 kg (-25.6 kg, +7.5 kg), -10.6 kg (-27.7 kg, +6.4 kg), and +0.5 kg (-12.8 kg, +13.8 kg) respectively. eLBW deriving directly from a transverse CT image of the pelvis can accurately predict mLBW.展开更多
AIM： To retrospectively analyze the imaging features of solid-pseudopapillary tumors （SPTs） of the pancreas on multi-detector row computed tomography （MDCT） and define the imaging findings suggestive of malignant...AIM： To retrospectively analyze the imaging features of solid-pseudopapillary tumors （SPTs） of the pancreas on multi-detector row computed tomography （MDCT） and define the imaging findings suggestive of malignant potential. METHODS： A total of 24 consecutive cases with surgically and pathologically confirmed SPTs of the pancreas underwent preoperative abdominal MDCT studies in our hospital. All axial CT images, CT angiographic images, and coronally and sagittally reformed images were obtained. The images were retrospectively reviewed at interactive picture archiving and communication system workstations. RESULTS： Of the 24 cases of SPTs, 11 cases （45.8%） occurred in the pancreatic head and seven （29.1%） in the tail. Eighteen were pathologically diagnosed as benign and six as malignant. MDCT diagnosis of SPTs was well correlated with the surgical and pathological results （Kappa = 0.6, P 〈 0.05）. The size of SPTs ranged from 3 to 15 cm （mean, 5.8 cm）. When the size of the tumor was greater than 6 cm （including 6 cm）, the possibilities of vascular （8 vs 1） and capsular invasion （9 vs 0） increased significantly （P 〈 0.05）.Two pathologically benign cases with vascular invasion and disrupted capsule on MDCT presented with local recurrence and hepatic metastases during follow-up about 1 year after the resection of the primary tumors. CONCLUSION： Vascular and capsular invasion with superimposed spread into the adjacent pancreatic parenchyrna and nearby structures in SPTs of the pancreas can be accurately revealed by MDCT preoperatively. These imaging findings are predictive of the malignant potential associated with the aggressive behavior of the tumor, even in the pathologically benign cases.展开更多
AIM: The purpose of this study was to compare the diagnostic accuracy of biphasic multi-detector row helical computed tomography (MDCT), digital subtraction angiography (DSA)and Lipiodol computed tomography (CT) in de...AIM: The purpose of this study was to compare the diagnostic accuracy of biphasic multi-detector row helical computed tomography (MDCT), digital subtraction angiography (DSA)and Lipiodol computed tomography (CT) in detection of hypervascular hepatocellular carcinoma (HCC).METHODS: Twenty-eight patients with nodular HCC underwent biphasic MDCT examination: hepatic arterial phase (HAP) 25 s and portal venous phase (PVP) 70 s after injection of the contrast medium (1.5 mL/kg). They also underwent hepatic angiography and intra-arterial infusion of iodized oil. Lipiodol CT was performed 3-4 wk after infusion. MDCT images were compared with DSA and Lipiodol CT images for detection of hepatic nodules.RESULTS: The three imaging techniques had the same sensitivity in detecting nodules ＞20 mm in diameter. There was no significant difference in the sensitivity among HAP-MDCT, Lipiodol CT and DSA for nodules of 10-20 mm in diameter. For the nodules ＜10 mm in diameter, HAP-MDCT identified 47, Lipiodol CT detected 27 (X2= 11.3, P= 0.005＜0.01, HAP-MDCT vs Lipiodol CT) and DSA detected 16(X2= 9.09, P= 0.005＜0.01 vs Lipiodol CT and X2= 29.03,P = 0.005＜0.01 vs HAP-MDCT). However, six nodules ＜10 mm in diameter were detected only by Lipiodol CT.CONCLUSION: MDCT and Lipiodol CT are two complementary modalities. At present, MDCT does not obviate the need for DSA and subsequent Lipiodol CT as a preoperative examination for HCC.展开更多
Over the past several years,advances in the technical domain of computed tomography(CT) have influenced the trend of imaging modalities used in the clinical evaluation of the urinary system.Renal collecting systems ca...Over the past several years,advances in the technical domain of computed tomography(CT) have influenced the trend of imaging modalities used in the clinical evaluation of the urinary system.Renal collecting systems can be illustrated more precisely with the advent of multi-detector row CT through thinner slices,high speed acquisitions,and enhanced longitudinal spatial resolution resulting in improved reformatted coronal images.On the other hand,a significant increase in exposure to ionizing radiation,especially in the radiosensitive organs,such as the gonads,is a concern with the increased utilization of urinary tract CT.In this article,we discuss the strategies and techniques availablefor reducing radiation dose for a variety of urinary tractCT protocols with metabolic clinical examples.We also reviewed CT for hematuria evaluation and related scan parameter optimization such as,reducing the number of acquisition phases,CT angiography of renal donors and lowering tube potential,when possible.展开更多
Objective To determine if multi-detector CT （MDCT） characterization of plaque is correlated with the classification of acute coronary syndrome （ACS）. Methods Altogether 1900 patients were examined by MDCT from De...Objective To determine if multi-detector CT （MDCT） characterization of plaque is correlated with the classification of acute coronary syndrome （ACS）. Methods Altogether 1900 patients were examined by MDCT from December 2007 to May 2009, of whom 95 patients fulfilled the criteria of ACS. Those patients were divided into the discrete plaque group （n=61） and diffuse plaque group （n=34） based on the findings in MDCT. The clinical diagnosis of ACS and CT results were analyzed, including segment stenosis score, segment involvement score, 3-vessel plaque score, left main score, calcification score, and remodeling index. The incidences of major adverse cardiac events in follow-up period were also recorded. Results The patients of the diffuse plaque group were older than those of the discrete plaque group （P〈0.0001）. The diffuse plaque group presented more cases of hypertension, peripheral artery disease, diabetes, and heart failure than discrete plaque group （all P〈0.05）. All the 5 patients with ST-segment elevation myocardial infarction were found in discrete plaque group. The segment stenosis score of the discrete plaque group was lower than that of the diffuse plaque group （5.15±3.55 vs. 14.91±5.37, P〈0.001）. The other four scores demonstrated signiflcant inter-group difference as well （all P〈0.05）. The remodeling index of the discrete plaque group was higher （1. 12±0.16 vs. 0.97±0.20, P〈0.05）. Follow-up data showed that major adverse cardiac events occurred more frequently in diffuse plaque group than in discrete group （29.41% vs. 11.48%, P=0.0288）. Conclusions Characteristics of discrete and diffuse plaques may be significantly different among different classes of ACS. The diffuse plaque may present higher risk, correlated to higher mortality. The diagnosis of discrete and diffuse plaques by MDCT would provide a new insight into the prognosis and treatment of ACS.展开更多
Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-tr...Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography(CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.展开更多
文摘CT scan is regarded as the imaging modality of choice in patients with pancreaticobiliary ductal abnormalities. However, the axial orientation of the CT images provides only limited anatomical view of pancreaticobiliary ductal abnormalities. The technological advances of multi-de-tector row CT and three-dimensional image processing in workstations allows rapid image acquisition and a short postprocessing time. In particular, multiplanar reforma-tions (MPR) and minimum intensity projections (MinIP) offer rapid and accurate images of the anatomy and ab-normalities of the pancreaticobiliary tree. Moreover, MPR and MinIP help determine the relationship between the pancreaticobiliary ductal anatomy and the surrounding structures. This pictorial review illustrates the wide spec-trum of images obtained by the MPR and MinIP of the anomalies and disorders of the pancreaticobiliary tree.
文摘Purpose: To present an application of the anisotropic diffusion (AD) method to improve the accuracy of the functional images of perfusion parameters such as cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) generated from cerebral CT perfusion studies using multi-detector row CT (MDCT). Materials and Methods: Continuous scans (1 sec/rotation ×60 sec) consisting of four 5-mm-thick contiguous slices were acquired after an intravenous injection of iodinated contrast material in 6 patients with cerebrovascular disease using an MDCT scanner with a tube voltage of 80 kVp and a tube current of 200 mA. New image data were generated by thinning out the above original images at an interval of 2 sec or 3 sec. The thinned-out images were then interpolated by linear interpolation to generate the same number of images as originally acquired. The CBF, CBV and MTT images were generated using deconvolution analysis based on singular value decomposition. Results: When using the AD method, the correlation coefficient between the MTT values obtained from the original and thinned-out images was significantly improved. Furthermore, the coefficients of variation of the CBF, CBV and MTT values in the white matter significantly decreased as compared to not using the AD method. Conclusion: Our results suggest that the AD method is useful for improving the accuracy of the functional images of perfusion parameters and for reducing radiation exposure in cerebral CT perfusion studies using MDCT.
文摘Estimated LBW could be used to determine the contrast material dose and rate during MDCT. The aim of this study is to test the accuracy of a technique for estimation of lean body weight (LBW) from a single multi-detector row computed tomographic (MDCT) abdominal image, using a bioelectrical body composition analyzer scale as the reference standard. CT images of 21 patients with previously measured LBW (mLBW) were processed using computer-assisted, vendor-specific software (Advantage Windows 4.2;GE Healthcare, Inc). For each transverse image, a fat-fraction was automatically measured as the number of fat pixels (-200 to -50 HU) divided by the total number of pixels having an attenuation value ≥-200 HU. Estimated LBW (eLBW) of five single contiguous sections was calculated in each of three abdominal regions (upper abdomen, mid abdomen and pelvis) by multiplying TBW by (1 – fat-fraction). Bland-Altman plot with limits of agreement was used to assess agreement between mLBW and eLBW. The mean mLBW for all patients was 56 kg (range, 39 - 75 kg). Mean differences and limits of agreement between mLBW and eLBW measurements for the upper abdomen, mid abdomen and pelvis reported were -8.9 kg (-25.6 kg, +7.5 kg), -10.6 kg (-27.7 kg, +6.4 kg), and +0.5 kg (-12.8 kg, +13.8 kg) respectively. eLBW deriving directly from a transverse CT image of the pelvis can accurately predict mLBW.
基金Supported by Shanghai Leading Academic Discipline Project (S30203)
文摘AIM： To retrospectively analyze the imaging features of solid-pseudopapillary tumors （SPTs） of the pancreas on multi-detector row computed tomography （MDCT） and define the imaging findings suggestive of malignant potential. METHODS： A total of 24 consecutive cases with surgically and pathologically confirmed SPTs of the pancreas underwent preoperative abdominal MDCT studies in our hospital. All axial CT images, CT angiographic images, and coronally and sagittally reformed images were obtained. The images were retrospectively reviewed at interactive picture archiving and communication system workstations. RESULTS： Of the 24 cases of SPTs, 11 cases （45.8%） occurred in the pancreatic head and seven （29.1%） in the tail. Eighteen were pathologically diagnosed as benign and six as malignant. MDCT diagnosis of SPTs was well correlated with the surgical and pathological results （Kappa = 0.6, P 〈 0.05）. The size of SPTs ranged from 3 to 15 cm （mean, 5.8 cm）. When the size of the tumor was greater than 6 cm （including 6 cm）, the possibilities of vascular （8 vs 1） and capsular invasion （9 vs 0） increased significantly （P 〈 0.05）.Two pathologically benign cases with vascular invasion and disrupted capsule on MDCT presented with local recurrence and hepatic metastases during follow-up about 1 year after the resection of the primary tumors. CONCLUSION： Vascular and capsular invasion with superimposed spread into the adjacent pancreatic parenchyrna and nearby structures in SPTs of the pancreas can be accurately revealed by MDCT preoperatively. These imaging findings are predictive of the malignant potential associated with the aggressive behavior of the tumor, even in the pathologically benign cases.
基金Supported by the Medical Science Research Fund of Sichuan Province,No. 200054
文摘AIM: The purpose of this study was to compare the diagnostic accuracy of biphasic multi-detector row helical computed tomography (MDCT), digital subtraction angiography (DSA)and Lipiodol computed tomography (CT) in detection of hypervascular hepatocellular carcinoma (HCC).METHODS: Twenty-eight patients with nodular HCC underwent biphasic MDCT examination: hepatic arterial phase (HAP) 25 s and portal venous phase (PVP) 70 s after injection of the contrast medium (1.5 mL/kg). They also underwent hepatic angiography and intra-arterial infusion of iodized oil. Lipiodol CT was performed 3-4 wk after infusion. MDCT images were compared with DSA and Lipiodol CT images for detection of hepatic nodules.RESULTS: The three imaging techniques had the same sensitivity in detecting nodules ＞20 mm in diameter. There was no significant difference in the sensitivity among HAP-MDCT, Lipiodol CT and DSA for nodules of 10-20 mm in diameter. For the nodules ＜10 mm in diameter, HAP-MDCT identified 47, Lipiodol CT detected 27 (X2= 11.3, P= 0.005＜0.01, HAP-MDCT vs Lipiodol CT) and DSA detected 16(X2= 9.09, P= 0.005＜0.01 vs Lipiodol CT and X2= 29.03,P = 0.005＜0.01 vs HAP-MDCT). However, six nodules ＜10 mm in diameter were detected only by Lipiodol CT.CONCLUSION: MDCT and Lipiodol CT are two complementary modalities. At present, MDCT does not obviate the need for DSA and subsequent Lipiodol CT as a preoperative examination for HCC.
文摘Over the past several years,advances in the technical domain of computed tomography(CT) have influenced the trend of imaging modalities used in the clinical evaluation of the urinary system.Renal collecting systems can be illustrated more precisely with the advent of multi-detector row CT through thinner slices,high speed acquisitions,and enhanced longitudinal spatial resolution resulting in improved reformatted coronal images.On the other hand,a significant increase in exposure to ionizing radiation,especially in the radiosensitive organs,such as the gonads,is a concern with the increased utilization of urinary tract CT.In this article,we discuss the strategies and techniques availablefor reducing radiation dose for a variety of urinary tractCT protocols with metabolic clinical examples.We also reviewed CT for hematuria evaluation and related scan parameter optimization such as,reducing the number of acquisition phases,CT angiography of renal donors and lowering tube potential,when possible.
基金Supported by the Supporting Program of the "Eleventh Five-year Plan" for Science & Technology Research of China (2006BAI01A02)
文摘Objective To determine if multi-detector CT （MDCT） characterization of plaque is correlated with the classification of acute coronary syndrome （ACS）. Methods Altogether 1900 patients were examined by MDCT from December 2007 to May 2009, of whom 95 patients fulfilled the criteria of ACS. Those patients were divided into the discrete plaque group （n=61） and diffuse plaque group （n=34） based on the findings in MDCT. The clinical diagnosis of ACS and CT results were analyzed, including segment stenosis score, segment involvement score, 3-vessel plaque score, left main score, calcification score, and remodeling index. The incidences of major adverse cardiac events in follow-up period were also recorded. Results The patients of the diffuse plaque group were older than those of the discrete plaque group （P〈0.0001）. The diffuse plaque group presented more cases of hypertension, peripheral artery disease, diabetes, and heart failure than discrete plaque group （all P〈0.05）. All the 5 patients with ST-segment elevation myocardial infarction were found in discrete plaque group. The segment stenosis score of the discrete plaque group was lower than that of the diffuse plaque group （5.15±3.55 vs. 14.91±5.37, P〈0.001）. The other four scores demonstrated signiflcant inter-group difference as well （all P〈0.05）. The remodeling index of the discrete plaque group was higher （1. 12±0.16 vs. 0.97±0.20, P〈0.05）. Follow-up data showed that major adverse cardiac events occurred more frequently in diffuse plaque group than in discrete group （29.41% vs. 11.48%, P=0.0288）. Conclusions Characteristics of discrete and diffuse plaques may be significantly different among different classes of ACS. The diffuse plaque may present higher risk, correlated to higher mortality. The diagnosis of discrete and diffuse plaques by MDCT would provide a new insight into the prognosis and treatment of ACS.
文摘Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography(CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.
