Multi-slice spiral computed tomography diagnosis of juxta-papillary duodenal diverticulum and its relationship with biliopancreatic diseases

BACKGROUND

Juxta-papillary duodenal diverticula (JPDD) are common but are usually asymptomatic, and they are often diagnosed by coincidence.

OBJECTIVE

To analyse the anatomy and classification of JPDD and its relationship with biliary and pancreatic disorders, and to explore the diagnostic value of multi-slice spiral computed tomography (MSCT) in patients with JPDD.

METHODS

The imaging data of patients with JPDD, which was obtained via abdominal computed tomography examination and confirmed via gastroscopy and/or upper gastrointestinal barium enema, in our hospital from 1 January 2019 to 31 December 2020 were retrospectively analysed. All patients were scanned using MSCT, and the imaging findings, classification and grading were analysed.

RESULTS

A total of 119 duodenal diverticula were detected in 96 patients, including 73 single diverticula and 23 multiple diverticula. The imaging findings were mainly cystic lesions of the inner wall of the duodenum protruding to the outside of the cavity. The thin layer showed a narrow neck connected with the duodenal cavity, and the shape and size of the diverticula were different: 67 central-type cases and 29 peripheral-type cases. There were 50 cases of type I, 33 cases of type II, 19 cases of type III and six cases of type IV. Furthermore, there were seven small, 87 medium and 14 large diverticula. The differences in the location and size of the JPDD in MSCT grading were statistically significant (P< 0.05).

CONCLUSION

The MSCT method has an important diagnostic value for the classification of JPDD, and MSCT images are helpful in the clinical evaluation of patients with JPDD and the selection of treatment options.

Value of multi-slice spiral computed tomography for diagnosis of tracheobronchial foreign body aspiration in children: 5-year retrospective study

BACKGROUND

Tracheobronchial foreign body (TFB) aspiration is a significant cause of respiratory problems in children. The timely diagnosis of TFB is important to decrease the mortality rate and the incidence of complications. Advances in radiology have led multi-slice spiral computed tomography (MSCT) to become the best technique for diagnosing TFB.

METHODS

We performed a retrospective study over 5 years from July 2008 to June 2013. We collected information on children who were diagnosed with a TFB by bronchoscopy, and analyzed age, sex, location, type of foreign body, and various MSCT manifestations.

RESULTS

A total of 382 children were included and 68.6% of them were aged 1 to <2 years. The majority (95.8%) of aspirated foreign bodies were vegetation items, and nearly half (47.6%) of them were peanut kernels, followed by sunflower seeds (26.2%). A total of 4.7% of TFBs were in the trachea, 51.0% were in the left main bronchus, and 44.2% were in the right main bronchus. Among the TFBs, 359 (95.5%) showed a high-density shadow in the tracheal / bronchial lumen using MSCT, which could establish the presence of a foreign body directly. Emphysema, localized obstruction and pneumonia were more commonly detected in the 7-21 days and ≥21 days group compared with those in the <7 days group (all P < 0.01). Bronchiectasis was found in two children who were diagnosed at least 21 days after aspiration.

CONCLUSIONS

Multi-slice spiral computed tomography is very sensitive to TFBs. Timely diagnosis and treatment of TFB is important to prevent long-term sequelae in children.

The clinical application value of multi-slice spiral CT enhanced scans combined with multiplanar reformations images in preoperative T staging of rectal cancer

This study aims to evaluate the diagnostic accuracy and clinical application value of multi-slice spiral CT (MSCT) enhanced scans combined with multiplanar reformations (MPRs) images compared with postoperative pathological results in preoperative T staging of rectal cancer.One hundred sixty-eight consecutive patients with rectal cancer were admitted in our hospital between January 2013 and October 2018. Conventional MSCT plain scans, multi-phase dynamic contrast-enhanced scans, and MPRs were performed in all patients before surgical operation. The preoperative T staging of the rectal cancer lesions was evaluated using MSCT enhanced scans combined with MPRs, which was verified by postoperative pathological results. The diagnostic accuracy of MSCT enhanced scans combined with MPRs in evaluating T staging of the rectal cancer lesions were analyzed by χ test and Kappa test.Compared with postoperative pathology, T staging using MSCT enhanced scans combined with MPRs had overall accuracy of 85.7%. Consistency between MSCT enhanced scans combined with MPRs and postoperative pathological staging was effective for T staging (Kappa = 0.658, χ = 4.200, P = .122).Conventional MSCT enhanced scans combined with MPRs are simple and feasible. It is consistent with the pathological diagnosis of evaluating T staging in the rectal cancer lesions. It can provide reliable imaging evidence for the preoperative evaluation of primary rectal cancer, especially in patients with magnetic resonance imaging (MRI) contraindications, or in grass-roots hospitals due to lack of MRI equipment.

Values of thoracic contrast-enhanced computed tomography in detecting incidental pulmonary thromboembolism in patients with malignant tumors

This study aimed to evaluate the values of thoracic multi-slice spiral computed tomography (CT) in the diagnosis of incidental pulmonary thromboembolism (IPTE) in patients with malignant tumors. The clinical data and imaging features of a total of 1,684 patients with malignant tumors, treated in the Fourth Hospital of Hebei Medical University, were analyzed retrospectively in order to investigate the types of malignancies, the patients' clinical features, and the emboli-preferred sites. Among the 1,684 patients, 60 patients had experienced IPTE (3.56%), 35 were females (58.33%), 25 were males (41.67%). Lung cancer had the highest incidence (n=22, 36.67%). The most common site of IPTE was the left lower lobe of pulmonary artery (n=46, 76.67%). The imaging results revealed that in 5 patients (8.33%) IPTE did not occur. Thoracic multi-slice spiral CT has a high detection rate of IPTE in patients with malignant tumors. Early diagnosis is helpful for early clinical treatment and has significant importance for patients' prognosis.

Comparative study of primary pulmonary cryptococcosis with multiple nodules or masses by CT and pathology

The manifestations of pulmonary cryptococcosis with multiple nodules or masses on computed tomography (CT) are diverse and difficult to differentiate from those of lung cancer and pulmonary tuberculosis. The present study compared the multislice spiral CT signs with pathological results and used the pathological results to explain the CT signs with the aim of improving the accuracy of the diagnosis of this disease. A retrospective analysis of 20 patients with primary pulmonary cryptococcosis with multiple nodules or masses was performed. Based on the CT signs, eight patients had been misdiagnosed with lung cancer accompanied by intrapulmonary metastasis andthree patients had been misdiagnosed with tuberculosis. The major CT manifestations were a cluster of nodules or masses located within 2 cm below the pleura and distributed along the bronchi. A total of nine patients had primary lesions with diameters of 1.1–2.0 cm and 12 patients had satellite lesions with diameters of 0.1–1.0 cm. Regarding treatment, 5 patients underwent surgical monotherapy, 12 patients underwent antifungal monotherapy and three patients received surgery in combination with antifungal therapy. HE staining indicated that Cryptococcus neoformans was engulfed by macrophages, which were surrounded by massive infiltrating lymphocytes and a large amount of fibrous tissue, which formed multinucleated macrophages or granulomas. Periodic acid-Schiff staining was positive and acid fast staining was negative. In conclusion, comparison of CT signs with the pathological manifestation of pulmonary cryptococcosis with multiple nodules or masses indicated that the pathological results may explain certain imaging signs. Combination of CT and pathological examination may provide a deeper understanding of this disease and improve the accuracy of its diagnosis.

Evaluation of a multi-slice spiral computed tomography perfusion for the prediction of the recurrence of gastric cancer

AIM

The study aimed to elucidate the value of multislice spiral computed tomography (MSCT) perfusion for the early prediction of gastric cancer (GC) recurrence.

METHODS

MSCT perfusion scans were performed to obtain values pertaining to blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface (PS). Logistic regression analysis was employed to evaluate the risk factors of postoperative recurrence in GC.

RESULTS

The maximum diameter of GC has a positive relationship with PS. The maximum enhancement of GC was positively correlated with BF, blood volume and PS. PS, BF, vascular thrombus and Tumor, Node, Metastasis staging were found to be significant risk factors in relation to the recurrence of GC (p = 0.006, p = 0.002, p < 0.001).

CONCLUSION

MSCT perfusion is strongly correlated with postoperative recurrence of GC, and PS and BF values, vascular thrombus and Tumor, Node, Metastasis staging were discovered as being prominent factors influencing the recurrence of GC.

Interventional treatment of isolated dissection of the celiac artery: A case report and literature review

RATIONALE

Isolated dissection of the celiac artery (IDCA) is one of isolated visceral artery dissection, which can occur alone, and can also be complicated with superior mesenteric artery dissection and splenic artery pseudoaneurysm. This disease is very rare in clinic. The exact pathogenesis of IDCA remains unknown. At present, no consensus has yet been reached on the best treatment strategy for this rare disease. In the present study, the clinical data of one IDCA patient diagnosed and treated in our hospital was retrospectively analyzed, and related literatures were reviewed, in order to improve the understanding of the disease.

PATIENT CONCERNS

The patient was a 49-year-old male, who was admitted in our hospital because of "pain of subxyphoid area for one month". One month before, the patient presented with persistent pain in the subxyphoid area after he had a cold, on paroxysmal exacerbation occurred. After taking "stomach drug", the subjective symptoms eased slightly, but the disease attacked again two hours later.

DIAGNOSES

The patient was diagnosed with "isolated dissection of the celiac artery" by enhanced CT.

INTERVENTIONS

The patient was interventionally treated with bare stent implantation.

OUTCOMES

The symptom of the patient disappeared after interventional therapy.

LESSONS

In the present study, the clinical symptoms and treatment process of one patient with IDCA were described. The clinical symptoms of IDCA are often atypical, and its incidence is extremely low, therefore it is extremely easily misdiagnosed. The definite diagnosis depends on imaging examination. Interventional therapy is the first choice for treating this disease due to its advantages of small trauma and good curative effect.

Comparison between multi-slice spiral CT and magnetic resonance imaging in the diagnosis of peritoneal metastasis in primary ovarian carcinoma

The advent of disease evaluation by means of multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) represents a continually emerging role in the evaluation of various diseases; however, its role is yet to be adequately defined. Thus, the aim of the study was to compare the diagnostic value of MSCT and MRI in the diagnosis of peritoneal metastasis in primary ovarian carcinoma. Between January 2013 and December 2015, MSCT or MRI data were collected from 42 patients who had been previously diagnosed with peritoneal metastasis of ovarian carcinoma at the First Affiliated Hospital of Kunming Medical University. The tumor location, size, edge, and shape were all evaluated independently by three qualified imaging physicians using a double-blind method to confirm whether the patients were indeed suffering from peritoneal metastasis, as well as to rank the metastatic lesions recorded on a five-point scale. It was hypothesized that MRI and MSCT were comparable in the evaluation of ovarian carcinoma. Therefore, a receiver operating characteristics (ROC) curve was used to analyze the results and also to directly compare the respective diagnostic values of MSCT and MRI. In total, 165 metastatic lesions were confirmed by means of surgical operation. MSCT revealed 131 metastatic lesions, while MRI confirmed 154 metastatic lesions. The metastatic sites were primarily located on the subphrenic, epiploon, and gastrocolic ligaments and were further confirmed by either MRI or CT. In regard to MSCT, the most common site of underdiagnoses was in the vicinity of the uterus-rectum-fossa. MRI displayed a high detection rate in every site. The omission diagnostic rate of MSCT and MRI were 20.61% and 6.67%, respectively, while the accuracy rates were 79.39% and 93.33%, respectively. The obtained results revealed that the MSCT value of area under the ROC curve was smaller than that for MRI. Our findings provided evidence asserting that MRI, in comparison to MSCT, was more accurate in diagnosing peritoneal metastasis in patients with ovarian carcinoma.

Study on the diagnosis of small hepatocellular carcinoma caused by hepatitis B cirrhosis via multi-slice spiral CT and MRI

The present study compared the diagnostic accuracy of multi-slice spiral computed tomography (CT) and magnetic resonance imaging (MRI) on small hepatocellular carcinoma (SHCC) caused by hepatitis B cirrhosis. A total of 160 patients with hepatitis B cirrhosis were selected between January 2012 and April 2016, and 183 SHCC lesions were included in the present retrospective study. Patients were divided into the SHCC group (T stage) and the micro hepatocellular carcinoma (MHCC) group (T1 stage). There were a total of 129 SHCC lesions and 54 MHCC lesions identified. All patients underwent multiphasic CT and MRI imaging. The liver acquisition with volume acquisition (LAVA) technique was utilized for MRI. Furthermore, SPSS 20.0 was used for statistical analyses. LAVA in the arterial phase and CT in the arterial phase revealed significantly higher diagnostic rates for the diagnoses of 183 lesions. In addition, standard CT scan exhibited significantly reduced diagnostic rates in SHCC lesions. Results indicated that LAVA in the equilibrium phase had the lowest diagnostic rate in MHCC lesions, which was statistically significant (P<0.05). Overall, the diagnostic rate of CT (79.63%) for MHCC was significantly lower than that of MRI (96.29%) (P<0.05). However, the diagnostic rate of CT for SHCC (96.12%) was significantly higher than that for MHCC (79.63%) (P<0.05). MRI-LAVA in the arterial phase has the highest diagnostic rate for SHCC and MHCC. However, the diagnostic capability of MRI for MHCC lesions is superior to that of CT.

Combination diagnosis of multi-slice spiral computed tomography and secretary phospholipase A2-IIa for solitary pulmonary nodules

INTRODUCTION

This study was aimed to compare the diagnostic value of multi-slice spiral computed tomography (CT) and secretary phospholipase A2-IIa (sPLA2-IIa) in differentiating between malignant and benign solitary pulmonary nodules (SPNs).

METHODS

A total of 223 patients with SPNs (91 patients with malignant SPNs and 132 patients with benign SPNs) were included from Weihai Central Hospital during October 2014 to December 2016. SPN diagnosis was confirmed in all patients using needle biopsy, surgery and bronchoscopy. The patients were managed with dynamic multi-slice CT scans, and their sPLA2-IIa levels were also detected. By selecting the area of interest of focus, the perfusion parameters of multi-slice CT targeting the focus were obtained.

RESULTS

The levels of MTT, PS, BV, BF and sPLA2-IIa significantly increased with increasing severity of SPNs (P<.05). Notably, BV (area under the ROC curve [AUC]=0.915; 95%CI: 0.88-0.95; sensitivity=91.21%; specificity=78.79%) showed a higher potential to discriminate patients with malignant SPNs from those with benign SPNs than did BF (AUC=0.712; 95%CI: 0.65-0.78; sensitivity=72.50%; specificity=59.10%), PS (AUC=0.772; 95%CI: 0.71-0.84; sensitivity=65.93%; specificity=82.58%) and MTT (AUC=0.600; 95%CI: 0.52-0.68; sensitivity=52.75%; specificity=78.03%). Finally, the combined diagnostic value of BV and sPLA2-IIa was quite ideal (AUC=0.947; 95%CI: 0.92-0.97; sensitivity=85.70%; specificity=92.70%) for malignant and benign SPNs.

CONCLUSIONS

The combined diagnostic value of BV and sPLA2-IIa appeared as a desirable detection method for malignant and benign SPNs.

The use of sequential X-ray, CT and MRI in the preoperative evaluation of breast-conserving surgery

The aim of the study was to investigate the value of sequential application of molybdenum target X-ray, multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) in the preoperative evaluation of breast-conserving surgeries. In total, 76 patients with indications for breast-conserving surgery due to complicated breast cancer participated in the study and were assigned to either control or observation group (n=38 per group). The patients in the control group were evaluated with two sets of random combinations of molybdenum target X-ray, MSCT or MRI with ultrasound inspection, whereas the patients in the observation group were evaluated by sequential inspection methods of molybdenum target X-ray, MSCT and MRI. A comparison of surgery outcomes, incidence of complications, rate of positive surgical margins, and recurrence and survival rates in the groups during a follow-up period of 24 months was made. Comparisons of the preoperative evaluation results for tumor number, average maximum diameter, number of lymphatic metastatic groups and number of metastatic lymph nodes in the observation group showed the numbers to be significantly higher than those in the control group (P<0.05). Conversely, the comparisons of age, tumor distribution and T-staging yielded no significant differences, validating the analysis. The percentage of successful breast-conserving surgeries in the observation group was significantly higher than that in the control group, while the incidence of complications in the observation group was lower (P<0.05). The rate of positive surgical margins and the recurrence rate of cancer in the observation group were lower than those in the control group, and the survival rate in the observation group was higher, with differences having statistical significance (P<0.05). In conclusion, the sequential application of molybdenum target X-ray, MSCT and MRI during the preoperative evaluation for breast-conserving surgery positively affects the success rate of the procedure improving the diagnostic accuracy and therapeutic effects.

64-Slice spiral computed tomography and three-dimensional reconstruction in the diagnosis of cystic pancreatic tumors

The present study aimed to describe the characteristics of cystic pancreatic tumors using computed tomography (CT) and to evaluate the diagnostic accuracy (DA) of post-imaging three-dimensional (3D) reconstruction. Clinical and imaging data, including multi-slice spiral CT scans, enhanced scans and multi-faceted reconstruction, from 30 patients with pathologically confirmed cystic pancreatic tumors diagnosed at the Linyi People's Hospital between August 2008 and June 2014 were retrospectively analyzed. Following the injection of Ultravist® 300 contrast agent, arterial, portal venous and parenchymal phase scans were obtained at 28, 60 and 150 sec, respectively, and 3D reconstructions of the CT images were generated. The average age of the patients was 38.4 years (range, 16-77 years), and the cohort included 5 males and 25 females (ratio, 1:5). The patients included 8 cases of mucinous cystadenoma (DA), 80%]; 9 cases of cystadenocarcinoma (DA, 84%); 6 cases of serous cystadenoma (DA, 100%); 3 cases of solid pseudopapillary tumor (DA, 100%); and 4 cases of intraductal papillary mucinous neoplasm (DA, 100%). 3D reconstructions of CT images were generated and, in the 4 cases of intraductal papillary mucinous neoplasm, the tumor was connected to the main pancreatic duct and multiple mural nodules were detected in one of these cases. The DA of the 3D-reconstructed images of cystic pancreatic tumors was 89.3%. The 64-slice spiral CT and 3D-reconstructed CT images facilitated the visualization of cystic pancreatic tumor characteristics, in particular the connections between the tumor and the main pancreatic duct. In conclusion, the 3D reconstruction of multi-slice CT data may provide an important source of information for the surgical team, in combination with the available clinical data.