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Objective:To evaluate spectral CT metal artifacts reduction (MAR) technique in reducing metal artifacts of spinal implants in a phantom.Methods:Ovine spines were chosen as anthropomorphic phantom. The phantom including the pedicle screws, 3D-printed vertebral body (VB) and mesh cage were examined using spectral CT. Postoperative CT images were reconstructed at 70—140 keV with 10 keV interval of MAR and non-MAR. Artifact index (AI) and signal-to-noise ratio (SNR) were evaluated by CT and SD values in ROIs around the implants. Visibility of bony structures, the artifacts of pedicle screw, 3D-printed VB and mesh cage were subjectively evaluated. Plotting curves of AI and SNR with the increasing keV were drawn. The AI and SNR were compared at lower (70 keV), medium (100 keV) and high (130 keV) level between MAR and non-MAR images using the paired t-test, and the subjective scores were compared using Wilcoxon signed rank-sum test. Results:The AI values around pedicle screws (anterior, posterior and lateral), 3D-printed VB and mesh cage decreased with the increase of keV, while SNR improved in MAR and non-MAR images. The AI values in the anterior, lateral and posterior pedicle screws and lateral titanium implants were significantly lower in MAR than those in non-MAR ( P<0.05). The AI value in posterior 3D-printed vertebral was lower in MAR than that of non-MAR only at 70 keV ( P<0.001). The SNR values in the anterior and posterior pedicle screws, 3D-printed VB increased with the increase of keV, but decreased in other ROIs. In the subjective evaluation, the image scores of MAR were higher than those of non-MAR ( P<0.05). Conclusion:Spectral CT using the MAR reconstruction can effectively reduce metal artifacts of spinal implants. The effect is better in pedicle screw and mesh cage than 3D-printed VB.
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Objective:To investigate the accuracy of 3.0 T MR in the diagnosis of full thickness tear and partial thickness tear of the supraspinatus-infraspinatus tendon, and to analyze the causes of missed diagnosis and misdiagnosis of the supraspinatus-infraspinatus tendon tear.Methods:The MRI diagnosis report and arthroscopic surgery records of 210 patients with shoulder joint injuries in Peking University Third Hospital were analyzed retrospectively. Taking the results of arthroscopic surgery as the gold standard, the diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive values of 3.0 T MR for full thickness tear and partial thickness tear of the supraspinatus-infraspinatus tendon were calculated, and the reasons of missed diagnosis and misdiagnosis were analyzed.Results:In 210 patients with rotator cuff injury, the diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MRI for full thickness tear of the supraspinatus-infraspinatus tendon were 81.4% (171/210), 83.1% (98/118), 79.3% (73/92), 83.7% (98/117) and 78.4% (73/93) respectively. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MRI for partial tears of the supraspinatus-infraspinatus tendons were 77.6% (163/210), 65.7% (44/67), 83.2% (119/143), 64.7% (44/68) and 83.8% (119/142) respectively. Among the 44 cases of missed diagnosis and misdiagnosis of the supraspinatus-infraspinatus tendon tear, 21 cases (47.7%) occurred in the junction supraspinatus and infraspinatus tendon-osseous (stop). Among the 7 cases of intra-tendon tear of supraspinatus and infraspinatus muscle, 6 cases were misdiagnosed cases, which was the most easily missed diagnosed type of partial tear. The reason for missed diagnosis was that the signal of partial tear was not high (no fluid signal was shown on T 2WI). Complex laceration was also a type of missed diagnosis in partial tears. Among the 4 cases of superior and inferior surface tendons combined with intra-tendon lacerations, 3 cases were missed diagnosed. Conclusion:3.0 T MR has higher accuracy for the diagnosis of full thickness tear and partial thickness tear of supraspinatus-infraspinatus tendon, but there is still a certain rate of misdiagnosis and missed diagnosis. A full understanding of the causes of misdiagnosis and missed diagnosis of MR in the diagnosis of rotator cuff tears of supraspinatus and infraspinatus tendons is helpful to further improve the accuracy of MR in the diagnosis of supraspinatus and infraspinatus tendon injuries of shoulder joint.
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Objective:To explore the value of X-ray signs with applying low dose of contrast agent to confirm successful puncture in direct shoulder MR arthrography.Methods:In total 669 patients who underwent shoulder MR arthrography in Peking University Third Hospital from January 2016 to August 2018 were retrospectively analyzed. All patients received the anterior approach puncture in shoulder arthrography. X-ray films were taken after 1-2 ml contrast agent was injected. Six X-ray signs of contrast agent distribution were recorded. MR arthrography findings were used to confirm whether the puncture was success. Kappa analysis was used to verify the consistency between each 2 signs. The accuracy rate of each X-ray sign to confirm the successful puncture was calculated. X-ray signs were paired to define the best diagnostic index of successful puncture.Results:Successful puncture was performed in arthrographies for all 669 cases .The displaying rates of six signs were as follows. Contrast agent distribution at overlapping humeral head away from the needle was 66.8% (447/669), in axillary recess was 64.7% (433/669), in glenohumeral space was 93.9% (628/669), in subscapular bursa was 69.8% (467/669), in sheath of long head tendon of biceps brachii (LHBT) was 1.9% (13/669), between LHBT and supraspinatus tendon was 17.2% (115/669). Consistency of each 2 signs was poor (Kappa<0.2), in which the poorest consistency was found between contrast agent overlapping humeral head away from the needle and contrast agent in glenohumeral space (Kappa=-0.115). With combining the above 2 signs, the accuracy rate for defining successful puncture was 100% (669/669).Conclusion:In direct shoulder arthrography by anterior approach, X-ray signs with low dose of contrast agent can be regard as the method to confirm successful puncture. The accuracy rate of the signs of contrast agent distribution at overlapping humeral head away from the needle or in glenohumeral space to define a successful puncture is 100%.
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The cross-fusion research of artificial intelligence technology and spinal surgery represented by machine learning and neural network model is a new research direction and hot issue in the field of artificial intelligence in recent years. The anatomy and disease symptoms of the spine are complex, and the diagnosis and treatment of spinal surgery require rich clinical experience. However, the distribution of medical resources in China is seriously uneven. How to improve the ability of primary medical services so that the most extensive patient groups can benefitis still an urgent problem to be solved. Artificial intelligence is a technical science that researches and develops theories, methods, technologies, and application systems for simulating, extending and expanding human intelligence. With the advent of the era of big data medical technology, artificial intelligence technology may solve this problem by transforming "experts sinking" into "tech sinking" . At present, technologies such as confrontation learning, weakly supervised learning, intensive learning and graph neural networks have become research hotspots in the field of artificial intelligence, and have also played an important role in many fields of clinical medicine. Based on the advantages of deep learning and neural network in disease learning, many spine surgeons combine it with the diagnosis and treatment of cervical spondylosis, low back pain, lumbar degenerative diseases, spinal deformity, spinal tumors, and other spine-related diseases. The rapid location and accurate diagnosis of the disease not only makes it an effective tool for the comprehensive diagnosis of spinal diseases but also provides the basis for the most reasonable treatment options for spinal diseases. In the domestic application of artificial intelligence in the diagnosis and treatment of spinal surgery, it can also solve the problems of difficult diagnosis and complicated treatment of spinal diseases faced by primary doctors, reduce the rate of misdiagnosis and missed diagnosis, and effectively reduce the economic and social burden of spinal diseases. This paper reviews the research progress of artificial intelligence represented by deep learning in the field of diagnosis and treatment of spinal surgery at home and abroad, and the advantages and application prospects of artificial intelligence in the diagnosis and treatment of spinal surgery.
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Objective To explore the best percentage of adaptive statistical iterative reconstruction Veo (ASiR-V)in detection of pulmonary nodule by chest ultralow dose CT (ULDCT).Methods 81 patients with pulmonary nodule detected by chest low dose CT (LDCT)underwent a local ULDCT scan at the center of the nodule with a range of 3 cm scan length.LDCT was performed with the mode of the Assist kV (120/100 kV)/Smart mA with noise indices of 14.1 HU and reconstructed with ASiR-V 50% algorithm.ULDCT was acquired at a tube potential of 120 kV and tube current-time product of 2.8 mAs and reconstructed with ASiR-V 50%,70% and 90%algorithms.Subjective and obj ective image qualities,sensitivities of detection and diameter of nodule among all ULDCT images were compared.Results Compared with the radiation dose of LDCT [(0.9 9±0.3 6)mSv],a 90.2% decrease was seen with the ULDCT, for which the calculated mean effective radiation dose was (0.097±0.007)mSv.The noise values of fat and paravertebral muscle for ULDCT reconstructed with ASiR-V 90% were 12.33±1.86 and 14.82±2.6,which were significantly lower than those in the group of ASiR-V 50% (1 9.73±1.98, 21.19±2.46)and the group of ASiR-V 70% (15.79±1.82,17.71±2.50)(P＜0.05).The subjective scores of images reconstructed with ASiR-V 70% (4.13±0.47)were the highest,which were slightly higher than those in 90%groups (4.03±0.38)(P＜0.05).No significant differences for overall sensitivity of nodule detection were observed among the ULDCT reconstructed with ASiR-V 50%(86.42%),ASiR-V 70%(87.04%)and ASiR-V 90% (88.89%)(P＞0.05).The mean nodule diameter measurements were (6.4±2.0)mm,(5.9±2.2)mm,(6.0±2.2)mm and (6.1 ±2.2)mm for LDCT and ULDCT (ASiR-V 50%,70% and 90%),respectively with P＞0.05.Conclusion At extremely low exposure levels,ASiR-V can obviously improve the image qualities of ULDCT,and 90% is the best percentage for lung algorithm reconstruction with a high sensitivity of pulmonary nodule detection.
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The cross-fusion research of artificial intelligence technology and spinal surgery represented by machine learning and neural network model is a new research direction and hot issue in the field of artificial intelligence in recent years.The anatomy and disease symptoms of the spine are complex,and the diagnosis and treatment of spinal surgery require rich clinical experience.However,the distribution of medical resources in China is seriously uneven.How to improve the ability of primary medical services so that the most extensive patient groups can benefitis still an urgent problem to be solved.Artificial intelligence is a technical science that researches and develops theories,methods,technologies,and application systems for simulating,extending and expanding human intelligence.With the advent of the era of big data medical technology,artificial intelligence technology may solve this problem by transforming "experts sinking" into "tech sinking".At present,technologies such as confrontation learning,weakly supervised learning,intensive learning and graph neural networks have become research hotspots in the field of artificial intelligence,and have also played an important role in many fields of clinical medicine.Based on the advantages of deep learning and neural network in disease learning,many spine surgeons combine it with the diagnosis and treatment of cervical spondylosis,low back pain,lumbar degenerative diseases,spinal deformity,spinal tumors,and other spine-related diseases.The rapid location and accurate diagnosis of the disease not only makes it an effective tool for the comprehensive diagnosis of spinal diseases but also provides the basis for the most reasonable treatment options for spinal diseases.In the domestic application of artificial intelligence in the diagnosis and treatment of spinal surgery,it can also solve the problems of difficult diagnosis and complicated treatment of spinal diseases faced by primary doctors,reduce the rate of misdiagnosis and missed diagnosis,and effectively reduce the economic and social burden of spinal diseases.This paper reviews the research progress of artificial intelligence represented by deep learning in the field of diagnosis and treatment of spinal surgery at home and abroad,and the advantages and application prospects of artificial intelligence in the diagnosis and treatment of spinal surgery.
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Objective To investigate the clinical and imaging manifestations of benign and aggressive spinal osteoblastoma. Methods Seventeen patients with benign osteoblastoma (BO) and 18 patients with aggressive osteoblastoma(AO) from May 2004 to November 2015 diagnosed by orthopedic doctor and pathologist were analyzed retrospectively. Thirty four patients (17 BO, 17 AO ) underwent CT plain scanning, 26 patients underwent MRI. The follow-up time was 6 to 96 months, the postoperative recurrence rate was calculated. The continuous variables including the age, the duration of symptoms and the size of tumor were compared between AO and BO with the 2-tailed Student t test or Mann-Whitney U test. The categorical variables were compared between AO and BO with χ2test.A P value<0.05 was considered statistically significant. Results The age was significantly different between AO and BO [(29.82 ± 14.69) Y vs (19.76 ± 10.33)Y, P<0.05]. The duration of symptoms was significantly different between AO and BO [15(6,96)m vs 6(1,60)m, P<0.05].The size of tumor was significantly different between AO and BO [(4.01 ± 1.46) cm vs (2.08 ± 0.64) cm, P<0.05]. Neurological deficit was found in 2 patients with BO and 9 patients with AO, there was significant difference(P<0.05).In the BO group,the adjacent bone involved(n=3),the calcification of the lesion(n=17),intact bony cortex(n=17),the ill-defined sclerotic bone around the lesion(n=17),the edema of bone marrow and adjacent soft tissue around the lesion (n=11), and intense enhancement (n=2) were observed in BO. While in the AO group, there were 11 patients with adjacent bone involved. The calcification of the lesion (n=12),intact bony cortex(n=0), the ill-defined sclerotic bone around the lesion(n=11),the edema of bone marrow and adjacent soft tissue around the lesion(n=10), and intense enhancement (n=10) were observed in AO. The above imaging features of BO were significantly different from that of AO(P all<0.05).The sex distribution,the location of the lesion,preoperative ALP,the type of bone destruction,the signal intensity were not significantly different between BO and AO(P>0.05).The recurrence rate of AO(37.50%)was significantly different from that of BO (6.67%,P=0.04).Conclusion The clinical features including the age,duration of symptoms,neurological deficit contributed to differentiating BO from AO.The size of AO was bigger than BO,and AO didn't have intact bony cortex.In the AO group,there was less calcification in the lesion,less edema of bone marrow and adjacent soft tissue around the lesion.The post-operation recurrence of AO was higher than BO.
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Objective To analyze the joint lesions of synovial thickening after anterior cruciate ligament (ACL) reconstruction,and to explore the differences of MRI findings between joint infection and adhesion.Methods Clinical and MRI data of 25 patients with synovial thickening (11 with infections and 14 with adhesion) confirmed by arthroscopy were retrospectively analyzed.The time interval from first ACL reconstruction to the arthroscopy after ACL was 0.3-2.5 (mean[1.1±0.6]) months and 6.0-19.0 (mean[11.0±4.9]) months,respectively.Results The lesions caused synovial thickening on MRI included joint infection and joint adhesion.MRI findings of joint infection included synovial thickening,moderate to massive joint effusion,different degrees of soft tissue swelling,bone marrow edema of distal femur and proximal tibia,ACL graft continuous fiber (high signals in 5 patients) and bone tunnel pseudo widened in 5 patients,while of joint adhesion included synovial thickening,striped short T2 signals in part of the thickened synovium on suprapatellar bursa,medial and lateral recess,the infrapatellar fat pad and the intercondylar fossa,without or only a small amount of joint effusion,ACL graft continuous,as well as high signals and rough edge in 3 patients,while bone tunnel was not significantly widened.Statistical differences of joint effusion,soft tissue swelling,edema of bone marrow and bone tunnel pseudo widened were found between joint infection and joint adhesion (all P＜0.05).Conclusion MRI findings of joint infection mainly included synovial thickening,joint effusion and high signal of joint cavity,while of joint adhesion were synovial thickening,equal or slightly high signal of joint cavity.Joint infections mainly occurred in the early stage after operation,while joint adhesions mainly occurred in the middle and late stage after operation.
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Objective To assess the feasibility of quantitative measurement of subcutaneous and supraclavicular adipose tissue with iterative decomposition of water and fat with echo asymmetry and least square estimation-iron quantification sequence (IDEAL-IQ).Methods Totally 87 normal young female volunteers (20-35 years old) were recruited and divided into body mass index (BMI)＜24 kg/m2 group (n=72) and BMI≥24 kg/m2 group (n=15).Fat fraction (FF) and T2* relaxation rate (R2*) of supraclavicular adipose tissue,chest wall adipose tissue,abdominal wall adipose tissue and liver were measured,respectively.The differences of FF and R2* value of chest wall,subcutaneous and supraclavicular adipose tissue were compared between two groups,and the correlation between FF,R2* value of supraclavicular adipose tissue and BMI was respectively analyzed.Results FF of supraclavicular adipose tissue ([80.99 ± 7.73]％) was lower than that of chest wall subcutaneous adipose tissue ([93.04 ± 1.55] ％,P＜0.001).R2* of supraclavicular adipose tissue ([65.52±23.59]Hz) was higher than that of chest wall subcutaneous adipose tissue ([38.82±7.11]Hz,P＜0.001).The differences of FF and R2* values of supraclavicular adipose tissue,chest wall,abdominal wall subcutaneous adipose tissue and liver were significant between BMI＜24 kg/m2 group and BMI≥24 kg/m2 group (all P＜0.05).There was positive correlation (r=0.601,P＜0.001) between FF of supraclavicular adipose tissue and BMI and negative correlation (r=-0.409,P =0.001) between R2* of supraclavicular adipose tissue and BMI.Conclusion IDEAL-IQ technique can quantitatively assess the difference between subcutaneous and supraclavicular adipose tissue in healthy young women.FF and R2 * value has significant difference between the above mentioned positions.
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Objective To explore the value of T1ρin the diagnosis of knee osteoarthritis(OA),and to compare the diagnostic ability of T1ρ, MR and arthroscopy for early patellar cartilage injury.Methods 28 patients underwent T1ρMR imaging.We processed the images and measured T1ρvalues of the normal and damage cartilage.All cases were recorded results of MR and arthroscopy.Results T1ρ sequence could show cartilage clearly,and performed different colour levels,T1ρvalues of normal cartilage were less than 50 ms,and increased with aggravation of cartilage injury.The differences ofⅠ-ⅡandⅢ-Ⅳhad statistically significant.9 cases in grade 0 under MR and arthroscopy performed high values in T1ρ,which similar to gradeⅠ-Ⅱinjury,the diagnosis sensitivity of T1ρfor early cartilage injury was higher than MR and arthroscopy.In addition,arthroscopy and MR had high consistency in the diagnosis of cartilage.Conclusion T1ρcan effectively predict early cartilage injury and knee OA non-invasively,and can detect early cartilageinjury before MR and arthroscopy.
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Objective To investigate the MRI features of spinal epidural angiolipomas.Methods Clinical and MRI data of 18 patients with spinal epidural angiolipomas confirmed pathologically were retrospective analyzed.The MRI features of lesion site,size,shape,signal,bone destruction,enhancement and typing were observed and analyzed.Results One case of 18 cases were located in cervical vertebra,15 cases were thoracic vertebra,and 2 cases were lumbar vertebra.Ten cases formed paravertebral lump through foramen intervertebrale and damaged adjacent bones.MRI showed that T1W1 signal intensity was either isointense (n 11),mixed intense (n=5) or hyperintense (n =2).T2WI showed signal intensity was hyperintense (n=13) or mixed intense (n=5).The fat signal was seen in 5 cases,both T1W1 and T2W1 showed hyperintense.All the 18 cases showed remarkable enhancement.Ⅰ type (lesions confined to the spinal canal) was 8 cases (8/18,44.44％),Ⅱ type (lesions were dumbbell-shaped to the spinal canal) was 10 cases (10/18,55.56％).Conclusion The location of occurrence and the manifestations of MRI in spinal epidural angiolipomas have certain characteristics,which provides important clues to the preoperative diagnosis.
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Objective To explore the diagnostic value of ADC values in fetus with mild ventriculomegaly.Methods Fifteen fetuses with mild ventriculomegaly (mild ventriculomegaly group) and fifteen healthy controls (control group) were scanned with DWI.The ADC values in bilateral frontal lobes,parietal lobes,temporal lobes,occipital lobes,basal ganglia,thalamus and cerebella were measured.The ADC values of mild ventriculomegaly group were compared with those of control group.And the ADC values in left regions were compared with those in right regions of fetuses with mild ventriculomegaly.The correlation between ADC values of all fetuses and gestational age,as well as the correlation between the diameters of ventriculomegaly in feutes with mild ventriculomegaly and gestational age were analyzed.Results Compared with control group,ADC values were lower in bilateral frontal lobes and parictal lobes in mild ventriculomegaly group (all P＜ 0.05).There were no significant differences of ADC values between left regions and right regions (all P＞0.05).Correlation analysis showed that ADC values of all fetuses in bilateral occipital lobes,basal ganglia,thalamus,cerebella and left temporal lobe were negatively correlated with gestational age.The diameters of ventriculomegaly were positively correlated with gestational age (r=0.635,P=0.011).Conclusion The ADC values decrease in frontal lobes and parietal lobes in fetuses with mild ventriculomegaly.The ADC value may be more sensitive for detecting potential damage of brain,which is helpful for the diagnosis of fetus ventriculomegaly.
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Objective To detect the application value of the apparent diffusion coefficient (ADC) values using diffusion weighted imaging (DWI) in detection of fetus with enlargement of cisterna magna.Methods Sixteen fetuses with enlargement of cisterna magna (group 1) and other sixteen healthy controls (group 2) were scanned by DWI.The ADC values were measured and compared between two groups at the same regions, and between left and right brain in group 1.The correlations between ADC values,the enlarged degree of cisterna magna and gestational age were calculated respectively.Results The ADC values were lower in the white matters of bilateral frontal lobes and parietal lobes, bilateral thalami and cerebellum in group 1 than those in group 2.There were no significant differences in ADC values between left areas and right areas in group 1 (P>0.05).The ADC values in bilateral basal ganglia and thalami were negatively correlated with the gestational age (P0.05).Conclusion The ADC values were decreased in certain regions in fetuses with enlargement of cisterna magna, which suggested that ADC value might be more sensitive for detecting potential damage of brain.Combined with conventional MRI, DWI and ADC values could be regarded as accurate protocols for the detection of fetus abnormalities.
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Objective To investigate the CT and MRI features of Langerhans cell histiocytosis (LCH) with multiple spinal involvement.Methods The CT and MRI data of 13 patients with multiple LCH lesions in spine confirmed by pathology were retrospectively analyzed.All of 13 cases underwent CT examination (1 case underwent enhanced scanning) and 12 cases underwent MR examination (6 cases underwent enhanced scanning).Results In 13 cases,there were 8 cases of single central lesions invading the adjacent vertebrae and 5 cases of multiple central lesions.There were 19 core spinal lesions and 15 adjacent invading lesions in a total of 34 vertebrae lesions.Eighteen core lesions (18/19,94.74 ％) had different degrees and shape of vertebral compression.A total of 34 abnormal vertebrae were found in 13 cases by CT,which were manifested as osteolytic bone destruction.Eighteen cortical bones of 19 core vertebrae were incomplete,and a paravertebral soft-tissue masses were observed.There were 33 vertebrae lesions in 12 patients who underwent MR examination,including 18 core spinal lesions and 15 adjacent invading lesions.The lesions displayed equal,slightly lower or low signal on T1WI,slightly higher or high signal on T2WI and high signals on fat suppression sequences.A paravertebral soft-tissue masses were observed in 17 core spinal lesions (17/18,94.44％).Conclusion CT and MRI manifestations of spinal multiple LCH have certain characteristics.The level of diagnosis and differential diagnosis should be improved by deepen understanding of the disease image performance,but the diagnosis still depends on the pathology.
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Objective To explore the imaging appearances of adult Langerhans cell histiocytosis (LCH) in spine and improve the awareness of this disease.Methods Imaging appearances of 29 patients with adult LCH in spine confirmed by clinic and pathology were analyzed retrospectively and the lesions number,location,the type of bone destruction,paravertebral and intraspinal and MRI signal and enhancement characters were evaluated.Results The total sum of spine lesions was 48 including 26 cervical lesions,17 thoracic lesions and 5 lumbar-sacrum lesions among 29 cases,and 11 cases involved multiple segments.Bone destruction was located in vertebral body in 15 cases accounting for 51.72％ (15/29),and 14 cases involved posterior arch accounting for 48.28％ (14/29).Sclerosis rim was found in 10 cases (10/29,34.48％) and bone sclerosis was found in 4 cases (4/29,13.79％).75.86％ (22/29) LCH extended to paravertebral space and the incidence of compressed fracture was 48.28％ (14/29),4.13％ (7/29) appeared as vertebra plana.On T2-weighted image,LCH showed iso-or-hypointensity (11/19,57.89％),hyperintensity (6/19,31.58％),heterogenous signal (2/19,10.53％).On MR enhanced scan,94.12％ (16/17) cases was significant enhanced,5.88％ (1/17) was moderate enhanced.Conclusion Cervical was commonly found in adult LCH,and bone destruction was mainly in vertebrae.It may involve one or multiple spine segments and bone destruction may be continuous or skip distribution.Vertebra plana was not rare.Bone sclerosis around bone destruction may be helpful for diagnosing LCH.
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Purpose To explore the CT and MRI manifestations of spinal solitary fibrous tumor (SFT) to improve the accuracy of imaging diagnosis.Materials and Methods CT and MRI manifestations of eight pathologically confirmed SFT were retrospectively analyzed.CT and MRI scan were performed in 8 cases.The location,shape,size,density/signal,margin,condition of the internal lesion,adjacent bone destruction and reinforcement characteristic were also analyzed.Results Of the 8 patients,4 cases were pathologically confirmed benign and the other 4 cases were malignant.6 cases showed trans-intervertebral foramen dumbbell shaped soft tissue masses,1 case showed lobulated soft tissue mass lying outside the invertebrate canal and 1 case showed long fusiform lying in intradural extramedullary of spinal canal.6 cases had adjacent bone swelling or osteolytic destruction,1 case had compressive bone defect,and 1 cases showed no obvious bone destruction.The tumor showed an equal/mixed density on CT scan.T1WI equal/low signal was seen in MRI scan.Equal/slightly higher T2WI signals were seen in 6 cases and mixed signals in 2 cases.All patients undergoing enhanced scan showed obviously inhomogeneous enhancement.Conclusion Spinal solitary fibrous tumors are lobulated or dumbbell shaped and growth clinging to or surround the dura mater.The feature of MRI signal is evident that T1WI is mostly equal/low signal and T2WI is usually slightly higher/equal signal,often accompanied by bone destruction.
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Purpose To explore the application value of dynamic contrast enhanced MRI (DCE-MRI) in judging and diagnosing metastasis of lung cancer.Material and Methods Sixty-one metastatic spinal tumor patients received DCE-MRI and their images acquired after scanning were post-processed.Signal intensity-time curve,signal intensity amplification in rising period of the curve (Peak SE％),maximum ascending linear slope of the curve (Max Wash-in SE％) and descending slope of the curve (Wash-out SE％) and other semiquantitative parameters were acquired.Double chamber pharmacokinetics was adopted to analyze and obtain Ktrans,rate constant (Kep) and other quantitative parameters.CHAID method was taken to establish tree structure model to confirm optimal sorting parameter and identify optimal division.Results For the DCE-MRI scanning parameters for 61 metastatic spinal tumor patients,differences of Wash-out SE％ and Kep between lung cancer and other tumor spinal metastasis were statistically significant (P＜0.01),while differences of Peak SE％,Max Wash-in SE％ and Ktrans between the two were not statistically significant (P＞0.05).When Wash-out SE％＞-660.6％ and Max Wash-in SE％＞98.0％,original focus of about 94.7％ was possible to come from lung.When taking tree structure model set up in the study for identification,10-fold cross-validation indicated (29.5±5.8)％ error rate.Conclusion Taking DCE-MRI semi-quantitative and quantitative analysis parameters for identification and diagnosis of metastasis of lung cancer is feasible.It can provide reference evidence for source identification of spinal sarcoma and clinical treatment.
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Purpose Early diagnosis of Alzheimer's disease is lack of objective imaging marker.This study evaluates characteristics of cerebral blood flow (CBF) and gray matter atrophy in patients with mild Alzheimer's disease (AD) by using 3D arterial spin labeling (3D ASL) and thin slice 3D T1 weighted images of voxel-based method (VBM).Materials and Methods Sixteen mild AD patients (mild AD group) and sixteen normal control subjects (control group) were recruited.3D ASL and T1WI SPGR sequences were performed.By using voxel-based method,the whole brain CBF and T1WI images were analyzed.CBF and volume of gray matter were compared between two groups,and correlation analysis was done.Results Compared with control group,CBF hypoperfusion was detected in bilateral precuneus,cunei,middle temporal cortex,superior temporalcortex,left parahippocampal gyrus,left superior temporal pole and right superioroccipital gyrus in mild AD group (t=3.84,Pcorrected＜0.05).Compared with control group,gray matter atrophy was found in bilateral hippocampi,amygdalae,superior temporal pole,left parahippocampal gyrus,left inferior temporal cortex in mild AD group (t=4.12,Pcorrected＜0.05).There was a correlation in left parahippocampal gyrus and left upper pole of the temporal between changes of CBF and volume of gray matter in mild AD patients (r=0.50,P＜0.05).Conclusion Voxel-based VBM and ASL can evaluate AD patients' cerebral atrophy and CBF change in early stage,and there is a correlation between changes of CBF and gray matter atrophy in some overlap areas.
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Objective To study the correlations among lumbosacral anatomical structure variations and herniation of intervertebral disc.Methods Through analyzing lumbar CT images of 684 patients with lumbocrural pain between 15 to 24 years old, the anatomical variations of spondylolysis, scoliosis deformity, lumbosacral transitional vertebra, subfissure, lumbosacral angle and others (including vertebral muscles beside, spines, transverse process on both sides) were observed, and the correlations among these anatomical variations and herniation of intervertebral disc were analyzed.Results The correlations among these above mentioned anatomical variations and herniation of intervertebral disc were 93.6%,92.3%,87.5%,81.3%,72.1%,53.3% respectively.In 91.4% of patients, the lumbosacral anatomical structure variations suffered herniation of intervertebral disc at the same time.But only 36.2% of patients suffered herniation of intervertebral disc without lumbosacral anatomical structure variations.Conclusion Lumbosacral anatomical structure variation is the main reason of herniation of intervertebral disc on teenagers.CT examination,which can reflect the correlation between them.
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Objective To evaluate the efficacy of computed tomography ( CT ) image?guided 125 I radioactive seed implantation for locally recurrent rectal cancer ( LRRC ) , and to analyze the relationship between the dosimetry and prognosis. Methods A retrospective analysis was performed on the clinical data of 36 patients with LRRC who received CT image?guided 125 I seed implantation in our hospital from 2003 to 2011. Dosimetric verification was performed using CT scan immediately after 125 I seed implantation. The D90 , D100 , V100 , and V150 values were evaluated. In all the patients, the median activity of seeds was 0?7 mCi (0?4?0?8 mCi) and the median number of implanted seeds was 74(33?137). The local control (LC) and overall survival ( OS ) rates were calculated using the Kaplan?Meier method. The log?rank test and Cox regression model were used for the univariate and multivariate analyses, respectively. Results The median OS time was 16?2 months ( 95% CI= 13?5?18?9 months ) . The median LC time was 10?0 months (95% CI=6?2?13?8 months). The D90 and V100 values were (118.6±25?1) Gy and (90.0±0?3)%, respectively. The univariate analysis suggested that D90 was correlated with the LC time ( P=0?048) and V100 was correlated with the OS time ( P=0?035) . The multivariate analysis showed that a V100 value higher than 90% was a prognostic factor of OS (P=0?044). Conclusions In the treatment of LRRC using CT image?guided 125 I radioactive seed implantation, a D90 value larger than 140 Gy and a V100 value higher than 90% in the postoperative verification plan help improve the LC and OS rates. The D90 and V100 values in the postoperative verification plan may predict treatment outcomes in patients.