To study the correlation between LI-RADS category with tumor differentiation, Ki67 index, microvascular infiltration, and prognosis in HCC / 中华肝胆外科杂志

Objective:To study the correlation between liver imaging reporting and data system (LI-RADS) category with tumor differentiation, Ki67 index, microvascular infiltration, and predictive prognosis in hepatocellular carcinoma (HCC).Methods:We retrospectively analyzed the clinical and radiological data of 178 patients with HCC who were confirmed by histopathological studies after liver resection between January 2015 and September 2020 at Lishui Central Hospital and Lishui People’s Hospital. There were 156 males and 22 females, with age of (57±10) years old. These patients were assessed for LI-RADS categories according to the 2018 version of LI-RADS, and they were divided into 4 groups according to the assessment results: 12 patients with LI-RADS-3 (the LI-RADS-3 group); 26 patients with LI-RADS-4 (the LI-RADS-4 group); 102 patients with LI-RADS-5 (the LI-RADS-5 group); and 38 patients with LI-RADS-M (the LI-RADS-M group). The patients' general information, tumor markers, pathology and other clinical data were recorded. Correlation analysis between the LI-RADS category with pathology was performed by the Kendall's tau-b test. Survival analysis between groups was performed by the Kaplan-Meier analysis. The Cox regression risk model was used to analyze the relationship between these variables with the risk of death.Results:The Kendall's tau-b test showed that LI-RADS category was positively correlated with the degree of tumor differentiation ( t=0.204, P=0.002), but not with microvascular infiltration and Ki 67 index ( P>0.05). All patients were followed up for 4.2 to 84.2 months (median follow-up 36.3 months). By the end of follow-up, 31 patients had died and 147 patients were alive. The cumulative 1-year and 3-year survival rates of the LI-RADS-5 group were 97% and 90% respectively, which were significantly higher than those in the LI-RADS-M group (81% and 63%), and the LI-RADS-4 group (96% and 81%), ( P<0.05). The cumulative 1-year and 3-year survival rates of patients in the LI-RADS-3 group were 100% and 67% respectively, and there was no statistically significant difference with the LI-RADS-5 group ( P>0.05). The Cox multivariate regression analysis showed that tumor glycoantigen 199 (>50 μl/ml) to be an independent influencing factor in survival of HCC patients ( HR=0.43, 95% CI: 0.24-0.76, P=0.004). Conclusion:The LI-RADS category of HCC was positively correlated with the degree of tumor differentiation, and patients with HCC meeting the LI-RADS-5 criteria had relatively better prognosis.

Primary clinical application of Y-shaped jogged stent in patients with malignant hilar biliary obstruction / 中华放射学杂志

Objective To evaluate the feasibility, safety, and efficacy of Y-shaped jogged stent in patients with malignant hilar biliary obstruction. Methods During the period of January 2010 to June 2015,We retrospectively reviewed 98 cases of malignant hilar biliary obstruction who were received implantation of biliary tract stent. 17 consecutive patients who were treated with Y-shaped jogged stent were identified (group A) during January 2012 to June 2015. Group A was carefully matched according to patients' age, sex, type of tumor, stage, type of biliary obstruction, level of bilirubin at diagnosis, presence of metastasis and treatment, and 17 patients who were underwent unilateral stent placement alone with PTCD were chosen as control group (group B). Patients' baseline characteristics, stenting strategy, complications, stent patency time and survival rates were analyzed, and continuous variables of the two groups were compared using Student's t-test. Categorical variables were analyzed using the Fisher exact test. Results Y-shaped jogged stent implantation group and control groups were closely matched in terms of patients' age, sex, type of tumor, stage, type of biliary obstruction, level of bilirubin at diagnosis, presence of metastasis and treatment ( P>0.05). The bilirubin decreased rate in the two groups was 88.2%and 53.0%respectively (P<0.05). The median time of stent patency after stent implantation was(7.3 ± 1.0)months and(5.7 ± 0.9) months respectively (χ2=4.04,P=0.044), and the median survival time was(9.1 ± 1.5)months and(7.2 ± 1.1)months (χ2=4.60,P=0.032), with significant difference according to Kaplan-Meier analysis. There were no severe complications such as massive hemorrhage, perforation, biliary fistula and severe pancreatitis, which were associated with stent implantation. Conclusions The application of Y-shaped jogged stent is safe, feasible and effective in patients with malignant hilar biliary obstruction. It can relieve the clinical symptoms of biliary obstruction effectively with prolongation of stent patency time and survival rate significantly.

Evaluation of a Chest Circumference-Adapted Protocol for Low-Dose 128-Slice Coronary CT Angiography with Prospective Electrocardiogram Triggering

OBJECTIVE: To assess the effect of chest circumference-adapted scanning protocol on radiation exposure and image quality in patients undergoing prospective electrocardiogram (ECG)-triggered coronary CT angiography (CCTA). MATERIALS AND METHODS: One hundred-eighty-five consecutive patients, who had undergone prospective ECG triggering CCTA with a 128-slice CT, were included in the present study. Nipple-level chest circumference, body weight and height were measured before CT examinations. Patients were divided into four groups based on kV/ref.mAs = 100/200, 100/250, 120/200, and 120/250, when patient's chest circumference was 95.0 (n = 32), respectively. Image quality per-segment was independently assessed by two experienced observers. Image noise and attenuation were also measured. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The effective radiation dose was calculated using CT dose volume index and the dose-length product. RESULTS: A significant correlation was observed between patients' chest circumference and body mass index (r = 0.762, p < 0.001). Chest circumference ranged from 74 to 105 cm, and the mean effective radiation dose was 1.9-3.8 mSv. Diagnostic image quality was obtained in 98.5% (2440/2478) of all evaluated coronary segments without any significant differences among the four groups (p = 0.650). No significant difference in image noise was observed among the four groups (p = 0.439), thus supporting the validity of the chest circumference-adapted scanning protocol. However, vessel attenuation, SNR and CNR were significantly higher in the 100 kV groups than in the 120 kV groups (p < 0.05). CONCLUSION: A measure of chest circumference can be used to adapt tube voltage and current for individualized radiation dose control, with resultant similar image noise and sustained diagnostic image quality.

Diagnostic value of multi-slice CT for adult non traumatic acute abdomen / 中华放射学杂志

Objective To investigate the value of MSCT and its reconstruction technique for etiological factors of adult non traumatic acute abdomen.Methods The CT findings and clinical data of 1 632 adult patients with non traumatic acute abdomen confirmed by clinical treatment or pathological examination from July 2007 to June 2013 were retrospectively analyzed.Six hundred and sixty-four patients underwent plain scan and 968 patients underwent plain and enhanced scan.We observed MSCT manifestations of acute abdomen , calculated the accurate rate of diagnosis , and analyzed causes of missed diagnosis or misdiagnosis.Results CT diagnosis of 1 580 cases were entirely or partially consistent with the final results in 1 632 cases.Overall accuracy rate was 96.8%.Misdiagnosis or missed diagnosis accounted for 3.2% ( 52/1 632 ).The corresponding accuracy rates using CT with various etiology were: urinary system stones 100.0% ( 293/293 ) , appendicitis 99.3% ( 278/280 ) , abdominal tumors 98.3%(227/231), cholecystitis and cholelithiasis 96.4% (213/221), acute pancreatitis 95.8% (159/166), intestinal adhesion 92.6%(100/108), gastrointestinal perforation 97.9%(92/94), internal and external hernia 95.2% ( 59/62 ) , intussusceptions 95.4% ( 42/44 ) , volvulus 91.7% ( 33/36 ) , foreign bodies 95.6%(22/23), ectopic pregnancy 92.3%(12/13), vascular disease 100.0% (16/16), inflammatory bowel disease 77.8%(7/9), and other diseases 75.0%(27/36).The main cause of missed diagnosis was the absence of obvious morphologic changes at early stage of the diseases.Atypical MSCT features resulted in misdiagnosis.Conclusion MSCT is a valuable tool in diagnosing adult non traumatic acute abdomen and its etiology.

CT features of renal epithelioid angiomyolipoma / 中华放射学杂志

Objective To explore the CT features of renal epithelioid angiomyolipoma (EAML), and to improve the diagnosis of this disease.Methods The clinical materials and image findings of 15 cases (8 female, 7 male) with renal EAML proved by pathologies were retrospectively studied.Plain and enhancement CT scan were performed in all 15 patients.Nine of the 15 cases were correctly diagnosed and the other were misdiagnosed as renal cell carcinoma (RCC) (n=5), renal oncocytoma (n=1).Results There were some distinctive findings of EAML: (1) Little hypodense or iso-high-density, well defined, round lesion with diameter of 2 to 5 cm.(2) The tumor may involve the medulla of kidney or grow out without haematuria.(3) Most lesions showed obviously uniformity enhancement at artery phase, with a few of them showed inhomogeneous enhancement There were thickening and circuitous vessels in a few lesions.(4) Enhancement mode was quick-in and quick-out.Conclusions CT findings combined with clinical materials have important value in making a correct diagnosis of EAML preoperatively.

Comparison of human mesenteric artery multislice spiral CT images with anatomy / 解剖学报

Objective To measure and evaluate mesenteric artery by comparing the multi-slice spiral CT mesenteric artery images with autopsy specimens. Methods Totally 230 normal subjects were selected to undergo abdominal multi-slice spiral CT and enhanced CT. We processed the images;R3econstructed 3D images, analyzed and compare the mesenteric artery images obtained by multi-slice spiral CT with autopsy specimens. Results 1. Diameters of mesenteric artery obtained by vivo image were significantly larger than that of autopsy specimens (P<0.05);2. Start locations, branch types and running directions of both superior mesenteric artery and inferior mesenteric artery were much different between traditional autopsy specimens information and our results.3. Different reconstruction methods had different advantages. Especially, STS-MIP method could present the level of mesenteric artery better. Conclusion The method for mesenteric artery study using multi-slice spiral CT can enhance scanning and 3D reconstruction with workstation has been approved to work well, and it is superior to traditional autopsy specimen method. It is also convenient for mesenteric artery scientific evaluation. The result data of this method are reliable. Moreover, this method is available to research with large number of specimen.

CT diagnosis of concealed rupture of intestine following abdominal trauma / 中华放射学杂志

Objective To investigate CT findings of concealed rupture of intestine following abdominal trauma.Methods CT findings of 11 cases with concealed rupture of intestine following abdominal trauma proved by surgery were identified retrospectively.Results The main special signs included:(1)Free air in 4 cases,mainly around injured small bowel or under the diaphragnl,or in the retroperhoneal space or and in the lump.(2)High density hematoma between the intestines or in the bowel wall(4 cases).(3)Bowel wall injury sign,demonstrated as low density of the injured intestinal wall,anenuated locally but relatively enhanced in neiighbor wall on enhanced CT.(4)Lump around the injured bowel wall with obvious ring.shaped enhancement(4 cases).Other signs included:(1)Free fluid in the abdominal cavity or between the intestines with blurred borders.(2)Bowel obstruction.Conclusion CT is valuable in diagnosing concealed rupture of intestine following abdominal trauma.