Microhemorrhage identified on 3.0 T MR susceptibility-weighted imaging for prognosis of viral encephalitis.

OBJECTIVE: To evaluate the relationship of microhemorrhage on susceptibility-weighted imaging (SWI) with the severity of clinical symptoms and the prognosis of viral encephalitis. MATERIALS AND METHODS: Thirty patients with clinically diagnosed viral encephalitis were divided into three groups according to the Glasgow Coma Scale (GCS) and the condition of recovery namely, Group I (n = 12): Glasgow Coma Scale (GCS)≥13 and recovered with no sequelae; Group II (n = 11): GCS 9-12 and recovered with some sequelae; Group III (n = 7): GCS 3-8 and recovered with more severe sequelae. The microhemorrhage detectability on SWI and conventional MR imaging in these three groups was compared and their correlations with different seriousness of clinical symptoms and prognosis were analyzed. RESULTS: There was a significant difference in microhemorrhage volume among different MR sequences (p < 0.05). SWI was more sensitive to detect microhemorrhage than conventional MR imaging techniques. Microhemorrhages on SWI were significantly different among the three groups (p < 0.01). The volume of microhemorrhage on SWI was well correlated with the degree of clinical symptoms and the prognosis of viral encephalitis. CONCLUSION: SWI can be used to detect microhemorrhage in patients with viral encephalitis. Assessment of microhemorrhage with SWI can provide useful information for the prognosis evaluation of viral encephalitis.

A comparison of hepatic segmental anatomy as revealed by cross-sections and MPR CT imaging.

To compare the areas of human liver horizontal sections with computed tomography (CT) images and to evaluate whether the subsegments determined by CT are consistent with the actual anatomy. Six human cadaver livers were made into horizontal slices with multislice spiral CT three-dimensional (3D) reconstruction was used during infusion process. Each liver segment was displayed using different color, and 3D images of the portal and hepatic vein were reconstructed. Each segmental area was measured on CT-reconstructed images, which were compared with the actual area on the sections of the same liver. The measurements were performed at four key levels namely: (1) the three hepatic veins, (2) the left, and (3) the right branch of portal vein (PV), and (4) caudal to the bifurcation of the PV. By dividing the sum of these areas by the total area of the liver, the authors got the percentage of the incorrectly determined subsegmental areas. In addition to these percentage values, the maximum distances of the radiologically determined intersegmental boundaries from the true anatomic boundaries were measured. On the four key levels, an average of 28.64 ± 10.26% of the hepatic area of CT images was attributed to an incorrect segment. The mean-maximum error between artificial segments on images and actual anatomical segments was 3.81 ± 1.37 cm. The correlation between radiological segmenting method and actual anatomy was poor. The hepatic segments being divided strictly according to the branching point of the PV could be more informative during liver segmental resection.

[Application of prospective ECG-triggering dual-source CT angiography in infants and children with congenital heart disease].

OBJECTIVE: To explore the application of prospective ECG-triggering dual-source CT (DSCT) angiography in infants and children with complex congenital heart disease (CHD) compared with transthoracic echocardiography (TTE). METHODS: Eighty-seven patients (mean age: 28 months, range 3 months to 6 years; male 46; mean weight: 15 kg) underwent prospective ECG-triggering DSCT angiography and TTE. Surgery was performed in 54 patients. The overall imaging quality was evaluated on a four-point scale. Inter-observer agreement in subjective image quality grading was assessed by kappa statistics. The accuracy of DSCT angiography and TTE was calculated based on the surgery findings in the 54 patients who were performed with surgery. RESULTS: A total of 267 cardiovascular deformities were diagnosed by DSCT angiography, and 231 deformities were diagnosed by TTE. There was a good agreement on overall image quality (kappa = 0.78). A total of 173 cardiovascular deformities were confirmed by surgery findings in 54 patients. The accuracy of DSCT angiography and TTE was 97.69% (169/173) and 82.08% (142/173). The mean effective dose was (0.40 ± 0.08) mSv. CONCLUSIONS: Prospective ECG-triggering DSCT angiography with a very low effective radiation dose allows the accurate diagnosis of anomalies in infants and children with complex CHD compared with TTE. It has great value for preoperative assessment of CHD.

[Functional magnetic resonance imaging on acupuncturing Yuan-Source and He-Sea acupoints of stomach Meridian of Foot-Yangming].

OBJECTIVE: To explore the functional brain localization with magnetic resonance imaging (MRI) after acupuncturing the Yuan-Source and He-Sea acupoints of Stomach Meridian of Foot-Yangming (ST). METHODS: The study was performed in 30 healthy volunteers who underwent acupuncture at Yuan-Source acupoint (Chongyang, ST42) and He-Sea acupoint (Zusanli, ST36) (ST group). Ten of these were also underwent acupuncture at the non-acupoints as the control group. Blood oxygenation level dependent functional MRI was performed. RESULTS: In the ST group, signal increasing areas were demonstrated in bilateral superior temporal gyri (Broadmann 22), bilateral supramarginal gyri (Broadmann 40), bilateral cerebellar hemispheres, bilateral cingulate gyri and isthmus of cingulate gyri (Broadmann 32, 30), bilateral superior parietal lobules (Broadmann 7); signal decreasing areas were shown in bilateral orbital gyri (Broadmann 11), bilateral temporal pole (Broadmann 38), right inferior frontal gyrus (Broadmann 47) and right medial occipitotemporal gyrus (Broadmann 36). In the control group, signal increases areas were demonstrated in superior temporal gyri, precentral gyri, cingulate gyri, thalamus, insula and cerebellum. The size, signal intensity and number of increasing areas in control group are less than in ST group. CONCLUSION: Combined acupuncture of Yuan-Source and He-Sea acupoints of ST can activate and decrease the multiple brain regions of "splanchnic brain" and thus reach a new functional balance to relieve pain.

Clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot.

OBJECTIVE: To explore the clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. METHODS: Eighteen patients with diagnosed Tetralogy of Fallot underwent cardiac CT angiography with 64-slice CT (CTA). Two- and three-dimensional images were used for diagnosing in all cases by means of MPR (coronal, sagital and oblique), cMPR, MIP and VRT. RESULTS: All patients had ventricular septal defect, pulmonary stenosis and hypertrophy of right ventricle. The morphologic features of Tetralogy of Fallot were equal to echocardiography. Patent ductus arteriosus (PDA) were detected on eight patients. Main coronary artery branches and partial sub-branches were visualized in all patients. Abnormal coronary arteries were found in seven cases: both left and right main coronary artery arising from the right aortic sinus one case, right main coronary artery and circumflex (CX) arising from the right aortic sinus one case, left anterior descending (LAD) and CX arising from left aortic sinus directly one case, left and right coronary artery arising from back and front of the aortic sinus, respectively, three cases. Pulmonary artery branch stenosis was found in 12 cases and branch pulmonary artery dilation noticed in 1 case. Double superior vena cava was also found in one case. According to the surgery the diagnostic accuracy of CT and Echocardiography was 95.45 and 83.33%, respectively. CONCLUSION: Two- and three-dimensional 64-slice CTA not only show the overall anatomical structure of the heart, but also show coronary and pulmonary arteries. With these results, evaluation of coronary anomalies and pulmonary artery stenosis with 64-MSCT is extremely valuable for planning the operative procedure on the patients with Tetralogy of Fallot.

Technical feasibility and histopathologic studies of poly (N-isopropylacrylamide) as a non-adhesive embolic agent in swine rete mirabile.

BACKGROUND: Non-adhesive liquid embolic agents are increasingly gaining importance in the embolization of cerebral arteriovenous malformations (AVMs). We investigated the use of poly (N-isopropylacrylamide) (PNIPAM) as a non-adhesive embolic agent in swine rete mirabile. METHODS: The PNIPAM hydrogel was mixed with iohexol and embolization was performed in swine rete mirabile in 30 animals. The microcatheter was examined after embolization. Follow-up angiography was performed for embolic efficacy after embolization. Embolized retia were examined histopathologically, and the alterations of inside rete and surrounding tissue were observed. RESULTS: The copolymer hydrogel was used for rete embolization in 30 swine, 28 swine survived the procedure, 2 swine died, 1 swine died of cerebrum infarction and the other died of embolic agent reflux into the occipital artery. The inside wall of the microcatheter was smooth, without copolymer adhering to it. Follow-up angiography was performed in 22 swine, there was no rete recanalization in 20 swine and partial rete recanalization in 2 swine because of the trunk embolization of ascending pharyngeal arteries. Histopathologically, the copolymer was found diffused into vessels of 100 - 150 microm in diameter. In acute group, neutrophils scattered surrounding the copolymer and endothelial integrity was observed, without endothelial denuding and necrosis. In subacute and chronic groups, the copolymer was found inside retia, a few mononuclear cells and eosinocytes scattered inside and surrounding it. The muscular layer was loosened with most muscular nuclei degraded. CONCLUSION: Experimental rete embolization with PNIPAM, made radiopaque with iohexol, is technically feasible in swine. Because of its properties, PNIPAM has great potential as a therapeutic non-adhesive embolic agent.

[The application of multi-slice CT dynamic enhancement scan in the diagnosis and treatment of colonic lymphomas].

OBJECTIVE: To discuss the value of multi-slice CT dynamic enhancement scan in the diagnosis and treatment of colonic lymphomas. METHODS: 16 patients with colonic lymphomas underwent multi-slice CT dynamic enhancement scans, images of axial and reconstructive images of VR, MPR and CTVE were analyzed, patients were respectively diagnosed. RESULTS: Appearances of primary colorectal lymphomas were categorized into focal and diffuse lesions. Focal and diffuse lesions were 6 and 10 patients, respectively. The accuracy rate of diagnosis was 87.5%. CONCLUSION: MSCT dynamic scan has distinctive superiority in diagnosis and treatment of colonic lymphomas.

[Multi-slice spiral CT using spinal structure assessment in elderly patients with osteoporosis].

OBJECTIVE: To explore the clinical value of 64-slice spiral CT for spinal structure assessment in elderly patients with osteoporosis. METHODS: The computed radiography (CR) films and 64-slice spiral CT isotropic scanning images of 40 patients who had been diagnosed as osteoporosis by dual-energy X-ray absorptiometry (DXA) were retrospectively analyzed. The patients were divided into two groups according to their T-scores by DXA: group A (T-score was -1.0 - (-2.5)); and B group (T-score was below -2.5). RESULTS: The diagnostic results of axial CT images combined with multi-planar reconstruction (MPR) was negatively correlated with the measurement results of DXA in the diagnosis of spinal osteoporosis, and such correlation was higher in group B than in group A. Compared with CR films, axial CT images combining with MPR showed superior effectiveness in the diagnosis of osteoporosis. CONCLUSIONS: 64-slice spiral CT is better than CR in diagnosis of osteoporosis. CT-MPR and 3D reconstruction not only can be used to diagnose osteoporosis early, but also to observe the changes of skeleton's shape and overall structure.

Significance of the preoperative guidance of dual-source CT in carotid body tumor.

BACKGROUND: Accurate views of the head and neck vessels, tumor angiogenesis and the relationship of tumor and the surrounding blood vessels are especially crucial to carotid body tumor (CBT) patients. The aim of this study was to explore the value of dual-source CT (DSCT) cerebral and carotid angiography in CBT diagnosis. METHODS: DSCT cerebral and carotid angiography was performed on nine patients with CBT. Two-dimensional and three-dimensional reconstruction images were obtained by means of multiple planar reconstructions (MPR), maximum intensity projection (MIP) and volume rendering (VR). All patients were subjected to color Doppler flow imaging (CDFI) examination. Two kinds of examinations were performed in 3 days, and all patients were confirmed by surgery. RESULTS: DSCT angiography was successful in all patients. CBTs were diagnosed in 9 patients with 10 lesions (1 case had multiple bilateral CBTs). The largest lesion was 12 cm in diameter, and the smallest one was 1.6 cm in diameter. All patients had clearly demonstrated head and neck vessels, tumor angiogenesis, and tumor relationship with the surrounding blood vessels. The internal and external carotid artery (ICA, ECA) were involved in 2 cases. There were 7 cases with basilar artery ring integrity, and 1 case had the posterior communicating artery absent; 1 case had middle cerebral artery stenosis; 4 cases (4 tumors) showed arterial phase homogeneous enhancement; 5 cases (6 tumors) had obvious heterogeneous enhancement where irregular low-density necrosis could be seen in the tumors. CDFI could demonstrate the nearby blood vessels and tumor structure, instead of tumor angiogenesis. However, DSCT can display both the tumor and the peripheral vascular tumor angiogenesis consistent with surgical findings. CONCLUSIONS: DSCT cerebral and carotid angiography can provide reliable information for the operation. It might be a valuable CBT diagnostic method by showing accurate views of the CBT along with the bilateral neck and brain blood vessels.

Diagnostic value of dual-source CT in Kawasaki disease.

BACKGROUND: Doppler color echocardiography is a common method for detecting coronary artery lesions in patients with Kawasaki disease (KD). However, the diagnostic accuracy for the whole coronary artery lesions is limited. The purpose of this study was to compare the diagnostic value of dual-source computed tomography (DSCT) and Doppler color echocardiography for the assessment of coronary artery lesions caused by KD. METHODS: Sixteen patients, 12 with typical KD and 4 with atypical KD, underwent DSCT and Doppler color echocardiography. The position and internal diameter of each coronary artery lesion was measured. Correlation analysis was used to compare the diagnostic value of the two imaging modalities. RESULTS: In the typical KD group, seven patients did not have any coronary artery lesion as confirmed by both DSCT scans and Doppler color echocardiography; in four patients proximal coronary artery injuries were identified by both modalities; in one patient an aneurysm in the middle and distal segments of the coronary artery was detected by DSCT but was negative in Doppler color echocardiography. In the atypical KD group, three cases showed the same results with both modalities, while one case with coronary artery stenosis in the middle segment was identified by DSCT but not detected by Doppler color echocardiography. There was a good correlation between the two imaging modalities (Kappa value, 0.768 (>or= 0.75)). CONCLUSION: DSCT coronary artery angiography is an accurate, non-invasive, and valuable technique for detecting and following up coronary artery lesions in patients with KD.

[CT multiplan reconstruction images of disorder of stapes].

OBJECTIVE: To evaluate the clinical application of multi-planar reformation (MPR) for the stapes with multi-slice spinal thin-section CT in the patients with disorder of stapes before prosthetic ossicular reconstruction and their impact on surgical decision. METHODS: Axial CT scanning of temporal bone was undergone in 50 volunteers. Multiplan reformatted images included coronal, sagittal and oblique MPR, were made. All the MPR images were compared with each other in order to show which one could reveal the whole structures of stapes better. The height of stapes was measured with the oblique MPR. CT findings were evaluated in 102 cases with disorder of stapes. Prosthetic ossicular reconstruction was made in 65 cases. RESULTS: The full stapes cannot be shown in axial, coronal and sagittal MPR images, however, it was shown in oblique MPR in all the cases. The highness of stapes was (3.3 +/- 0.4) mm in the abnormal group. There was chronic otitis media in 69 cases (90 ears) and congenital abnormalities of the stapes in 33 cases (47 ears) which included the dispart of incudostapedial joint in 5 cases (7 ears), defect of head and crus of stapes in 9 cases (13 ears), defect of one side of crus in 3 cases (4 ears) and absence of the oval window in 16 cases (23 ears). CONCLUSIONS: Coronal and oblique MPR images from Axial Spiral CT Data are essential for the pre-operative planning of prosthetic ossicular reconstruction. The ship, structure or defect of stapes can be shown in the oblique MPR images. It is important for the patient to choose the type of operation.