Multi-slice Spiral CT Imaging Research Articles

Diagnostic value of identifying location and amount of free gas in the abdominal cavity by multidetector computed tomography in patients with acute gastrointestinal perforation

Objective: To evaluate the relationships between the location and extent of diffusion of free intraperitoneal air by multi-slice spiral CT (MSCT) and between the location and size of acute gastrointestinal perforation. Methods: This was a descriptive case series. We examined abdominal CT images of 33 patients who were treated for intraoperatively confirmed gastrointestinal perforation (excluding appendiceal perforation) in the Department of General Surgery, Nanfang Hospital between January and September 2022. We identified five locations of intraperitoneal air: the subphrenic space, hepatic portal space, mid-abdominal wall, mesenteric space, and pelvic cavity. We allocated the 33 patients to an upper gastrointestinal perforation (n=23) and lower gastrointestinal perforation group (n=10) base on intraoperative findings and analyzed the relationships between the locations of free gas and of gastrointestinal perforation. Additionally, we established two models for analyzing the extent of diffusion of free gas in the abdominal cavity and constructed receiver operating characteristic (ROC) curves to analyze the relationships between the two models and the size of the gastrointestinal perforation. Results: In the upper gastrointestinal perforation group, free gas was located around the hepatic portal area in 91.3% (21/23) of patients: this is a significantly greater proportion than that found in the lower gastrointestinal perforation group (5/10) (P=0.016). In contrast, free gas was located in the mesenteric interspace in 8/10 patients in the lower gastrointestinal perforation group; this is a significantly greater proportion than was found in the upper gastrointestinal perforation group (8.7%, 2/23) (P<0.010). The sensitivity of diagnosis of upper gastrointestinal perforation base on the presence of hepatic portal free gas was 84.8% and the specificity 71.4%. Further, the sensitivity of diagnosis of lower gastrointestinal perforation base on the presence of mesenteric interspace free gas was 80.0% and the specificity 91.3%. The rates of presence of free gas in the subdiaphragmatic area, mid-abdominal wall, and pelvic cavity did not differ significantly between the two groups (all P>0.05). Receiver operating characteristic curves showed that when free gas was present in four or more of the studied locations in the abdominal cavity, the optimal cutoff for perforation diameter was 2 cm, the corresponding sensitivity 66.7%, and the specificity 100%, suggesting that abdominal free gas diffuses extensively when the diameter of the perforation is >2 cm. Another model revealed that when free gas is present in three or more of the studied locations, the optimal cutoff for perforation diameter is 1 cm, corresponding to a sensitivity of 91.7% and specificity of 76.2%; suggesting that free gas is relatively confined in the abdominal cavity when the diameter of the perforation is <1 cm. Conclusion: Identifying which of five locations in the abdominal cavity contains free intraperitoneal air by examining MSCT images can be used to assist in the diagnosis of the location and size of acute gastrointestinal perforations.

Retracted: Application of Multislice Spiral CT Imaging Technology in the Diagnosis of Patients with Chest Sarcoidosis.

[This retracts the article DOI: 10.1155/2021/2887639.].

Value of MSCT plus MRI in the Detection of Colon Cancer.

Colon cancer is a common digestive system malignancy with nonspecific early symptoms, which necessitates better early detection methods. The present study was conducted to assess the accuracy and clinical value of multislice spiral CT (MSCT) plus magnetic resonance imaging (MRI) for colon cancer. Between January 2019 and July 2020, 100 patients with pathologically confirmed colon cancer treated in Wuxi People's Hospital were assessed for eligibility and recruited. All eligible patients received MRI and MSCT without any treatment prior to scanning. The accuracy of preoperative diagnosis and staging of colon cancer by MRI, MSCT, and MRI plus MSCT were analyzed using postoperative pathological results as the gold standard, and consistency analysis was performed. The receiver operating characteristic curve (ROC) was plotted, and the area under the curve (AUC) was obtained to analyze the preoperative diagnostic value. The accuracy of MRI, MSCT, and MRI plus MSCT was 98.00%, 96.00%, and 100% with good consistency (Kappa = 0.732, 0.703, and 0.756). The AUC of MRI, MSCT, and MRI plus MSCT was 0.889, 0.861, and 0.903, respectively. The preoperative diagnostic accuracy of MRI for colon cancer at T1, T2, T3, and T4 stages was 76.92%, 82.61%, 73.47%, and 86.67%, respectively, those of MSCT was 53.85%, 69.57%, 63.27%, and 40.00%, respectively, and those of MRI plus MSCT was 100.00%, 95.65%, 95.92%, and 86.67%, respectively. Consistency analysis yielded good consistency for the diagnosis of the T-staging of colon cancer (Kappa = 0.754, 0.731, 0.776). MSCT plus MRI yielded higher accuracy, specificity, and sensitivity in the detection of colon cancer versus the standalone MRI or MSCT, which demonstrated great potential in the early detection of colon cancer with a high clinical value.

The feasibility analysis of multi-slice spiral CT features of gastric stromal tumors in predicting pathological National Institutes of Health risk classification

Objective: To investigate the feasibility of multi-slice spiral CT(MSCT) imaging features of gastric stromal tumor (GST) in predicting pathological NIH risk classification, providing imaging basis for patients with GST before treatment. Methods: The clinical and CT imaging data of 504 patients(506 GST lesions), 259males and 245 females, aged from 13 to 85(60±11) years, with GST confirmed by surgery and pathology collected in the Zhongshan Hospital Affiliated to Fudan University and the Affiliated TCM Hospital of Southwest Medical University. According to pathological NIH risk classification, 506 lesions were divided into low risk group (very low and low risk degree, 277 lesions) and high risk group (medium and high risk degree, 229 lesions).Clinical data and imaging characteristics were compared between two groups. Multivariate logistic regression analysis was performed to screen out independent risk factors for statistically significant imaging indicators. Receiver operating curve (ROC) was used to evaluate the predictive value of tumor length for risk classification. Resulst: Between low risk group and high risk group,there were significant differences in gender(male/female:131/146 vs 129/100), gastrointestinal bleeding(present/absent:39/238 vs 59/170), morphology(regular/Irregular:218/59 vs 95/134), calcification(present/absent:36/241 vs 53/176), degree of necrosis(0°/Ⅰ°/Ⅱ°/Ⅲ°:197/61/16/3 vs 58/98/32/41), ulceration(present/absent:32/245 vs 94/135), growth pattern(endophytic/exophytic/mixed:102/105/70 vs 44/98/87), tumor location(fundus/cardia/body/angle/antrum:98/7/135/12/25 vs 98/6/114/5/6), feeding artery(present/absent:32/245 vs 104/125), vascular enhancement(present/absent:19/258 vs 88/141), effusion of around the disease(present/absent:0/277 vs 13/216), positive sign of fat around the disease(present/absent:0/277 vs 30/199),maximum long diameter[2.82(2.04,3.80) cm vs 5.93(4.06,8.29) cm] and short diameter [2.31(1.60,2.88) cm vs 4.40(3.21,6.37) cm]of tumor(all P<0.05).The maximum long diameter of tumor (OR=2.08,95%CI:1.35-3.20) and ulceration positive(OR=2.01,95%CI:1.03-3.92) were independent risk factors of risk classification(all P<0.05).Gastric antrum was used as the reference for tumor location, gastric fundus(OR=7.77,95%CI:2.00-30.24) and gastric body(OR=3.93,95%CI:1.03-15.01) were independent risk factors of risk classification(all P<0.05).The area under curve(AUC) of the maximum long diameter of tumor for predicting risk classification was 0.87, and the optimal critical value, sensitivity and specificity were 4.98cm, 62.9% and 95.3% respectively. Conclusions: MSCT image features of GST had certain characteristics. MSCT has certain predictive value for pathological NIH risk classification of GST, which can provide certain imaging basis for patients before treatment.

Comparison of the Value of Color Doppler Ultrasound and Multislice Spiral CT in the Differential Diagnosis of Benign and Malignant Nodules in the Liver.

Objective This study aimed to explore the value of color Doppler ultrasound and multislice spiral CT (MSCT) in the differential diagnosis of benign and malignant nodules in the liver. Methods The clinical imaging data of 102 patients with nodular hepatocellular carcinoma (hepatocellular carcinoma group) and 50 patients with focal nodular hyperplasia (FNH) of the liver (FNH group) admitted to our hospital were collected, and their color Doppler ultrasound and MSCT imaging features were retrospectively analyzed to explore the value of their clinical application in the differential diagnosis of benign and malignant nodules in the liver. Results The sensitivity, accuracy, and negative predictive value of MSCT in the diagnosis of nodular liver cancer were 94.12%, 92.76%, and 88.24%, respectively, which were significantly higher than those of color Doppler ultrasound 79.41%, 84.21%, and 69.12%, and the difference was statistically significant (P < 0.05). Conclusion In conclusion, the value of MSCT in the differential diagnosis of benign and malignant liver nodules was significantly better than color Doppler ultrasound.

Analysis of CT and MRI in the Diagnosis of Shoulder Joint Injury

Objective: To observe the effect of multi-slice spiral CT and magnetic resonance imaging (MRI) in the diagnosis of shoulder injury. Methods: 120 patients with shoulder injury who were treated in our hospital (January 2020 to December 2021) and underwent surgical treatment were diagnosed as shoulder injury. They were divided into CT group, MRI group and joint diagnosis group. The detection rates of the two methods were compared. Results: In the diagnosis of shoulder injury, MRI group was higher than CT group, and the joint diagnosis group was higher than the other two groups. Conclusion: In the diagnosis of shoulder injury, the joint examination of multi-slice spiral CT and magnetic resonance imaging (MRI) can obtain a higher diagnostic rate and ideal effect.

Multislice Spiral CT Imaging Localization and Nursing Care of Catheter Fracture of Scalp Vein Indwelling Needle.

In order to improve the success rate of scalp venous indwelling needles in infants, image positioning and nursing of scalp venous indwelling needle catheters broken with multislice spiral CT were discussed. In this method, three-dimensional reconstruction of multislice spiral CT was used to diagnose and locate the broken catheter according to the anatomical morphology of the indwelling needle, and the treatment and related nursing were carried out. The results showed that the body temperature was 38.7°C, the pulse was 106 times/min, the respiration was 30 times/min, and the body weight was 15 kg. Laboratory examination: the percentage of leukocytes was 10.00 × 10/L, the percentage of lymphocytes was 24.8%, and the percentage of neutrophils was 63.7%. Head CT examination: no obvious abnormalities were observed. 31.9% of children diagnosed with hyperfebrile convulsions had good image quality after treatment with MSCT for catheter fracture of scalp vein indwelling needle; good quality was 52.8%, and barely diagnosed was 12.1%. Multiple post-treatment functions of MSCT have important value in the application of three-dimensional localization of foreign bodies in soft tissues in children and play a more important role in the diagnosis and preoperative evaluation of foreign bodies. Appropriate nursing care for children in the image location examination has very important guiding significance.

Application of Multislice Spiral CT Imaging Technology in the Diagnosis of Patients with Chest Sarcoidosis.

Objective To study the qualitative value of multislice spiral CT (MSCT) dynamic enhancement scanning for solitary nodules (SPN) of the chest. Methods In this paper, 40 cases of chest nodules (including 25 cases of malignant nodules, 8 cases of inflammatory nodules, and 7 cases of benign nodules) were first scanned to determine the scope of nodules. At the two rates of 5 ml/s and 3 ml/s, CT dynamic enhancement scans were performed at the center of the nodule, and the CT values, peak enhancement (PH) and peak time (PT) before and after SPN enhancement, were recorded. It is mainly strengthened, with 80% (20/25) of net added value between 20 and 60 Hu, and 20% (5/25) >60 Hu or <20 Hu. The enhancement peak and peak time are (31.31 ± 10.62) Hu and 45 s, respectively. The time-density curve (T-DC) showed a slowly rising type; the inflammatory nodules were mainly severely strengthened, with a net increase of >40 Hu. The enhancement peak value is (49.25 ± 12.44) Hu, and the peak time is 80 s and 140 s. There is a characteristic of rising and falling and then rising in the curve. Conclusion Multislice spiral CT dynamic enhancement scan reflects the dynamic characteristics of chest nodular blood flow, which can be used to noninvasively evaluate and diagnose SPN.

Multi-slice spiral CT findings of tubulovillous adenoma of the duodenum

ObjectivesTo analyze the appearance of duodenal tubulovillous adenoma on multi-slice spiral CT images to facilitate early diagnosis and treatment to potentially improve prognosis. MethodsWe retrospectively analyzed clinical data and CT imaging findings of 11 cases of duodenal tubulovillous adenomas, all confirmed by pathology. The location, size, shape, CT density, relationship with surrounding structures, accompanying bile duct obstruction, and enhancement pattern of each lesion were documented. ResultsAll 11 lesions occurred in the descending part of the duodenum. Ten cases occurred in the duodenal papilla area. Nine cases had a low-density ring sign or semicircle sign between the lesion and the adjacent normal intestinal wall on axial images. Eight cases had differing degrees of bile duct dilatation, five of which had concomitant pancreatic duct dilatation. Noncontrast images revealed uniform soft tissue density; contrast enhanced images showed moderate, mostly uniform enhancement, with the most enhancement in the venous phase. In the arterial phase, two lesions showed linear enhancing vessels. ConclusionsOn multi-slice spiral CT imaging, duodenal tubulovillous adenomas have certain characteristics that could be used for clinical diagnosis and treatment. PrecisOn multi-slice spiral CT imaging of duodenal tubulovillous adenoma, findings of nodular or cauliflower-like shape, uniform density, uniform moderate enhancement, and a peripheral low-density ring sign could improve diagnostic accuracy.

Diagnostic Value of Multi-Row Spiral CT Imaging in Emergency Connoisseurs Injury Combined with Shock

In this paper, multi-slice spiral CT imaging is used to diagnose emergency connoisseurs injury hemorrhagic shock and brain perfusion scans in patients with the connoisseur’s injury. The EDS spectrum of multi-slice spiral CT obtained Perfusion imaging as the perfusion parameters. The patient’s CTA and volume reproduction images can be displayed at the same time. The patient’s diagnostic relationship can be visually observed. The best results set up two recommended schemes and compare the perfusion parameters and radiation dose with the standard control group. Ensuring the image quality required for diagnosis and effectively reducing the radiation, it had great diagnostic value in emergency connoisseurs injury which combined with shock. Three-dimensional image reconstruction results of this study can observe the anatomical positional relationship between intracranial lesions and surrounding skulls, skulls, and other important structures before surgery. The design of the bony window provides a more intuitive and convenient basis and guarantee for the preoperative evaluation of the neurosurgery operation and the smooth operation of the operation.

Clinical Analysis of Magnetic Nanoparticle Contrast Agent in the Diagnosis of Occult Fracture by Multislice Spiral CT and MRI

To investigate the differences in the diagnosis and treatment of occult fractures between multi-slice spiral CT (CT) and magnetic resonance imaging (MRI) using I/Fe₃O₄ nanometer contrast agent. This retrospective study analyzed the clinical data of 60 patients with occult fractures and compared the diagnosis results of multislice CT (observation group) and MRI (control group). All the contrast agents used were I/Fe₃O₄ nanometer contrast agents. In the control group, 55 cases (91.67%) were detected on T1-weighted imaging versus 58 cases (96.67) on T2-weighted imaging. In the observation group, 47 cases (78.33%) were diagnosed. The intergroup difference was significant (P < 0.05). Clinically, I/Fe₃O₄ nanometer contrast agent can be used to affect imaging. The detection rate of MRI is higher than that of CT, and the ability to obtain detailed data of occult fractures is better.

CT-Radiomic Approach to Predict G1/2 Nonfunctional Pancreatic Neuroendocrine Tumor

Tumor grading of nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) determines the choice of clinical treatment and management. The pathological grade of pancreatic neuroendocrine tumors is usually assessed on postoperative specimens. The goal of our study is to establish a tumor grade (G) prediction model for preoperative G1/2 NF-pNETs using radiomics for multislice spiral CT image analysis. This retrospective study included a primary cohort of 59 patients and an independent validation cohort of 40 consecutive patients; their multislice spiral CT images were collected from October 2012 to October 2016 and October 2016 to June 2018, respectively. All 99 patients were diagnosed with clinicopathologically confirmed NF-pNETs. Most significant radiomic features were selected using the minimum redundancy and maximum relevance algorithm. Support vector machine classifier with a radial basis function-based predictive model was subsequently developed for clinical use. A total of 585 radiomics features were extracted from every phase for each patient. Six of these radiomics features were identified as most discriminant features for G1 and G2 tumors and used to construct the tumor grade prediction model. The prediction model resulted in the area under the curve values of 0.968 (95% CI: 0.900-0.991) and 0.876 (95% CI: 0.700-0.963) for the training cohort and validation cohort, respectively. Sensitivity and specificity were 96.4% and 83.9%, and 90.9% and 88.9% for the training and validation cohorts, respectively. The decision curves indicated that if the threshold probability is above 0.1, using the rad-score in the current study on G1/2 NF-pNETs is more beneficial than the treat-all-patients scheme or the treat-none scheme. Radiomics developed with a combination of nonenhanced and portal venous phases can achieve favorable predictive accuracy for histological grade for G1/G2 NF-pNETs.

Multislice spiral CT images combined with CEA and lymphocyte-to-neutrophil ratio predict recurrence and post-operative metastasis of rectal cancer

To explore the early predictors of post-operative recurrence and metastasis of rectal cancer, analyse the associated risk, and construct a model. Retrospective collection. Four hundred patients with rectal cancer underwent surgical resection and pathological diagnosis from September 2013 to September 2014. During the post-operative period, the patients were tested by imaging examination, serum tumour markers, and routine blood follow-up for at least 3 years. Preoperative CT examination of tumour size, lymphocyte-to-neutrophil ratio, and CEA were significant biomarkers for predicting recurrence and/or metastasis of post-operative rectal cancer. The stratified threshold of the lesion size cut-off point in CT images of patients with rectal cancer was 18.75 cm3, the cut-off point value of the lymphocyte-to-neutrophil ratio was 0.33, and the CEA cut-off point value was 16.97 ng/ml. We used the cut-off point to perform stratified survival analysis to obtain two K-M curves and conduct a log-rank test. The Cox multivariate risk regression results were as follows: preoperative CT images of lesion size, lymphocyte-to-neutrophil ratio, and CEA. The AUC of the normogram model for the prediction of post-operative recurrence and metastasis of rectal cancer is 0.939. Preoperative CT examination of tumour size can predict post-operative recurrence and metastasis of rectal cancer and can be used to analyse its risk. The lymphocyte-to-neutrophil ratio and CEA can also predict post-operative tumour recurrence and metastasis risk.

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.

Differences of CT pulmonary function indexes in asbestosis patients engaged in different types of work

Objective To evaluate the changes and characteristics of pulmonary function in asbestosis patients engaged in different types of work by multi-slice spiral CT imaging. Methods Total 30 asbestosis patients were equally divided into three groups, who engaged in the work of raw asbestos processing, fiber combing and pressure molding, respectively. The pulmonary volume, pulmonary density and pulmonary small airway indexes were measured by a whole lung scanning at maximum inspiratory and maximum expiratory efforts. The pulmonary volume indexes include maximum inspiratory volume, maximum expiratory volume, pulmonary volume difference and pulmonary volume ratio. The mean pulmonary density indexes include the mean pulmonary densities after inspiratory and expiratory activities, pulmonary density difference and pulmonary density ratio. The small airway indexes include the diameter ratios of the wall after inspiratory and expiratory activities and the percentage of bronchial wall area after inspiratory activity. Results The differences of the gender, age, stage, and contact history of the patients are not statistically significant for all the groups (all P>0.05). The differences of the mean pulmonary densities after expiratory activity, the left and right pulmonary densities after expiratory activities, pulmonary density ratio, diameter ratios of the wall after inspiratory and expiratory activities, and the percentage of bronchial wall area after inspiratory activity are statistically significant among the three groups (all P 0.05). The differences among the three groups in other indexes are not statistically significant (all P>0.05). Conclusions The emphysema with fibrous thickening in the alveolar septum and small airway wall is more severe in the workers who engaged in asbestos fiber combing comparing with in raw asbestos processing and asbestos pressure molding. Therefore, the medical protection of these groups of patients should be strengthened. Key words: Asbestosis; Respiratory dysfunction; Occupation

Evaluation of respiratory dysfunction in patients with asbestos lung based on pulmonary function indexes utilizing CT

Objective To evaluate the changes and characteristics of respiratory function and pulmonary function in patients with asbestosis by multi-slice spiral CT imaging. Methods 61 asbestosis patents and 30 healthy subjects were enrolled and divided into normal respiratory function group, mild injury group and moderate/severe injury group according to forced vital capacity and forced expiratory volume in one second. The lungs were scanned at the end of inspiratory and expiratory phase, and the lung volume, lung density and small airway index were measured. Results There were significant differences in lung volume (inspiratory and expiratory volume, volume difference, and volume ratio) among the normal group, the mild injury group and the moderate/severe injury group (all P<0.05). There were statistically significant differences in the mean lung density (lung density at the end of inspiratory and expiratory phase, lung density difference, lung density ratio) among the three groups (all P<0.05). There were significant differences in the small airway indexes (tracheal wall thickness ratio at the end of inspiratory and expiratory phase, bronchial wall area ratio) among the three groups (all P<0.05). Conclusions CT lung function imaging techniques can be used to assess the degree of respiratory dysfunction in asbestosis patients. With the development of pulmonary respiratory dysfunction, the total lung volume decreased, the amount of lungs gradually increased, emphysema gradually increased, and the thickness of small airway wall and alveolar fibrous hypertrophy gradually increased. Key words: Asbestosis; Pulmonary respiratory dysfunction; Pulmonary function

Clinical value of spiral CT in diagnosis of small bowel tumors

Objective To explore the clinical vaue of multilayer spiral CT in diagnosis of small intestinal tumor.Methods 36 cases with small intestinal tumor were selected as the research objects,the multi-slice spiral CT imaging results were analyzed retrospectively.Results Sensitivity of multi-slice spiral CT was 94.4％,accuracy of 88.9％.Conclusion Spiral CT is a safe,simple,non-invasive,effective method in diagnosis of small bowel tumors,it has high detection rate. Key words: Tomography,X-ray computed; Ileal neoplasms; Jejunal neoplasms; Diagnosis

Predetermination of structure surrounding duodenal papilla before EST by multi-slice spiral CT

Objective To study the predetermination value of multi-slice spiral CT for showing the major blood vessels, bile and pancreatic ducts around normal duodenal papilla before EST. Methods A 16- slice spiral CT was used to perform 28s and 68s enhanced scan for normal structures surrounding duodenal papilla in 30 subjects. Post-processing was done to the raw data with thin-slice maximum intensity projection （TSMIP） and thin-slice average intensity projection （TSAIP）, and then the structure of bile and pancreatic ducts, duodenal artery and pancreatic-duodenal conjunction were reconstructed. The reconstructed images were double-blind evaluated. Distances between papilla and upper, front, and behind edge of the pancreatic- duodenal conjunction, situation of the duodenal papilla artery and the distance from the papilla artery end to the papilla were recorded. Results After dual-phase enhanced scan, the post-processing results for the ima- ges of the surrounding structure of pancreatic and duodenal papilla were stable and the results of double-blind evaluation were consistent. Image scores of the arteries surrounding duodenal papilla and pancreatic duct at 28th second were significantly higher than those of 68th second, whereas bile duct and the ampulla structure image scores of 68th second were higher. TSMIP of local vascular structure could display anterior-superior pancreatic-duodenal artery （ASPDA） in 93.3% of the subjects, posterior-superior pancreatic-duodenal ar- tery （PSPDA） in 73.3%, inferior pancreatic-duodenal artery （IPDA） in 73.3%, duodenal-papillary artery （DPA） in 56. 7% , bile duct in 96. 7% , pancreatic duct in 90. 0% and pancreatic and duodenal parenchima in 100. 0%. The DPAs all started from PSPDA origin and down to papilla, with only 2 cases of 30 （6. 7% ） reached the upper edge of the duodenal papilla. Others showed arteries turned thin obviously at 12 mm above the papilla; the normal common bile duct can be tracked to the opening of the papilla. The Coronal Oblique TSAIP imaging showed the distance from the duodenal papilla-bile duct ending to the lower edge of the pan- creatic-duodenal upper conjunction was 15.7 ± 1.9 mm. Distance from papilla to the front edge of pancreat- ic-duodenal conjunction was 16.6 ±3.2 mm and to the behind edge was 1.7 ±0.4 mm. Distance （depth） from the inner edge of the papilla to the bile-pancreatic conjunction was 8. 0±1.7 mm. Conclusion The 3D reconstruction of the Multi-slice spiral enhancement CT Imaging can provide high quality images of relative vascular, bile-pancreatic and obvious surrounding structures to the forthcoming operation. Massive hemorrhage and perforation risks of EST can be evaluated based on the vascular distribution and directions around duodenum and pancreas and the bile duct imaging. Key words: Helical CT; Imaga reconstruction; Endoscopic sphincterotomy; Duodenal papilla major

Diagnostic value of multislice spiral CT and MRI in detection of tumor recurrence after liver transplantation for hepatocellular carcinoma

To investigate the manifestation and diagnostic value of multislice spiral CT (MSCT) and MRI imaging in detection of tumor recurrence after liver transplantation for hepatocellular carcinoma (HCC). The clinical data of 161 consecutive HCC patients who underwent orthotopic liver transplantation were retrospectively reviewed. Twenty-nine HCC patients were classified by pTNM according to the "Pittsburgh criteria". MSCT and MRI findings of tumor recurrence after liver transplantation were evaluated retrospectively in 29 stage II-IVb HCC patients. The recurrence site and relapse interval between liver transplantation and recurrence were analyzed. Lung tumor recurrence were found in 21 cases, presented as cotton-like lesions in a diameter of 2 - 3 cm, with a clear margin and homogeneous density. Pleural tumor recurrence was detected in 4 cases. Liver tumor recurrence were found in 9 cases, which can be divided into four subtypes: multinodular in 4 cases, diffuse lesion in 2 cases, huge mass in 2 cases, and uninodular in 1 case. Two cases showed tumor thrombus in the inferior vena cava and portal vein. Lymph node tumor recurrence was found in 9 cases, presented as multiple nodules at hepatic hilum, lesser peritoneal sac, posterior mediastinum, retroperitoneum, or around pancreatic head, and accompanied with merging and necrosis in one case. Bone tumor recurrence were found as osteolytic destruction in 4 cases, and accompanied with adjacent soft-tissue mass in 2 cases. The recurrence sites of the 29 cases were as following: lung (21 cases, 72.4%), liver (9 cases, 31.0%), lymph nodes (9 cases, 31.0%), bone (4 cases, 13.8%) and other sites (3 cases, 10.3%). Lung tumor recurrence was found in all the 10 stage IVb patients with tumor recurrence after liver transplantation, significantly more frequent than that in stage IVa patients (P = 0.023). After liver transplantation, all 25 patients with stage III approximately IVb HCC developed recurrence within one year, but in the 4 cases with stage II HCC at one year later (P = 0.009). The results of our study show that in hepatocellular carcinoma patients after liver transplantation, the lung and pleura are the most frequent site of recurrence, followed by liver, lymph node and bone as the second and third sites. The Stage IVb hepatocellular carcinoma should be regarded as a contradiction for liver transplantation due to rapid recurrence. Tumor recurrence occurs later in stage II HCC than in stage III approximately IVb patients. MSCT and MRI are of significant importance in diagnosis and formulating operation plan in HCC patients with recurrence after liver transplantation.

Value of multi-slice spiral CT in diagnosis of malignant gastrointestinal stromal tumors

The aim of this study was to investigate the value of multi-slice spiral CT (MSCT) in the diagnosis of malignant gastrointestinal stromal tumors (GISTs). Twenty-seven cases of MSCT images of malignant GIST proved by surgery and pathology were retrospectively analyzed. Both plain and enhanced CT scan was performed and multiplanar reconstruction was made in all cases. The lesions originated from the stomach (n = 11), small intestine (n = 9), colon (n = 4), rectum (n = 1), and mesentery (n = 2). The transverse diameters of mass were 4.2–22 cm, the edges clearly (n = 12), unclearly (n = 15). The mass were mainly irregular in shape lobulated (n = 19). The lesions were mainly heterogeneity on plain scan, moderate to marked enhancement in arterial phase and durative enhanced in venous phase. Cystic necrosis were observed in all the lesions, 9 cases were cystic and solid mixed mass. Hepatic metastases (n = 4), pulmonary metastasis (n = 1), lymphatic metastasis (n = 2) were detected. The accuracy rate of MSCT diagnosis for location and pathologic features of GISTs were 85.2% (23/27) and 77.8% (21/27). Two-phase MSCT examination and axial images combined with multiplanar reconstruction images have important value for diagnosis of malignant GIST.