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2011 Vol. 2, No. 3

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Original Contributions
Dual-source Computed Tomography for the Diagnosis of Patients with Congenital Heart Disease
Yi-ning WANG, Ling-yan KONG, Qi MIAO, Li-gang FANG, Shuo LI, Kang ZHOU, Zhi-wei WANG, Kai XU, Hong-ling FAN, Zheng-yu JIN
2011, 2(3): 200-204. doi: 10.3969/j.issn.1674-9081.2011.03.002
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  Objective  To evaluate the value of dual-source computed tomography (DSCT) in the diagnosis of congenital heart disease.  Methods  Twenty patients aged 4 months to 53 years (mean age 19 years) with congenital heart disease underwent contrast-enhanced DSCT. The results were compared with those of echocardiography (ECHO) and confirmed by surgery.  Results  Among the 20 patients, DSCT detected 59 of 63 (93.7%) anomalies that confirmed by surgery, and ECHO detected 55 of 63 (87.3%) (χ2=1.474, P=0.225). In the 41 intracardiac anomalies, DSCT was as sensitive as ECHO (both 90.2%, P=1.000). In the 9 heart-vessel conjunction deformities, no significant difference was found between the sensitivities of two modalities (100% vs. 88.9%, P > 0.05). In the 13 great vessel deformities, no significant difference was found between the sensitivities of two modalities (100% vs. 76.9%, P > 0.05).  Conclusion  DSCT detects intra- and extra-cardiac anomalies with high sensitivity and has an important value in the diagnosis of congenital heart disease especially those with extra-cardiac anomoalies.
Computed Tomography Features of Inflammatory Myofibroblastic Tumor
Bin LI, Wei-dong PAN, Ming-wei QIN
2011, 2(3): 205-208. doi: 10.3969/j.issn.1674-9081.2011.03.003
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  Objective  To summarize the computed tomography (CT) features of inflammatory myofibroblastic tumor (IMT).  Methods  CT findings were retrospectively reviewed in 9 patients with pathologically proved IMT.  Results  Three IMTs in the lungs were detected by CT. Two of them manifested masses with well demarcation while another case only showed bronchial obstruction without detectable mass. Three tumors were located in the mediastinum and showed soft tissue attenuation under CT. One was well-defined and the other two had unclear border with the surrounding structures. IMTs were also found at nasion (n=1), neck (n=1), and pelvis (n=1), which were shown to be cystic-solid or solid masses while some tumors were invasive with ill-defined margin. After contrast administration, 3 cases showed marked heterogeneous enhancement.  Conclusion  IMTs have certain CT features, but the final confirmation depends on pathology.
Application of High-resolution Magnetic Resonance Imaging in Measuring Olfactory Bulb Volume in Patients with Alzheimer Disease
Hui YOU, Fu-sheng NIU, Jian WANG, Fu-ling ZHENG, Chun-ling MENG, Zhen-xin ZHANG, Dao-feng NI, Feng FENG
2011, 2(3): 209-212. doi: 10.3969/j.issn.1674-9081.2011.03.004
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  Objective  To explore the change of olfactory bulb (OB) volume in patients with Alzheimer disease (AD) and assess the value of high-resolution magnetic resonance imaging (MRI) in measuring OB volume.  Methods  Fourteen AD patients and 25 normal aging volunteers (control group) underwent high-resolution MRI imaging of OB and the OB volume was measured.  Results  The OB volume in AD patients[(32.2±7.7) mm3] was significantly smaller than that in control group[(40.6±6.6) mm3](P=0.002). The OB volume in AD patients didn't correlate significantly with their mini-mental state examination (MMSE) scores (P=0.205).  Conclusions  AD patients show more prominent OB atrophy than normal aging volunteers do, which is in agreement with the pathological findings. High-resolution MRI is valuable in identifying the change of OB volume and therefore might be beneficial for AD diagnosis.
Conversion of Percutaneous Endoscopic Gastrostomy to Percutaneous Endoscopic Jejunostomy under Fluoroscopic Guidance for Debilitated Elderly
Xiao-guang LI, Zheng-yu JIN, Zhi-qiang MA, Wei-ming KANG, Jian-chun YU
2011, 2(3): 213-216. doi: 10.3969/j.issn.1674-9081.2011.03.005
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  Objective  To explore the value of the conversion of percutaneous endoscopic gastrostomy (PEG) to percutaneous endoscopic jejunostomy (PEJ) under fluoroscopic guidance for the debilitated elderly.  Methods  The clinical data of 12 debilitated elderly patients who underwent the conversion of PEG to PEJ under fluoroscopic guidance from January 2009 to April 2011 were retrospectively analyzed.  Results  Technical success was achieved in all these patients after 16 times of conversion. The procedure time was 8 to 32 minutes (mean:18 minutes). No complications occurred.  Conclusion  Conversion of PEG to PEJ under fluoroscopic guidance is safe and feasible.
Diagnosis of Hypopharyngeal and Esophageal Foreign Bodies with Multi-slice Spiral Computed Tomography
Zhu-hua ZHANG, Shuo LI, Bai-yan SU, Hao SUN, Ling-yan KONG, Yi-ning WANG, Hua-dan XUE, Xiao-li ZHU, Zhi-qiang GAO, Zheng-yu JIN
2011, 2(3): 217-221. doi: 10.3969/j.issn.1674-9081.2011.03.006
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  Objective  To explore the radiological findings and diagnostic points of hypopharyngeal and esophageal foreign bodies with multi-slice spiral computed tomography (MSCT).  Methods  The medical records and CT images of 25 emergency patients with clinically confirmed hypopharyngeal and esophageal foreign bodies were retrospectively analyzed. The location and morphology of the foreign bodies on multi-slice spiral CT images were observed. The longitudinal diameter of the foreign body and the distance from the center of the foreign body to the lower margin of the cricoid cartilage were measured. The margin of the esophagus, the relationship of the foreign body and its neighboring structures, and the existence of pneumoderma and mediastinal emphysema were evaluated.  Results  The location, size and their relationship with the surrounding anatomical structures of all the hypopharyngeal and esophageal foreign bodies were clearly shown by multi-slice spiral CT. Most of the foreign bodies located in the junction of the hypopharynx and the esophagus and the cervical esophagus. The average length of the foreign bodies was (20.4±7.4) mm (range 5.4 to 42.0mm), while the mean distance from the center of the foreign body to the lower margin of the cricoid cartilage was (13.1±17.0) mm (range-5.0 to 30.0 mm). The foreign bodies of 12 cases located transversely, that of 10 cases located obliquely, while that of 3 cases located vertically. One case showed a poor margin of the esophagus, and one case has pneumoderma and mediastinal emphysema.  Conclusions  Multi-slice spiral CT can provide clear radiological information for the clinical extraction of foreign bodies by displaying their location, size, and their relationship with the surrounding anatomical structures.
Magnetic Resonance Imaging of Sella after Transsphenoidal Resection of Pituitary Macroadenoma
Ming-li LI, Jian ZHANG, Yang LIU, Zheng-yu JIN
2011, 2(3): 222-226. doi: 10.3969/j.issn.1674-9081.2011.03.007
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  Objective  To summarize the magnetic resonance imaging (MRI) features of sella after transsphenoidal resection of pituitary macroadenoma, and explore the rational opportunities for the first radiological follow-up.  Methods  The clinical data and preoperative and postoperative MRI of 40 patients with macroadenoma were retrospectively analysed. The postoperative MRI was performed at early period (within 1 week), medium period (about 3 month), or later period (after 6 months or 1 year).  Results  Patients were divided into two groups based on preoperative data:invasive macroadenoma group (n=16) and noninvasive macroadenoma group (n=24). Residual tumors (n=11) were only found in the invasive macroadenoma group during the radiological follow-up. During the early period of postoperative follow-up, pituitary mass can still be found in soft tissue, with the heights decreased in varying degrees compared with those of the preoperative mass. The implanted material showed no enhancement on post-contrast MRI. The residural tumors showed mild to middle enhancement, while the residual pituitary gland showed apperent enhancement. During the medium period of postoperative follow-up, the implanted material was obviously or completely absorbed; the pituitary glands often collapsed, while the residual pituitary glands showed remarked enhancement. The re-expansion of the gland was found in some cases. The residural tumors were shown clearly, and the visibility of these residural tumors were not apparently different from those in the early period. The MRI features in the later were similar to those in the medium period. The inflammation of sphenoid sinus were absorbed slowely, and was still present after 6 months after surgery in most cases. Tumor recurrences were found in three patients one year later after the surgury, shown as the increased residural tumors (n=2), and newly developed soft tissue (n=1).  Conclusions  The MRI features differ at different time points after transsphenoidal resection of pituitary macroadenoma. For noninvasive macroadenoma, an MRI follow-up 3 months after surgery was appropriate and sufficient. For invasive macroadenoma, however, postoperative residual tumors may be found during early-and medium-period followup.
Aortic and Coronary Assessment in Retrospectively Electrocardiogramgated Thoracal-abdominal Dual-source Computed Tomographic Angiography of Aorta
Ling-yan KONG, Hua-dan XUE, Min SHENG, Yi-ning WANG, Wei LIU, Shuo LI, Bai-yan SU, Zheng-yu JIN
2011, 2(3): 227-232. doi: 10.3969/j.issn.1674-9081.2011.03.008
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  Objective  To evaluate image quality of aortic and coronary arteries and radiation dose in retrospective electrocardiography (ECG) -gated thoracal-abdominal dual-source computed tomographic angiography (CTA) of aorta.  Methods  Totally 45 patients who underwent aorta CTA from December 2009 to Novem-ber 2010 were evaluated retrospectively. Among them 23 patients underwent retrospective ECG-gated thoracalabdominal dual-source CTA of aorta, while 22 underwent conventional non-ECG-gated aortic CTA. The attenuation and image noise of 4 parts of aorta (aortic root, aortic arch, abdominal aorta, and aortic bifurcation) were evaluated. Image quality of aortic root and coronary arteries were assessed using a 3-point scale. Attenuation, image noise, image quality, and radiation dose were compared between two groups who underwent different scan protocols.  Results  Attenuation of 4 different parts of aorta showed no significant difference between two groups (P > 0.05). Image noise was significantly lower in conventional non-ECG-gated group than in retrospective ECG-gated group (P=0.002). The percentage of patients with diagnostic image quality was high in retrospective ECG-gated group:aortic root, 100% (23/23); coronary artery, 83% (19/23), which was significantly higher than in conventional non-ECG-gated group; aortic root, 5% (1/22); coronary artery, 0% (0/22) (P < 0.001). The effective radiation dose was significantly higher in retrospective ECG-gated group than in conventional non-ECG-gated group (P=0.038).  Conclusions  Retrospective ECG-gated thoracal-abdominal dual source CTA of aorta provides well attenuated whole aorta, well displayed aortic root, and assessable coronary arteries. However, the effective radiation dose used in this mode is higher than that in conventional nonECG-gated aortic CTA.
Adrenal Venography Using Multi-slice Spiral Computed Tomography
Wei LIU, Hua-dan XUE, Hao SUN, Xuan WANG, Yu CHEN, Bai-yan SU, Xiao-na ZHANG, Zheng-yu JIN
2011, 2(3): 233-236. doi: 10.3969/j.issn.1674-9081.2011.03.009
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  Objective  To assess the image quality of multi-slice spiral computed tomography (MSCT) for adrenal venography and describe the anatomic and morphologic features of adrenal veins.  Methods  The abdominal MSCT images of 100 patients (M:F=54:46, 55.7±15.7 yrs old) with normal adrenal morphologies were retrospectively reviewed. The bilateral adrenal veins were displayed using maximum intensity projection (MIP) or multi-plannar reformation (MPR) software and the image quality was assessed using a 3-point grading scale (excellent, sufficient and non-diagnostic). The anatomical location, anomalies and spatial interrelationships of the renal veins and inferior vena cava (IVC) were also described.  Results  In the evaluation of image quality with MIP or MPR images, the left adrenal vein was excellent in 97% patients, sufficient in 1%, and non-diagnostic in 2%. For the right adrenal vein, 52% were excellent, 19% were sufficient, and 29% were non-diagnostic. The left adrenal vein was always a single one, 91% of which joined the inferior phrenic vein and then drained into the left renal vein. The diameter of the left adrenal vein ranged 2.4 mm to 4.5 mm (mean:3.6±0.6 mm). The angle of the left adrenal vein and left renal vein ranged 150° to 58° (mean:121.9±16.0°). Two patients were found to have double right adrenal veins. The right adrenal vein drained into the IVC in 67 of 71 patients (94%) and into the right accessory hepatic vein in 4 patients (6%). The average diameter of the right adrenal vein ranged 1.9 mm to 4.0 mm (mean:3.2±0.5 mm). The angle of the right adrenal vein and IVC ranged 90° to 35° (mean:75.3±16.6°).  Conclusion  MSCT venography, together with the application of MIP and MPR permits satisfying visualization of the bilateral adrenal veins, especially the left one, in most cases.
Non-contrast-enhanced Magnetic Resonance Angiography for Selective Visualization of Hepatic Vasculature with True Steady-state Free-precession Sequence Combined with Time-spatial Labeling Inversion Pulses
Xuan WANG, Hua-dan XUE, Zheng-yu JIN
2011, 2(3): 237-241. doi: 10.3969/j.issn.1674-9081.2011.03.010
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  Objective  To explore the value of the respiratory-triggered three-dimensional (3D) true steady-state free-precession (SSFP) combined with time spatial labeling inversion pulse (T-SLIP) in the selective visualization of hepatic arteries, portal veins and hepatic veins, with an attempt to improve the understanding of non-contrast-enhanced magnetic resonance angiography (NCE-MRA) for liver.  Methods  The clinical data of four patients who underwent NCE-MRA in our hospital from October 2010 to May 2011 were retrospectively analyzed.  Results  Selective visualization of hepatic vessels was successfully acquired in all cases. No anatomical variation of hepatic arteries was found. Two cases had portal vein invasion and one case had broadening of main portal vein. One case had hepatic veins involvement, accompanied with the opening of accessory hepatic vein.  Conclusion  3D true SSFP scan with T-SLIP can be effectively applied for the selective NCEMRA of hepatic vasculature.
Computed Tomography Guided Percutaneous Bacterial Liver Abscess Drainage
Zhi-wei WANG, Hai-feng SHI, Hao SUN, Kang ZHOU, Xiao-guang LI, Jie PAN, Xiao-bo ZHANG, Wei LIU, Ning YANG, Zheng-yu JIN
2011, 2(3): 242-245. doi: 10.3969/j.issn.1674-9081.2011.03.011
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  Objective  To evaluate the safety and effectiveness of computed tomography (CT) -guided percutaneous drainage of bacterial liver abscesses.  Methods  CT-guided percutaneous abscess drainages were performed in 54 patients with bacterial liver abscesses in our hospital between January 2004 and December 2010. The clinical data of these patients were retrospectively reviewed.  Results  Of these 54 patients, 37 had single abscesses and 17 had multiple abscesses. The mean diameter of abscesses was (10.5±5.6) cm. The technical success rate of drainage was 100%. No procedure-related major complications was noted. Symptoms were improved after drainages in all patients. The mean duration of catheterization was (20.6±7.8) days for 41 patients, and 13 patients were discharged from hospital with catheters.  Conclusion  CT-guided percutaneous drainage is a safe and effective procedure in the treatment of bacterial liver abscess.
Head and Neck Dual Energy Bone Removal Computed Tomography Angiography Using the Intracranial Aneurysms
Yu CHEN, Hua-dan XUE, Xiao-bo ZHANG, Wei LIU, Hao SUN, Xuan WANG, Bai-yan SU, Yong-lan HE, Ke-fei WANG, Zheng-yu JIN
2011, 2(3): 246-251. doi: 10.3969/j.issn.1674-9081.2011.03.012
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  Objective  To evaluate the diagnostic accuracy of dual energy bone removal CT angiography (DEBR CTA) in the detection of intracranial aneurysms, compared with the findings of digital subtraction angiography (DSA) and three-dimensional rotational digital subtraction angiography (3DRA).  Methods  Eight patiens with suspected intracranial aneurysms underwent dual energy CTA, DSA, and 3DRA. The intracranial arteries were divided into 16 areas according to the locations of tumor-carrying arteries. Aneurysms detected with DEBR CTA was compared with DSA/3DRA findings on a per-patient and a per-aneurysm basis. Aneurysms were classified into four groups according to the maximun diameter, which included:not detected, less than 3 mm, 3-5 mm and more than 5 mm.  Results  Nine aneurysms were detected by DEBR CTA in eight patients, and all of them were confirmed by DSA/3DRA. The maximum diameter of the aenrysms detected by DSA/3DRA and DEBR CTA was (5.2±5.1) mm and (5.7±5.6) mm, respectively (P > 0.05). Two distal blood-supply arteries of two aneurysms were not detected by DEBR CTA, which were shown by CTA without bone removal and DSA/3DRA. In the detection of aneurysms larger than 5 mm, DEBR CTA had an accuracy of 100%. One considered to be less than 3 mm in DEBR CTA was detected to be 3-5 mm in DSA/3DRA.  Conclusions  DEBR CTA has a high diagnostic accuracy in the detection of intracranial aneurysms, and has shown good consistence with DSA/3DRA. However, DEBR CTA may miss small distal blood-supply arteries and underestimate the size of small aneurysms near the skull base.
SD Rat Adipose Derived Stem Cells Labeled with Ultrasmall Superparamagnetic Iron Oxide
Jian CAO, Yi-ning WANG, Ling-yan KONG, Hua-dan XUE, Jing LEI, Yong-lan HE, Zhuo LI, Jie MENG, Zheng-yu JIN
2011, 2(3): 252-257. doi: 10.3969/j.issn.1674-9081.2011.03.013
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  Objective  To investigate the efficacy and safety of ultrasmall superparamagnetic iron oxide (USPIO) labeling adipose derived stem cells (ADSCs) of SD rats and explore the feasibility of tracing labeled cells with magnetic resonance imaging (MRI).  Methods  ADSCs were incubated with culture medium containing USPIO and poly-L-lysine (PLL) for 24h. The efficacy and safety of labling with USPIO was assessed, and the labeled cells were imaged with MRI in vitro.  Results  Prussian blue staining showed the percentage of labeled ADSCs reached 99% after coincubating for 24 h. Transmission electron microscopy showed iron particles inside the cells were mainly in lysosomes. Trypan-Blue stain showed the proportion of living cells was greater than 95%. MTS[3-(4, 5-dimethylthiazol-2-yl)-5 (3-carboxymethoxyphenyl)-2-(4-sulfopheny)-2H-tetrazolium] experiments suggested that USPIO at different concentrations (10, 20, 40, 80, 160μg/ml) exerted no significant influence on the proliferation of ADSCs. Enzyme-linked immunosorbent assay (ELISA) revealed VEGF level was not significantly different between labeled cells and unlabeled cells. The signal intensity of MRI was positively correlated with the amount of labeled cells in vitro.  Conclusion  USPIO is safe and efficient in labeling ADSCs and the signal intensity of MRI is associated with the amount of labeled cells, indicating that USPIO can be used for tracing the labled cells under MRI in vitro.
Imaging Features of Computed Tomography of Non-benign Intraductal Papillary Mucinous Neoplasm of Pancreas
Liang ZHU, Xiao-yan CHANG, Hao SUN, Xuan WANG, Yu CHEN, Yong-lan HE, Hua-dan XUE, Zheng-yu JIN
2011, 2(3): 258-264. doi: 10.3969/j.issn.1674-9081.2011.03.014
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  Objective  To evaluate the imaging features of computed tomography (CT) of non-benign intraductal papillary mucinous neoplasm (IPMN) of pancreas, and to explore the correlation between radiological and pathological finding.  Methods  CT images of 12 patients who were pathologically diagnosed as non-benign IPMN of pancreas between May, 2008 and February, 2011 in Peking Union Medical College Hospital were retrospectively evaluated. Their pre-surgery CT images were reviewed by 2 experienced radiologists, and the radiopathological results were compared to evaluate the diagnostic value of CT techniques.  Results  Of these 12 patients, 4 were pathologically proved as borderline IPMN, 2 as non-invasive intraductal papillary mucinous carci-noma (IPMC), and 6 as invasive IPMC. The clinical manifestations including weight loss, jaundice and diabetes suggested malignancy, while abdominal discomfort or pain has no specificity. IPMN were divided into 3 types according to CT classification, namely main pancreatic duct type, branch pancreatic duct type and mixed type. The branch duct type were rarely seen in malignant IPMN cases. The common radiological features of IPMN included pancreatic duct dilation or large cysts formation (with septa or focal nodules inside), pancreatic parenchymal calcification and atropy, which were seen in both borderline IPMN and IPMC. However, for malignant cases, the pancreatic duct dilation were much severer; CT values in the dilated pancreatic ducts were higher, and showed a heterogeneity within the duct. Common bile duct dilation were seen in invasive IPMC only.  Conclusions  Multi-slice spiral CT is valuable in the pre-surgery diagnosis of non-benign IPMN, and shows a good agreements with pathological results. The CT features of IPMN lesions can predict the degree of malignancy and the involvement of surrounding tissues at a favorable accuracy, and therefore provides useful information for clinical diagnosis and decision for surgery.
2011, 2(3): 197-199. doi: 10.3969/j.issn.1674-9081.2011.03.001
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2011, 2(3): 212-212.
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2011, 2(3): 245-245.
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2011, 2(3): 251-251.
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2011, 2(3): 265-268. doi: 10.3969/j.issn.1674-9081.2011.03.015
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2011, 2(3): 269-272. doi: 10.3969/j.issn.1674-9081.2011.03.016
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2011, 2(3): 272-272.
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2011, 2(3): 273-276. doi: 10.3969/j.issn.1674-9081.2011.03.017
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2011, 2(3): 276-276.
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2011, 2(3): 277-280. doi: 10.3969/j.issn.1674-9081.2011.03.018
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2011, 2(3): 281-284. doi: 10.3969/j.issn.1674-9081.2011.03.019
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2011, 2(3): 285-287. doi: 10.3969/j.issn.1674-9081.2011.03.020
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2011, 2(3): 288-290. doi: 10.3969/j.issn.1674-9081.2011.03.021
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2011, 2(3): 291-292. doi: 10.3969/j.issn.1674-9081.2011.03.022
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2011, 2(3): 293-294. doi: 10.3969/j.issn.1674-9081.2011.03.023
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