Objective To evaluate the clinical importance of doublecontrast CTdiagnosis of traumatic anterior shoulder instability. Methods Forty-eight patients underwent double contrast CT scan. With the guide of CT scan, anterior arthrocentesis of the shoulder was performed and 4 ml of 76% urografin was injected into the joint and then 10 ml of filtrated air was injected. The patients wereexamined by SOMATOM CR Systematic CT. The results of double contrast CT of the 48 patients were divided into Ⅰ, Ⅱ and Ⅲ degree according to the CT results related to their injury history, clinical symptoms, signs and operation findings. Results The patients had no complaint after the CT examination exceptfor 3 patients, who had slight pain within 2 days after CT examination. The results of double contrast CT were as follow:Ⅰ degree: 9 patients, Ⅱ degree: 22 patients, and Ⅲ degree: 17 patients. All patients with Ⅰ degree injuries were treated with rehabilitation program. The patients with Ⅱ degree injuries were mainly treated withrehabilitation program, but took much longer time. The patients with Ⅲ degreeinjuries were suggested to be treated with surgery. Conclusion To divide the results of double contrast CT into Ⅰ，Ⅱ and Ⅲ degree not only reflects the severity of traumatic anterior shoulder instability but provides information for the treatment of the instability.
ObjectiveTo summarize the status and progress of imaging studies of pancreatic neuroendocrine neoplasms (pNENs).MethodThe relevant literatures published recently at domestic and abroad about the imaging of pNENs were collected and reviewed.ResultsDue to poor visibility of pancreatic body and tail, the application of ultrasound (US) was limited. Compared with US, endoscopic ultrasound (EUS) and contrast-enhanced ultrasound (CEUS) could improve the detection rate of pNENs. The ability of plain CT scans to differentiate pathological grades was still controversial, but the value of enhanced scan was higher. CT texture analysis was feasible in the discrimination of nonhypervascular pNENs and pancreatic ductal adenocarcinoma (PDAC). Teta2 was the parameter with the highest diagnostic performance. The enhanced features of MRI were similar to CT. Combined with the apparent diffusion coefficient (ADC) value, the diagnostic and classification capabilities of MRI were improved, and the sensitivity and specificity of different ADC thresholds were also different. 68Ga-tetraazacyclododecane tetraacetic acid (68Ga-DOTA) peptide PET-CT had good preliminary diagnostic value for well-differentiated pNENs, and 18Fluoro-fluorodeoxyglucose (18F-FDG) PET-CT had limited diagnostic value.ConclusionsSomatostatin receptor imaging is of high diagnostic value and can guide clinical treatment and predict prognosis, but it has not been widely used in China. Conventional morphological images have advantages in the diagnosis and classification of pNENs. Therefore, it is important to choose a proper image inspection method.
Objective
To investigate the feasibility and application value of digital technology in establishing the micro-vessels model of cross-boundary perforator flap in rat.
Methods
Twenty 8-week-old female Sprague Dawley rats, weighing 280-300 g, were used to established micro-vessels model. The cross-boundary perforator flaps of 10 cm×3 cm in size were prepared at the dorsum of 20 rats; then the flaps were suturedin situ. Ten rats were randomly picked up at 3 and 7 days after operation in order to observe the necrosis of flap and measure the percentage of flap necrosis area; the lead-oxide gelatin solution was used for vessels perfusion; flaps were harvested and three-dimensional reconstruction of micro-vessel was performed after micro-CT scanning. Vascular volume and total length were measured via Matlable 7.0 software.
Results
The percentage of flap necrosis area at 3 days after operation was 19.08%±3.64%, which was significantly lower than that at 7 days (39.76%±3.76%;t=10.361, P=0.029). Three-dimensional reconstruction via the micro-CT clearly showed the morphological alteration of micro-vessel of the flap. At 3 days after operation, the vascular volume of the flap was (1 240.23±89.71) mm3 and the total length was (245.94±29.38) mm. At 7 days after operation, the vascular volume of the flap was (1 036.96±88.97) mm3 and the total length was (143.20±30.28) mm. There were significant differences in the vascular volume and the total length between different time points (t=5.088, P=0.000; t=7.701, P=0.000).
Conclusion
The digital technology can be applied to visually observe and objectively evaluate the morphological alteration of the micro-vessels of the flap, and provide technical support for the study of vascular model of flap.
ObjectiveTo explore the effect of icariin on early steroid-induced osteonecrosis of the femoral head in rabbits.MethodsFifty mature New Zealand rabbits (weighing, 2.5-3.0 kg) were randomly divided into control group (n=10), model group (n=20), and experimental group (n=20). The rabbits of model and experimental groups were injected with lipopolysaccharide and methylprednisolone to establish the animal model of early steroid-induced osteonecrosis of the femoral head. The rabbits of experimental group were feeded with icariin solution once a day for 6 weeks since the first injection of methylprednisolone, whereas the rabbits of control and model groups were given normal saline at the same time points. The left femoral heads were removed after 6 weeks and gross morphological features were evaluated. Micro-CT scan was performed to analyze the trabecular microstructure with the following parameters: trabecular bone volume to total volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Tn), and trabecular separation (Tb.Sp). The Micro-CT scan was also converted to three-dimensional reconstruction images for observation. HE staining was applied to observe the trabecular structure and morphological changes of osteocytes and marrow adipocytes. It was also used to determine whether the samples of femoral heads occurred osteonecrosis based on the criteria for pathological diagnosis, and calculate the rate of empty lacunae.ResultsSeven rabbits died during the study, and 9, 16, and 18 rabbits in the control, model, and experimental groups, respectively, enrolled the final analysis. Compared with control group, the femoral head collapse and trabecular breaks were more obvious, and the trabeculae were sparse with irregular arrangement in the model group according to the results of gross observation, Micro-CT scan, and three-dimensional reconstruction images. But in the experimental group, the surface of femoral head was slight shrinking without obvious collapse, and the degeneration of trabecular structure was mild. According to bone microstructures analysis, the Tb.N, Tb.Tn, and BV/TV of femoral head in model and experimental groups were lower than those in control group, while the Tb.Sp in the model and experimental groups were significantly higher. The Tb.N, Tb.Tn, and BV/TV of femoral head in experimental group were higher than those in model group, while the Tb.Sp in the experimental group was significantly lower. The differences between groups were all significant (P<0.05). In the model group, HE staining showed that the number of osteocytes reduced, the number of empty lacunae increased, and the marrow adipocytes piled up in the space between femoral trabeculae, some even mashed together like a cyst. In the experimental group, the trabecular structure was still relatively complete compared with model group, no obvious apoptosis of osteocytes was observed, the size and number of adipocytes were basically normal. None of the animals in control group occurred osteonecrosis of the femoral head based on the criteria for pathological diagnosis, and the incidence of osteonecrosis were 81.3% (13/16) in the model group and 66.7% (12/18) in the experimental group, and the difference was not significant (P=0.448). The rate of empty lacunae of osteonecrotic femoral heads in the model group was 33.1%±1.4%, which was higher than that in experimental group (18.9%±0.8%) and in control group (12.7%±1.5%), and the differences between groups were significant (P<0.05).ConclusionThe icariin has a protective effect on the early steroid-induced osteonecrosis of the femoral head in rabbits, which can decrease osteocytes apoptosis, improve the bone microstructure, and delay such disease processes.
Objective To review the principles and techniques of CT perfusion imaging and its applications in the imaging diagnosis of abdominal disorders. Methods All the relevant literatures were reviewed. The principles and techniques of CT perfusion imaging were described and summarized in detail. The functional information of a target abdominal organ (e.g. the liver and pancreas) revealed by CT perfusion imaging, such as hemodynamics and microcirculation status, was also evaluated. Results In addition to the morphologic information, CT perfusion imaging can also provide functional information about the circulation parameters of target abdominal organs. Moreover, such functional information can be generated for the neovasculature and microcirculation of tumor lesions of abdominal organs, which is very helpful for not only the diagnosis, but also the evaluation of tumor invasiveness and response to treatment. Conclusion CT perfusion imaging offers an effective method for studying abdominal disorders by providing functional information that is quite useful for the differential diagnosis and assessment of therapeutic response.
Objective To explore the application value of artificial intelligence (AI) pulmonary artery assisted diagnosis software for suspected pulmonary embolism patients. Methods The data of 199 patients who were clinically suspected of pulmonary embolism and underwent pulmonary artery CT angiography (CTA) from June 2016 to December 2021 were retrospectively analyzed. Images of pulmonary artery CTA diagnosed by radiologists with different experiences and judged by senior radiologists were compared with the analysis results of AI assisted diagnostic software for pulmonary artery CTA, to evaluate the diagnostic efficacy of this software and low, medium, and senior radiologists for pulmonary embolism. The agreement of pulmonary embolism based on pulmonary artery CTA between the AI software and radiologists with different experiences was evaluated using Kappa test. Results The agreement of the AI software and the evaluation of pulmonary embolism lesions by senior radiologists based on pulmonary artery CTA was high (Kappa=0.913, P<0.001), while the diagnostic results of pulmonary artery CTA AI software was good after judged by senior radiologists based on pulmonary artery CTA (Kappa=0.755, P<0.001). Conclusions The AI software based on pulmonary artery CTA diagnosis of pulmonary embolism has good consistency with diagnostic images of radilogists, and can save a lot of reconstruction and diagnostic time. It has the value of daily diagnosis work and worthy of clinical promotion.
Objective
To realize the visualization of three-dimensional microstructure of rabbit sciatic nerve bundles by micro-CT and three-dimensional visualization software Mimics17.0.
Methods
The sciatic nerve tissues from 6 New Zealand rabbits were divided into 2 groups (n=3), and the sciatic nerve tissues were stained by 1% (group A) and 5% (group B) Lugol solution respectively. After staining for 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, and 3.5 hours, the imaging changes of specimens were observed by light microscope and micro-CT. The clear micro-CT images were exported to the Mimics software to complete the visualization of three-dimensional microstructure of rabbit sciatic nerve according to three-dimensional reconstruction tool.
Results
The clear three-dimensional microstructure images could be observed in group A at 2.5 hours after staining and in group B at 1.5 hours after staining by light microscope and micro-CT. The sciatic nerve of New Zealand rabbits were divides into 3 bundles and each of them was relatively fixed. There was no obvious crossing or mergers between each bundle. The cross-sectional area of each bundle was (0.425±0.013), (0.038±0.007), and (0.242±0.026) mm2 respectively. The digital model could clearly reflect the microstructure of the sciatic nerve at all cross sections.
Conclusion
The internal structure of New Zealand rabbits sciatic nerve can be clearly reflected by micro-CT scanning. It provides a reliable method for establishing a nerve microstructure database with large amount specimens.
ObjectiveTo investigate the correlation between CT value and Cage subsidence in patients with lumbar degenerative disease treated with stand-alone oblique lumbar interbody fusion (OLIF). MethodsThe clinical data of 35 patients with lumbar degenerative diseases treated with stand-alone OLIF between February 2016 and October 2018 were retrospectively analyzed. There were 15 males and 20 females; the age ranged from 29 to 81 years, with an average of 58.4 years. There were 39 operative segments, including 32 cases of single-segment, 2 cases of double-segment, and 1 case of three-segment. Preoperative lumbar CT was used to measure the CT values of the axial position of L1 vertebral body, the axial and sagittal positions of L1-4 vertebral body, surgical segment, and the axial position of upper and lower vertebral bodies as the bone mineral density index, and the lowest T value was recorded by dual-energy X-ray absorptiometry. The visual analogue scale (VAS) and Oswestry disability index (ODI) scores were recorded before operation and at last follow-up. At last follow-up, the lumbar interbody fusion was evaluated by X-ray films of the lumbar spine and dynamic position; the lumbar lateral X-ray film was used to measure the subsidence of the Cage, and the patients were divided into subsidence group and nonsubsidence group. The univariate analysis on age, gender, body mass index, lowest T value, CT value of vertebral body, disease type, and surgical segment was performed to initially screen the influencing factors of Cage subsidence; further the logistic regression for multi-factor analysis was used to screen fusion independent risk factors for Cage subsidence. The receiver operating characteristic (ROC) curve and area under curve (AUC) were used to analyze the CT value and the lowest T value to predict the Cage subsidence. Spearman correlation analysis was used to determine the correlation between Cage subsidence and clinical results. Results All the 35 patients were followed up 27-58 months, with an average of 38.7 months. At last follow-up, the VAS and ODI scores were significantly decreased when compared with preoperative scores (t=32.850, P=0.000; t=31.731, P=0.000). No recurrent lower extremity radiculopathy occurred and no patient required revision surgery. Twenty-seven cases (77.1%) had no Cage subsidence (nonsubsidence group); 8 cases (22.9%) had at least radiographic evidence of Cage subsidence, the average distance of Cage subsidence was 2.2 mm (range, 1.1-4.2 mm) (subsidence group). At last follow-up, there was 1 case of fusion failure both in the subsidence group and the nonsubsidence group, there was no significant difference in the interbody fusion rate (96.3% vs. 87.5%) between two groups (P=0.410). Univariate analysis showed that the CT value of vertebral body (L1 axial position, L1-4 axial and sagittal positions, surgical segment, and upper and lower vertebral bodies axial positions) and the lowest T value were the influencing factors of Cage subsidence (P<0.05). According to ROC curve analysis, compared with AUC of the lowest T value [0.738, 95%CI (0.540, 0.936)], the AUC of the L1-4 axis CT value was 0.850 [95%CI (0.715, 0.984)], which could more effectively predict Cage subsidence. Multivariate analysis showed that the CT value of L1-4 axis was an independent risk factor for Cage subsidence (P<0.05). Conclusion The CT value measurement of the vertebral body based on lumbar spine CT before stand-alone OLIF can predict the Cage subsidence. Patients with low CT values of the lumbar spine have a higher risk of Cage subsidence. However, the Cage subsidence do not lead to adverse clinical results.
ObjectiveTo measure anatomical parameters related to cervical uncovertebral joint and provide data support for the design of uncovertebral joint fusion cage.MethodsAccording to the inclusion and exclusion criteria, raw DICOM data of cervical CT scan in 60 patients (30 males and 30 females, aged 39-60 years) were obtained, then the three-dimensional cervical spine model was reconstructed for anatomical measurement by using the Mimics19.0 software. The height of the uncinate process, the length of the uncinate process, the width of the uncinate process, and the length of the uncovertebral joint in the intervertebral foramen region were measured bilaterally from C3 to C7. The anterior and posterior distances between the uncinate processes were measured from C3 to C7. The height of the uncovertebral joint space, the central height of the intervertebral disc space, and the depth of the intervertebral disc space were also measured from C2, 3 to C6, 7. The mean, standard deviation, maximum, and minimum were calculated by using the SPSS22.0 statistical software for the design of uncovertebral joint fusion cage.ResultsThe height of the uncinate process, the length of the uncinate process, the width of the uncinate process, and the length of the uncovertebral joint in the intervertebral foramen region of C3-C7 and the height of the uncovertebral joint space of C2, 3-C6, 7 showed no significant difference between two sides (P>0.05). The height of the uncovertebral joint space also had no significant difference between females and males (P>0.05). The anterior distances between the uncinate processes of C3-C7 were significantly larger than the posterior distances between the uncinate processes (P<0.05), the uncovertebral joint presented a posterior cohesive shape. The central height of the intervertebral disc space in male group was slightly higher than that in female group, and the differences were significant (P<0.05) at C2, 3 and C5, 6; the depth of the intervertebral disc space in male group was significantly higher than that in female group (P<0.05). The central height of the intervertebral disc space was (4.94±0.49) mm (range, 3.81-5.90 mm), the depth of the intervertebral disc space was (15.78±1.23) mm (range, 12.94-18.85 mm), the anterior and posterior distances between the uncinate processes were (17.19±2.39) mm (range, 13.39-24.63 mm) and (10.84±2.12) mm (range, 7.19-16.64 mm), respectively. According to the results of the anatomical research, the height of the uncovertebral joint fusion cage was designed as 5, 6, 7, and 8 mm; the depth of the uncovertebral joint fusion cage was designed as 12, 13, 14, 15, and 16 mm; the width of the uncovertebral joint fusion cage was designed as 14-18 mm; and the two wings are designed as arc-shape with 2 and 3 mm in width.ConclusionThere are certain differences in the anatomical parameters of the uncovertebral joint between different segments. The uncovertebral joint fusion cage that designed based on the results of anatomical research is suitable for most patients.
Objective To review the vascular anatomy of the donor and the reci pient for the l iving kidney transplantation. Methods The recent l iterature about the vessels of donor and reci pient in cl inical appl ications was extensively reviewed. Results The pertinent vascular anatomy of the donor and recipient was essential for the screening of the proper candidates, surgical planning and long-term outcome. Early branching and accessory renal artery of the donor were particularly important to deciding the side of nephrectomy, surgical technique and anastomosing pattern, and their injuries were the most frequent factor of the conversion from laparoscopic to open surgery. With increase of laparoscopic nephrectomy indonors, accurate venous anatomy was paid more and more attention to because venous bleeding could also lead to conversion to open nephrectomy. Multidetector CT (MDCT) could supplant the conventional excretory urography and renal catheter angiography and could accurately depict the donors’ vessels, vascular variations. In addition, MDCT can excellently evaluate the status of donor kidney, collecting system and other pertinent anatomy details. Conclusion Accurate master of related vascular anatomy can facil iate operation plan and success of operation and can contribute to the rapid development of living donor kidney transplantation. MDCT has become the choice of preoperative one-stop image assessment for living renal donors.
