ObjectiveTo explore the clinical value of low-dose contrast agnet in CT angiography (CTA) for head and neck by SOMATOM Definition Flash CT.MethodsSixty consecutive patients with head and neck vessel diseases examined by CTA in the head and neck were chosen from West China Hospital of Sichuan University from March to July 2015, and then were randomly divided into two groups (the experimental group: n=30, 30 mL contrast medium; the control group: n=30, 50 mL contrast medium). Imaging post processing techniques included curved plannar reconstruction, volume rendering, and maximal intensity projection. CT values of the different level of carotid arteries (aortic arch, carotid bifuracation, and M1 segment of middle cerebral artery) were measured. The artifact of the remaining contract in the jugular vein and overall quality of the image were observed by two senior doctors using double blind method.ResultsAll the patients in the two groups completed CTA for head and neck successfully. The image qualities of the two groups satisfid clinical diagnostic requirements, and there was no difference in the image qualities between the two groups (P>0.05). The evaluation of venous pollution in the experimental group was lighter than that in the control group (P<0.05). The CT values of aortic arch, carotid bifuracation, and M1 segment of middle cerebral artery in the experimental group [(341.3±89.5), (391.0±103.7), (305.0±62.0) HU] were slightly lower than those in the control group [(437.3±83.7), (532.5±113.3), (396.6±93.1) HU], which were statistically significant (P<0.05).ConclusionLow-dose contrast in CTA for head and neck by SOMATOM Definition Flash CT can satisfy the clinical diagnostic requirements, and reduce the dose of contrast agent and venous pollution, with a good clinical value.
Objective To investigate the value of contrast-enhanced ultrasonography in detection and diagnosis of small primary liver cancer. Methods SonoVue-enhanced ultrasonography were performed on 353 patients with 378 primary liver cancer, less than 3 cm in diameter. Enhancement patterns and enhancement phases of hepatic lesions on contrast-enhanced ultrasonography were analyzed and compared with the results of histopathology. Results In all hepatic tumors, 96.6% （365/378） lesions enhanced in the arterial phase. Among them, 317 (83.9%) tumors enhanced earlier than liver parenchyma and 48 (12.7%) tumors enhanced synchronously with liver parenchyma, and 342 (90.5%) tumors showed early wash-out in the portal and late phases. With regard to the enhancement pattern, 329 (87.0%) tumors presented whole-lesion enhancement, 35 (9.3%) to be mosaic enhancement and 14 (3.7%) to be rim-like enhancement. If taking the whole-lesion enhancement and mosaic enhancement in arterial phase as diagnotic standard for primary liver cancer on contrast-enhanced ultrasonography, the sensitivity was 92.9%(351/378), and if the earlier or synchronous enhancement of the tumor compared with liver parenchyma in arterial phase and the wash-out in portal phase were regarded as the stardand, the sensitivity was 87.3%(330/378). Conclusion Contrast-enhanced ultrasonography could display real-time enhancement patterns as well as the wash-out processes both in hepatic tumors and the liver parenchyma. It might be of clinical value in diagnosis of primary liver cancer based on the hemodynamics of hepatic tumors on contrast-enhanced ultrasonography.
Gallbladder polypoid lesion (GPL) is a common gallbladder disease, mainly including tumor lesions such as gallbladder cancer and gallbladder adenoma and non-tumor lesions such as cholesterol polyps and gallbladder adenomyomatosis. Contrast-enhanced ultrasound (CEUS) can improve the diagnostic accuracy of GPL. This paper reviews the application progress of CEUS in the diagnosis of gallbladder cancer, gallbladder adenoma, gallbladder cholesterol polyps and gallbladder adenomyosis, and the limitations of CEUS in the diagnosis of GPL.
ObjectiveTo observe the changes of macular visual function after myopic foveoschisis (MF) and pars plana vitrectomy (PPV) combined with internal limiting membrane peeling and air filling. MethodsA single-center, retrospective study. From October 2018 to October 2019, 29 MF inpatients (32 eyes) in Tianjin Eye Hospital were included in this study. There were 3 males (4 eyes) and 26 females (28 eyes). The age was 63.00±3.45 years old. Equivalent spherical lens degree was －14.16±2.54 D, and axial length was 29.14±1.04 mm. Among them, 3 patients (3 eyes) had lamellar macular holes. All eyes underwent standard pars plana three-channel 25G PPV combined with internal limiting membrane peeling and air filling. Before surgery and at 1, 3, and 6 months after surgery, macular microperimetry was performed with a macular integrity assessment instrument, and the mean retinal sensitivitie (MS) within 10° of the macula, fovea 2° and 4° fixation rates (P1, P2), 63% and 95% bivariate contour ellipse area (BCEA) were recorded. The comparison of MS, P1, P2, 63%BCEA and 95%BCEA at different times before and after surgery was performed by paired t test; the comparison of fixation stability rate was performed by χ2 test. ResultsCompared with before surgery, there were significant differences in the improvement of MS in affected eyes at 1, 3 and 6 months after surgery (t=－2.208, －3.435,－4.919; P=0.038, 0.002, 0.000). In the pairwise comparison at different times after surgery, only 6 months after surgery and 1 month after surgery were significantly different (P=0.036). Compared with the preoperative P1, P2, 63%BCEA and 95%BCEA, the P1 and P2 of the eyes gradually increased after surgery, while the 63%BCEA and 95%BCEA gradually decreased, however, the difference was not statistically significant (P1: t=－1.595,－1.698,－1.966; P=0.125, 0.104, 0.062. P2: t=－1.622,－1.654,－1.707; P=0.119, 0.112, 0.102. 63%BCEA: t=1.410, 1.409, 1.553; P=0.172, 0.173, 0.135. 95%BCEA: t=1.412, 1.408, 1.564; P=0.172, 0.173, 0.132). Six months after surgery, all the eyes underwent anatomical repositioning of the macular area, and no serious complications such as full-thickness macular hole and macular hole retinal detachment were found. ConclusionsPPV with internal limiting membrane peeling and air filling is an effective and safe method for MF, and the macular function improved significantly within 6 months postoperatively.
Objective To explore the indication, advantage and disadvantage of modified or classical technique of intraoral sagittal split ramus osteotomy (SSRO) for correction of mandibular prognathism. Methods From January 1997 to January 2005, 95 patients suffering from mandibular prognathism or accompanied by other deformities were treated with modified or classical technique of intraoral SSRO. Of 95 cases, there were 34 males and 61 females, aging 15 to 44 years, including 53 cases of single mandibular prognathism, 28 cases accompanied with mandibular deviation, 11 cases accompanied with maxillaryretrognathism, 2 cases accompanied with glossacele and 1 case accompanied with malar protrution. X-ray cephalometry showed: sella-nasion-A point(SNA) 80-83°, sella-nasion-B point(SNB) 80-84°, A point-nasion-B point(ANB)-3-1°.Fortythree cases were corrected by modified SSRO and 52 cases by classical SSRO. Results The face appearance and dental articulation of all the patients were improved greatly. In patients by classical SSRO, disorder of local sensibility occurred in 9 cases, mandibular fracture during the cleavage ofthe ascending ramus in 1 case, significant bleeding in 1 case, postoperative infection in 1 case and postoperative relapse in 3 cases. In patients by modifiedSSRO, disorder of local sensibility occurred in 2 cases and postoperative relapse in 1 case; no mandibular fracture, significant bleeding, postoperative infection and other complications occurred. With a follow-up of 3 months to 7 years, X-ray cephalometry showed SNA 81-83°, SNB 78-81°and ANB 1-4°. 〖WTHZ〗Conclusion Modified SSRO is an ideal method of correcting mandibular prognathism, especially severer mandibularprognathism accompanied by mandible deviation deformity.
ObjectiveTo assess the image quality and radiation dose of gemstone CT coronary angiography (CCTA) with low tube voltage and low concentration contrast medium.
MethodsSixty-nine patients who underwent CCTA from January to March 2014 were randomly divided into group A and B. CCTA was performed in thirty-four patients in group A with tube voltage of 100 kV and concentration of contrast medium of 300 mgI/mL. And thirty-five patients in group B underwent CCTA with 120 kV and 370 mgI/mL. According to upgrading American Heart Association standard all segments and all vessels were evaluated. We measured the CT value of ascending aortic root, left main coronary artery, and the initial segment of left anterior descending branch, left circumflex, right coronary artery, and also adjacent tissues. Besides, we recorded CT dose volume index (CTDIvol) and the dose length product (DLP) and calculated effective radiation dose.
ResultsThe image quality scores were not significantly different between two groups (P>0.05). The density in the contrast enhanced vessel lumens in group A were signifcantly higher than that in group B (P<0.05). There was no significant difference in signal to noise ratio and carrier to noise ratio between the two groups (P>0.05). Noise in group A was higher than that in group B (P<0.05). The CTDIvol and effective radiation dose in group A were significantly lower than those in group B (P<0.05).
ConclusionThe combination of 100 kV with low concentration contrast medium (300 mgI/mL) still maintains the image quality, as well as significantly lowers the radiation dose and the dose of iodine.
Objective To investigate the value of contrast enhanced ultrasound (CEUS) in evaluating the short term therapeutic response to radiofrequency ablation (RFA) of primary hepatocellular carcinoma. Methods One hundred and ten lesions were studied in 96 patients. Each patient underwent CEUS within a week before RFA, the number, size, border, inner echo and perfusion pattern of lesions were observed. One month after ultrasound-guided RFA, color Doppler flow imaging, CEUS and contrast enhanced computed tomography (CECT, reference standard) were performed to assess the therapeutic response. Results Before RFA, in 96 cases with 110 lesions, 83 lesions showed homogeneous hyper-enhancement and the other 27 heterogeneous hyper-enhancement in arterial phase, and 98 lesions were hypo-enhanced in portal venous phase and late phase and the other 12 iso-enhanced. One month after RFA, 99 of 110 lesions were found no-enhancement in entire CEUS procedure, while 11 lesions showed local enhancement on the edge of lesion. Ninety-six of 110 lesions showed no-enhancement and other 14 with irregular enhancement by CECT. There was no statistical significance between CEUS and CECT (χ2=0.406, Pgt;0.05). Fourteen lesions as tumor residual by CECT were underwent RFA again, and then 1 month after RFA no-enhancement was showed by both CECT and CEUS. Conclusion CEUS can play a role in assessing the short term therapeutic response to RFA of hepatocellular carcinoma.
Sample size calculation is an important factor to evaluate the reliability of the diagnostic test. In this paper, a case study of the clinical diagnostic test of artificial intelligence for identification of liver contrast-enhanced ultrasound was performed to conduct two-category and multi-categories studies. Based on sensitivity and specificity, the sample size was then estimated in combination with the statistical characteristics of disease incidence, test level and one/two-sided test. Eventually, the sample size was corrected by integrating the factors of the proportion of training/test dataset and the dropout rate of cases in the medical image recognition system. Moreover, the application of Sample Size Calculator, MedCalc, PASS, and other software can accelerate sample size calculation and reduce the amount of labor.
ObjectiveTo systematically review the value of ultrasound contrast agents injected subcutaneously for diagnosing sentinel lymph nodes of breast cancer.
MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library, CNKI, CBM, WanFang Data, and Medalink from their inception to July 2014, to collect diagnostic accuracy studies of ultrasound contrast agents injected subcutaneously for diagnosing sentinel lymph nodes of breast cancer. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using Meta-Disc 1.4 software.
ResultsEight studies involving 311 sentinel lymph nodes were included. The results of meta-analysis showed that, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under curve (AUC) of SROC were 0.89 (95%CI 0.84 to 0.93), 0.81 (95%CI 0.72 to 0.87), 4.14 (95%CI 2.20 to 7.79), 0.15 (95%CI 0.10 to 0.25), 33.23 (95%CI 11.17 to 98.83), and 0.96 respectively.
ConclusionContrast-enhanced ultrasound has a high value in diagnosis of sentinel lymph nodes of breast cancer. Due to limited quality and quantity of the included studies, more high quality and large-scale studies are needed to verify the above conclusion.
Objective To determine the correlation between central macular thickness (CMT) and the visual function in patients iwht macular edema (ME). Methods The clinical data of 42 eyes of 40 patients with ME which were examined by optical coherence tomography (OCT) and microperimetry (MP-1) were retrospectively analyzed. In 40 patients (42 eyes), diabetic ME (DME) was in 27 eyes，branch retinal vein occlusion was in 11eyes, and central retinal vein occlusion was in 4 eyes. All of the eyes had undergone OCT，MP-1 and best-corrected visual acuity (BCVA) test. Central macular thickness (CMT) was measured by fast macular scans using OCT. Retinal sensitivity (MS) and fixation patterns were evaluated by Mp-1. The position was chosen :2 disc diameters (DD) temporal to the disc and one third of a DD inferior to the centre of the disc. Results The correlation between CMT and BCVA is not significant (r＝－0.429，P=0.069) as well as the correlation between CMT and MS (r＝－0.433，P=0.058). The difference of CMT between the unstable and stable group was significant (F=3.262, P=0.039）. The difference of CMT between the central fixation group and preferred retinal locus (PRL) group was significant (F=3.173, P=0.044). Conclusions BCVA and MS have no significant correlation with CMT. When CMT increases, the fixation stability decreases, fixation location.changes, and PRL occurs.
