Nowadays,pyogenic liver abscess(PLA)is still a common and severe intra-abdominal infection,and Klebsiella pneumoniae had emerged as the most common pathogenic bacteria worldwide in the past ten years.Our study aims to...Nowadays,pyogenic liver abscess(PLA)is still a common and severe intra-abdominal infection,and Klebsiella pneumoniae had emerged as the most common pathogenic bacteria worldwide in the past ten years.Our study aims to achieve an early pathogenic diagnosis and rational therapy modality for Klebsiella pneumoniae liver abscess(KLA)through clinical data analysis.A total of 197 inpatients in Zhongshan Hospital,Shanghai,diagnosed as having liver abscess between March 2001 and September 2009 were enrolled.Patients with monomicrobial infection were divided into two groups:patients with K.pneumoniae liver abscess(KLA group,n=106)and those with non-Klebsiella pneumoniae liver abscess(NKLA group,n=56).A retrospective analysis was made between these two groups on the aspects of underlying diseases,clinical characteristics,laboratory data,culture results,and imaging findings.To evaluate the effects of different medical interventions,monomicrobial KLA patients were further divided into four subgroups(percutaneous liver aspiration,aspiration plus antibiotics flushing,aspiration plus retained catheter,and aspiration plus antibiotics flushing and retained catheter),and corresponding therapeutic effects were analyzed.KLA was more likely to occur in patients with coexisting diseases such as diabetes mellitus(53.77%vs 25.00%,P=0.001)and hepatic adipose infiltration(16.04%vs 5.36%,P=0.029).Compared to NKLA group,clinical characteristics including abdominal pain(40.57%vs 57.14%,P=0.044),hypodynamia(19.81%vs 46.43%,P=0.001),and hepatomegaly(4.72%vs 14.29%,P=0.033)were much milder,but with a higher fasting blood glucose level(7.84±0.36 vs 5.76±0.30,P=0.001)on admission in KLA group.In addition,KLA abscess often appeared singly in the right lobe of the liver with gas forming nature(32.88%vs 13.51%,P=0.039),unsmooth rim(71.23%vs 40.54%,P=0.002),and dynamic septum enhancement(41.10%vs 16.22%,P=0.009).Compared to mono aspiration subgroup,additional antibiotic flushing could not further improve clinical outcomes of KLA patients(P>0.05);how展开更多
Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the ...Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum.The bowel wall was normal in non-enhanced images,and normal or inconspicuous in arterial phase enhanced images.In one of the three cases,the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images.No filling defect was seen in the lumen of the superior mesenteric artery and vein.No peritoneal effusion or mesentery abnormality was found.Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time.Only one patient suffered mild diarrhea after scanning which had resolved by the following day.The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms.Differential diagnosis may include inflammatory and ischemic bowel disease,as well as neoplasms.A three-phase CT protocol and good under-standing of this disorder are fundamentally important in the diagnosis of this condition.The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions.The predilection location of transient anaphylactic bowel angioedema is the small intestine,particularly the proximal segment.A speculated cause may be the richer supply of vessels in the small intestine,ample mucous folds and loose connective tissue in the duodenum and the jejunum.展开更多
Pneumo-computed tomography (PnCT) is a technique primarily developed and used to study stenotic lesions of the esophagus, gastroesophageal junction and stom-ach for pre-surgical planning. It helps to define both upper...Pneumo-computed tomography (PnCT) is a technique primarily developed and used to study stenotic lesions of the esophagus, gastroesophageal junction and stom-ach for pre-surgical planning. It helps to define both upper and lower borders of neoplasms located in the aforementioned areas. It achieves maximum lumen distension with CO2 highlighting thickened areas of the esophageal wall, thus allowing an accurate quantifica-tion of their extents. Although there are other alterna-tives for distension (oral contrast agents, water and ef-fervescent granules), they may be suboptimal. Patients with locally advanced esophageal cancer have a dismal prognosis despite surgical resection. Therefore, neo-adjuvant treatment strategies using radiation therapy and chemotherapy were developed to improve sur-vival. Neoadjuvant therapy improves esophageal tumor prognosis in a substantial proportion of patients, and the use of imaging techniques is mandatory to detect their response. PnCT combined with virtual endoscopy and multiplanar reconstruction enhances morphologic details in esophageal cancer, and thus would allow animproved assessment of response to neoadjuvant treat-ment. Therefore, more information could be provided to assess the efficacy of pre-surgical treatment. We de-scribe the potential use of PnCT to assess the response to neoadjuvant therapy in esophageal cancer with an imaging pathologic correlation.展开更多
We implemented a new protocol—multiphase dynamic helical scan to acquire CT angiography(CTA)and whole brain CT perfusion(CTP)images simulta-neously with single scan on 16 multidetector CT(MDCT).A total of 90 patients...We implemented a new protocol—multiphase dynamic helical scan to acquire CT angiography(CTA)and whole brain CT perfusion(CTP)images simulta-neously with single scan on 16 multidetector CT(MDCT).A total of 90 patients who were randomly assigned into 3 groups were included in our study.Each group underwent CT scan by using the new protocol,traditional CTA and CTP protocol,respectively.The image quality of CTA,the CTP parameter values and the X-ray doses were measured and compared between the new protocol and the traditional protocols.There was no statistically significant difference in the CTA image quality between the above methods(P=0.55).For CTP parameters,the new protocol tended to overestimate the blood volume(BV)and bloodflow(BF)value,and to underestimate the mean transit time(MTT)value compared with the traditional method.However,there was no statistically significant difference in BV,BF,and MTT value between the two methods except permeability surface(PS)(P>0.05).The volume CT dose index(CTDIvol)and dose length product(DLP)of our protocol were lower than the traditional one.The new protocol can obtain valuable diagnostic information in a shorter time without significant compromise in image quality.In addition,it reduces the radiation dose as well as contrast medium usage on the patient.展开更多
Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the commonest malignant neoplasms of the diaphragm; however, only a few(less than 20) cases have ...Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the commonest malignant neoplasms of the diaphragm; however, only a few(less than 20) cases have been reported to date. We present the case of an extremely rare tumor of the diaphragm mimicking a liver mass. The patient, a young 28-year-old woman, presented with an 8-month-history of mildly progressive upper abdominal pain and early fullness after meals. Computed tomography scan of the abdomen revealed a mass located in the region of the left lobe of the liver with non visualized left lobe and partial vascular supply of the mass from the left hepatic artery. The tumor was also seen to draw its vascularity from bilateral internal mammary arteries. Surgical excision and hepatectomy was planned, keeping in mind the diagnosis of an atypical left hepatic mass. Laparotomy revealed a left diaphragmatic tumor growing caudally into the upper abdomen, compressing and splaying the liver along the left medial surface where the tumorwas virtually adherent to it. Successful excision of the mass and subsequent histopathological and immunochemistry examination of the specimen revealed low grade fibromyxoid sarcoma of the diaphragm. This case highlights the unusual presentation of a diaphragmatic mesenchymal tumor and how it can be mistaken as an atypical liver mass. It also emphasizes the tumoral vascular supply as an indicator of its organ of origin.展开更多
目的：探讨CT能谱成像不同评估参数在肝细胞癌与肝转移瘤间的差异。方法回顾性分析行能谱CT 三期对比剂增强扫描的肝肿瘤患者31例（肝细胞癌15例，肝转移瘤16例），分别在三期能谱图像上对病灶边缘与腹主动脉、门静脉及下腔静脉的能谱...目的：探讨CT能谱成像不同评估参数在肝细胞癌与肝转移瘤间的差异。方法回顾性分析行能谱CT 三期对比剂增强扫描的肝肿瘤患者31例（肝细胞癌15例，肝转移瘤16例），分别在三期能谱图像上对病灶边缘与腹主动脉、门静脉及下腔静脉的能谱参数进行测量，并计算50～70keV下的标准化CT 值、标准化碘（水）浓度、铁（水）浓度、水（碘）浓度、有效原子序数、能谱曲线斜率及动静脉碘浓度差等。分析肝细胞癌与肝转移瘤之间、肝细胞癌转移灶与肝转移瘤之间各测量和统计参数的差异。结果肝细胞癌组在门脉期50、60、70keV 下 CT 值分别为142．500±29．106、112.010±20．864、93．727±15．331，碘浓度值为17．235±5．089（100ug／ml），有效原子序数为8．594±0．266，明显高于肝转移瘤组，并具有统计学差异（ P ＜0．05），且门脉期较动脉期差异更为明显。肝细胞癌转移灶组与肝转移瘤组相比较，50～70keV下的CT值、碘（水）浓度、铁（水）浓度、水（碘）浓度、有效原子序数及标化后CT值、标准化碘（水）浓度、铁（水）浓度、有效原子序数肝细胞癌转移灶组明显高于肝转移瘤组，也具有统计学差异（ P ＜0．05），且随着扫描时间延长，两组差异逐渐变小。结论肝细胞癌与肝转移瘤、肝细胞癌转移灶与肝转移瘤的C T 能谱成像具有不同的特征，低能量keV可以对两组病变进行定量鉴别。展开更多
文摘Nowadays,pyogenic liver abscess(PLA)is still a common and severe intra-abdominal infection,and Klebsiella pneumoniae had emerged as the most common pathogenic bacteria worldwide in the past ten years.Our study aims to achieve an early pathogenic diagnosis and rational therapy modality for Klebsiella pneumoniae liver abscess(KLA)through clinical data analysis.A total of 197 inpatients in Zhongshan Hospital,Shanghai,diagnosed as having liver abscess between March 2001 and September 2009 were enrolled.Patients with monomicrobial infection were divided into two groups:patients with K.pneumoniae liver abscess(KLA group,n=106)and those with non-Klebsiella pneumoniae liver abscess(NKLA group,n=56).A retrospective analysis was made between these two groups on the aspects of underlying diseases,clinical characteristics,laboratory data,culture results,and imaging findings.To evaluate the effects of different medical interventions,monomicrobial KLA patients were further divided into four subgroups(percutaneous liver aspiration,aspiration plus antibiotics flushing,aspiration plus retained catheter,and aspiration plus antibiotics flushing and retained catheter),and corresponding therapeutic effects were analyzed.KLA was more likely to occur in patients with coexisting diseases such as diabetes mellitus(53.77%vs 25.00%,P=0.001)and hepatic adipose infiltration(16.04%vs 5.36%,P=0.029).Compared to NKLA group,clinical characteristics including abdominal pain(40.57%vs 57.14%,P=0.044),hypodynamia(19.81%vs 46.43%,P=0.001),and hepatomegaly(4.72%vs 14.29%,P=0.033)were much milder,but with a higher fasting blood glucose level(7.84±0.36 vs 5.76±0.30,P=0.001)on admission in KLA group.In addition,KLA abscess often appeared singly in the right lobe of the liver with gas forming nature(32.88%vs 13.51%,P=0.039),unsmooth rim(71.23%vs 40.54%,P=0.002),and dynamic septum enhancement(41.10%vs 16.22%,P=0.009).Compared to mono aspiration subgroup,additional antibiotic flushing could not further improve clinical outcomes of KLA patients(P>0.05);how
文摘Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum.The bowel wall was normal in non-enhanced images,and normal or inconspicuous in arterial phase enhanced images.In one of the three cases,the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images.No filling defect was seen in the lumen of the superior mesenteric artery and vein.No peritoneal effusion or mesentery abnormality was found.Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time.Only one patient suffered mild diarrhea after scanning which had resolved by the following day.The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms.Differential diagnosis may include inflammatory and ischemic bowel disease,as well as neoplasms.A three-phase CT protocol and good under-standing of this disorder are fundamentally important in the diagnosis of this condition.The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions.The predilection location of transient anaphylactic bowel angioedema is the small intestine,particularly the proximal segment.A speculated cause may be the richer supply of vessels in the small intestine,ample mucous folds and loose connective tissue in the duodenum and the jejunum.
文摘Pneumo-computed tomography (PnCT) is a technique primarily developed and used to study stenotic lesions of the esophagus, gastroesophageal junction and stom-ach for pre-surgical planning. It helps to define both upper and lower borders of neoplasms located in the aforementioned areas. It achieves maximum lumen distension with CO2 highlighting thickened areas of the esophageal wall, thus allowing an accurate quantifica-tion of their extents. Although there are other alterna-tives for distension (oral contrast agents, water and ef-fervescent granules), they may be suboptimal. Patients with locally advanced esophageal cancer have a dismal prognosis despite surgical resection. Therefore, neo-adjuvant treatment strategies using radiation therapy and chemotherapy were developed to improve sur-vival. Neoadjuvant therapy improves esophageal tumor prognosis in a substantial proportion of patients, and the use of imaging techniques is mandatory to detect their response. PnCT combined with virtual endoscopy and multiplanar reconstruction enhances morphologic details in esophageal cancer, and thus would allow animproved assessment of response to neoadjuvant treat-ment. Therefore, more information could be provided to assess the efficacy of pre-surgical treatment. We de-scribe the potential use of PnCT to assess the response to neoadjuvant therapy in esophageal cancer with an imaging pathologic correlation.
文摘We implemented a new protocol—multiphase dynamic helical scan to acquire CT angiography(CTA)and whole brain CT perfusion(CTP)images simulta-neously with single scan on 16 multidetector CT(MDCT).A total of 90 patients who were randomly assigned into 3 groups were included in our study.Each group underwent CT scan by using the new protocol,traditional CTA and CTP protocol,respectively.The image quality of CTA,the CTP parameter values and the X-ray doses were measured and compared between the new protocol and the traditional protocols.There was no statistically significant difference in the CTA image quality between the above methods(P=0.55).For CTP parameters,the new protocol tended to overestimate the blood volume(BV)and bloodflow(BF)value,and to underestimate the mean transit time(MTT)value compared with the traditional method.However,there was no statistically significant difference in BV,BF,and MTT value between the two methods except permeability surface(PS)(P>0.05).The volume CT dose index(CTDIvol)and dose length product(DLP)of our protocol were lower than the traditional one.The new protocol can obtain valuable diagnostic information in a shorter time without significant compromise in image quality.In addition,it reduces the radiation dose as well as contrast medium usage on the patient.
文摘Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the commonest malignant neoplasms of the diaphragm; however, only a few(less than 20) cases have been reported to date. We present the case of an extremely rare tumor of the diaphragm mimicking a liver mass. The patient, a young 28-year-old woman, presented with an 8-month-history of mildly progressive upper abdominal pain and early fullness after meals. Computed tomography scan of the abdomen revealed a mass located in the region of the left lobe of the liver with non visualized left lobe and partial vascular supply of the mass from the left hepatic artery. The tumor was also seen to draw its vascularity from bilateral internal mammary arteries. Surgical excision and hepatectomy was planned, keeping in mind the diagnosis of an atypical left hepatic mass. Laparotomy revealed a left diaphragmatic tumor growing caudally into the upper abdomen, compressing and splaying the liver along the left medial surface where the tumorwas virtually adherent to it. Successful excision of the mass and subsequent histopathological and immunochemistry examination of the specimen revealed low grade fibromyxoid sarcoma of the diaphragm. This case highlights the unusual presentation of a diaphragmatic mesenchymal tumor and how it can be mistaken as an atypical liver mass. It also emphasizes the tumoral vascular supply as an indicator of its organ of origin.
文摘目的：探讨CT能谱成像不同评估参数在肝细胞癌与肝转移瘤间的差异。方法回顾性分析行能谱CT 三期对比剂增强扫描的肝肿瘤患者31例（肝细胞癌15例，肝转移瘤16例），分别在三期能谱图像上对病灶边缘与腹主动脉、门静脉及下腔静脉的能谱参数进行测量，并计算50～70keV下的标准化CT 值、标准化碘（水）浓度、铁（水）浓度、水（碘）浓度、有效原子序数、能谱曲线斜率及动静脉碘浓度差等。分析肝细胞癌与肝转移瘤之间、肝细胞癌转移灶与肝转移瘤之间各测量和统计参数的差异。结果肝细胞癌组在门脉期50、60、70keV 下 CT 值分别为142．500±29．106、112.010±20．864、93．727±15．331，碘浓度值为17．235±5．089（100ug／ml），有效原子序数为8．594±0．266，明显高于肝转移瘤组，并具有统计学差异（ P ＜0．05），且门脉期较动脉期差异更为明显。肝细胞癌转移灶组与肝转移瘤组相比较，50～70keV下的CT值、碘（水）浓度、铁（水）浓度、水（碘）浓度、有效原子序数及标化后CT值、标准化碘（水）浓度、铁（水）浓度、有效原子序数肝细胞癌转移灶组明显高于肝转移瘤组，也具有统计学差异（ P ＜0．05），且随着扫描时间延长，两组差异逐渐变小。结论肝细胞癌与肝转移瘤、肝细胞癌转移灶与肝转移瘤的C T 能谱成像具有不同的特征，低能量keV可以对两组病变进行定量鉴别。
