• Thứ 3, 11/08/2020
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Vai trò của ADC trong chẩn đoán phân biệt giữa tổn thương lành tính và ác tính ở gan

Vai trò của ADC trong chẩn đoán phân biệt giữa tổn thương lành tính và ác tính ở gan

03/31/2020 15:24:03 | 0 binh luận

summary

Purpose: Assessing the role of Apparent Diffusion Coefficient (ADC) measurement in differentiation of benign and malignant focal hepatic lesions.

Methods and Materials: Retrospectively evaluated the 248 patients cases, executed hepatic MRI at Medic Medical center, from on February 2011 to on February 2013, age range 41 - 78years, with 142 benign hepatocellular lesions (30 FNHs, 9 HCAs, 63 hemangiomas and 40 cysts) and 104 malignant lesions (76 HCC and 28 metastasis) diagnosed, 50 patients had normal liver. All the patients executed Diffusion weighted imaging - MRI with three b values (0, 500, 800 sec/mm2) on the Siemens Avanto 1,5T MRI.

Results: We found difference between ADC of benign lesions compared with malignant lesions (mean ± standard deviation): ADC of normal liver (1.242 × 10−3 mm2/sec ± 0.33), FNH-HCA (1.742 × 10−3 mm2/sec ± 0.40), Hemangiomas (2.084 × 10−3 mm2/sec ± 0.46), Cyst (2.861 × 10−3 mm2/sec ± 0.34), HCC (1.093× 10−3 mm2/sec ± 0.37), Metastasis (1.126 × 10−3 mm2/sec ± 0.48). ADC of benign lesions: (2.327 × 10−3 mm2/sec ± 0.41), compared with malignant lesions: (1.113 × 10−3 mm2/sec ± 0.39).

Conclusion: Mean value of apparent diffusion coefficient (ADC) contribute to differential diagnosis between benign and malignant focal hepatic lesions.

Ung thư gan vỡ, xuất huyết ổ bụng, được trị liệu hóa dầu thuyên tắc mạch qua catheter (TOCE) tai bệnh viện Hoàn Mỹ Đà Nẵng: Nhân một trường hợp

Ung thư gan vỡ, xuất huyết ổ bụng, được trị liệu hóa dầu thuyên tắc mạch qua catheter (TOCE) tai bệnh viện Hoàn Mỹ Đà Nẵng: Nhân một trường hợp

03/26/2020 22:18:24 | 0 binh luận

Ruptured hepatocellular carcinoma (hcc), bleeding in abdomen is treated by toce (transcatheter oily chemoembolization) at hoanmy DaNang hospita: a case report

SUMMARY

- HCC is the most common of cancer liver.

- Nature progress, metastasis is complex, multiple organs.

- Ruptured HCC, Bleeding in abdomen, hypotention, shock,...: is severe statement, progress is very rapid, complex, serious, dead rate is hight.

- Diagnotic and treatment (TOCE) of ruptured HCC must rapid, exact. Doing everything possible to keep the patient alive !.

- A report of a man patient 79 year olds, at emergency room of Hoan My Da Nang hospital, was diagnosted ruptured HCC, hypotention,…He hadbeen taken emergency abdoment CT and treatmented

– TOCE. The doctors did everything possible to keep him alive.

- Follow- up and consolidate TOCE, crux problem !\

Keyword: Hepatocellular Carcinoma, Computed tomography, Digital Subtraction Angiography, Transcatheter Oily Chemoembolization, Gastrointestinal endoscopy surgery, laparoscopic surgery.

Các dấu hiệu chụp cắt lớp vi tính chẩn đoán thiếu máu và hoại tử ruột ở tắc ruột non quai kín

Các dấu hiệu chụp cắt lớp vi tính chẩn đoán thiếu máu và hoại tử ruột ở tắc ruột non quai kín

12/17/2019 10:30:16 | 0 binh luận

CT findings for diagnosis of bowel ischemia and necrosis in closed-loop small-bowel obstruction

SUMMARY

Purpose: The aim of this study was to investigate the imaging features of contrast-enhanced CT (CECT) to diagnosis for bowel ischemiaand necrosis in closed-loop small-bowel obstruction

Materials and Methods: Thirty-three patients with CL-SBO confirmed by laparotomy. Based on the surgical findings, these patients were classified into three groups: necrosis group (n = 9), ischemia without necrosis group (n = 12), and no-ischemia group (n = 12). Two blinded radiologists retrospectively reviewed CECT including multiplanar reconstruction images and evaluated 11 CT findings. The sensitivity and specificity of each finding were compared among the three groups, and logistic regression analysis was performed. Results:Reduced bowel- wall enhancement, reduced enhancement of the mesenteric veins showed high specificities of 92%, 96% and sensitivities of 62% and 78%, respectively, for the prediction of bowel necrosis in CL-SBO. The target sign in the ischemia group were 83% and 76%, respectively, for sensitivities and specificities, compared with 22% and 46% of the necrosis group. We have included the data in a univariate and multivariate logistic regression analysis, but there is no correlation between imaging features and surgical findings. This can be explained by the interval between CT and laparotomy has altered bowel conditions.

Conclusions: In our prospective patients, reduced enhancements of bowel wall and mesenteric veins were good indicators of bowel necrosis. On the contrary, target sign was a predictor of a viable bowel.

Key words: intestinal obstruction, closed loop, ischemia, necrosis, computed tomography.

Đặc điểm hình ảnh X quang cắt lớp vi tính trong chẩn đoán bục xì miệng nối ống tiêu hóa

Đặc điểm hình ảnh X quang cắt lớp vi tính trong chẩn đoán bục xì miệng nối ống tiêu hóa

12/04/2019 12:11:04 | 0 binh luận

Describsing the features of computed tomography in diagnosting of anastomotic leak

SUMMARY

Purpose: Describe the features of anastomotic leak on computed tomography (CT).

Materials and Methods: Retrospective studies described case series of patients who were diagnosed anastomotic leak at University Medical Center at HCMC and Cho Ray hospital from December 2014 to June 2018, and had CT scan before surgery. The CT features of anastomotic leak were collected.

Results: There were 31 patients. Mean age 58, ratio male/female 1,8. Peri-anastomotic gas-fluid collection 58,1 %; density of peri-anastomotic fluid collection varies from 5 HU to 30 HU (mean # 20,3 HU); extraluminal gas in contact with the anastomosis 71,0 %. Only 1 case that has mural discontinuity sign (3,2 %). Intraluminal bowel contrast CT scan was used in 2 cases and both had extravasation (100 %).

Conclusion: CT scan is valuable in helping to diagnose anatomotic leak. Two most common and signficant signs in the diagnosis are perianastomotic gas-fluid collection and extra-luminal gas in contact with the anastomosis.

Key words:Anastomotic leak, computed tomography findings.

Giá trị cắt lớp vi tính trong chẩn đoán phân biệt các u nguyên phát thường gặp ở ruột non

Giá trị cắt lớp vi tính trong chẩn đoán phân biệt các u nguyên phát thường gặp ở ruột non

12/04/2019 20:32:12 | 0 binh luận

SUMMARY

Objectives:

The purpose of the this study was to analyze imaging roles to assessthe diagnostic capacity for differentiating the common primary small bowel tumors.

Methods: We performed a retrospective study from the medical database from January 2015 to May 2018 at University medical center and Cho Ray hospital. The inclusion criteria were as follows: pathologically proven primary small bowel neoplasms andpatients were performed MDCT with intravenous contrast media. Radiologist were blinded to the pathological information, reviewed the image findings according to the data collection paper. Radiologist collects the characteristics of neoplasm such as anatomical distribution, growth, enhancement, wall thickening patterns, size, hyperplasia vascular on tumor surfaces and lymph node characteristics. Then, comparing each findings to pathology report to access specificity, sensitivity and positive predictive value (PPV) of them.

Results: A total of 98 patients met the criteria for analysis in thepresent retrospective study, 31 adenocarcinomas, 22 lymphomas, 30 GISTs anf 15 others. The extramural growth pattern isreliable prediction of GIST, with PPV of 82.3%. All of GISTs show moderate to avid enhancement. Tumor density of greater than or equal to 110 HU is likely to be GIST, with PPV of84.9%. Proliferation of blood vessels on tumor surfaces can help discriminate GIST from the others, with PPV of92%. Bowel wall thickening is the common patternof adenocarcinoma and lymphoma. Apple-core-like, shoulder defect and focal involvement are probably findings of adenocarcinoma, with PPV of 81.8%, 71.4% and 76.9%, respectively. Aneurysmal dilatation of the lumen and marked thickening wall bowel equal or greater than 25mm can strongly suggest lymphoma, with PPV of 87.5% and 72.7%, respectively. Enlarged lymph node with shorter axis greater than 20mmor multiple lymph nodes fused together forming a bulky massare likely to be lymphoma, with specificity of 100%.

Conclusion: MDCT findings could potentially be useful to differentiate the common primary small bowel neoplasms based on analyzing specific imaging characteristics of each tumor after classifying by growth pattern lesion.

Keywords: Small bowel neoplasm, differentiate

Tụy lạc chỗ tại ruột non với biến chứng viêm hoại tử ruột: Báo cáo một trường hợp hiếm và tổng kết trên y văn

Tụy lạc chỗ tại ruột non với biến chứng viêm hoại tử ruột: Báo cáo một trường hợp hiếm và tổng kết trên y văn

04/15/2020 20:42:50 | 0 binh luận

Ectopic pancreas in the wall of intestine complicated with necrotic and inflamed intestine: A case report and review literature

SUMMARY

Background: Ectopic pancreas is a rare congenital condition characterized by pancreatic tissues located outside normal of confines of pancreas and lacking any anatomic or vascular connection with main pancreas. It can occur anywhere in the gastrointestinal tract but rarely are found in small intestine. Its preoperative diagnosis is difficult because the clinical symptoms are often nonspecific. We introduce a case of ectopic pancreas in the intestinal wall complicated with necrotic and inflamed intestine, which received a treatment by resection.

Case presentation: A 44 years old man attended to Bach Mai hospital due to acute abdominal pain in epigastrium as result of gastrointestinal perforation. Contrast enhanced computed tomography (CT) of abdomen showed a mesenteric mass surrounded by inflamed fat in the left lower quadrant abdomen. In addition, CT images also suggested necrosis of the bowel wall next to the mass caused by twisting the mesentery and mesenteric vessels (whirlpool sign). The patient underwent local surgical resection and following histology revealed ectopic pancreatic tissues in the wall of intestine and necrosis of intestine.

Conclusion: Although ectopic pancreas is rare, it should be considered in the differential diagnosis of a mesenteric or intestinal mass surrounded by necrotic and inflamed intestine.

Keyword: Ectopic pancreas, mesenteric mass, intestinal mass, whirlpool sign.

Nghiên cứu đặc điểm hình ảnh và đánh giá tính chất xâm lấn, di căn của ung thư dạ dày trên cắt lớp vi tính đa dãy

Nghiên cứu đặc điểm hình ảnh và đánh giá tính chất xâm lấn, di căn của ung thư dạ dày trên cắt lớp vi tính đa dãy

04/01/2020 16:03:31 | 0 binh luận

Imaging characteristics and the invasion, abdominal metastases of gastric cancer with MDCT

SUMMARY

Purposes: Describe imaging characteristics and assess value of MDCT in evaluating the invasion, abdominal metastase of gastric adenocarcinoma based on the 7 th AJCC guidelines.

Materials and methods: From 4/2014 to 3/2015, there are 32 consecutive patients with gastric adenocarcinoma were undergone 64-slide-CT. All of them were undergone operation with pathology after surgery.

Results: The average age is 63 years old, and male/ female=2/1. In 37.2% of cases gastric carcinoma is located on antrum. About macroscopic type, the forth type (linitis plastica) rates are highest 68.8%. The thickness of gastric cancer is pricipal 15-19 mm, all of cases heterogeneous enhancement. There are 17 cases invasion adjacent organs, in which tranverse colon is 8 cases and pancreas is 7 cases. Evaluating the value of diagnosis peritoneal metastase between MDCT and surgical resection is appropriated with medial level Kappa = 0.53, the sensitivity is 75%, the specificity is 89.3%. The overall accuracy of T staging is 62.5% (T1 66.7%, T2-T3 69.2%, T4a 44.4%, and T4b 71.4%). Diagnosis lymph nodes metastasis based on the diameter has got the low valuation with p>0.05, based on the short axis diameter is < 8mm and ≥8mm has got p <0.05. About the shape of lymph nodes, based on irregular shape, peripheral enhancement and round shape to evaluate metastasis with p <0.05.

Conclusion: MDCT with multi-planar reformatted images has increased the accuracy of T and N staging, evaluated the invasion, abdominal metastase of gastric cancer on MDCT.

Áp xe cạnh đại tràng xich ma do dị vật phát hiện trên CLVT

Áp xe cạnh đại tràng xich ma do dị vật phát hiện trên CLVT

04/01/2020 09:14:07 | 0 binh luận

A case report of parasigmoidabcess due to foreign body

SUMMARY

We present the case of parasigmoidabscess due to foreign body that was diagnosed and treated in NHP, Hanoi. The childaged 4 years old, hospitalized with abdominal paint, fever and diarrhea. The child was examined by Abdominal Ultrasound, CT scanner. Operation revealed the diagnosis of parasigmoidabscess due to foreign body.

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