The Establishment And Application Research In The Clinical For MDCT Imaging Technology Of Digestive Diseases

Background The development of MDCT technology has realized the perfect unionof spatial, temporal resolution and scan range,namely in greatly increase the scanningvelocity and covering rang and ensure a high resolution, is truly to isotropic scanning.The diagnosis and differential diagnosis of CD and HVOD is difficulty in clinical work.There are many blind area in the accurate judgment of location and nature of the smallintestinal hemorrhagic lesions.As soon as possible to colorectal lesions screening andpostoperative follow-up need to perfect and improve.So,in desperate need of a safe,effective and high sensitivity checking method in patients.Purpose This study to present the most mature clinical use64row helical CT,on thebasis of experiments, discusses the feasibility of MDCT digestive diseases imagingtechnology (MDCTC MDCTE) establishment in clinical.To study the value of MDCTin diagnosis and differential diagnosis CD and HVOD. Searching the advantage indiagnosing the location and quality of hemorrhagic lesions in small intestine. Evaluatingthe advantages and shortcomings of MDCTC in screening colorectal lesions in the earlyand follow-up of the postoperaton.Material and Mathod The study consists of two major parts, the establishment ofdigestive system imaging technology and the clinical application.Of the first part research based on experiment,this paper discusses the establishment of MDCT digestivesystem imaging technology and the feasibility of its application in clinical.For thesecond part,we make in-depth study about the value of MDCT digestive system imagingtechnology in diagnosing and differential diagnosis in inflammatory boweldisease,Intestinal tumor, gastrointestinal bleeding and HVOD.The detailed contents areas follows:It has explored, through the experiments, the consistency of intestinal canal's finestructure imaged in MDCT enterology (MDCTE) and real lesions, to provide basis fordisplaying superficial ulceration of small intestine mucosa and the changes in vasa rectaof intestinal wall by MDCTE. Due to the low spatial resolution, temporal resolution andlimited scanning range of conventional CT, the fine structure of intestinal tract showedis not satisfactory. Through scanning naturally formed small excavated lesions in colonspecimens, a comprehensive evaluation about the advantages of MDCT in displayingintestinal subtle anatomical structure was carried out, which has provided strong supportfor displaying early mucosal superficial lesions of crohn disease (CD) and otherinflammatory bowel disease (like ulcers), and the changes in vasa recta of intestinalwall; as well, provide the possibility for early diagnosis of CD and other inflammatoryintestinal disease and evaluating their activities.Discuss in detail the accuracy of colorectal lesions sizes measured by MDCT andappropriate window technique. Scan simulated colonic lesions with the use of MDCT,measure the sizes of lesions in different window technique, to obtain the appropriatewindow technique for MDCT to measure the size of enterology focus by comparing thetrue lesion size. The sizes of lesions are quite different in different window techniques,the window technique with most accurate lesion measurement will contribute a greathelp to the clinical field, particularly important for polyps and other lesions; because the diameter size of polyp directly determines the malignant transformation rate of polyp. Inclinically,the malignant transformation is under1%if polyps diameter less than1centimeter.But it is possible of30%malignant transformation that the poleyps diametermorn than2centimeter.Comprehensively study the advantages of MDCTE in displaying a variety ofcommon clinical and pathological changes of CD. CD is a granulomatous inflammatorydisease, characterized by segmental involvement of intestinal wall and transmuralinflammation. In early stage, it is manifested as edema of the mucosa or submucosa,ulceration of mucosal surface, and then the lesions involving the whole intestinal walllayer, leading to the intestinal wall fibrosis, stenosis, perforation, or even the formationof fistula and sinus, resulting in perienteric fat, mesentery, the involvement of adjacenttissue and organ. MDCTE not only show the thickening, location, extent of CDintestinal wall and other lesions of intestinal wall itself, but also clearly displayperienteric and parenteral lesions, such as the increase and thickening of intestinal wallvasa recta caused by CD, exudative changes of the intestinal wall, fistula, sinus, abscessand other complications caused by penetrated intestinal wall by CD disease, whichplayed a very important role in objective evaluation, activity assessment, clinicaltherapeutic schedule selecting of CD disease. While conventional colonoscopy,gastrointestinal imaging or capsule enteroscopy rapidly developed in recent years onlycould observe the lesions of intestinal mucosa and intestinal cavity, but no intestinalwall, perienteric and parenteral lesions.Systematically study the correlation between MDCTE characteristicperformances of CD and CDAI. Crhon's disease activity index (CDAI) is currentgenerally accepted index for clinically evaluating CD activity. CDAI is a comprehensivejudgment index obtained from the chief complaint of comprehensive patient, various clinical laboratory indicators, clinical manifestation and other factors; it can be moreobjective in assessing the severity of patients with CD. However, more subjectivefactors are involved in the specific assessment of CDAI, different condition statementsfrom different patients, the bias of clinical examination indicators, and incoordination ofdetails grasping of different doctors in assessment can affect the results of CDAI, thus,there maybe different CDAI results from different doctors for one patient. Therefore,clinically, CDAI score of the patients often are not completely consistent with the actuallesions. If the typical CD sign on MDCTE is obvious, CDAI score will be lower; on thecontrary, CDAI score will be higher if the MDCTE lesion is relatively minor.Preliminary studies indicate that CDAI score is closely related to thickness of intestinalwall, strengthen extent and manner of the diseased intestinal wall, perienteric vascularsituation and whether having complications or not. This paper attempts to endow certainscore to the typical performance of CD in MDCTE to create MDCTE rating criteria toevaluate CD activity, thus to objectively assess the condition of patients with CD,monitor the changes in the biological type of patients and guide clinical treatment.Make detailed study about value of MDCTC in the diagnosis of colorectal lesions.The negative predictive value of MDCTC is100%, it can be considered as screeningtool for high-risk colorectal neoplasms. Female patients over40years old in Europe andthe United States and other Western developed countries receive MDCTC check once ayear in order to find tumors and other lesions early. In China, because of the constraintsand conceptual difference, MDCTC screening is not popularized in clinical practice.MDCTC possesses high sensitivity and specificity to rectal mass (polyps, tumors, etc.).The sensitivity of conventional CT colonography to polyps with diameter≥1cm10mm is100%,83.3%to the polyps with diameter of6～9mm,51.3%to the polyps withdiameter≤5mm. The overall sensitivity to colonic lesions is96.0%, specificity of96.6%.Even being considered as the best douDCBE, its sensitivity to the polyps≥1cm is only 70％～90％and "false positive" of5％～10％. For the polyps with diameter≤5mm,MDCTC sensitivity is more than95%. For colorectal cancer, sensitivity and specificityof MDCTC is close to100%. Clinically, it is always required to make postoperativefollow-up visit for colorectal lesions; because of its tolerance and security issues,colonoscope should not be used as a routine follow-up tool. MDCTC has high security,comfortableness, and important applications in the postoperative follow-up. Comparingwith conventional inspection methods MDCTC has incomparable advantages inanastomotic stoma, polyp removing by forceps, tumor recurrence, of. However, thelong-term and repeated MDCTC check may give patients additional radiation dose.How to give full play to the MDCTC advantage, while significantly reducing theradiation dose to patient is a subject needed to be concerned in the follow-up study.For clinical diagnosis is difficult of the small intestine hemorrhagic lesions,MDCTE has high sensitivity.To some tumor lesions caused by bleeding,MDCTE canqualitative diagnosis,such as mesenchymal tumor lymphoma and lipoma, etc.MDCTEcan accurate judgment to the parts of the lesion properties, especially vascular lesionscaused by bleeding,MDCTE has great value of clinical application.MDCTE can be avery good detected the bleeding site in some blood loss was and the hidden partpetients.Hepatic veno-occlusive disease(HVOD)is a syndrome characterized by as clinicalfeatures as rapid weight gain,ascites,painfull hepatomegaly,and jaundice. HVOD is oneof the hepatic venous outflow obstruction.Compared with other liver diseases,HVODneeds special therapeutic method.Therefore,early diagnosis and exact differentialdiagnosis are essential.It is difficult diagnosis of HVOD,by now,diagnosis of HVOD isbased on the clinical sign and liver biopsy.It is very characteristic of hepaticveno-occlusive diseases MDCT sign.In this study,evaluating the value of MDCT in diagnosing HVOD by retrospective studies the sign of HVOD.Make in-depth study theconsistency between the characteristic MDCT sign of HVOD and clinical pathology.Conclusion1. MDCT digestive system imaging technology can objective display the pathologicalchanges of CD.Having a good correlation between the imaging characteristics andclinical pathology.MDCTE can be used to diagnose,differential diagnosis and theirclinical curative effect evaluation of CD.2. There is a correlation between the MDCTE signs of CD and CDAI score.The lesionsite,section of the involvement,several complications and parenteral lesions have certaineffect on CDAI score. MDCTE can be used to objective evaluation patient's conditionand guide clinical treatment and drug use.3. HVOD have high specific and sensitivity MDCT signs.MDCT can be used todiagnose and differential diagnosiing and evaluate curative effect and prognosis throughthe MDCT signs changing of the before and after treatment..4. MDCTC have great application advantages in colorectal lesions screening in the early.MDCTC combined with traditional colonoscopy inspection method can greatly improvethe detection rate of colorectal lesions and can be served as an effective follow-upreview tool in clinical application widely.