Search

A 58-year-old woman presented with a 1-day history of abdominal pain. Abdominal CT showed an oval soft tissue density mass in the fundus of the gallbladder (red arrow), approximately 4.0 cm × 3.0 cm in size. The level of cancer antigen 199 was elevated (275.80 U/mL; normal level, 0.0-27.0 U/mL). Other tumor markers were normal including alpha fetoprotein, carcinoembryonic antigen. Abdominal magnetic resonance imaging demonstrated the mass with characteristic of mixed signals, containing marked enhanced ingredient (yellow arrow) and poor blood supply ingredient (blue arrow). Radical cholecystectomy, partial liver resection, and regional lymphadenectomy were performed. Pathological examination indicated mixed adenoneuroendocrine carcinoma, with the following immunohistochemistry results: CD56 (+) (Figure 1F), Syn (+) (Figure 1G), CK19 (+) (Figure 1H), CgA (+), MLHL (+), PMS2 (+), MSH2 (+), MSH6 (+), Ki-67 (60%+).

Objective: To explore the diagnostic value of dual source computed tomography (CT) in the diagnosing acute pulmonary embolism (PE)., Methods: A total of 20 cases with suspected PE were scanned by dual source CT and the data were analyzed with the software packages of conventional 3D, pulmonary embolism detection (PED), lung vessels and lung PBV. The examination with the highest detection rate was used to screen for pulmonary segment of PE and verify the diagnostic consistency with dual-energy perfusion imaging (DEPI) on pulmonary segment of PE., Results: The detection rates for PE in pulmonary artery branches were all 30% for CTPA, lung vessels and PED. There were no statistical difference. The detection rates for PE in pulmonary lobar arteries were 47.0%, 49% and 50% for CTPA, lung vessels and PED. There were no statistical difference. The detection rates for PE in pulmonary segment arteries were 14.2%, 19.7% and 26.1% for CTPA, lung vessels and PED. Statistical differences existed among CTPA, lung vessels and PED. The detection rates for PE in pulmonary subsegment arteries were 3.7%, 4.5% and 7.0% for CTPA, lung vessels and PED. Statistical differences existed between PED, CTPA and lung vessels. No statistical difference existed between CTPA and lung vessels. PED had the higher clinical value on the diagnosis of PE of pulmonary segmental artery and inferior segmental artery. The sensitivity of DEPI for PE was 85.7%, specificity 94.1% and kappa 0.789. The diagnosis on PE of DEPI and PED image had a higher consistency., Conclusion: The dual-energy scanning of dual source CT has higher practical values in the diagnosis of PE. And PED can visualize the pulmonary artery segment and a downstream segment of PE. Pulmonary perfusion imaging may show the perfusion abnormalities due to pulmonary blood flow changes. A combination of both increases the diagnostic rate of PE.