螺旋CT表面覆盖法的肺部应用

螺旋ＣＴ表面覆盖法的肺部应用杨健郭佑民杨广夫刘继汉鱼博浪螺旋ＣＴ（ｓｐｉｒａｌＣＴ，ＳＰＣＴ）三维成像中的表面覆盖法（ｔｈｒｅｓｈｏｌｄｓｈａｄｅｄｓｕｒｆａｃｅｄｉｓｐｌａｙ，ＳＳＤ）是目前应用最广泛的方法之一。笔者着重研究ＳＳＤ法中肺部血管成像（...     

颌面部骨折的CT三维表面成像及容积成像对比研究

目的 观察比较螺旋ＣＴ三维表面成像（ｓｕｒｆａｃｅ ｓｈａｄｉｎｇ ｄｉｓｐｌａｙ,ＳＳＤ）和容积成像（ｖｏｌｕｍｅｔｒｉｃ ｒｅｄｅｒｉｎｇ,ＶＲ）显示颌面部骨折的效果,探讨二者的成像技术以及临床应用价值。方法 对３２例外伤致颌面部骨折病人进行轴面容积扫描,其中５例经钛合金复位复查,然后在工作站进行三维ＳＳＤ和ＶＲ成像,立体显示颌面骨,结合二维图像比较二者在显增骨折线、移位旋转、塌陷程度以及总体     

喉癌的 CT 诊断(附58例分析)

喉癌的ＣＴ诊断（附５８例分析）任健①孙清荣②喉部ＣＴ检查自Ｍａｎｃｕｓｏ首次报道以来，近年来已广泛应用于临床，尤其是对喉部肿瘤的定位及侵犯范围的诊断是较理想的影像检查。本文对５８例经喉镜、手术和病理证实的喉鳞癌的影像资料进行回顾和对照分析，重点探讨喉...     

喉癌的螺旋CT诊断

螺旋ＣＴ以其高分辨率、多平面、三维立体重建和仿真内镜技术 ,有助于喉部病变的确诊及喉部肿瘤手术计划的制定 ,笔者利用此技术对 34例喉癌进行观察并与纤维喉镜、手术病理所见进行对比研究。1　材料与方法34例喉癌患者中 ,声门上型 13例 ,声门型 16例 ,贯声门型 5例。平均年龄 5 1.1岁。以声音嘶哑为主要临床症状。所有患者均行喉螺旋ＣＴ扫描并与纤维喉镜、术后病理对照研究。采用ＧＥＨｉｓｐｅｅｄＣＴ扫描机 ,Ｐｉｔｃｈ为 1.0～ 1.2 ,扫描层厚3ｍｍ ,1～ 1.5ｍｍ层厚重建轴位图像 ,并行多平面及三维重建。利用ＡｄｖａｎｔａｇｅＷｉ…     

螺旋CT在喉及下咽部的临床应用价值(兼与传统CT比较)

目的探讨螺旋ＣＴ在喉及下咽部的临床应用价值。方法喉及下咽癌５７例，１９例螺旋ＣＴ扫描与３８例传统ＣＴ扫描行对比分析，８例多平面重建图像与轴位图像对比；８例（另有４例正常喉及１例声带息肉）螺旋ＣＴ扫描后经软件处理行仿真内窥镜成像，并与纤维喉镜对照研究。结果⑴１９例螺旋ＣＴ轴位图像在显示粘膜表面病变，估计深部浸润范围，喉软骨破坏，以及颈部淋巴结方面均与手术所见相符；而３８例普通ＣＴ中有３例对侧声带表面病变、１例喉软骨破坏及１例颈部淋巴结转移漏诊。⑵８例螺旋ＣＴ多平面重建中７例从不同角度、不同方位显示了喉内解剖、肿瘤及其浸润范围及血管、气道的情况。⑶４例正常喉、１例双侧声带息肉及８例喉癌ＣＴ仿真内窥镜从头端入路显示喉内解剖及病变位置、形态、大小范围与纤维喉镜所见一致，且２例从足端入路显示了纤维喉镜不能显示的声门下及气道狭窄远端情况。结论螺旋ＣＴ较传统ＣＴ敏感度及准确率高；多平面重建可更好地显示喉室、颈部血管及气道情况，是轴位图像的很好补充；ＣＴ仿真内窥镜成像可以分别从头端或从足端入路显示喉腔结构，是纤维喉镜的补充手段     

支撑喉镜下显微手术61例分析

支撑喉镜下显微手术６１例分析北京市复兴医院耳鼻喉科龙玲金俊杰徐冠杰①（北京１０００３８）关键词支撑喉镜显微喉手术显微喉镜用于喉部手术是一项重大改革。自Ｓｃａｌｃｏ于１９６０年首先报告将手术显微镜与Ｌｙｎｃｈ型悬吊喉镜相结合用于喉部手术,取得良好效果后...     

正常听骨链的CT仿真内镜和三维重建

探讨正常听骨链ＣＴ仿真内镜（ＣＴＶＥ）和三维（３Ｄ）重建方法及其应用价值。材料和方法：２０例无中耳疾病者采用层厚１．０ｍｍ、螺距１．０轴位薄层扫描,骨算法、０．１ｍｍ～０．２ｍｍ间隔重建,分别做ＣＴＶＥ成像、表面（ＳＳＤ）和骨最大密度投影（ＭＩＰ）３Ｄ重建,观察和比较ＣＴＶＥ和３Ｄ显示正常听骨链的能力。结果：ＣＴＶＥ上,锤、砧骨及锤砧关节显示率都是１００％,镫骨底板显示率为３５％,仅２５％能分辨镫     

喉部螺旋CT内窥镜的临床应用价值

目的：探讨螺旋ＣＴ仿真内窥镜在喉部的临床应用价值。方法：共１７例,其中７例为正常喉,９例为喉癌,１例为喉乳头状瘤;行喉部螺旋ＣＴ扫描后在工作站经软件处理,得到喉部仿真内窥镜图像,并与纤维喉镜进行对照研究。结果：喉部螺旋ＣＴ仿真内窥镜检查,自头端入路可见７例正常喉能清楚显示喉部解剖形态,９例喉癌和１例乳头状瘤能清楚显示肿瘤位置、形态、大小范围,与纤维喉镜检查一致。自足端入路,可见１例声门下软组织块影,２例声门下粘膜增厚,２例气管内结节影;而纤维喉镜却难以观察到。结论：螺旋ＣＴ仿真内窥镜可以清楚观察到喉腔内表面结构以及病变的位置、形态、大小范围;而足端入路对声门下结构的观察是纤维喉镜难以做到的。它是纤维喉镜的重要补充方法。     

内耳结构多层螺旋CT容积漫游技术成像初探

内耳结构复杂 ,位于颞骨岩部骨质内 ,一般影像手段难以显示。螺旋ＣＴ在耳科的临床应用 ,为显示内耳结构创造了条件。通过容积扫描 ,可获得二维横断面图像 ,并可经工作站处理 ,获得内耳ＳＳＤ三维影像 ,为临床医师了解内耳结构提供信息[1] 。目前 ,国内外文献尚未见有应用容积漫游技术 (ｖｏｌｕｍｅｒｅｎｄｅｒｉｎｇ ,ＶＲ)进行内耳结构成像的报道。笔者应用多层螺旋ＣＴ(ｍｕｌｔｉ ｓｌｉｃｅＣＴ ,ＭＳＣＴ) ,尝试对内耳结构进行容积漫游技术三维成像 ,获得满意效果 ,现报道如下。材料与方法2 0 0 0年 10月至 2 0 0 1年 5月间 ,共有 1…     

螺旋CT三维成像在诊断气管、支气管疾病中作用的评价

目的 评价综合运用三维成像技术在诊断气管、支气管疾病中的作用。材料与方法 选择５３直支气管以上气道疾病患者行高档螺旋ＣＴ扫描,将容积扫描数据预处理后传至计算机工作站,分别用ＣＴ仿真支气管内镜（ＣＴＶＢ）,表面遮盖显示法（ＳＳＤ）,最大强度投影（ＭＩＰ）,最小强度投影（Ｍｉｎ ＩＰ）,多平面重构（ＭＰＲ）进行重建,分析影像学表现,４例与手术标本进行对照。结果 在轴位图像基础上,气管肿瘤在ＭＰＲ、ＣＴ     

喉部螺旋CT三维成像技术的应用价值

目的：评价喉部螺旋CT多平面重建及仿真内镜技术，结合轴位对喉部病变的诊断意义和临床应用价值。方法：本组31例经手术病理证实的喉部病变采用东芝Asteion螺旋CT检查，扫描参数为准直3mm，螺距1．O，重建间隔3mm，仿真内镜重建间隔1mm，利用工作站进行图像后处理，选择多平面重建、仿真内镜进行观察。结果：螺旋CT轴位片对病变的敏感性为100％，特异性96．8％，轴位所见均与手术吻合，MPR重建及CT仿真内镜，相互补充可显示更多细节，但诊断符合率并无差别。结论：常规CT轴位结合MPR及CT仿真内镜，使喉部病变的细节显示得到了很大提高，病变定位定性的准确对临床制定治疗方案有重要意义和价值。     

Enhanced four-detector row computed tomography imaging of laryngeal and hypopharyngeal cancers

PURPOSE: Four-detector row computed tomography (4D CT) enables imaging of the larynx and hypopharynx with high temporal resolution and rapid reformatting of coronal planes. The aim of our study was to assess the usefulness of postcontrast biphasic 4D CT in diagnosing tumor extent. METHODS: Forty-seven patients with laryngeal or hypopharyngeal cancer were investigated using 4D CT. Two radiologists retrospectively evaluated transverse and reformatted coronal images in both the early and late phases. RESULTS: Images in the late phase were superior to those in the early phase in the conspicuity of the depicted lesions. The coronal images facilitated assessment of the craniocaudal extension of tumors and obliteration of the paraglottic space. The maximal diameter of tumors tended to be larger on the coronal image than on the transverse image. CONCLUSIONS: Images in the late phase were more informative than images in the early phase to demonstrate tumor extension. Reformatted coronal imaging was useful in evaluating craniocaudal extension.     

Coronal reformations of volumetric expiratory high-resolution CT of the lung

OBJECTIVE: The purposes of this study were to evaluate the quality of coronal reformatted images obtained from volumetric expiratory high-resolution CT imaging and to compare coronal and axial images with regard to their usefulness in detecting and characterizing air trapping. SUBJECTS AND METHODS. We studied 40 consecutive patients with known or suspected diffuse lung diseases with airway abnormalities who underwent volumetric expiratory high-resolution CT between May and July 2003. Respiratory motion artifacts were evaluated at upper, middle, and lower lung areas. Cardiac motion, beam-hardening, and other artifacts were evaluated throughout the lung fields. Detectability, clarity of borders, size, distribution, and extent of air trapping were compared on axial versus coronal end-expiratory high-resolution CT images. RESULTS: Respiratory motion artifacts were either imperceptible or not diagnostically limiting in all patients except three (7%) with diagnostically limiting image degradation at lower lung areas. Other diagnostically limiting image degradation was caused by beam-hardening artifacts in two patients (5%) and by quantum noise in two other patients (5%). The borders of air trapping were more clearly identified on coronal images than on axial images (grade 1 [vague], nine vs three; grade 2 [partially clear], 23 vs 21; grade 3 [completely clear], eight vs 16; median, two vs two; p = 0.001). The coronal reformatted images were as informative as axial images for detecting and assessing the classification and extent of air trapping. CONCLUSION: Coronal reformations of volumetric expiratory high-resolution CT scans were acceptable in image quality and provided additional value by affording clearer visualization of the borders of air trapping than was found in contiguous axial images.     

喉部螺旋CT图像后处理功能的临床初步应用

目的；探讨喉部螺旋CT图像后处理的技术特点以及在临床初步应用及评价。方法：对正常组20例和病变组13例进行螺旋CT扫描，然后进行MPR、SSD、CTVE等图象后处理。结果：MPR、SSD、CTVE上均可清楚地显示正常喉部的解剖结构。病变组中，6例喉癌在MPR、SSD、CTVE上有不同程度的改变，3例声带慢性炎症伴息肉在SSD、CTVE上未显示，2例外伤在SSD、CTVE上1例有喉腔、气道的变形，1例无异常，2例声带固定在MPR、SSD、CTVE上都能很好显示。结论：喉部的MPR是最重要、最有价值的一种后处理技术，是轴位CT图象的重要补充。合理的使用CTVE、SSD、Raysun、MPR等多种图像后处理技术，相互结合，可以增加诊断信息量，提高诊断的正确率。     

CT断层图像和三维重建在主动脉腔内隔绝术术前评估中的价值

目的比较CT断层图像和三维重建在主动脉腔内隔绝术术前评估中的价值。方法将接受主动脉腔内隔绝术的20例主动脉夹层瘤和12例腹主动脉瘤患者作为研究对象,术前分别在CT断层图像与三维重建图像上测量的各相关参数,与主动脉造影所测量的相同参数进行对照分析。结果CT断层图像上所测量的主动脉弓直径及各种长度指标均小于主动脉造影结果;夹层瘤近段主动脉直径及近端瘤颈直径、主动脉中段直径以及左右髂动脉直径均大于主动脉造影结果;三维重建所测量的上述各项参数与主动脉造影结果非常接近,并能清楚显示夹层分离的破裂口,而断层图像上不易发现破裂口;断层图像和三维重建在显示主动脉附壁血栓和测量最大瘤体直径方面优于主动脉造影。以三维重建测量为标准选择覆膜支架,所有患者均成功封闭瘤体。结论主动脉腔内隔绝术术前评估时应结合CT断层图像和三维重建图像综合分析,覆膜支架的选择应以三维重建测量结果为主。     

3D-imaging of the facial skeleton with an isocentric mobile C-arm system (Siremobil Iso-C3D)

OBJECTIVES: The purpose of this study was to compare three-dimensional (3D) imaging of the facial skeleton using an isocentric mobile C-arm system vs CT. METHODS: A dried human skull was scanned using a Siremobil Iso-C3D and a multi-detector CT (SOMATOM Volume Zoom; Siemens Medical Solutions, Erlangen, Germany) to compare reconstructed data sets. For each group of scans a standard protocol and a high resolution protocol were used. Image quality was analysed using six anatomical and six virtual structures in the primary reconstructed axial images of both data sets of the Siremobil Iso-C3D compared with CT. A receiver operating characteristic (ROC) study was performed with six examiners. RESULTS: The original categorical response data revealed no significant differences in sensitivity and specificity (P < 0.05). However, image quality of the reconstructed images of the Siremobil Iso-C3D was inferior to the CT images, with metal artefacts having a more prominent negative effect. CONCLUSIONS: The Siremobil Iso-C3D produces 3D images of the facial skeleton suitable for imaging osseous structures. No significant differences were found in sensitivity or specificity between the two methods. Metal objects degrade the image from the Iso-C method to a greater extent than those from CT.     

螺旋CT轴位扫描及重建诊断隐匿性骨折的临床价值

目的:探讨螺旋CT轴位扫描及重建(MPR、3D)在隐匿性骨折诊断中的临床价值。方法:选择33例隐匿性骨折患者,将螺旋CT扫描(2~5 mm)的容积数据转输至工作站进行MPR和3D处理,并对轴位、MPR和3D图像进行比较。结果:轴位平扫33例均显示了隐匿性骨折的基本情况,MPR图像25例从多平面、曲面显示了隐匿性骨折及周围结构,3D图像29例通过旋转和切割技术充分暴露病变,直观、逼真地显示隐匿性骨折立体关系。结论:螺旋CT对隐匿性骨折的诊断具有较高应用价值。MPR、3D及轴位图像的联合应用,可为临床医师提供立体、直观、多方位的影像信息,有利于临床治疗方案的选择。     

螺旋CT在喉部病变的临床应用

目的探讨螺旋CT在喉部病变中临床应用价值.方法29例喉部病变进行螺旋CT扫描、多平面三维重建及CT仿真内窥镜成像,并与纤维喉镜及病理对照研究.结果螺旋CT轴位图像薄层重建、多平面三维重建、CT仿真内窥镜所见病变的形态学改变、与周围组织的关系及气道狭窄情况与纤维喉镜及术后病理相符合.结论螺旋CT薄层重建分辨率明显提高,图像更加清晰.对观察病变的部位、与周围组织关系及气道狭窄,多平面三维重建是对轴位图像的很好补充.CT仿真内窥镜可分别从头端或足端入内观察喉腔结构,是纤维喉镜的辅助手段.     

Helical CT angiography and three-dimensional reconstruction of total anomalous pulmonary venous connections in neonates and infants

OBJECTIVE: The objective of this study was to investigate the usefulness of helical CT angiography in the evaluation of total anomalous pulmonary venous connections. MATERIALS AND METHODS: Fourteen patients with total anomalous pulmonary venous connections underwent helical CT angiography and subsequent three-dimensional (3D) reconstruction. They ranged in age from 3 days to 8 months (median age, 2.3 months) and in weight from 2.3 to 7.1 kg (median weight, 4.3 kg). The types of total anomalous pulmonary venous connections and the number of pulmonary veins were evaluated on axial and 3D images. Qualitative evaluations were performed for extent of pulmonary vascular enhancement and contrast- or motion-induced artifacts. RESULTS: In all patients, helical CT angiography correctly depicted total anomalous pulmonary venous connections. Seven cases were the supracardiac type, four cases were the cardiac type, one case was the infracardiac type, and two cases were the mixed type. The detection rate of the pulmonary vein in 3D reconstruction images (95-98%) was slightly lower than that of the pulmonary vein in the axial images (100%), but the difference between axial and 3D reconstruction images was not statistically significant (p > 0.1). No statistically significant differences were noted among 3D reconstruction images in the detection rates of the pulmonary vein (p > 0.1). The extent of contrast enhancement of the pulmonary vein was good or excellent in all patients. In five patients, there were contrast-induced artifacts that made some surrounding vascular distortion but did not interfere with the pulmonary vein analysis, except in one patient. Motion-induced artifacts were observed in nine patients. One of them had an obstacle in pulmonary vein analysis. CONCLUSION: The combination of axial and 3D images in helical CT angiography is helpful in the assessment of a total anomalous pulmonary venous connection containing the individual pulmonary vein, and this combination can be a good diagnostic tool in preoperative evaluation of neonates and infants with a total anomalous pulmonary venous connection.     

Three-dimensional CT in the diagnosis of spinal trauma: comparison with plain film and two-dimensional CT examinations

To assess the value of three-dimensional (3D) image reconstructions of two-dimensional (2D) data from contiguous non-overlapping slices in the diagnosis of spinal trauma, 21 patients with a total of 36 injured vertebrae and 4 normal controls were examined. Forty plain films in two planes, 40 axial CT scans with multiplanar reformatted (MPR) 2D reconstructions and 40 sets of 3D images (surface rendering technique) were independently evaluated by four readers. The final diagnosis was defined after a panel review of clinical, surgical and imaging findings on all modalities. The 3D image reconstructions were not as accurate as axial CT with MPR 2D reconstructions in the diagnosis of vertebral body (n = 20) and posterior element fractures (n = 35). Dislocation (n = 3) was equally well detected by all imaging modalities. Narrowing of the spinal canal (n = 17) was best assessed by either MPR 2D CT or 3D images. A rotational component was diagnosed more accurately by 3D images, followed by 2D CT and plain films. Thus, 3D images combined with MPR 2D CT reconstructions are an important adjunct for an accurate diagnosis of spinal trauma, especially when a rotational component is suspected.Presented at the 1993 ECR Scientific Assembly Correspondence to: C. H. Buitrago-Téllez