CT灌注成像在早期非小细胞肺癌疗效评估和预后评价中的应用

目的 评价CT灌注参数与非小细胞肺癌(NSCLC)早期疗效及预后的关系,以期对患者的个体化治疗和个体化预后评估发挥一定的作用.方法 对152例拟诊肺癌的患者行前瞻性MSCT灌注扫描,采用非离子型对比剂50 ml,注射流率4.0 ml/s,延迟10 s,扫描时间50 s.152例中123例病理证实为肺癌.评价CT灌注图像质量,对接受化疗、放疗或同步放化疗的患者进行早期疗效评估.采用t检验和Kaplan-Meier生存分析,评价NSCLC灌注参数与化、放疗早期疗效及预后的关系.结果 病理证实且图像质量达到评价标准的NSCLC 35例,缓解组(21例)和未缓解组(14例)的血流量(BF)分别为(81.0±33.6)和(56.3±23.1)ml·min~(-1)·100g~(-1),差异有统计学意义(t=9.341,P=0.023).血流量≤80与>80 ml·min~(-1)·100 g~(-1)组比较,中位无进展生存期分别为11.8和8.0个月,差异无统计学意义(P>0.05).血容量≤6与>6 ml/100 g~(-1)组比较,中位无进展生存期分别为9.2和8.0个月,差异无统计学意义(P>0.05).结论 NSCLC的高灌注状态提示对化、放疗反应相对敏感,早期缓解率高,但肿瘤进展时间相对较短.     

Ⅰ期非小细胞肺癌CT形态学征象和预后的相关性研究

目的探讨Ⅰ期非小细胞肺癌(non-small cell lung cancer,NSCLC)CT形态学征象与预后的相关性。方法搜集161例具有完整胸部CT影像资料及手术病理结果的Ⅰ期NSCLC患者的资料,均具备完整的患者的5年总生存期。结果 161例Ⅰ期NSCLC患者5年总生存率(overall survival,OS)为71.4%;按性别分成两组,单因素生存分析差异具有统计学意义(P=0.041),而多因素分析差异无统计学意义;按患者年龄(≤60岁、>60岁)、病理类型及发病部位进行分组,经多因素生存分析,差异均无统计学意义(P>0.05);肿瘤分期T1a、T1b及T2a期对应患者的5年OS分别为87.2%、70.7%和58.9%,单因素生存分析,结果显示差异具有统计学意义(P<0.05);按IA、IB期分类,对应5年OS分别为78.1%和58.9%,单因素及多因素生存分析,结果显示差异均具有统计学意义(P<0.05)。根据肿瘤的密度分类,经单因素及多因素预后分析,结果显示差异无统计学意义(P>0.05);肿瘤的边缘、周围情况及与邻近胸膜的关系方面,单因素预后分析结果显示差异均具有统计学意义,而多因素预后分析结果显示病灶"毛刺征"、"胸膜凹陷征"具有统计学意义(P<0.05)。结论 CT像上肿瘤的大小、"短毛刺征"、"胸膜凹陷征"是影响Ⅰ期NSCLC患者的独立预后因素。     

交通性脑积水脑室分流前后的脑脊液MRI定量研究

目的运用MRI cine PC定量研究交通性脑积水脑室分流前后的脑脊液流动情况.材料和方法在1.5T GEHo rizon Signa磁共振机器上利用MRI cine PC程序,在以前实验所得的液体流速与信号强度关系公式的基础上,对16例交通性脑积水的中脑导水管、枕大孔和C2水平脑脊液流速、流量情况进行MRI cine PC检查(1.5TGE Horizon Signa),并对其中10例交通性脑积水脑室引流后的中脑导水管和枕大孔处脑脊液的流速和流量同样进行测量,并与术前进行比较.同时作为对照,对31例正常志愿者颅内中脑导水管、枕大孔和C2水平的脑脊液流速和流量进行测定.结果交通性脑积水中脑导水管水平脑脊液流速和流量明显增快,与正常者进行统计有明显差异(P＜0.05),向下峰速和向上峰速分别为47.57±16.71mm/s和44.48±19.22mm/s,向下流量及向上流量明显增大为3.142±1.055ml/s及3.143±1.055ml/s;脑脊液净流量为0±0.003ml/s.而枕大孔向下峰速和向上峰速分别为1.37±0.44mm/s和1.33±0.41mm/s,向下流量及向上流量分别为0.351±0.125ml/s及0.350±0.121ml/s;脑脊液净流量为0.001±0.007ml/s.C2水平脑脊液向下峰速和向上峰速分别为2.41±1.27mm/s和2.95±1.15mm/s,向下流量及向上流量分别为0.521±0.214ml/s和0.519±0.214ml/s;脑脊液净流量为0.002±0.003ml/s.其中10例交通性脑积水经VP手术前后对比分析,发现术后症状改善明显者中脑导水管脑脊液流速和向上、下的流量均较术前明显减少(P＜0.05).结论MRI cine PC对脑脊液(CSF)流动的研究具有非损伤性和对脑脊液流动敏感的特点,是一种优于其他方法的研究CSF流动的重要方法,同时对脑脊液循环障碍疾病的脑脊液流动情况也能定量测定,对VP分流前后的交通性脑积水的脑脊液流速、流量和方向的确定,对估计其术后效果具有重要意义.     

颅脑损伤CT计分与手术指征的相关研究

目的: 探讨颅脑损伤CT计分与手术指征的关系.材料和方法: 对520例颅脑损伤患者外伤后24h内行头颅CT扫描和并行CT计分,得到CT图像计分.分保守治疗组(312例)和手术组(208例)进行预后对照分析.结果: 按CT计分将颅脑损伤分为轻型(<5分)占22.7%(118例),中型(5～10分)占35.6%(185例),重型(>10分)占41.7%(217例).中型手术组预后的重残死亡率(21.0%)远低于保守组(44.2%)(P<0.05);轻、重型无显著差异.结论: 颅脑损伤CT计分是较准确可靠的手术指征之一.     

小脑上脚纤维交叉MR扩散加权成像研究

目的 探讨小脑上脚纤维(SCP)交叉在MR扩散加权成像(DWI)中的表现.资料与方法 应用Siemens3.0 T MR及工作站对20名正常人行头部DWI扫描,扩散敏感梯度(Cd)分别施加在层面选择方向(DWIslice)、相位编码方向(DWIphase)、频率读出方向(DWIread),b=0和b=1000 s/mm2,获得SCP交叉DWI图像;行头部扩散张量成像(DTI),分别测量SCP和SCP交叉的表观扩散系数(ADC)、各向异性分数(FA)值,进行配对t检验,比较两者之间的差异.结果 SCP交叉在DWI上有三种表现:在DWIslice图中:表现为一个高信号,位于脑中线,中脑导水管前方,大脑脚间后方,呈左右对称倒三角形.在DWIphase图中:表现为两个高信号,位于脑中线两侧,中脑导水管前方,大脑脚间后方,呈左右对称两个半圆形.在DWIread图中:无高信号表现.SCP交叉不同区域,包括DWIslice、DWIphase(左)、DWIphase(右)的ADC值分别为:(1.31±0.24)×10-3 mm2/s、(1.21±0.27)×10-3mm2/s、(1.09±0.31)×10-3 mm2/s,两两之间差异无统计学意义(t分别为0.71、0.89、0.82,P值均>0.05);FA值分别为:0.38±0.13、0.35±0.16、0.41±0.11,两两之间差异无统计学意义(t分别为0.84、0.91、1.13,P值均>0.05).SCP和SCP交叉的ADC值分别为:(1.12 ±0.22)×10-3 mm2/s、(1.24 ±0.34)×10-3 mm2/s,两者之间差异无统计学意义(t=0.93,P>0.05);FA值分别为:0.65±0.08、0.40 ±0.13,两者之间差异有统计学意义(t=7.22,P<0.05).结论 SCP交叉走行复杂,在DWI上有三种表现形式,这与Gd的方向有关;SCP的FA值高于SCP交叉FA值.     

IgA肾病长期预后影响因素分析

目的探讨IgA肾病(IgAN)预后与肾脏病理组织学改变、尿蛋白及其变化的关系。方法根据10年间Ccr变化情况将135例IgAN分为3组:肾功能稳定组(66例)、肾功能进展组(33例)、透析组(36例);按照初期Ccr不同分为肾功能正常组(112例)和肾功能降低组(23例),观察10年间各组Ccr变化情况;初期肾功能、尿蛋白、病理组织学改变,病程中的尿蛋白变化、蛋白尿≥1 g/d且持续时间占整个观察时间的比例等与预后的关系。结果10年间3组Ccr均降低,稳定组、进展组、透析组分别为10 ml/min、40 ml/min、70 ml/min,尿蛋白的推移稳定组维持在0.5 g/d以下,进展组在1 g/d左右,透析组在1.5 g/d左右。初期Ccr<70 ml/min的病例,尿蛋白多、组织学损害明显的其预后不良,与肾功能正常组比较差异有统计学意义;Ccr≥70 ml/min的病例,初期尿蛋白≥1 g/d的与尿蛋白<1 g/d组比较差异有统计学意义。无论组织学损害程度如何,如果临床过程中尿蛋白≥1 g/d,并且持续的时间超过整个观察时间40%以上的病人以后肾功能降低的可能性大。结论对尿蛋白持续>1 g/d的患者将尿蛋白降低至1 g/d以下对稳定肾功能是有积极意义的,如果降低至0.2~0.5g/d以下意义将更大。     

层面选择方向扩散加权成像在中脑大脑脚间产生高信号的机制

目的 研究层面选择方向扩散加权成像(DWIs)在中脑大脑脚问产生高信号的机制.方法 健康志愿者10名,以邻近中脑大脑脚问为中心进行MR扫描:(1)采用心电门控(ECG),测量收缩期与舒张期扩散敏感因子(b值)为0和1000 mm2/s的单独DWIs,比较两期测量中脑亮点区MR信号强度及表观扩散系数(ADC)值.(2)变换选层方向,分别采集平行于颅底、平行于系统Y轴,Y-Z坐标30°夹角的单独DWIs,观察中脑亮点形状的变化.(3)采集全脑6个方向DWI,利用扩散张量成像(DTI)白质纤维束追踪成像技术显示以亮点区为种子的神经纤维束走行起止,测量亮点区及其相连邻近纤维走行区的ADC值与各向异性分数(FA)值.将测量得到的亮点区ADC及FA值与相连邻近纤维走行区的ADC及FA值分别进行配对t检验,比较两者之间的差异.结果 心脏收缩期采集的DWIs信号强度分别为296.28±38.19、153.81±37.91,舒张期分别为295.36.±38.84、154.03±37.52,两者间差异无统计学意义(t值分别为1.34、0.62,P值均＞0.05);心脏收缩与舒张期测量的ADC值分别为(6.07±2.20)×10-4、(6.69±1.44)×10-4 mm2/s,两者间差异无统计学意义(t=0.94,P＞0.05).纤维束追踪显示中脑高信号亮点位于小脑上脚神经纤维束的中脑交叉区.常规扫描层面上,DWIs高信号亮点表现为狭长心形和狭长条形,其形状随扩散敏感梯度施加方向的变化而改变.多方向DWI测量亮点区与结合臂区的ADC值分别为(10.61±3.42)×10-4与(9.24±2.21)×10-4 mm2/s,两者间差异无统计学意义(t=0.61,P＞0.05).亮点区FA值为O.43±0.13,结合臂FA值为0.61±0.08,两者间差异有统计学意义(t=8.32,P＜0.05).结论 中脑水平DWIs亮点征象由小脑上脚在中脑层面神经纤维及交叉区的各向异性造成,因此,其亮点信号的形状与DWIs的选层层面方向有关,与心动周期相关的脑搏动对亮点征象无影响.     

表观扩散系数在中脑脚间区扩散高信号与急性脑梗死中的鉴别诊断价值

目的 探讨表观扩散系数(ADC)在中脑脚间区扩散高信号与急性脑梗死鉴别诊断中的价值.方法 回顾性分析经临床证实的中脑脚间区急性脑梗死31例(病例组)、健康受检者31例(对照组,中脑脚间区在DWI上呈高信号).均行常规MRI及DWI.由两名医师先采用双盲法独立对图像进行评估,并采用组内相关系数(ICC)值分析两名医师测量ADC值的一致性.计算两名医师测量ADC值的平均值,并采用独立样本t检验比较病例组与对照组ADC值的差异.以临床结果为金标准,绘制ADC值诊断中脑脚间区急性脑梗死的ROC曲线,判断最佳诊断界值点,计算ADC值诊断中脑脚间区急性脑梗死的敏感性、特异性和准确性.结果 两名医师测量ADC值的一致性好(ICC =0.926,P＜0.001).对照组ADC值为(635.69 ±54.16) ×10-6mm2/s(95％可信区间为615.83～655.56×10-6mmn2/s),病例组ADC值为(472.08±87.65)×10-6mm2/s(95％可信区间为439.93 ～ 504.23×10-6mm2/s),差异有统计学意义(t=8.842,P=0.000).ADC值诊断中脑脚间区急性脑梗死的ROC曲线下面积为0.935,最佳诊断界值为546×10-6mm2/s,诊断中脑脚间区急性脑梗死的敏感性为87.1％(27/31),特异性为93.5％(29/31),准确性为90.3％ (56/62).结论 ADC值有助于中脑脚间区扩散高信号与急性脑梗死的鉴别.     

正常中脑导水管脑脊液MR流速流量研究

目的探讨中脑导水管脑脊液(CSF)流速、流量测量正常值。方法应用Philips Intera Achieva 1.5TMR机对30例健康志愿者行导水管MR相位对比法CSF-QF序列扫描,用流动分析软件测量中脑导水管脑脊液速、流量。结果中脑导水管截面像素为13.73±3.59,导水管CSF的上峰速度为(6.40±1.85)cm/s,下峰速度为(7.88±3.04)cm/s,上峰流量为(0.12±0.05)ml/s,下峰流量为(0.15±0.07)ml/s,返流系数为(90.86±6.79)%,绝对流量为(0.07±0.05)ml/s,平均流速值为(0.01±0.18)cm/s。中脑导水管CSF搏动性流动与心动周期的关系为正弦波形。结论建立了Philips Intera Achieva 1.5T中脑导水管脑脊液流速、流量正常值。     

高血压脑出血CT影像与临床预后关系的前瞻性研究

目的 探讨CT影像在高血压脑出血风险预测及预后评估中的价值.方法 前瞻性录入42例连续的急性高血压脑出血患者入院时临床资料及颅脑CT影像特征,随访患者发病3个月的生存质量(做mRS评分)和总体认知功能(做MMSE评分),对CT影像特征与临床预后的关系进行单因素和多因素分析.结果 血肿体积、血肿周围水肿体积是发病14 d神经功能缺损程度的预测因素;年龄、血肿体积和首次NIHSS评分是发病3个月预后不良的独立风险预测因素;出血量超过10 ml神经组织的损伤程度及对预后的影响将明显增加;发病年龄是认知功能障碍的预测因素.结论 CT影像特征可作为高血压脑出血疾病转归的评价指标,可为高血压脑出血早期治疗及预后评估提供影像学依据.     

闭合性阴囊损伤的CT诊断

目的确定闭合性阴囊损伤的ＣＴ诊断价值。方法 对２３例闭合性阴囊损伤的ＣＴ资料及临床处理进行回顾性分析。结果 根据睾丸失去正常的卵圆形结构，白膜中断，睾丸组织突出或睾丸断片分离等征象，ＣＴ正确诊断睾丸破裂８例；ＣＴ亦能显示阴囊壁血肿，鞘膜积血，白膜下血肿，睾丸实质血肿，睾丸附睾挫伤，精索及附睾血肿等其他病理改变。１７例手术探查证实ＣＴ显示的各种病理改变与手术病理完全相符。结论 ＣＴ能准确诊断各种类型     

Cervical lymph node metastases of unknown origin: primary tumor detection with whole-body positron emission tomography/computed tomography

Background: Identification of primary tumor in patients with cervical lymph node metastasis of unknown primary (MUO) has a great impact on therapy approach and potentially on patient prognosis.

Purpose: To assess the diagnostic accuracy of combined positron emission tomography (PET)/computer tomography (CT) for primary tumor detection in cervical metastases of unknown origin compared to PET, CT, and PET+CT side-by-side evaluation.

Material and Methods: 39 consecutive patients (eight women, 31 men; mean age 59.9±11.2 years) with MUO were enrolled in this study. PET/CT images were obtained 1 hour after injection of 350 MBq of fluorodeoxyglucose. Oral and intravenous contrast agents were administered in all patients to ensure diagnostic CT data. Fused PET/CT data were evaluated for primary tumor detection. Diagnostic accuracy was calculated and compared with CT alone, PET alone, and side-by-side PET+CT evaluation. Statistical analysis of differences in diagnostic performance between the different imaging procedures was based on the McNemar test.

Results: Fused PET/CT depicted the primary tumor in 11 of 39 (28%) patients. In 28 (72%) patients, the primary tumor remained occult. CT revealed the primary in five (13%), PET alone in 10 (26%), and side-by-side evaluation of PET+CT in 10 (26%) of 39 patients. Statistical analysis showed no significant differences between the imaging modalities.

Conclusion: PET, side-by-side PET+CT, and PET/CT revealed similar detection rates for primary tumors in cervical MUO patients. Therefore, cervical metastases of an unknown primary may be assessed with either of these imaging modalities. Detection rates with CT were substantially lower. Thus, inclusion of functional data for assessment of cervical MUO patients must be recommended.     

An assessment of factors which influence the effectiveness of the modified in vivo technetium-99m-erythrocyte labeling technique in clinical use.

This study assessed factors which may contribute to suboptimal image quality when the modified in vivo erythrocyte labeling technique is used with standard clinical 99mTc activities. For each assessment duplicate or triplicate blood specimens were withdrawn from > or = 10 patients, into syringes containing 700-900 MBq 99mTc as pertechnetate. After incubation the percent of 99mTc which was not bound to erythrocytes at blood re-injection time (%Unbound 99mTc), was measured and compared when one of four factors was varied. The most significant results, in descending order of measured effect were: [table: see text] Our data suggest that the requirements for optimal erythrocyte labeling with standard clinical 99mTc activities are: (A) Erythrocyte tinning time between 10 and 30 min; (B) blood volume > or = 3 ml; (C) blood incubation time > or = 20 min; and (D) Generator ingrowth time < or = 24 hr.     

Low-high and high-low biphasic injection forms in computed tomography examinations of the upper abdomen

Purpose: To analyze the influence of different biphasic and monophasic injection rate protocols in abdominal computed tomography (CT).

Material and Methods: A randomized, consecutive, parallel group study was designed and conducted in 60 patients studied with the same CT helical protocol. Patients were randomly distributed into three groups: (A) monophasic (120 ml at 2.5 ml/s); (B) low-high biphasic (120 ml, first 60 ml at a rate of 2 ml/s, the other 60 ml at 2.5 ml/s); and (C) high-low biphasic (120 ml, first 60 ml at a rate of 2.5 ml/s, the other 60 ml at 2 ml/s). All patients were injected with 300 mg I/ml non-ionic contrast media at a fixed delay time of 55 s. Contrast enhancement efficacy was evaluated by attenuation coefficient measurements.

Results: Although non-significant, monophasic protocol enhancements were higher than biphasic protocol enhancements in all measurements except aortic bifurcation (p = 0.003). At this level, biphasic protocols obtained an increased mean enhancement from 7.6% to 2.5% compared to monophasic protocols.

Conclusion: Monophasic contrast agent injection in helical CT of the upper abdomen produces a higher enhancement of parenchymal and venous structures. No significant difference was observed between low-high and high-low biphasic protocols.     

Evaluation of global left ventricular function assessment by dual-source computed tomography compared with MRI

Left ventricular (LV) function assessment by dual-source computed tomography (DSCT) was compared with the reference standard method using magnetic resonance imaging (MRI). Accurate assessment of LV function is essential for the prediction of prognosis in cardiac disease. Thirty-four patients undergoing DSCT examination of the heart for various clinical indications underwent MRI after DSCT. Short-axis cine images were reconstructed from the DSCT datasets and were analyzed using a dedicated post-processing software-tool to generate global left ventricular function parameters. Five DSCT datasets were considered to be of insufficient image quality. DSCT showed a small overestimation of end-diastolic and end-systolic volumes of 11.0 ml and 3.5 ml, nrespectively. Myocardial mass assessed by DSCT showed an average underestimation of 0.2 g. DSCT showed a small overestimation of LV ejection fraction (LVEF) of 0.4%-point with a Bland-Altman interval of [−8.67 (0.40) 9.48]. Global LV functional parameters calculated from DSCT datasets acquired in daily clinical practice correlated well with MRI and may be considered interchangeable. However, visual assessment of the image quality of the short-axis cine slices should be performed to detect any artifacts in the DSCT data which could influence accuracy.     

恶性梗阻性黄疸介入治疗短期预后的多因素分析

目的 探讨影响恶性梗阻性黄疸经皮肝穿胆道引流或(和)胆道支架置入术近期预后的相关因素.方法 分析2008年12月至2009年6月经PTBD或(和)PTBS治疗的梗阻性黄疸患者67例,参照胆红素下降程度和术后30 d内生存情况分为短期治疗有效(54例)和无效(13例)2组,应用X~2进行单因素分析,非条件Logistic进行多因素分析.结果 单冈素分析方法显示患者梗阻时间、引流方式、术前胆道感染和肝功能Child-Pugh评分、TBIL、HGB、Cr 7个因素有统计学意义.多因素分析示术前胆道感染、肝功能Child-Pugh评分≥11分、Cr>115 μmol/L3个因素有统计学意义.结论 术前胆道感染、肝功能Child-Pugh评分≥11分、Cr>115μmol/L与梗阻性黄疸短期预后关系密切,对梗阻性黄疸介人治疗的术前评估有重要参考意义.     

Effect of saline pushing after contrast material injection in abdominal multidetector computed tomography with the use of different iodine concentrations

Purpose: To investigate whether saline pushing after contrast material improves hepatic vascular and parenchymal enhancement, and to determine whether this technique permits decreased contrast material concentration.

Material and Methods: 120 patients who underwent hepatic multidetector computed tomography were divided randomly into four groups (Groups A-D): receiving 100 ml of contrast material (300 mgI/ml) only (A) or with 50 ml of saline solution (B); or 100 ml of contrast material (350 mgI/ml) only (C) or with 50 ml of saline solution (D). Computed tomography (CT) values of the aorta in the arterial phase, the portal vein in the portal venous inflow phase, and the liver in the hepatic phase were measured. Visualization of the hepatic artery and the portal vein by 3D CT angiography was evaluated as well.

Results: Although the enhancement values of the aorta were not improved significantly with saline pushing, they continued at a high level to the latter slices with saline pushing. The enhancement value of the portal vein increased significantly and CT portography was improved with saline pushing. The enhancement value of the liver was not improved significantly using saline pushing. In a comparison between groups B and C, the enhancement values of the aorta and portal vein and the visualization of CT arteriography and portography were not statistically different.

Conclusion: The saline pushing technique can contribute to a decrease in contrast material concentration for 3D CT arteriography and portography.     

弥散加权成像在弥漫性轴索损伤伤情判断和预后评价中的应用价值

目的 探讨弥散加权成像(DWI)对弥漫性轴索损伤(DAI)患者伤情判断和预后评估的价值. 方法 回顾性分析29例DAI患者临床影像学资料及伤后6个月随访结果,比较DWI与常规MRI序列脑内病灶的检出数,分析DWI中不同部位病灶数与患者相应GCS、GOS评分的关系. 结果 (1)29例各序列脑内DAI病灶平均检出数为:DWI(19.24±5.72)个,FLAIR(14.41±4.50)个,T2WI(10.58±3.79)个,T1WI(4.83±2.11)个.DWI的病灶检出数最高,与其他序列比较差异有统计学意义(P<0.05).(2)脑中轴(胼胝体、基底节区、脑干)病灶数与GCS、GOS评分旱负相关(P<0.05),总病灶数及外周病灶数与GCS、GOS评分均无相关性(P>0.05).结论 DWI为DAI病灶检出的敏感序列,脑巾轴病灶检出数可作为DAI患者伤情判断和预后评估的客观指标.     

25G结膜无缝合玻璃体切割治疗阻塞性玻璃体积血

目的：观察25G经结膜无缝合玻璃体切割手术系统（2SGTSV）在血管阻塞性玻璃体积血手术治疗中的应用价值。方法：回顾性分析18例血管阻塞性玻璃体积血患者的临床资料，其中视网膜中央静脉阻塞者5例；分支静脉阻塞者13例。结果：18例患者中除2例于术中改2．0G玻切手术，并于术中充填硅油外其余16例均顺利完成手术。术后随访视力增加至O．3以上者8例。结论：25GTSV应用于血管阻塞性的单纯玻璃体积血，手术安全、省时、术后恢复快，