成人胸内淋巴结结核的多层CT表现及与病理临床的关系

目的 探讨成人胸内淋巴结结核的多层CT(MSCT)表现,及与病理、临床的关系.资料与方法 回顾性分析42例成人胸内淋巴结结核的MSCT表现,包括淋巴结的部位、数量、形态、边缘、平扫密度及增强表现,并与病理(n=37)、临床表现进行对照.结果 185个淋巴结主要位于4R区、2R区、7区和IOR区,8例累及1个区淋巴结,34例累及2个以上区淋巴结.145个淋巴结平扫密度基本均匀,40个不均匀.37例进行病理对照的169个淋巴结中,122个未融合者呈卵圆形或圆形,边缘清楚;47个融合者呈分叶状或不规则形,边缘欠清楚或模糊.共有7种强化形式:12个淋巴结均匀强化无中心低密度区,病理上呈结核性增生,无干酪样坏死及临床表现;22个不均匀强化中心有小的低密度区,结核性肉芽肿多,中心小量干酪样坏死,轻度临床表现;52个周边不规则厚壁强化中心无强化,结核性肉芽肿构成强化厚壁,中心干酪样坏死,轻度临床表现;36个周边薄环状强化中心无强化,强化环为小量结核性肉芽肿,中心大量干酪样坏死,中度临床表现;4个周边不规则强化中心无强化区延伸至淋巴结外,干酪样坏死物质破溃到淋巴结包膜外,重度临床表现;40个周边不规则环状强化中心分隔状强化,多个含有干酪样坏死的淋巴结融合,结核性肉芽肿构成强化环及分隔,重度临床表现;3个无明显强化,基本上为干酪样坏死,重度临床表现.11例显示为单一强化形式,26例为24种强化形式.结论 成人胸内淋巴结结核的MSCT表现主要为多区淋巴结受累,呈卵圆形或圆形,边缘清楚,平扫密度基本均匀,周边不规则厚壁强化中心无强化、周边不规则环状强化中心分隔状强化、周边薄环状强化中心无强化等多种强化形式.MSCT表现能够反映其病理改变,并且与临床表现密切相关.     

脾脏结核的CT诊断

目的 探讨脾脏结核的CT表现及其诊断价值.方法 回顾性分析经病理所证实或经抗结核治疗取得明显疗效而确诊的10例脾结核的CT表现.结果 (1)粟粒型脾结核4例,CT表现为脾脏弥漫性肿大,伴有多发粟粒状低密度灶,增强扫描病灶无明显强化;(2)结节型脾结核4例,CT表现为脾内单发或多发结节状低密度灶或混杂密度结节灶,病灶常伴有粉末状或斑点状钙化,增强后边缘轻度强化;(3)脓肿型脾结核2例,CT表现为多个干酪性结节灶相互融合,液化坏死形成较大的囊性病变,边缘轻度强化,周围可伴有卫星灶.其中6例肝门、胰周及腹膜后淋巴结肿大,部分有融合,增强呈典型环状强化.结论 各种类型脾结核CT表现具有一定特征性,CT对脾结核的正确诊断具有重要价值.     

成人纵隔肺门淋巴结结核的多层螺旋CT特点分析

目的:分析成人纵隔淋巴结结核的多层螺旋CT(MSCT)特点以提高诊断水平。方法:回顾性分析经临床病理证实的42例成人纵隔型淋巴结结核的MSCT表现并进行总结。结果:①部位:42例CT共见淋巴结肿大185个,淋巴结主要位于4R区、2R区,8例累及1个区淋巴结,34例累及2个以上区;②大小:短轴直径范围10～54 mm,加权平均(18±6)mm,长轴直径范围10～68 mm,加权平均(26±11)mm;③形态:37例进行病理对照的169个淋巴结中,122个(72.189%)未融合的淋巴结呈卵圆形或圆形,47个(27.811%)融合的淋巴结呈分叶状或不规则形;④边缘:122个(72.189%)未融合的淋巴结边缘光滑、清楚。47个(27.811%)淋巴结干酪样坏死,边缘欠清楚;⑤密度:145个(78.378%)淋巴结平扫密度基本均匀,CT值40～60 HU。40个(21.622%)淋巴结平扫密度不均匀,中央部分CT值16～37 HU,平均25.2 HU;32个淋巴结内或周边有斑点状钙化。⑥增强表现:169个淋巴结表现为7种强化形式。a.均匀强化(12个);b.不均匀强化、中心低强化有小的低密度区(22个);c.周边不规则厚壁强化、中心无强化(52个);d.周边薄环状强化、中心无强化(36个);e.周边不规则强化、中心无强化区延伸至淋巴结外(4个);.f周边不规则环状强化、中心分隔状强化(40个);g.无明显强化(3个);⑦肺内结核:8例(19.048%)肺内有结核病灶,其中6例为非活动性条索状影及钙化灶,2例为斑片状活动性结核。结论:MSCT对成人纵隔淋巴结结核具有重要诊断价值。     

浆膜型肝结核的CT表现

目的:探讨浆膜型肝结核的CT表现及诊断价值.方法:回顾性分析经病理证实的8例浆膜型肝结核CT表现,所有病例均行CT平扫及增强检查.结果:本组浆膜型肝结核8例中,6例单发,2例多发,共10个病灶.CT表现为肝包膜区梭形或多发结节性低密度灶,增强扫描后病灶呈环形强化8个,蜂窝状或多环状强化2个;10个病灶中明显强化3个,轻至中度强化7个;病灶边缘或中央见点状或条状钙化3个.累及邻近肝实质2例;伴有少量腹水及后腹膜淋巴结轻度肿大1例.结论:浆膜型肝结核的CT表现有一定的特征,当病灶内发现斑点状或条状钙化或病灶呈多环状强化时结合临床表现及实验室检查可作出提示性诊断.     

腮腺淋巴结病变的MRI表现

目的 :分析腮腺淋巴结病变的MRI形态学表现及特征。方法:收集19例经手术病理证实的腮腺淋巴结病变患者的MRI资料。结果 :本组淋巴结反应性增生5例,淋巴瘤4例,非结核性淋巴结肉芽肿性炎3例,结核性淋巴结肉芽肿性炎2例,增殖性淋巴结核1例,嗜酸性淋巴肉芽肿1例,Castleman病1例,淋巴结转移腺癌1例,慢性腮腺淋巴结炎1例。1例慢性淋巴结炎表现为单发不规则肿块,边界不清,信号不均,增强扫描显著强化;1例淋巴结转移癌表现为腮腺后下极单发圆形结节,边界清楚,T1WI呈中央均匀稍高信号、周围环形低信号,T2WI呈中央高信号、边缘环状稍高信号,2例均术前误诊。其余17例均表现为腮腺单侧或双侧多发结节及肿块,边界清楚,信号均匀一致;1例淋巴瘤见不规则融合状,其余为圆形或卵圆形;3例淋巴瘤及1例嗜酸性肉芽肿部分病变融合,其余不相融;均伴腮腺周围、颈部、颌下淋巴结增大且信号一致。结论:腮腺淋巴结病变病理种类较多,且影像表现共性较多,部分单发病变缺乏特点易误诊,多发病变结合腮腺外淋巴结可诊断,但部分病理类型鉴别困难。     

CT影像组学鉴别儿童化脓性与结核性淋巴结炎

目的:探讨基于CT增强静脉期图像采用机器学习方法构建的影像组学模型结合多期CT图像上的影像学特征对儿童颈部伴有坏死的化脓性淋巴结炎与结核性淋巴结炎的鉴别诊断价值。方法:搜集2014年9月-2022年5月我院CT增强检查发现颈部淋巴结坏死并经病理活检或临床确诊为颈部化脓性淋巴结炎(n=52)或颈部结核性淋巴结炎(n=49)患儿的临床和影像资料。分析两组患儿10个主要CT征象(最大坏死淋巴结短径、最大坏死结的坏死区/淋巴结面积比、坏死区内有无分隔、坏死区边缘是否光滑、平扫坏死区是否可见、有无钙化、淋巴结强化形状、淋巴结强化程度、淋巴结边缘、淋巴结融合)的差异。使用Radcloud平台,在CT增强静脉期图像上于病变淋巴结内勾画ROI并提取1409个影像组学特征。利用方差阈值、SelectKBest、最小绝对收缩和选择算法对提取的特征逐步进行降维和筛选,随后采用6种机器学习方法(k-最邻近算法、支持向量机、极限梯度提升、随机森林、逻辑回归和决策树)构建预测模型,采用受试者工作特征(ROC)曲线及符合率、敏感度和特异度等指标来评估模型对两种不同类型淋巴结炎的预测效能。结果:两组之间最大短径、淋巴...     

艾滋病合并肺结核CT与病理对照分析

目的：探讨艾滋病合并肺结核的CT影像表现与病理改变及其临床意义。方法：回顾性分析经确诊的13例艾滋病合并肺结核患者的CT影像表现及穿刺活检病理相关资料。13例患者CD4T淋巴细胞计数均小于200/μl。结果：13例肺结核中,CT多表现为结节、肿块影及片状实变影,合并纵隔淋巴结肿大及胸膜炎。病理组织抗酸杆菌染色阳性9例。干酪样坏死及炎性细胞浸润5例,淋巴细胞、纤维组织增生或类上皮细胞浸润5例,肺组织坏死并炎性细胞浸润3例。所有患者的病理组织中均未见到典型结核结节及朗罕氏巨噬细胞。结论：艾滋病合并肺结核主要表现为结节、肿块或片状实变影,合并胸膜炎或纵膈淋巴结肿大。其病理改变主要为炎性肉芽肿和/或合并干酪坏死,缺乏典型结核结节及郎罕氏巨噬细胞,诊断还应结合抗酸杆菌染色。     

颈部非器官源性软组织肿块的CT表现

目的:分析颈部非器官源性软组织肿块的CT特征,提高诊断水平。方法:回顾性分析19例经病理证实的颈部软组织肿块,分析其发病部位及CT表现。结果:淋巴结病变9例,以颈部Ⅰ～Ⅳ区多见。9例中,淋巴结转移瘤2例,淋巴结结核3例,淋巴结化脓性炎症1例,淋巴瘤3例。淋巴结核、淋巴瘤的淋巴结多呈类圆形,边缘多清晰。淋巴结转移瘤、结核多呈边缘和分隔样强化,内部多见液化坏死区;淋巴瘤内部轻度强化;化脓性淋巴结炎边缘模糊,多结节融合,呈环样及分隔样强化。神经源性肿瘤5例,多位于颈动脉间隙及椎旁间隙,颈动脉间隙神经源性肿瘤位于颈动静脉后内方,呈类圆形,边缘清晰,密度均匀或不均匀。迷走神经源性肿瘤使颈动静脉分离。咽部先天性囊肿3例,其中腮裂囊肿2例,位于颈侧区口咽扁桃体周围,胸锁乳突肌前内方,呈类圆形囊状低密度影,边缘清晰光滑,并发感染则边缘模糊,囊壁增厚强化明显。甲舌囊肿1例,位于颈中区,边缘清晰之囊状影,与舌骨相连。淋巴管瘤2例,其中1例位于颈根后三角区,1例位于颈侧胸锁乳突肌前,边缘清晰,形态不规则,穿行颈部肌间隙内,无强化。结论:熟悉颈部正常解剖,掌握病变各自特点,对颈部软组织肿块的定位、定性诊断有重要价值。     

艾滋病颅内机遇性感染及肿瘤病变的CT诊断

目的:探讨HIV/AIDS相关性颅内感染及肿瘤病变的CT表现特点,提高颅内感染性及肿瘤病变的诊断水平。方法:回顾分析在博茨瓦纳玛丽娜公主医院临床及病理检验证实的26例AIDS患者的头颅CT表现。全部病例均有完整的CT资料。结果:①AIDS合并脑弓形虫感染6例,典型表现为颅内单发或多发结节影,边缘不规则,中央见坏死灶,增强扫描病灶明显强化,4例坏死灶不均匀轻度强化,周围见明显水肿带;②脑结核3例,表现为颅内多发散在低密度区及小结节灶,增强扫描2例病灶强化,1例表现为多发散在钙化点;③病毒性脑炎4例,两侧大脑多发片状低密度区,增强CT无明显强化,1例见沿脑回线样强化,轻度脑肿胀;④结核性脑膜炎2例,增强扫描见两侧大脑外侧裂池、桥脑环池明显异常强化;⑤脑脓肿7例,表现为颅内厚壁空洞形成,增强后壁明显强化,病灶周围水肿明显;⑥淋巴瘤4例,表现为颅内团块状影,平扫呈等或稍高密度,密度较均匀,增强后中度或明显强化,周围轻中度水肿。结论:CT检查是AIDS所致颅内机遇性感染最基本的影像学检查方法,能很好地显示病变的部位、形态以及病灶周围水肿情况。但在临床定性诊断时需要结合实验室检测和组织活检。     

CT在胰腺结核诊断中的价值

目的：探讨胰腺结核的CT征象及其诊断价值。资料与方法：回顾性分析14例胰腺结核的CT表现及临床资料。结果：胰腺结核表现为3型：（1）局灶型：9例，多位于胰头，表现为低密度肿块伴有周边或蜂房状强化；（2）多结节型：4例，胰腺内多发低密度病变，无强化或轻度强化，胰头病变明显，呈蜂房状强化；（3）弥漫型：1例，表现为胰腺弥漫性肿大，边缘模糊。胰腺结核常伴有胰外结核。胰周淋巴结肿大9例，7例增强，呈花环状或环形强化；肝脏受累3例，脾脏受累4例，表现为肝、脾实质内低密度无强化病灶；胆管梗阻、结核性腹膜炎各3例。结论：胰腺结核CT表现多样，包括胰腺局灶性低密度肿块、多发低密度结节或弥漫性胰腺肿大，但最常见的表现是胰腺内局灶性蜂房状强化的肿块。低密度的胰周和门静脉周围淋巴结肿大伴周边环形强化以及其他播散结核灶是支持胰腺结核诊断的重要辅助征象。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.