不典型肾实质内占位的高场强MRI与螺旋CT诊断价值分析

目的：评价高场强MRI与螺旋CT平扫与动态增强检查对不典型肾实质内占位的诊断价值。方法：37例肾实质内实性占位病变，包括肾癌21例，少脂肪血管平滑肌脂肪瘤6例，复杂良性囊性病变7例，肾嗜酸性细胞瘤1例，肾蔓状血管瘤伴出血1例，多房囊性肾瘤1例，均经1．5TMRI及螺旋CT平扫及多期动态增强检查，CT与MRI检查时间间隔2天至2月。所有病例均经手术病理证实。结果：高场强MRI检查对肾实质内不典型占位的诊断准确度为78．4％。高于螺旋CT检查的准确度(64．9％)。两者有显著差异性，P=0．025。MRI与CT检查相结合诊断准确度为89．2％，明显高于MRI及CT检查(P=0．003、0．001)。结论：MRI与螺旋CT检查相结合能明显提高不典型肾实质内占位的诊断准确度。     

螺旋CT及MRI在鉴别肾脏囊性占位病变中的作用

目的分析肾脏囊性占位病变的CT与MRI表现,并评价其对鉴别良恶性病变的临床意义。方法 151例由手术病理证实的肾脏囊性占位病变患者,包括多发囊肿125例,海绵状血管瘤16例及囊性肾癌10例,均经CT与MRI平扫及增强扫描。比较了CT与MRI对肾脏囊性占位病变的诊断能力。结果 151例中,CT诊断肾囊肿118例,血管瘤16例,以及囊性肾癌17例,其诊断敏感性,特异性及准确性分别为58.8%,95.0%及95.4%;MRI诊断肾囊肿122例,血管瘤16例,以及囊性肾癌13例,其诊断敏感性,特异性及准确性分别为76.9%,98.8%及98.0%。CT对肾良性病变低估7例,对恶性病变高估了7例,而MRI对肾良性病变低估3例,对恶性病变高估3例。结论 CT与MRI二者都能对血管瘤作出正确诊断,而在肾囊肿与囊性肾癌的诊断及鉴别诊断中,MRI明显优于CT。     

菲立磁增强磁共振成像在肝脏疾病诊断中的价值

目的　评价菲立磁增强MRI在肝脏疾病诊断中的应用价值。方法　对 31例经CT或MRI检查确定或怀疑有肝脏病变者进一步行菲立磁增强MRI检查 ,分别测量增强前后肝脏、病变及背景噪声的T2 WI信号强度 ,计算增强前后肝脏及病变的信噪比(SNR)、对比噪声比 (CNR)。分析平扫及增强后扫描检测的病灶数目。结果　菲立磁增强后肝脏的SNR明显降低 (Ρ <0 .0 1) ;恶性病灶的SNR变化不明显 (Ρ >0 .0 5 ) ;病灶 -肝脏CNR明显增高 (Ρ <0 .0 1)。增强后病变的检出数量增加 ( χ2 =8.5 7,Ρ <0 .0 1)。结论　菲立磁能显著提高肝脏恶性肿瘤的检出率 ,而且对肝脏小病灶的鉴别诊断提供有利的依据     

乳腺占位病变的高场强MRI诊断价值

目的 :总结乳腺良恶性占位病变在高场强MRI的影像表现 ,评价高场强MRI对乳腺良恶性病变的诊断价值。方法 :搜集1996～ 2 0 0 4年间经手术病理证实的 4 3例乳腺良恶性占位病变的MRI资料 ,分析其影像表现。结果 :典型乳腺良、恶性病变 ,高场强MR平扫即能准确诊断 ,而部分非典型良、恶性病灶 ,增强扫描形态、信号变化也有一定的重叠。结论 :MRI技术能够充分显示病变形态及与周围组织结构之间的关系 ,是建议活检或预防性手术的最有力的依据。但是 ,MRI平扫、增强技术对乳腺非典型病变 ,仍然有局限性     

结核性脑膜炎的CT和MRI诊断及对比分析

目的 :对比研究 CT、MRI扫描对结核性脑膜炎 (简称结脑 )的诊断价值。方法 :5 0例经临床确诊的结脑患者 ,CT平扫和增强扫描 5 0例 ,MRI扫描 31例 ,其中 2 0例作了增强扫描。结果 :CT和 MRI平扫的敏感度分别为 72 %和 77.3% ;增强扫描的敏感度分别为 88%和 90 % ,平扫加增强扫描 CT、MRI的敏感度分别为 90 %和 90 .3%。影像表现为 :脑池及脑膜异常 ,脑积水 ,结核瘤 ,脑梗塞 ,脑炎 ,脑膜钙化 ,血管神经异常。结论 :CT和 MRI扫描对显示结脑较为特征性的脑膜病变和结脑的继发病变都有很高的敏感度。 CT和 MRI增强扫描的敏感度高于各自平扫。 MRI显示病变波及范围和继发病变优于 CT。     

肾毛细血管瘤1例

患者女,53岁,体检发现左肾占位性病变4 d入院.查体无阳性体征,血、尿生化检查未见异常. 双肾CT平扫:左肾中上极可见稍低密度影,其内密度不均匀,与肾实质分界不清,大小约7 cm×6.5 cm×5 cm(图1).CT动态增强扫描:左肾病变于增强扫描各期呈不均匀强化,病变大部分为逐渐增强,动脉期CT值30 HU,至延时12 min扫描,CT值升至71 HU,仅病变前内上部分各期均无明显增强(图2,3).诊断:左肾中上极占位,血管瘤可能性大,不除外肾癌.MR平扫:左肾中上极见一较大不规则异常信号影,T1WI呈稍低信号,T2WI压脂呈高信号,内可见网状等信号影(图4).     

肾上腺占位病变的CT、MRI诊断(附71例报告)

目的探讨肾上腺占位病变的CT、MRI诊断价值,提高对肾上腺间质概念的认识. 资料与方法搜集1994年8月～2001年6月经手术和病理证实的肾上腺占位病变71例,46例行CT平扫,其中31例进行增强扫描;30例行MRI平扫,18例行增强扫描;共有5例行CT、MRI联合检查(平扫+增强). 结果 (1) 皮质占位36例(占50.7%),其中醛固酮腺瘤14例,皮质醇腺瘤11例,无功能腺瘤3例,皮质腺癌2例,皮质增生症6例;有1例伴性变态综合征.(2) 髓质占位29例(40.8%),其中嗜铬细胞瘤16例,成神经细胞瘤3例,节神经细胞瘤2例,转移瘤8例.(3)间质占位6例(8.5%),其中髓样脂肪瘤3例,囊肿2例,纤维脂肪瘤1例. 结论肾上腺占位病变多具有其特定的好发年龄、性别趋向及CT、MRI影像学特征,结合临床及实验室检查有助于提高占位病变诊断的准确性;但部分无功能腺瘤、转移瘤、间质肿瘤的定性诊断仍依赖于组织学检查.     

肝脓肿炎症期CT增强扫描与磁共振成像平扫的诊断分析

目的：采用双排螺旋CT三期增强扫描与低场强磁共振成像（MRI）平扫的诊断方法对肝脓肿炎症期患者进行分析。方法选取2010年1月1日至2013年12月31日在我院经多重方法确诊为肝脓肿炎症期的患者158例,将患者随机分为对照组79例、治疗组79例。给予对照组的肝脓肿炎症期患者采用双排螺旋CT三期增强扫描,给予治疗组肝脓肿炎症期患者采用双排螺旋CT三期增强扫描与低场强MRI平扫。结果使用双排螺旋CT三期增强扫描的对照组79例患者中诊断准确有48例患者,误诊有31例患者,使用双排螺旋CT增强三期增强扫描与低场强MRI平扫的治疗组79例患者中诊断准确有72例患者,误诊7例患者。治疗组的准确率（91.1%）明显好于对照组的准确率（60.8%）,两组比较具有统计学意义（P〈0.05）。结论采用双排螺旋CT三期增强扫描与低场强MRI平扫对肝脓肿炎症期患者进行诊断分析有较高的准确率,能够降低误诊率,可以广泛的应用于临床的检查中,值得大力推广。     

超声造影、增强CT及增强MRI对肾脏占位性病变的诊断价值比较

目的：比较超声造影、增强CT及增强MRI对肾脏占位性病变的诊断价值。资料与方法对78例经常规超声诊断为肾脏占位性病变患者的80个病灶进行实时超声造影检查,39个行增强CT检查,28个行增强MRI检查,其中5个同时行增强CT及增强MRI检查。以病理结果为“金标准”,比较超声造影、增强CT及增强MRI诊断肾脏占位性病变良恶性的价值。结果80个病灶中,57个为恶性病变,23个为良性病变;超声造影诊断肾脏病变良恶性的敏感度、特异度、阳性预测值、阴性预测值分别为93.0%、69.6%、88.3%、80.0%;增强CT诊断肾脏病变良恶性的敏感度、特异度、阳性预测值、阴性预测值分别为96.4%、72.7%、90.0%、88.9%;增强MRI诊断肾脏病变良恶性的敏感度、特异度、阳性预测值、阴性预测值分别为86.4%、66.7%、90.5%、57.1%;3种检查诊断效果间差异无统计学意义（P>0.05）。结论超声造影、增强CT及增强MRI对于肾脏占位性病变良恶性的诊断效果相当,临床可以根据各个检查技术的特点,为不同的患者选择适宜的检查,联合应用两种检查方法为肾脏占位性病变的诊断提供了更丰富的信息。     

肝胆管囊腺瘤的影像学表现

目的 探讨肝胆管囊腺瘤CT、MRI及B超表现,提高其诊断准确率.方法 回顾性分析9例经病理证实的肝胆管囊腺瘤患者,螺旋CT检查7例,MRI检查4例,B超检查5例.结果 7例患者CT平扫表现为多房囊性病变,囊内可见线状分隔,囊壁均匀增厚,壁光滑;MRI检查4例患者中,病变T1WI呈低信号多房囊性占位,T2WI病灶呈高信号为主混杂信号,囊内分隔呈低信号,增强后动脉期囊壁及分隔轻度强化,门脉期及延迟期继续强化.B超检查5例患者表现为肝内无回声暗区,边界清楚,内见多条强回声带,可见分隔或乳头状隆起.结论 平扫加动态增强CT、MRI及B超能够特征性反映肝胆管囊腺瘤的影像学特点,提高该疾病的诊断准确率.     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.