低剂量宝石能谱CT引导经皮肺穿刺活检术

目的探讨低剂量宝石能谱CT用于引导经皮肺穿刺活检术的可行性。方法收集接受宝石能谱CT引导经皮肺穿刺活检术的80例患者,穿刺过程中均多次重复定位,依次采用常规剂量及噪声指数(NI)为20、24、28的低剂量CT扫描,比较常规剂量和低剂量CT图像质量及CT容积剂量指数(CTDI_(vol))、剂量长度乘积(DLP)及有效辐射剂量(ED)。结果常规剂量和低剂量CT图像均能清晰显示穿刺针和病灶的位置关系,可满足穿刺需要;常规剂量与NI为20、24、28的低剂量图像质量级别差异均无统计学意义(P=0.08),常规剂量与NI为20、24、28的低剂量图像的CTDI_(vol)、DLP、ED差异均有统计学意义(P均0.01),且随着NI增加,CTDI_(vol)、DLP和ED逐渐降低(P均0.05)。结论低剂量宝石能谱CT扫描图像可以满足经皮肺穿刺活检术需要,并降低辐射剂量。     

双源CT定量容积成像技术预测肺癌患者术后肺功能改变的前瞻性研究

目的 探讨利用双源CT定量容积成像技术预测肺癌患者术后肺功能改变的可行性及临床应用价值.方法 选择2012年6月至2013年6月住院行单操作孔胸腔镜下肺叶或全肺切除的肺癌患者233例进行前瞻性研究,其中男性121例,女性112例,平均年龄(53±16)岁.术前进行常规肺功能检查;同时利用双源CT行深吸气末及深呼气末双时相扫描,分别测量患者的各肺叶、单侧肺及全肺的肺容积、像素指数分布直方图、肺密度值.术后3个月复查肺功能.最后比较CT容积扫描测得的肺容积值与患者术前肺功能指标的差异及相关性,比较根据CT容积值预测的术后肺功能指标与患者术后实测肺功能指标的差异及相关性.结果 CT容积扫描平卧位肺野上部密度为-(870 ±22) HU,下部密度为-(767±16)HU,差异有统计学意义(t=3.13,P＜0.01);右上、右中、右下、左上、左下肺叶,右全及左全肺占双肺容积比例分别为20.5％、10.3％、23.1％、24.6％、21.5％、53.9％、46.1％.CT容积扫描所得数据与患者手术前常规肺功能指标肺总量、用力肺活量(FVC)、第一秒用力呼气量(FEV1)、残气量、FEV1/FVC之间相关系数最高分别为0.92、0.76、0.70、0.85、0.53(t=3.14、3.05、2.86、3.09、2.68,均P＜0.01),与术后实测指标最高相关系数分别为0.87、0.68、0.75、0.81、-0.64(t=3.10、2.85、3.05、3.02、2.79;均P＜0.01).结论 利用双源CT定量容积成像技术对患者的术后肺功能改变进行预测是可行的,可精确评估待切除部位对术后肺功能影响并对术后肺功能进行预测.     

低剂量螺旋CT在颌面部骨折美容修复中的应用价值探讨

目的:探讨低剂量螺旋CT在颌面部骨折诊治中的应用价值。方法:选取2017年10月-2019年10月于笔者医院就诊的60例颌面部创伤患者为研究对象,随机分为常规剂量组(160mAs螺旋CT扫描)30例和低剂量组(30mAs螺旋CT扫描)30例,比较两组图像质量,辐射剂量参数包括容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP)和有效剂量(ED)。结果:两组满足诊断要求的图像比例比较,差异无统计学意义(P0.05);低剂量组手术发现47处骨折,常规剂量组手术发现49处骨折,两组骨折部位及比例构成无显著性差异(P0.05),均以上、下颌骨骨折为主;低剂量组CT三维重建颌面骨折检出率为93.62%,与常规剂量组CT三维重建检出率95.92%比较,差异无统计学意义(P0.05);低剂量组辐射剂量参数CTDIvol、DLP和ED均显著低于常规剂量组,差异有统计学意义(均P0.05)。结论:颌面部骨折患者临床诊疗中采用螺旋CT低剂量扫描,在保证诊断图像质量、不明显影响诊断准确性同时,大幅减少辐射剂量。     

双源CT低剂量扫描在上腹部增强检查中的应用

目的探讨双源CT上腹部增强扫描中低剂量技术的应用。方法搜集2011年7月至2012年2月期间来我院行双源CT上腹部增强检查的连续600例患者,按就诊时间先后分别依次采用常规管电流量(210 mAs)和低管电流量(200、190、180、170及165 mAs)扫描,分别为常规管电流量组和低管电流量组。测量、计算并评估各组患者动脉期和门脉期图像的皮下脂肪标准差(SD)值、肝脏和胰腺信噪比(SNR)、肝脏-竖脊肌和胰腺-竖脊肌对比噪声比(CNR)、图像主观质量评分以及射线剂量指标CT剂量指数(CTDI)、剂量长度乘积(DLP)、有效剂量(ED)。结果各组患者动脉期和门脉期图像的皮下脂肪SD值、肝脏和胰腺SNR、图像主观质量评分和射线剂量指标CTDI、DLP、ED之间差异均有统计学意义(P<0.05);各组肝脏-竖脊肌和胰腺-竖脊肌CNR之间差异无统计学意义(P>0.05)。其中165 mAs管电流量组图像SNR、射线剂量和主观质量评分均为最低,不能满足诊断需求。结论上腹部增强CT检查,通过阶段性降低管电流量使诊断医生逐渐适应低剂量图像质量,从而普及现有设备的低剂量扫描的方法是可行的。双源CT采用170 mAs的参考管电流量,既能获得满足临床诊断的合格图像,又能大大降低患者群体接受的辐射剂量。     

男性慢性阻塞性肺疾病患者血清睾酮水平变化的临床意义

目的探究不同严重程度男性慢性阻塞性肺疾病(COPD)患者血清睾酮水平变化的临床意义。方法收治的120例男性COPD患者为研究对象,按病情程度分为轻度组35例、中度组48例、重度组37例。患者就诊当日完成一般资料、病史信息采集及急性生理学和慢性健康(APACHE II)评分评估,于次日清晨入院采血检测血清睾酮水平,并通过测定第1秒用力呼气容积(FEV1)、用力肺活量(FVC)评估肺功能及痰液IL-8、TNF-α水平评估气道炎症反应。结果轻度组、中度组、重度组患者性别、年龄、病程比较无统计学意义(P0.05),但APACHE II评分轻度组中度组重度组,血清睾酮水平轻度组中度组重度组,差异有统计学意义(P0.05)。肺功能指标FEV1、FVC轻度组中度组重度组,气道炎症因子IL-8、TNF-α水平轻度组中度组重度组,差异均有统计学意义(P 0.05)。Spearman相关性分析显示男性COPD患者血清睾酮水平与APACHE II评分,痰上清液IL-8、TNF-α水平呈负相关(P 0.05),与FEV1、FVC呈正相关(P 0.05)。结论男性COPD患者血清睾酮水平随病情严重程度呈递减状态,并与肺功能及气道炎症反应密切相关。     

轻中度青少年特发性脊柱侧凸肺功能的影响因素分析

目的探讨轻中度青少年特发性脊柱侧凸(Adolescent Idiopathic Scoliosis,AIS)肺功能的影响因素。方法选取2016-01-2018-02,我院收治的60例青少年特发性脊柱侧凸患者,作为观察组;选择正常健康青少年20例,作为对照组。测定所有患者的肺功能指标,包括用力肺活量(FVC)、FVC预计值(FVC pred)、FVC占预计值的百分比(FVC pred%)、第1秒用力呼气量(FEV1)、FEV1预计值(FEV1 pred)、FEV1占预计值百分数(FEV1 pred%)、FEV1占FVC百分数(FEV1/FVC%)。结果两组FVC、FVC pred%、FVC pred、FEV1、FEV1 pred指标比较,差异无统计学意义(P0.05),而FEV1 pred%和FEV1/FVC%差异有统计学意义(P0.05)。根据患者脊柱不同侧凸类型比较,FVC、FEV1差异有统计学意义(P0.05)。AIS患者不同性别比较,各项肺功能指标FVC、FEV1/FVC%、FVC pred、FEV1 pred、FVC pred%、FEV1/FVC%、FEV1差异均无统计学意义(P0.05)。AIS患者的年龄相关系数比较中,FVC、FEV1、FVC pred、FEV1 pred比较差异有统计学意义(P0.05);最大Cobb角与FVC、FVC pred、FVC pred%、FEV1、FEV1 pred、FEV1 pred%、FEV1/FVC%均无相关性(P0.05)。结论轻、中度青少年特发性脊柱侧凸会导致肺功能障碍,并且与年龄成正比,而不同侧凸类型和Cobb角的大小与肺功能无关。     

低剂量螺旋CT应用于胸部外伤检查的临床效果分析

目的探讨分析低剂量螺旋CT应用于胸部外伤检查的临床效果。方法选取2016年1月到2017年5月间在本院就诊的300例胸部外伤患者,均采用常规剂量螺旋CT扫描和低剂量螺旋CT扫描。准确记录每位患者的CTDI(CT剂量指数)和DLP(剂量长度乘积),计算患者ED(有效剂量),并进行图像主管质量评分,分别进行比较。结果低剂量螺旋CT检查时,患者CTDI、DLP、ED明显低于常规剂量螺旋CT检查,两种方法之间存在显著的统计学差异(P0.05)。两种方法相比,图像主观质量评分不存在显著的统计学差异(P0.05)。结论采用低剂量螺旋CT检查可行性高,通过降低管电流可以有效降低CT辐射量,同时该方法也可获得清晰准确的图像,利于临床诊断和患者健康,具有较高的临床应用价值,值得应用推广。     

智能最佳管电压调节技术在儿童埋伏牙CT扫描中的应用

目的探讨双源CT智能最佳管电压调节(CARE kV)技术在儿童埋伏牙扫描中的应用价值。方法对90例埋伏牙患儿行CT扫描,并分为A、B、C 3组,每组30例,A组常规扫描(100kVp/150mAs),B组开启CARE Dose 4D扫描(100kVp/参考管电流150 mAs),C组CARE kV联合CARE Dose 4D扫描(参考管电压100kV/参考管电流120mAs)。比较3组的辐射剂量、图像平均CT值、噪声、SNR、CNR、主观评分及CT诊断与临床诊断的差异。结果 3组实际扫描管电流、管电压及辐射剂量差异均有统计学意义(P均0.05),与A组比较,B组有效剂量(ED)减低约15.74%,C组ED减低26.85%;图像的平均CT值、噪声、SNR、CNR及主观评分比较差异均无统计学意义(P均0.05);3组CT与临床诊断结果比较差异无统计学意义(P0.05)。结论采用双源CT智能最佳管电压调节技术行儿童埋伏牙CT扫描,可有效降低辐射剂量,在保证图像质量的同时,不影响诊断。     

螺旋CT常规剂量与低剂量扫描检出肺结节的对比研究

目的通过螺旋CT肺部常规剂量与低剂量扫描的对比分析,评价低剂量扫描检出肺结节的价值。方法对40例肺内结节患者分别行常规剂量螺旋CT（160mA,螺距1．0,层厚5mm）扫描及低剂量螺旋CT（40mA,螺距2．0,层厚5mm）,采用双盲法对结节的数目、大小及结节的细节征象（分叶、毛刺、胸膜凹陷、钙化、空洞及支气管气像）进行分析。结果低剂量CT扫描检查对结节的检出及细节征象与常规剂量扫描检查均无明显差异。但低剂量扫描剂量当量（CTDlw）仅为常规扫描的12．4％。结论低剂量螺旋CT与常规剂量螺旋CT对肺结节的显示相仿,可用于高危人群肺癌筛查。     

多排螺旋CT非螺旋低剂量扫描筛查肺结节

目的探讨4排螺旋CT非螺旋低剂量扫描方式在肺结节诊断中的价值。方法对30例胸片可疑肺结节患者分别行螺旋低剂量和非螺旋低剂量扫描。采用Toshiba 4排多层螺旋CT（Asteion 4）扫描机。螺旋扫描采用预设35.5 mAs,床进20 mm/圈（即螺距1）,0.75 s/圈,非螺旋扫描预设24 mAs,床进20 mm/圈（层厚=层距）,0.48 s/圈,其他扫描参数相同：120 kV,准直0.5×4,DFOV 300 mm,重建层厚5mm。根据出现伪影程度及是否分辨出肺结节来评价CT图像质量,对肺结节进行简单计数。比较两者发现肺结节的差异及有效放射剂量的差异。结果两种扫描方式检查30例患者均为阳性,发现各种肺结节都是108个。非螺旋扫描的有效放射剂量低于螺旋扫描方式（P〈0.001）。结论非螺旋方式扫描与螺旋方式扫描在胸部低剂量检查中对于肺内病灶的发现及诊断无统计学差异,扫描剂量相对更低的非螺旋方式扫描应用于胸部疾病的诊断及筛查是可行的。     

扫描及重建参数对肺磨玻璃结节体积测量影响的体模研究

目的探讨MSCT扫描与重建参数对仿真人体体模肺磨玻璃结节容积测量的影响。方法采用GE VCT对8个肺磨玻璃结节进行不同管电压(80 kV、100 kV、120 kV)、管电流(100 mA、150 mA、200 mA)扫描,并对80 kV、150 mA组原始数据行不同层厚(0.625 mm、1.250 mm)、不同重建算法(soft、standard、lung、bone)、不同重建野(36 cm、18 cm)重建。由2名胸部放射诊断医师分别用软件对磨玻璃结节进行容积测量,并对绝对错误率(APE)=(|V_(测量)-V_(实际)|)/V_(实际)×100%进行统计学分析。采用组内相关系数(ICC)评估2名医师体积测量结果的一致性。结果 2名医师对肺磨玻璃结节体积测量的ICC=0.98。不同管电压条件下各结节的APE值差异无统计学意义(P0.05),而管电流为150 mA,APE值最小(P0.05)。结节的APE值在2种层厚之间差异无统计学意义(P0.05)。随着重建野缩小,APE值减小(P0.05)。不同重建算法对结节的APE值影响不同,差异有统计学意义(P0.05),lung算法时APE值较小。低密度小结节(CT值为-800 HU,直径5 mm)在各种条件下的APE值均大于10。结论 MSCT采用80 kV、150 mA扫描结合靶重建、肺算法可一定程度减小辐射剂量并且提高磨玻璃结节容积测量的准确性。低密度小结节不适合用肺结节分析软件分析。     

Six-minute walking and pulmonary function test outcomes during the early period after lung cancer surgery with special reference to patients with chronic obstructive pulmonary disease

Objective: To evaluate physical dysfunction during the early period after lung resection in patients with lung cancer and coexisting chronic obstructive pulmonary disease (COPD), we examined the relationship between the ratio of the forced expiratory volume in 1 second to the forced vital capacity (FEV₁/FVC%) and the results of a 6-minute walk (6MW) test before and after surgery. Methods: Eighty-three patients who underwent lobectomy for lung cancer were classified into three groups according to their preoperative FEV₁/FVC: more than 70% (non-COPD, n=61), 60–69% (mild COPD, n=15), and 40–59% (moderate COPD, n=7). The 6MW and pulmonary function tests were performed before surgery and repeated 1 and 2 weeks after surgery. During the 6MW test, the distance covered during a 6MW test (6MWD) and the decrease in oxygen saturation (SpO₂) were measured. Results: During both the preoperative and postoperative 6MW tests, the decrease in SpO2 correlated significantly with the preoperative FEV₁/FVC% (p<0.001). The percentage decrease in 6MWD at 1 and 2 weeks after surgery correlated significantly with the preoperative FEV₁/FVC% (p<0.001 and p=0.04, respectively), but not with the concomitant percentage reduction in vital capacity (VC). The differences of the decreases in postoperative 6MWD and SpO₂ during the 6MW test were significant between the moderate and mild COPD patients and between the mild COPD and non-COPD patients (p<0.01–0.001). Conclusion: The decreases in 6MWD and SpO₂ after surgery were significantly influenced by the preoperative FEV₁/FVC%, but not by the decrease in VC. COPD patients have a limited capacity for walking during the early period after surgery due to significant oxygen desaturation.     

儿童单侧肺动脉缺如X线平片及CT表现

目的探讨先天性单侧肺动脉缺如(UAPA)的X线平片及CT表现。方法回顾性分析14例UAPA患儿的影像学资料,观察其X线平片及CT平扫特征。结果 X线平片:患侧肺体积减小9例(9/14,64.29%),透光度减低7例(7/14,50.00%),肺纹理较健侧稀疏9例(9/14,64.29%),合并肺部感染4例(4/14,28.57%);CT平扫:患侧肺体积减小12例(12/14,85.71%),透光度减低7例(7/14,50.00%),肺纹理纤细9例(9/14,64.29%),肺动脉主干缺如1例(1/14,7.14%),合并肺实变、间质改变8例(8/14,57.14%),合并肺内囊变3例(3/14,21.43%)。结论 UAPA的X线平片和CT平扫图像具有一定特征,对诊断UAPA具有重要提示作用。     

Improvement in pulmonary function in asthmatic patients after bariatric surgery: a systematic review and meta-analysis

BackgroundThe association between obesity and asthma is well-established. Some evidence suggests that weight loss may improve asthma outcomes; however, the effect of bariatric surgery on pulmonary function in asthmatic patients remains inconclusive. This systematic review and meta-analysis of observational studies assessed the impact of bariatric surgery on patients with asthma.ObjectivesTo investigate the effect of bariatric surgery on pulmonary function in patients with asthma.SettingSystematic review and meta-analysis of published studies.MethodsA comprehensive search of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted. The sole inclusion criterion was published studies that evaluated the effects of bariatric surgery on pulmonary function in asthmatic patients. The outcomes of interest were forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC. A meta-analysis of studies comparing pre- and postsurgery spirometric measures, and of studies comparing surgery and control groups was performed.ResultsFrom 25 full-text articles, 6 observational studies met the inclusion criteria and were included in this meta-analysis based on the random-effects model. A significant increase in FEV₁ and FVC was observed after bariatric surgery among studies without a control group (mean difference: .21 L, 95% confidence interval: .07–.35 for FEV₁, and mean difference: .34 L, 95% confidence interval: .14–.53 for FVC). There was no significant change in FEV₁/FVC after bariatric surgery compared with control.ConclusionsFEV₁ and FVC were both found to be significantly improved after bariatric surgery; however, no significant postsurgical improvement was observed for FEV₁/FVC.     

Preoperative assessment for pulmonary resection

Adequate preoperative assessment is important to stratify and therefore minimize the risk associated with pulmonary resection. It is a multidisciplinary process but should focus on selecting those with surgically resectable disease who will tolerate surgery with an acceptable risk. Anaesthetic assessment focuses on cardiovascular fitness and lung function, in particular evaluating the effects of resection on postoperative lung function. Predicted postoperative values of forced expiratory volume in 1 second (ppo FEV₁) and the diffusing capacity of the lung for carbon monoxide (ppo DLCO) can be estimated. These values are used to estimate risk of perioperative morbidity and mortality. Patients with ppo FEV₁ and ppo DLCO greater than 40% are deemed low risk. Patients with values less than these should undergo further cardiorespiratory evaluation to measure maximal oxygen consumption (Vo₂max). Only those with ppo FEV₁ and ppo DLCO less than 40% and Vo₂max less than 15 ml/kg/min should be considered too high a risk for conventional pulmonary resection. Risk assessment should always hold in context that surgery is the most effective treatment for early-stage lung cancer.     

Cross-sectional associations of pulmonary function with systemic inflammation and oxidative stress in individuals with chronic spinal cord injury

Context/Objective: Systemic inflammation, and to a lesser extent oxidative stress, have been associated with reduced pulmonary function. Our objective was to evaluate the associations between biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6)) and novel makers of global oxidative stress (fluorescent oxidation products (FLOx)) with spirometric and lung volume measures in individuals with chronic spinal cord injury (SCI).

Design: Cross-sectional study.

Setting: Veterans Affairs Medical Center.

Participants: One-hundred thirty-seven men with chronic SCI participating in an epidemiologic study.

Methods: Participants provided a blood sample, completed health questionnaires, and underwent pulmonary function testing, including helium dilution measurement of functional residual capacity (FRC). General linear models were used to model associations between increasing quartiles of inflammation or oxidative stress with each outcome measure, after adjustment for a number of potential confounders.

Outcome Measures: Percent-predicted forced vital capacity in one second (FEV₁), percent-predicted forced vital capacity (FVC), FEV₁/FVC, percent-predicted residual volume (RV), percent-predicted FRC, and percent-predicted total lung capacity (TLC).

Results: After adjustment for a number of confounders, participants with higher levels of CRP and IL-6 had lower percent-predicted FEV₁ and FVC measurements. There were no clear patterns of association with any of the oxidative stress biomarkers or other outcome measures.

Conclusion: Increased systemic inflammation was associated with reductions in FEV₁ and FVC independent of a number of covariates. Although the mechanism is uncertain, these results suggest that reductions in pulmonary function in SCI are associated with systemic inflammation.     

新型多晶体PET/CT低剂量与自动毫安秒技术降低辐射剂量

目的探讨新型多晶体PET/CT全身显像采用低剂量示踪剂注射与自动毫安秒技术相结合的方式,在降低辐射剂量中的应用价值。方法选取200例接受18 F-FDG PET/CT全身显像的患者,随机分为改良组和常规组,每组100例,改良组为示踪剂低剂量+自动毫安秒技术,常规组为示踪剂标准剂量+固定毫安秒技术。对比观察两组图像质量,分别计算全身PET有效辐射剂量(EPET)、全身CT有效辐射剂量(ECT)及全身PET/CT有效辐射剂量总量(EPET/CT),并对两组数据进行统计学分析。结果两组图像质量主观判断均满足诊断要求,改良组平均EPET、ECT、EPET/CT分别为(5.2±1.1)mSv、(3.6±2.2)mSv、(8.8±3.2)mSv,常规组分别为(6.0±0.8)mSv、(6.8±1.1)mSv、(12.8±1.9)mSv,改良组EPET、ECT、EPET/CT较常规组分别降低13.3%、47.0%、31.2%。结论新型多晶体PET/CT全身显像采用低剂量和自动毫安秒技术,在满足图像诊断质量要求的同时可有效降低受检者的辐射剂量。     

Severity Related Differences in Lung Attenuation in Men With COPD

Background and objectivesWe compare the inspiratory and expiratory regional lung densities between different levels of COPD severity (as assessed by the GOLD scale and by the BODE index), and to assess the relationship between regional lung densities and functional lung parameters.Patients and methodsFifty-five stable moderate-severe COPD men were selected. Functional evaluation included dyspnoea scale, blood gases, spirometry, plethysmography, diffusing capacity and six-minute walk test. Severity was classified according the GOLD scale and the BODE index. High resolution computed tomography (HRCT) scans of the entire lung at full inspiration and two sections at full expiration were obtained. Densitometry software was used to calculate the densities of the lung areas.ResultsInspiratory and expiratory mean lung densities (MLD) of the lower lobes were significantly lower in very severe and severe COPD patients than in moderate patients. In contrast, we only found differences between the upper lobe MLD values of moderate and severe COPD patients. Inspiratory and expiratory HRCT densities were similar among all BODE quartiles, for both the upper and lower lobes. In a multiple regression analysis, airway obstruction parameters were mainly related to the expiratory MLD of the lower lobes, whereas lung hyperinflation parameters were predicted by the inspiratory MLD of the lower lobes. Lastly, diffusion capacity was independently related to the expiratory/inspiratory MLD of the lower lobes and to the inspiratory MLD of the upper lobes.ConclusionsThere are differences in lung attenuation measurements by HRCT between the varying levels of COPD severity as assessed by the GOLD scale.