双源CT在主动脉弓断离诊断中的价值

目的 探讨双源CT(DSCT)门控下低剂量扫描在主动脉弓断离诊断中的价值.方法 对9例主动脉弓断离患儿行DSCT门控下低剂量心胸联合血管成像扫描并进行胸部动脉血管重建,进行诊断.所有患儿同时行心脏彩色多普勒(CDFI)检查,2种检查方法 在3 d内完成.所有患儿均行手术治疗.结果 9例行DSCT门控下低剂量心胸联合血管成像均成功完成,DSCT均诊断为主动脉弓断离,其中伴有室间隔缺损(VSD)9例、动脉导管未闭(PDA)8例、冠状动脉起源异常3例、支气管动脉扩张2例.断离后降主动脉的血液来源于肺动脉8例、肋间动脉和头臂动脉1例.CDFI诊断主动脉弓断离7例、动脉单干1例、主动脉缩窄1例,其中伴有VSD 9例、PDA 8例.5例断离后主动脉弓血液来源于肺动脉,1例断离后降主动脉的血液来源于肋间动脉及头臂动脉未能显示,1例显示支气管动脉扩张.与手术结果 对照:DSCT诊断准确率为94.12%(32/34处),CDFI诊断准确率为82.35%(28/34 处).结论 DSCT是诊断主动脉弓断离的有效方法 .     

针刺磁共振脑功能成像研究进展

针灸是中国传统医学的瑰宝,其价值和作用已经逐渐被国际社会公认[1~7]。但迄今为止,针刺疗法的作用机理尚不完全清楚,单纯应用中医理论亦难以圆满解释诸多针灸现象。因此,如何利用现代医学理论与技术研究说明针灸疗法,近年来已成为国际热门课题之一。医学成像技术的发展,特别是正电子发射体层成像(positron emission tomography,PET)和功能磁共振成像(functional magnetic resonance imaging,fM-RI)的日臻完善,为该课题的研究开辟了一个全新领域。借助这些现代化科学技术,人们对这一有着2500年悠久历史的传统中医疗法开始有了新的认识。…     

多层螺旋CT成像技术在结肠肿瘤诊治中的应用

目的：应用多层螺旋CT成像技术对结肠肿瘤者进行前瞻性研究，旨在提高多层螺旋CT在结肠肿瘤的诊断水平。方法：通过对30例结肠肿瘤病人的MSCT轴位图像和重建的4-D、MIP及仿真内窥镜图像进行观察分析，并与相应的钡灌肠及纤维结肠镜结果进行对照性研究。结果：全部病例诊断符合率为100％，仿真内窥镜结果与纤维结肠镜结果基本吻合。结论：多层螺旋CT在结肠肿瘤的诊断中具有独特的优越性。     

急性缺血性脑卒中的MSCT综合影像与溶栓治疗

临床溶栓治疗技术的开展，对急性缺血性脑卒中患者的影像学检查提出了更高的要求。溶栓治疗在发病3—6h内进行，才能获得较好的效果。多层螺旋CT可在较短时间内对急性缺血性脑卒中患者进行CT平扫、CT灌注成像与CT血管成像的综合影像评价，获得多方面的信息，以指导临床选择最佳治疗方案。     

双源CT双能量血管成像对颈内动脉海绵窦瘘的诊断价值

目的 探讨双源CT双能量血管成像(DE-CTA)对颈内动脉海绵窦瘘(CCF)的诊断价值.方法 选择14例临床疑诊CCF的患者进行DE-CTA.利用直接能最减影后的数据进行去骨图像重组,同时将能量平均后数据进行非去骨图像重组.由4名多年从事脑血管疾病影像诊断的放射科医师独立分析图像,其中2名评价颈内动脉海绵窦段DE-CTA的图像质量,2名评价瘘口位置、数量、大小及有无异常的颅内静脉扩张,比较各种后处理方法对CCF瘘口及相关病变的显示情况.利用Kappa检验分析2名医师对图像质量评价的一致性.利用t检验及相关性分析评价去骨与非去骨重组图像测得的瘘口大小.结果 14例患者28条颈内动脉颅内段均可以满足影像评价标准.14例患者经行双能量直接去骨颅脑CTA检查均确诊为CCF,其中,病变位于双侧2例,左侧7例,右侧5例.14例患者共16处病变,非去骨及去骨重组图像均发现瘘口16处.去骨及非去骨重组图像测得瘘口的平均大小分别为(0.36±0.10)、(0.35±0.11)mm,两者差异无统计学意义(t=0.29,P＞0.05),且二者测量值之间有很好的相关性(r=0.97,P＜0.05).去骨重组图像发现8例患者13支大脑皮质静脉扩张,非去骨重组图像仅发现6例患者9支大脑皮质静脉扩张.结论 DE-CTA图像多种重组方法相结合对CCF的诊断和治疗方案的制定具有重要价值.

Abstract：

Objective To explore the clinical value of dual-energy CT angiography (DE-CTA) in the diagnosis of carotid cavernous fistula. Methods Fourteen patients suspected of carotid cavernous fistula underwent DE-CTA between Dec. 2008 and Feb. 2010. Image post-processing of DE-CTA was performed with the dedicated software to obtain bone-removal and non bone-removal images. Four experienced radiologists evaluated image quality of DE-CTA, the number, location and size of fistulae and dilation of cerebral veins. The bone-removal and non bone-removal images were compared for displaying of fistulae and other related lesions. Kappa test was used to test the consistency of image quality evaluation between two radiologists. The sizes of fistulae were measured with bone-removal DE-CTA images and non bone-removal DE-CTA images respectively and their results were compared by using student's t-test and the correlation test. Results Twenty-eight intracranial internal carotid arteries of 14 patients showed acceptable image quality. Fourteen cases were diagnosed as carotid cavernous fistula with both bone-removal and non boneremoval DE-CTA images. Two patients presented with bilateral lesions, while 7 patients presented with left lesions and 5 patients had right lesions. Totally, sixteen fistulae lesions were detected in 14 patients. The mean size of fistulae was (0. 36 ±0. 10) mm by bone-removal images, whereas (0. 35 ±0. 11 ) mm by non bone-removal images. There was no significant difference between the two methods ( t = 0. 29, P ＞ 0. 05 ),and good correlation was found between the two methods ( r = 0. 97, P ＜0.05). Thirteen dilated cerebral veins in 8 cases were found by bone-removal images versus 9 dilated cerebral veins in 6 cases by non boneremoval images. Conclusions Image post-processing of DE-CTA is a simple and useful method to identify carotid cavernous fistula. DE-CTA is also useful for therapeutic planning.     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

开放式MRI导航系统导引行肺病变穿刺活检137例

目的 探讨MRI导引下肺穿刺活检术的可行性、准确性及其临床应用价值.方法 应用配备iPath 200光学追踪系统的低场开放式MR仪,对137例肺内结节或肿物患者行穿刺活检术,其中肺内孤立性结节或肿物103例,肺内多发病灶34例;病灶最大径≥3.5 cm的57例、1.5～3.4 cm的71例、≤1.4 cm的9例.结果 病灶最大径≥3.5 cm组、1.5～3.4 cm组、≤1.4 cm组及总的穿刺成功率分别为100.0%(57/57)、98.6%(70/71)、77.8%(7/9)、97.8%(134/137);穿刺组织病理检查诊断恶性肿瘤98例,良性39例;MRI导引肺穿刺活检的敏感度为94.2%(98/104),特异度为100.0%(33/33),准确性为95.6%(131/137),阳性预测值为100.0%(98/98),阴性预测值为84.6%(33/39).结论 开放式MRI导引肺穿刺活检术具有较高的安全性、准确性和有效性,值得在临床进一步推广和应用.     

多层CT血管成像技术对布加综合征的诊断价值

布加综合征（Budd—Chiari syndrome，BCS）是指南肝静脉和（或）其开口以上段下腔静脉梗阻引起的腹痛、肝功能障碍、腹水和下肢水肿及门静脉高压等病变。主要病理改变是肝后或肝上段下腔静脉和（或）肝静脉的膜性或节段性狭窄或闭塞及因此而导致的肝静脉和下腔静脉系统的回流障碍^[1]。该病在我国并不少见。山东省为高发区，     

MR扩散张量成像在急性一氧化碳中毒后迟发性脑病诊断中的应用价值

目的 探讨MR扩散张量成像(DTI)对急性CO中毒后迟发性脑病(DEACMP)的临床应用价值.方法 对35例DEACMP的患者(DEACMP组)和35例正常健康志愿者(对照组)行常规MRI及DTI扫描,分析其影像学表现,采用圆形感兴趣区(ROI)测量不同脑区的平均扩散系数(ADC)值、各向异性分数(FA)值,并对测值对进行统计学分析.结果 35例DEACMP患者均有异常影像表现.常规MRI表现可分为3个类型:脑白质受累型、神经核团受累型、皮层受累型.与对照组相比较,DEACMP组所测不同脑白质区的ADC值、FA值明显下降,差异有统计学意义(P＜0.05,P＜0.01),以半卵圆中心(ADC:3.87±0.42,FA:0.32±0.05)和侧脑室周围白质(ADC:4.48±0.51,FA:042±0.01)的ADC值、FA值下降最显著;而所测各神经核团的ADC值升高,FA值降低,差异有统计学意义(P＜0.05,P＜0.01),尤以苍白球的ADC升高(ADC:13.2±0.29,FA:0.19±0.07)及FA值降低最明显.结论 DTI技术可准确反映常规MRI所不能观察的DEACMP脑组织微观结构病理变化,量化脑组织损害的程度,为临床提供非常有价值的信息.     

胃粘膜巨大肥厚症(附4例报告)

近年来,我们遇见4例胃粘膜巨大肥厚症,其中3例经胃镜证实,4例均经手术及病理证实。现举2例报告如下。例1:男,46岁。因上腹不适、腹泻4个月,全身浮肿50天入院。查体:除腹水征