高危新生儿68例头颅CT分析

目的：提高对高危新生儿头颅CT异常表现的认识。方法：68例均为高危新生儿，出生后1小时－26天内行头颅CT扫描，不合作扫描前口服10％水合氯醛使其安睡。结果：颅内出血共20例，其中单纯颅内出血5例，颅内出血与脑缺氧缺血性损害并存15例。颅内出血的类型包括硬膜下出血、蛛网膜下腔出血、脑室出血、脑实质出血，单一类型的出血较少，多为2－3种类型的颅内出血混存。不合并颅内出血的单纯脑缺氧缺血性损害41例。正常CT表现7例。结论：CT对高危新生儿颅内出血或缺氧缺血性损害及分类有很高诊断价值。     

新生儿颅内出血CT表现及扫描技术的探讨

新生儿颅内出血是新生儿的常见急症，早期明确诊断并及时治疗将大大改善愈后。CT是确诊新生儿颅内是否出血的最佳检查方法。本文收集50例新生儿颅内出血患者的完整CT表现及临床资料进行分析，以提高CT对新生儿颅内出血的诊断以及选择合适的CT扫描技术。     

47例新生儿颅内出血的CT分析

为了解新生儿颅内出血的CT表现及产生后遗症的原因，分析47例病人CT常规扫描资料。结果：蛛网膜下腔出血22例，脑内出血8例，硬膜下血肿10例，硬膜外血肿5例，室管膜下及脑室内出血2例。新生儿颅内出血主要以产伤及窒息、缺氧所致。CT对新生儿颅内出血定性及动态观察均有重要的价值，对临床确定治疗方案有重要意义。     

新生儿缺氧缺血性脑病的CT临床表现分析

目的　通过对新生儿缺氧缺血性脑病的CT临床表现进行分析 ,提高对本病的认识。材料和方法　选择 4 9例有围产期窒息史的高危新生儿的头颅CT异常表现与临床表现进行对照分析。结果　 4 9例和头部CT均有不同程度的HIE表现 ,脑实质内范围大小不一的低密度灶 ,严重者合并有蛛网膜下腔出血和颅内出血。结论　头部CT扫描对诊断和鉴别新生儿缺氧缺血性脑病有重要参考价值     

围产儿脑损伤头颅CT改变与临床及预后的关系

目的 了解缺氧缺血性脑病(HIE)和颅内出血新生儿头颅CT改变与临床及预后的关系。方法 通过对脑损伤新生儿进行头颅CT扫描，了解头颅CT改变与临床症状及预后的关系。结果 HIE患儿头颅CT改变主要表现为大脑不同程度低密度改变，其程度与临床症状和患儿预后密切相关；新生儿颅内出血部位依次为：蛛网膜下腔出血、脑实质出血、脑室周围—脑室内出血、硬脑膜下出血、混合型出血，小脑出血等。结论 头颅CT检查对围产儿脑损伤的诊断和预后判断有重要的临床意义。     

新生儿迟发性维生素K缺乏症颅内出血的CT诊断

目的：探讨新生儿迟发件维生素K缺乏症颅内出血的CT表现,提高对本病的认识。方法：回顾性分析经临床证实的24例新生儿迟发性维生素K缺乏症颅内出血的临床表现及CT征象,所有病例均行常规颅脑CT平扫。结果：蛛网膜下腔出血18例,硬膜下出血14例,脑实质出血2例,脑室内出血3例。颅内单部位出血14例,多部位出血10例。结论：颅脑CT扫描对新生儿迟发性维生素K缺乏症颅内出血诊断有重要的作用,对指导临床进行早期合理的治疗有重要的临床意义。     

新生儿缺氧缺血性脑病早期CT诊断价值

目的　评价CT对新生儿缺血缺氧性脑病 (HIE)的诊断价值。方法　对确诊为HIE的 2 8例新生儿头颅CT表现进行回顾性分析。结果　所有患儿表现为不同程度脑水肿及颅内出血 ,是HIE的最早期CT表现。结论　CT扫描可清晰地显示HIE的病变范围、密度及并发症 ,是确诊早期HIE的最有效的方法之一 ,同时对临床治疗也有重要指导意义。     

新生儿颅内出血的CT诊断评价

目的：探讨新生儿颅内出血的CT表现与分娩中及新生儿评分的关系。方法：回顾性分析临床诊断为新生儿颅内出血的46例CT表现，并与分娩史及新生儿评分相比较。结果：新生儿评分≤7分或出现胎儿窘迫时，颅内出血的发病率明显增高，出血量也多。结论：在新生儿评分≤7分或在胎儿窘迫时，应尽早行CT检查，有助于早期诊断颅内出血，减少后遗症。     

64排螺旋CT对新生儿缺血缺氧性脑病的诊断价值

目的：探讨新生儿缺血缺氧性脑病（HIE）64排螺旋CT检查的价值。方法：回顾性分析80例新生儿缺血缺氧性脑病的临床资料和CT表现,并对其进行归纳。结果：CT扫描主要表现为白质区病变,分为轻、中、重三度。结论：64排螺旋CT能对新生儿缺血缺氧性脑病作出早期诊断和分度,能对颅内出血作出定性、定量诊断,对临床诊疗、预后评估有重要价值。     

新生儿颅内出血临床与CT表现分析

目的:提高对新生儿颅内出血的临床与CT表现的认识。方法:对62例新生儿颅内出血作回顾性分析。结果:新生儿颅内出血临床症状主要以中枢神经系统兴奋或抑制状态为主要特征,意识表现如哭闹不安、嗜睡、昏迷等;颅内压增高表现如前卤隆起、惊厥等;呼吸方面表现如呼吸增快或缓慢,不规则或呼吸暂停等。新生儿颅内出血CT主要表现为:硬膜下血肿71.0%(44/62);蛛网膜下腔出血38.7%(24/62);脑室周围-脑室内出血27.4%(17/62)。结论:CT是检查新生儿颅内出血较好的影像学方法,有助于临床制定治疗方案。     

彩色多普勒超声显像与能量多普勒显像对新生儿肾上腺出血及先天性神经母细胞瘤的鉴别

目的探讨彩色多普勒超声显像与能量多普勒显像对新生儿肾上腺出血及先天性神经母细胞瘤的鉴别价值。方法对10例新生儿肾上腺出血及1例先天性神经母细胞瘤患者进行彩色多普勒超声显像与能量多普勒显像检查。结果6例出血为囊状,而神经母细胞瘤和4例肾上腺出血显示实体外观。彩色多普勒超声显像与能量多普勒显像示神经母细胞瘤有血管存在。而10例肾上腺出血新生儿用两种方法均无血流信号。结论彩色多普勒超声显像与能量多普勒显像对新生儿肾上腺出血及先天性神经母细胞瘤具有鉴别诊断价值。     

Transcranial cerebral oximetry and transcranial doppler sonography in patients with ruptured cerebral aneurysms and delayed cerebral vasospasm.

BACKGROUND: Vasospasm is a major cause of ischemic neurological deficits developing after subarachnoid hemorrhage. The goal was to identify hemodynamic changes and the presence of clinical vasospasm in patients suffering from subarachnoid hemorrhage secondary to ruptured intracranial aneurysms. MATERIAL/METHODS: Pre- and postoperative serial transcranial cerebral oximetry and transcranial doppler sonography (TCD) examinations were performed in 75 patients operated for aneurysmal subarachnoid hemorrhage. RESULTS: No significant difference (p=0.14) was found in the levels of regional oxygen saturation (rSO2) between patients with vasospasm and those without. In patients who developed clinical vasospasm, the blood flow velocity values were significantly higher compared with those who did not (127.5+/-2.7 versus 92.5+/-1.2 cm/sec, p<0.001). In six patients with clinical vasospasm and low TCCO measurements, the use of triple-H therapy led to oxygen saturation increment and clinical improvement. CONCLUSIONS: Transcranial cerebral oximetry seems to be of limited value for the detection of vasospasm in patients with subarachnoid hemorrhage. However, it may be useful in estimating the clinical impact of triple-H therapy in such patients.     

脑血管病患者血浆同型半胱氨酸浓度及相关因素分析

目的: 探讨高同型半胱氨酸(Hcy)血症及其相关因素与脑血管病的关系。方法: 选择年龄及性别基本匹配的脑梗死组60例、脑出血组30例、神经系统其他疾病组30例和正常老年人组30名,采用酶联免疫分析法测定入选者血浆Hcy浓度,并同时测定血叶酸、维生素B₁₂。结果: 脑梗死组和脑出血组血Hcy浓度明显高于神经内科其他疾病组和正常老年人组(P<0.01)。相关回归分析显示:梗死组和脑出血组Hcy与叶酸、维生素B₁₂存在负相关。结论: 高Hcy血症与脑血管病相关。补充叶酸、维生素B₁₂可能有助于降低这一危险因素。     

The role of computed tomography and sonography in acute bullous pemphigoid

We report acute bullous pemphigoid occurring in an elderly female patient in whom abdominal sonography and computed tomography (CT) examinations revealed the presence of occult hepatic and splenic metastatic deposits from a primary pancreatic carcinoma. In the majority of cases bullous pemphigoid is a self limiting auto-immune disorder occurring in the absence of systemic disease. An association with visceral malignancy has been described by previous authors^(1–4) but the role of computed tomography and sonography in diagnosing occult malignancy and the subgroup of patients with pemphigoid in whom this should be undertaken has not been highlighted.     

血管紧张素原基因T704C多态性与长沙汉族 人群脑出血的关系

目的：探讨血管紧张素原 (angiotensinogen,AGT）基因T704C多态性与长沙地区汉族人群脑出血的关系。方法：收集2005年1月至2009年1月在湘雅医院神经内科就诊的273例脑出血患者（脑出血组）和140例健康体检者（对照组）的外周静脉血提取DNA,采用SNaPshot和DNA直接测序的方法检测AGT-T704C多态性;详细收集所有受试者的完整临床资料尤其是脑血管病的可能危险因素并按高血压的有无每组分为高血压亚组和正常血压亚组,对脑出血可能的危险因素和AGT-T704C多态性与脑出血的关系进logistic回归分析。结果：脑出血组和对照组间的饮酒史、冠心病史、高血压病史和血脂水平差异有统计学意义（P＜0.05）。Logistic回归分析显示高血压病史、收缩压水平升高和高密度胆固醇水平降低是长沙汉族人群脑出血的独立危险因素。脑出血组和对照组AGT-T704C的C/C,C/T与T/T基因型频率分别为0.692,0.279,0.029和0.629,0.350,0.021;2组的C/T等位基因频率分别为0.832,0.168和0.804,0.196;2组的各基因型频率和等位基因频率差异均无统计学意义（P＞0.05）;2组内和组间的高血压和正常血压亚组的各基因型和等位基因频率差异无统计学意义（P＞0.05）。结论：AGT-T704C多态性与长沙汉族人群脑出血及长沙汉族人群的血压水平无明显相关性, 高血压病史、收缩压水平升高和高密度胆固醇水平降低是长沙汉族人群脑出血的独立危险因素。     

肾自发性破裂出血的超声诊断

目的:探讨肾自发性破裂出血的超声诊断方法.方法:回顾分析2007～2011年我院的18例肾自发性破裂出血的超声图像.结果:超声诊断肾自发性破裂13例(72.2％),其中病因诊断明确9例(50％).误诊4例(38.5％).结论:超声是肾自发性破裂出血的重要诊断手段.     

磁共振快速场回波技术在急性脑出血诊断中的应用

目的：评价磁共振快速场回波技术（ FFE） T2 WI在急性脑出血诊断中的应用价值。方法选取发病1～24 h的急性脑出血患者32例,分别行CT检查、FFE T2 WI检查及常规MRI检查,比较其诊断价值。结果32例患者颅内出血灶在 FFE T2 WI均呈边界清楚的均质极低信号,或边界清晰的低信号环内部略高信号,或低信号区内混杂小斑点状高信号,脑出血灶清晰可见。有9例患者在基底节区、丘脑以及顶叶还发现1～3个直径2～4 mm的圆形、斑点状极低信号,证实为FFE T2 WI检测出的脑微出血。结论 FFE T2 WI技术对急性脑出血的诊断敏感性优于CT与常规MRI检查,可全面了解患者颅内损伤情况,值得临床推广应用。     

Medical imaging

There is now a wide choice of medical imaging to show both focal and diffuse pathologies in various organs. Conventional radiology with plain films, fluoroscopy and contrast medium have many advantages, being readily available with low-cost apparatus and a familiarity that almost leads to contempt. The use of plain films in chest disease and in trauma does not need emphasizing, yet there are still too many occasions when the answer obtainable from a plain radiograph has not been available. The film may have been mislaid, or the examination was not requested, or the radiograph had been misinterpreted. The converse is also quite common. Examinations are performed that add nothing to patient management, such as skull films when CT will in any case be requested or views of the internal auditory meatus and heal pad thickness in acromegaly, to quote some examples. Other issues are more complicated. Should the patient who clinically has gall-bladder disease have more than a plain film that shows gall-stones? If the answer is yes, then why request a plain film if sonography will in any case be required to ''exclude'' other pathologies especially of the liver or pancreas? But then should cholecystography, CT or scintigraphy be added for confirmation? Quite clearly there will be individual circumstances to indicate further imaging after sonography but in the vast majority of patients little or no extra information will be added. Statistics on accuracy and specificity will, in the case of gall-bladder pathology, vary widely if adenomyomatosis is considered by some to be a cause of symptoms or if sonographic examinations ''after fatty meals'' are performed. The arguments for or against routine contrast urography rather than sonography are similar but the possibility of contrast reactions and the need to limit ionizing radiation must be borne in mind. These diagnostic strategies are also being influenced by their cost and availability; purely pragmatic considerations are not infrequently the overriding factor. Non-invasive methods will be preferred, particularly sonography as it is far more acceptable by not being claustrophobic and totally free of any known untoward effects. There is another quite different but unrelated aspect. The imaging methods, apart from limited exceptions, cannot characterize tissues as benign or malignant, granulomatous or neoplastic; cytology or histology usually provides the answer. Sonography is most commonly used to locate the needle tip correctly for percutaneous sampling of tissues. Frequently sonography with fine needle aspiration cytology or biopsy is the least expensive, safest and most direct route to a definitive diagnosis. Abscesses can be similarly diagnosed but with needles or catheters through which the pus can be drained. The versatility and mobility of sonography has spawned other uses, particularly for the very ill and immobile, for the intensive therapy units and for the operating theatre, as well in endosonography. The appointment of more skilled sonographers to the National Health Service could make a substantial contribution to cost-effective management of hospital services. Just when contrast agents and angiography have become safe and are performed rapidly, they are being supplanted by scanning methods. They are now mainly used for interventional procedures or of pre-operative ''road maps'' and may be required even less in the future as MRI angiography and Doppler techniques progress. MRI will almost certainly extent its role beyond the central nervous system (CNS) should the equipment become more freely available, especially to orthopaedics. Until then plain films, sonography or CT will have to suffice. Even in the CNS there are conditions where CT is more diagnostic, as in showing calculations in cerebral cysticercosis. Then, too, in most cases CT produces results comparable to MRI apart from areas close to bone, structures at the base of the brain, in the posterior fossa and in the spinal cord. Scintigraphy for pulmonary infarcts and bone metastases and in renal disease in children plays a prominent role and its scope has increased with new equipment and radionuclides. Radio-immunoscintigraphy in particular is likely to expand greatly not only in tumour diagnosis but also in metabolic and infective conditions. Whether the therapeutic implications will be realized is more problematic. The value of MRS and NM for metabolic studies in clinical practice is equally problematical, although the data from cerebral activity are extremely interesting. While scanning has replaced many radiographic examinations, endoscopy has had a similar effect on barium meals and to a lesser extent on barium enemas. The combined visual/sonographic endoscope is likely to accelerate this process. There is no doubt that over the last 2 decades medical imaging has changed the diagnostic process, but its influence on the outcome of disease other than infections is less certain and probably indefinable. Data concerning the comparative efficacy in terms of patient outcome for each of the imaging techniques would be of considerable interest and a great help in determining diagnostic strategies.     

嗜中性粒细胞胞质因子1基因C923T多态性与长沙市汉族人群脑出血的相关性研究

目的:探讨嗜中性粒细胞胞质因子1(NCF1)基因第10外显子C923T(Ala308Val)多态性与湖南省长沙市汉族人群脑出血的关系.方法:采用PCR-单链构象多态技术和DNA直接测序法检测湖南省长沙市汉族人群脑出血患者110例、10个脑出血家系成员110例和健康对照者100名的NCF1基因第10外显子C923T多态性...     

低场强MRI T2^＊ WI FFE序列在颅脑血管性及出血性疾病中的应用研究

目的：探讨低场强MRI T2＊WI FFE序列成像在颅脑血管性及出血性病变检查中的敏感性。方法：分析110例临床可疑颅脑出血患者的常规MRI序列,包括自旋回波（SE）T1WI、快速自旋回波（TSE）T2WI、液体衰减反转恢复序列（T2-FLAIR）,以及T2＊快速场回波序列（T2＊WI FFE）资料,比较常规序列、T2＊WI FFE序列对颅脑出血病灶的显示率,分析其信号特征,并探讨T2＊WIFFE序列的可行性。结果：T2＊WI FFE序列为显示颅脑出血灶最敏感的序列,能显示常规序列所不能显示的脑微出血。无论在检出脑出血灶,还是图像信噪比,T2＊WI FFE均能满足临床需求。结论：低场强MRI T2＊WI FFE序列能明显提高颅脑出血灶的检出率,进而提高颅脑血管性及出血性疾病的早期诊断率。其在临床颅脑出血筛选方面具有常规MRI序列无法替代的作用。