肾囊肿的穿刺硬化剂治疗（附235例报告）

目的：总结ＣＴ导引下穿刺硬化剂治疗肾囊肿的经验。材料与方法：２３５例２７０个肾囊肿经皮穿刺抽吸酒精治疗，其中１８６例为单纯肾囊肿，４４例多发囊肿，５例多囊肾。囊肿大小直径为１．９～１３．５ｃｍ。用１９～２１Ｇ抽吸针穿刺抽吸，抽出囊液为３～７８０ｍｌ。注入９９．７％无水酒精，酒精量以抽出囊液的２５．０％为合适。结果：本组随访病例９７例（１０６个肾囊肿），随访时间为３个月以内到１年以上，单纯囊肿疗效为９７．１％，其中囊腔消失为７２．１％；多发囊肿和多囊肾的疗效为７６．３％，其中囊肿消失为３６．８％。并发症为局部疼痛（６．４％），无严重的并发症。结论：ＣＴ导引下经皮穿刺抽吸硬化剂治疗肾囊肿是一种安全、并发症低、疗效高的有价值的治疗方法。     

CT导引下肝囊肿硬化剂治疗

目的：评价ＣＴ导引下肝囊肿硬化剂治疗的疗效。材料和方法：２２例２４个肝囊肿用１９～２０Ｇ针穿刺抽吸，并注入９９．７％酒精到囊腔。囊腔大小直径为１．６～１９ｃｍ，抽出囊液为３ｍｌ到２６００ｍｌ。结果：本组随访病例为１１例（１３个囊肿），随访时间为１个月～４年，疗效为９２％，其中囊腔消失占３８％。其并发症仅为腹部疼痛。结论：ＣＴ导引下经皮细针穿刺硬化剂治疗肝囊肿已成为一种有价值的方法，此法安全，并发症少而疗效好。     

急性坏死性胰腺炎的介入治疗

目的评价经动脉插管灌注５Ｆｕ（５氟尿嘧啶）和抗生素治疗急性坏死性胰腺炎的疗效。方法２３例急性坏死性胰腺炎患者，根据ＣＴ检查结果置导管于病变部位的供血动脉。２１例置管于腹腔动脉，１例于脾动脉，１例于胃十二指肠动脉。经导管２４小时持续灌注５Ｆｕ和抗生素６～２０天。结果２３例中２０例经局部动脉药物灌注，病情得到缓解，２例药物灌注后行腹腔脓肿和假性囊肿感染手术引流，１例置管后尚未给药，病情即迅速恶化，死于多脏器衰竭。结论经腹腔动脉插管药物灌注治疗急性坏死性胰腺炎疗效肯定，并发症少，死亡率低，可改善患者的身体状况，即使发生胰腺感染，也有利于后期手术。     

CT导引下肝脓肿的介入治疗20例

目的：评价ＣＴ在肝脓肿穿刺介入中的价值。材料和方法：介绍ＣＴ导引定位,脓肿抽吸冲洗方法,对２０例穿刺治疗结果进行分析。结果：（９０％）病例经一次介入治疗脓肿完全消失。结论：此技术安全简便并发症少,疗效高,是肝脓肿治疗的首选方法。     

胰腺炎并发脾脏假性囊肿的CT诊断

胰腺假性囊肿为胰腺炎并发症之一。文献报道发生于急性胰腺炎者仅占 ２％～３％;发生于慢性胰腺炎者在２０％～３５％之间;假性囊肿发生于胰内或胰周,重症者还可由腹膜后蔓延至盆腔,肠系膜根部或结肠系统,在肝脾、胃壁、纵隔等部位亦可见到。约有１％～２％的胰腺炎患者并发脾脏假性囊肿［１］。本文重点论述发病机制、胰尾及脾门区的特殊解剖关系,ＣＴ表现、诊断及鉴别诊断。１正常解剖１．１胰尾部解剖胰尾是指胰腺左端钝圆缩细的部分,其上方为脾动静脉,下方为结肠脾曲,前近胃后邻左肾（Ｈｅｕｍａｎｎ指出, ＣＴ受检者中的胰尾…     

CT导引下肌肉骨胳活检

报告５１例ＣＴ导引下肌肉骨胳活检，其中３７例是骨胳系统活检，１４例是肌肉系统活检。活检正确率为９０．２％，假阴性９．８％。为了提高活检正确率需：（１）选择好最佳穿刺层面，穿刺点正确，多点穿刺；（２）骨钻针、切割针和／或抽吸法联合应用；（３）穿刺标本检查包括肿瘤细胞、细菌和具菌；（４）放射科和病理科之间密切的配合。本组未出现严重并发症。对ＣＴ导引下穿刺活检方法、适应证和其优点进行了讨论。ＣＴ寻引下肌肉骨胳活检是一种安全，有效的诊断和鉴别诊断方法。     

儿童急性胰腺炎的CT表现

目的：探讨儿童急性胰腺炎的CT特征及其CT检查价值。材料和方法：回顾性分析58例临床确诊的急性胰腺炎病例的临床和CT资料。结果：单纯水肿型胰腺炎43例（占74．1％），出血坏死型胰腺炎15例（占25．9％）。儿童胰腺炎CT表现包括：①胰腺本身改变：胰腺局部或弥漫性增大46例（占79．3％），密度改变18例（占31％），胰腺断裂2例（占3．4％），胰腺包膜掀起6例（占10．3％）。②胰外改变：主要为胰外积液，共38例占（65．5％）。胰外积液中以肾旁前间隙积液最多，有30例（占51．7％），小网膜囊积液次之，为26例（占44．8％）。③并发症：包括假性囊肿14例（占24．1％）、脓肿1例（占1．7％）等。结论：儿童胰腺炎胰腺坏死的发生率低，并发假性囊肿、脓肿较少，但胰外积液的发生率高。CT对儿童胰腺炎的诊断、病情监测、治疗评估等都有很大意义。     

超声引导下经皮介入治疗单纯肝肾囊肿

目的：观察ＣＯ２与无水酒精作为囊肿固定剂的疗效，比较肝、肾囊肿经介入治疗疗效差别。２２例单纯囊肿，其中肝囊肿１４例，肾囊肿８例，采用经皮穿刺抽吸囊液后，注入固定剂ＣＯ２或无水酒精１￣３次，随访２￣２９个月。结果：２２例２２个囊肿均获得不同程度的好转，占６２．５％。肾囊肿８例均一次治疗后最大直径在随访期间内未超过２ｃｍ，明显好转率为１００％。而肝囊肿１４例中仅５例一次治疗明显好转，占３５．７％。结论     

CT分类和定量诊断对重症胰腺炎的诊断价值

目的：探讨重症胰腺炎的ＣＴ定量诊断价值。方法：对４６例重症胰腺炎进行ＣＴ分类,评分及治疗后对比观察。结果：ＣＴ改变以胰腺肿大,实质内坏死,出血,积液,假囊肿及脓肿,以及胰外侵犯程度评分分四级。结论：重症胰腺炎ＣＴ分类,定量分析有助于临床治疗方法的选择及预后的估计     

CT影像学分级用于急性坏死性胰腺炎病情判别及预后评估的意义

目的：研究急性出血坏死性胰腺炎的ＣＴ分类标准和预后的意义材料与说法方法，搜集急性坏死性胰腺炎３９例，早期均行非手术治疗，均于入院后７２小时内行动态ＣＴ扫描，按ＣＴ影像学表现，将胰腺坏死分为３型，即点片状坏死，段状坏死（坏死部分超过整个胰腺的１／３，坏死范围贯穿胰腺全层）全胰腺坏死（超过胰腺８０％的段状坏死），点片状坏死作为基本记分，坏死部位分为胰头，胰体及胰尾，每一部位计１分；段状坏死３分；全胰腺     

CT引导下穿刺活检及介入治疗的临床应用(附56例分析)

目的：探讨ＣＴ引导下穿刺活检及介入治疗的临床应用价值。方法：ＣＴ引导下行诊断目的２９例,治疗目的１７例,诊断及治疗双目的的１０例病人。穿刺部位包括胸部１７例,腹部２７例,躯干及四肢１２例,共５６例６０个病灶。ＣＴ扫描确定穿刺点、角度及深度。局麻进针后,ＣＴ再次扫描确认针尖到达预定位置再进行活检取材或介入治疗。结果：６０ 个病灶穿刺６１针次,穿刺一次成功率１００％ ,确诊率９７．４％ ,治疗有效率８８．９％ ,并发症５．４％ 。结论：ＣＴ引导下穿刺活检及介入治疗属微创伤性技术,简便易行,安全有效,成功率高,并发症少。     

CT-guided percutaneous drainage and fluid aspiration in intensive care patients.

Fifty-two intensive care unit (ICU) patients with clinical signs of sepsis who were considered to be at extremely high risk for operation were subjected to CT-guided interventions. Bedside ultrasound (US) had been performed prior to CT in all patients but diagnoses were equivocal or US-guided interventions had failed. Nineteen patients solely underwent CT-guided diagnostic aspiration of fluid collections to rule out infection. Eighteen patients (72%) with abscess formations after surgery or trauma were cured by catheter drainage alone; 4 patients required additional surgery. Out of 8 patients suffering from acute pancreatitis (after several necrosectomies), abscesses could be cured in 5 (62.5%). Three patients with acute necrotizing pancreatitis (no surgery) were not cured by the interventional procedure and all required surgical debridement. Even patients who required additional surgery after drainage improved clinically after the interventional radiologic procedure. Our overall success rate was 64%, emphasizing the need for CT in the case of equivocal US results or if US-guided procedures have failed in ICU patients with signs of sepsis.     

CT导向下125I粒子植入治疗肝门区肝癌

目的评价CT导向下125I粒子植入治疗肝门区肝癌及淋巴结的临床价值.方法本组病例32例,其中肝门区肝细胞癌(HCC)8例,肝门区胆管癌(HC)12例,肝转移瘤6例,肝门区淋巴结转移6例.14例侵犯肝门胆管致肝内胆管扩张,22例合并肝硬化.全部病例经CT、MRI检查或病理穿刺活检证实.病灶平均直径为4.2 cm.采用TPS计算布源,在CT导向下将125I粒子植入瘤灶内,采用0.6～0.9 mCi活度的12I粒子相隔1.0～1.5 cm平面播植.结果2例死于远处转移,3例死于肝功能衰竭,全组中位生存时间10个月.2个月后CT复查,完全缓解(CR)2例;部分缓解(PR)20例;无变化(NC)5例;进展(pD)5例.总有效率(CR+PR)68.8%.2个月随访过程中发现7颗粒子在肝脏内游走,3颗粒子迁徙至肺内;1例出现气胸,肺压缩在30%以下,白细胞轻度下降1例.未见大出血、胆汁瘘、肠瘘、肠出血等严重并发症.结论CT导向下放射性粒子植入治疗肝门区肿瘤及淋巴结创伤小,并发症发生率低,生活质量改善明显,近期效果好,是治疗中晚期肝门区肿瘤及淋巴结的简单、安全、有效的方法.     

Failure of ultrasound to detect extra-pancreatic abscesses in severe acute pancreatitis

The development of intra-abdominal abscesses in patients with severe acute pancreatitis can be associated with a mortality as high as 100%. The clinical findings in these patients may be non specific and therefore imaging is essential. Computed tomography (CT) is the imaging modality of choice. However, a satisfactory ultrasound examination may be regarded as sufficient, particularly when there is limited availability of CT. A case of extra-pancreatic abscess complicating severe acute pancreatitis, in whom sonography was "normal", but CT demonstrated the abscess is presented. The importance of CT in these patients in whom an abscess is suspected and our experience with similar cases is discussed.     

CT引导下经皮穿刺肝脓肿的介入治疗

目的 探讨CT引导下穿刺抽吸、冲洗治疗肝脓肿的方法和价值。方法 在CT引导下经皮穿刺对35例肝脓肿进行抽吸及冲洗治疗，冲洗液采用庆大霉素与甲硝唑混合溶液。结果 本组35例肝脓肿中多房脓肿8例、单房脓肿27例；其中8例脓肿腔内见有气体。经过一次抽吸冲洗治愈者25例，二次治愈者4例，三次治愈者6例。抽吸冲洗出脓汁的量在35mL-760mL。绝大部分病人治疗后于当日体温恢复正常。5例未住院，其余30例病人住院时间平均6．5d。结论 CT引导下经皮穿刺治疗肝脓肿是一项操作简便安全、非常有效的治疗方法，这种方法具有定位准确、损伤小、适应性广泛、便于广泛推广的突出特点。     

The utility of urgent abdominal computed tomography in the elderly patient

The purpose of this study was to assess the utility of urgent abdominal computed tomography (CT) performed in a nontrauma setting on a predominantly elderly population. We retrospectively reviewed abdominal CT images of 170 patients (average age, 64 years); CT was performed on a “stat” basis to evaluate suspected acute abdominal pathology at a typical urban Veterans’ Affairs hospital. Imaging results were correlated with subsequent clinical intervention. Abdominal CT was most commonly ordered to assess abdominal pain (119 cases, 71%), suspected abdominal abscess (11 cases, 6.5%), suspected leaking abdominal aortic aneurysm (11 cases, 6.5%), and suspected acute pancreatitis (8 cases, 5%). Clinically relevant findings were recorded in 96 abdominal CT cases (56%), only 23 (13.5%) of which depicted acute pathology. This included nine patients with abscesses, four with diverticulitis, two with nonspecific enteric inflammation, and two with cholecystitis. Only 16 patients (9%) required urgent therapy. The most common clinically relevant findings not requiring prompt intervention were cholelithiasis (11 cases), chronic pancreatitis (9 cases), and liver metastases (6 cases). Of 13 patients with abdominal aortic aneurysm diagnosed on abdominal CT, 11 presented with abdominal pain, but none showed signs of rupture. Although, in a predominantly elderly population, urgent abdominal CT often reveals significant chronic disease, it seldom depicts pathology requiring prompt therapy. Therefore, a more focused use of this examination is warranted.     

介入治疗急性肾梗死的效果评价及预后分析

目的探讨急性肾梗死的临床特点和血管介入的临床应用。 方法回顾性分析我院2012—2014年收治的5例急性肾梗死患者的诊治情况。 结果5例患者根据临床症状、CT检查及血管造影均获明确诊断,1例患者行保守治疗后肾梗死无明显好转;4例行肾动脉血栓抽吸及溶栓治疗后,有3例患者症状缓解,梗死灶血流完全或部分恢复,1例患者出现部分肾梗死。 结论早期确诊后行介入治疗肾动脉闭塞,对肾功能恢复及预后意义重大。     

Diagnostic and interventional radiology workload in acute pancreatitis in an ITU/HDU setting

AIM: To determine the impact on diagnostic and interventional radiology services when imaging patients with severe pancreatitis on intensive therapy (ITU) and high-dependency units (HDU) in a tertiary referral centre. MATERIAL AND METHODS: One hundred and sixty-nine patients admitted to ITU/HDU over a 9-year period (1996-2004) with severe acute pancreatitis were reviewed. There were 109 admissions to the ITU with length of stay of 0.2-81.6 days (mean 19.7 days) and 92 admissions to the HDU with length of stay of 0.4-12.8 days (mean 4.9 days). RESULTS: One hundred and seventy-nine computed tomography (CT) and 199 ultrasound (US) examinations were performed on the ITU patients in whom interventional procedures were required in 24% of patients undergoing CT examinations and in 32% of patients undergoing US. Sixty-two CT and 60 US examinations were performed in the HDU patients. The percentage of interventional procedures performed in HDU patients was similar to that in ITU patients, i.e., 18% CT-guided and 35% US-guided. The proportion of patients that underwent investigations and interventions has gradually increased over the period of the study. Inpatient mortalities were 29% and 5.4%, respectively, in ITU and HDU patients. CONCLUSIONS: This study demonstrates the huge input and increasing workload undertaken by radiologists when managing patients with severe acute pancreatitis in an ITU/HDU setting. We believe this is partly due to the implementation of the British Society of Gastroenterology (BSG) guidelines on management of acute pancreatitis and partly due to the more intensive non-surgical management offered to patients being referred into a specialist tertiary referral unit.     

CT Pinpoint系统在介入放射中的临床应用

目的 评估Pinpoint系统在CT导引活检和介入治疗的临床应用。方法 报告148例Pinpoint系统的临床应用，其中101例活检、47例介入活治疗。Pinpoint系统主要由机械手、监视器和立体重建等组成，活检部位包括胸部76例、腹部17例、骨骼系统8例。介入治疗包括硬化剂治疗46例（其中肾囊肿硬化剂治疗32例，肝囊肿硬化剂治疗14例）和肾包膜下血肿抽吸1例。病灶大小范围为0．6－5．8cm。结果 活检刺中率为100％，活检正确率为91％（92例），并发症为轻、中度气胸，发生率为7．9％（6例），无出血感染等并发症。结论 应用Pinpoint系统作CT导引下活检和介入治疗创伤小、安全，具有应用价值。