闭合性腹部外伤致胰腺损伤的CT诊断(附15例报告)

目的:评价CT对闭合性腹部外伤所致胰腺损伤的临床诊断价值。方法:回顾性分析15例经手术证实的闭合性腹部外伤所致胰腺损伤的CT征象。结果:15例闭合性腹部外伤所致胰腺损伤中,胰腺挫伤5例,胰腺完全性断裂6例,胰腺不完全性断裂1例,胰腺出血3例。胰腺内出血、水肿,胰腺增粗是胰腺挫伤的直接征象;胰腺外形不连续、平扫或增强时垂直胰腺长轴的低密度、线条状影是胰腺断裂的直接征象。胰周积液、网膜囊积血积液,肾前筋膜增厚,腹腔积液是胰腺损伤的间接征象。结论:CT检查对胰腺损伤的诊断价值较大,CT增强比平扫更能明确胰腺的断裂;CT检查对于主胰管的断裂的诊断价值有待进一步研究。     

胰腺损伤的MRI诊断

目的:总结胰腺损伤的MR征象,评价MRI在胰腺损伤诊断中的作用。材料和方法:回顾性分析5例急性闭合性腹部外伤伴胰腺损伤患者的MRI表现。其中男性3例,女性2例,年龄14-52岁,平均33.60±15.34岁。MRI检查用GE 1.5T超导全身磁共振机,相控阵列线圈,包括T_1WI、T_2WI及MRCP等序列。结果:胰腺损伤的MRI表现有:①胰腺肿大(2例);②胰腺断裂(4例);③主胰管断裂(4例);④胰腺内出血(1例);⑤胰周改变:5例均有胰周被膜和肾旁前筋膜增厚,胰周、肾旁间隙广泛积液;⑥假性囊肿形成(2例)。结论:胰腺损伤具有较特征的MR表现,结合临床,可以明确诊断。     

胰肾联合移植术后多层螺旋CT表现

目的 应用多层螺旋CT（MSCT）及其后处理技术评价胰肾联合移植术后移植物的影像学表现及并发症的征象。资料与方法 14例行胰肾联合移植术的患者作16次MSCT检查。采用GE Lightspeed 16螺旋CT扫描仪，行平扫及增强扫描，然后将所有图像传入GE AW4．0工作站进行多平面重建（MPR）、最大密度投影（MIP）及容积再现技术（VR）进行后处理。结果 14例移植胰腺中，MSCT显示12例胰腺实质正常，CTA显示胰腺血管无狭窄及栓塞等异常；1例移植胰腺右侧髂外动脉近起始部至股动脉处血栓形成，胰腺体积小、密度低，未见明显强化，术后病检示胰腺内脾动脉血栓形成，胰腺缺血坏死及胰腺急性排斥反应；1例胰腺包膜下积液。14例移植肾显示11例肾实质正常，1例动脉期肾皮髓质分界欠清晰，提示为轻度急性排斥反应，后亦经肾穿刺所证实；1例MIP显示2处移植肾动脉狭窄；另1例显示移植肾静脉瘤形成。7例患者中MSCT均可见胰周、肾周少量积液。结论 MSCT以及后处理技术能对胰肾联合移植术后移植胰腺和肾脏形态及基本功能状态作出评估。     

急性胰腺炎CT诊断

目的:研究急性胰腺炎的CT征象及诊断价值.材料和方法:对85例急性胰腺炎采取5mm～10mm间隔平扫及增强扫描,对胰周液体聚集者作扩大区域扫描.结果:急性胰腺炎CT表现为不同程度的胰腺肿胀(83/85),胰腺坏死(44/85),胰周积液(46/85),胰腺脓肿(14/85).结论:CT检查在急性胰腺炎的确诊和监测病情的发展等方面有较大实用价值.     

胰腺撕裂伤的CT诊断

目的:探讨胰腺撕裂伤的CT表现。方法:搜集18例经临床手术证实的胰腺撕裂伤病例资料,分析其CT平扫及增强表现。普通CT扫描层厚5mm,螺旋CT均行薄层多平面重组(MPR)。结果:胰腺内血肿3例,胰腺局限或弥漫性肿胀11例,网膜囊积液12例,胰周积液及左侧肾前筋膜增厚18例,平扫9例胰腺实质内可见低密度撕裂口,增强扫描所有病例胰腺实质内均可见低密度撕裂伤口,其中胰头5例,胰颈8例,胰腺体尾部5例。主胰管损伤CT诊断符合率70%。合并其他脏器损伤12例。结论:胰腺撕裂伤有较特征性的CT表现,CT薄层增强扫描可准确诊断胰腺撕裂伤。CT对主胰管损伤的判断有一定的限度。     

急性胰腺炎156例的CT分析及临床意义

目的:探讨急性胰腺炎病人胰腺实质和胰外相关CT征象。方法:对经手术和临床证实的156例急性胰腺炎病人的CT征象进行回顾性分析。结果:156例中急性水肿性胰腺炎91例(58.3%),出血坏死性65例(41.7%)。CT发现胰腺肿胀115例;胰实质出血21例,坏死31例,胰腺脓肿15例。有胰周、胰外符合并症进106例(67.9%),其中胰周水肿76例,胰周积液27例,胰周峰窝织炎32例,胰周脓肿18例,胰内或胰周假性囊肿12例;前肾旁间隙积液56例;胆系结石83例,胆囊炎症41例,肝脂肪浸润26例;腹水42例;胸水96例,下肺炎症17例,心包积液9例,ARDS 7例。本组手术治疗29例,非手术治疗127例。治愈和好转148例,死亡8例(5.1%)。结论:CT检查有助于发现急性胰腺炎的胰实质、胰周和胰外相关病变,对本病的定性诊断、分型、治疗选择和预后评估有重要价值。     

急性闭合性胰腺损伤的CT诊断

目的 评价螺旋CT双期增强扫描对急性闭合性胰腺损伤的诊断价值.方法 回顾性分析21例临床资料完整的急性闭合性胰腺损伤的CT征象.结果 本组21 例中胰头损伤5例,胰体尾部损伤16例.胰挫伤或挫裂伤11 例(11/21),占52.38 %,胰内血肿6 例(6/21),占28.57 %,胰腺横断4 例(4/21),占19.05 %.增强扫描门脉期对胰腺实质的损伤灶显示达100%.均未能直接显示胰管断裂征象.结论 CT检查对急性闭合性胰腺损伤的诊断具有重要价值.     

钝性胰腺断裂伤的CT诊断

目的 探讨钝性胰腺断裂伤的CT表现.方法 回顾性分析经手术证实的6例钝性胰腺断裂伤的CT表现及其特点, 所有病例均行CT平扫,其中2例行增强扫描.结果 胰颈断裂4例,胰头钩突断裂1例,胰体尾断裂1例.CT直接征象为胰腺断裂口,3例于断裂处呈现线条样或宽带状低密度影,与胰腺长轴接近垂直,平扫断裂口边界欠清,增强扫描断裂口边界清楚;3例在平扫上呈楔形不均匀高密度血肿表现.间接表现为创伤性急性胰腺炎:6例均见胰腺局部或弥漫性肿大及胰周积液(血)、网膜囊血肿3例、肾前筋膜增厚6例,腹腔积液5例,胃肠道积气4例,胰管轻度扩张2例;合并脾破裂及十二指肠损伤各1例.结论 CT是诊断钝性胰腺断裂伤的首选方法.     

胰腺损伤早期CT检查的临床价值

目的:评价CT在胰腺损伤早期诊断中的临床价值。方法:回顾性分析17例胰腺损伤患者的CT资料,按照手术结果观察其首次CT表现及24h内动态变化特点。结果:17例胰腺损伤中,手术探查证实挫伤11例,裂伤6例;首次CT检查,胰腺未见异常3例,漏诊2例,明确提示有胰腺损伤12例,敏感性70%;10例经24h内的动态观察,CT均显示损伤加剧的征象。结论:胰腺损伤合并伤多且早期常缺乏特异的临床症状和体征,容易漏诊。胰腺损伤包括胰腺实质损伤和胰腺导管破裂,CT扫描对多数胰腺实质损伤能作出早期诊断,对胰腺导管破裂无法直接显示。对血液动力学稳定的患者,早期密切随访对胰腺损伤的诊断和决策治疗是必要的。     

MSCT在延迟性小肠破裂早期诊断中的应用

目的 探讨多层螺旋CT(MSCT)对延迟性小肠破裂的早期诊断价值及临床意义.方法回顾性分析16例临床经手术证实的小肠破裂患者的临床资料和CT表现,其中男12例,女4例.所有病例早期腹膜刺激征不明显,均在受伤后24 h~1周内进行手术治疗;术前均行MSCT腹部薄层扫描及重建检查,其中平扫12例,平扫+增强扫描4例.结果所有病例均手术证实小肠破裂,其中合并其他腹部脏器损伤3例(3/16),单纯小肠损伤13例(13/16).MSCT术前诊断阳性15例(15/16),其中局限于肠系膜间隙渗出积液、点状游离积气9例(9/15),单纯肠间积液4例(4/15),肠系膜间隙游离小气泡2例(2/15);伴肠管肿胀、管壁增厚11例(11/15).术前诊断阴性1例(1/16),经剖腹探查证实.受伤24 h后CT诊断小肠破裂3例(3/16),受伤后3 d内诊断者10例(10/16),受伤后1周内诊断者2例(2/16),其中受伤后3 d内作出诊断者共13例(13/16).结论 MSCT检查在延迟性小肠破裂的早期诊断中具有较高价值,对指导临床诊治具有重要参考价值.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Treatment of intrahepatic arteriovenous fistula in hepatocellular carcinoma with N-butyl-2-cyanoacrylate

Primary hepatocellular carcinoma (HCC) continues to be one of the most common malignancies with an incidence of approximately one million cases per year and a dismal prognosis; some authors have reported a median survival of 1 ～ 2 months after diagnosis. Although surgery remains the only hope for cure, few patients are candidates[1,2].