肺部韦格内氏肉芽肿的影像诊断

作者报告２例局限型ＷＧ，并结合文献对其肺部影像进行分析。ＷＧ肺部的主要表现是（１）两肺多发或单发的结节病灶，常伴有厚壁空洞；（２）多种多样的肺肺洋浸润性病灶，并具有易变性的特点。作者认为ＣＴ能够发现普通Ｘ线检查未能 病变，能够更清楚的显示病变的细节，有利于早期诊断。     

韦氏肉芽肿病的诊治

韦氏肉芽肿病的诊治上海第二医科大学瑞金医院（２０００２５）邓伟吾韦氏肉芽肿病（Ｗｅｇｅｎｅｒ’ｓＧｒａｎｕｌｏｍａｔｏｓｉｓ，ＷＧ）为一多系统免疫性疾病，主要表现为上、下呼吸道坏死性肉芽肿性血管炎和坏死性肾小球肾炎。亦可涉及其他多种脏器，但以肺部病变...     

抗癌药导入并放射治疗浅表肿瘤临床观察

目的：探讨抗癌药局部导入并放射治疗浅表肿瘤的临床效果。方法：对伴两个浅表病灶的肿瘤患者１２例，采用自身对照的方法分为两组，较大病灶给予局部导入抗癌药合并放疗（导放组），另一病灶给予单纯放疗（单放组），两组病灶均给予常规放疗（每周５次，每次２Ｇｙ），靶区剂量（ＤＴ）６０Ｇｙ／６Ｗ３０次。结果：导放组ＣＲ率为８３％，单放组为３３％，两放且为３３％，两组差异有显著性。导放组皮肤反应明显重于单放组（Ｐ〈０     

脊柱转移性肿瘤MRI扫描序列的选择

目的 探讨各种不同序列在显示转移性肿瘤病灶中的作用。材料与方法 收集１５例脊柱转移性肿瘤，其中乳腺癌骨转移４例，前列腺癌骨转移５例，肺癌骨转移６例，人武部病例均有明克的原发病灶，均经临床病史及追踪随访６月以上确诊。行颈椎、胸椎、腰椎ＳＥ序列＋增强、反相ＧＥ、同相ＧＥ、ＳＴＩＲ序列检查。结果 反相ＧＥ序列（４７／４９）与ＳＥ＋增强（４４／４９）显示病灶能力相当，同相ＧＥ序列显示的病灶（３４／４９）低于反相ＧＥ序列（４７／４９），反相ＧＥ序列（４７／４９）及ＳＥ＋增强序列（４４／４９）检出的病变数目相近，接近ＳＴＩＲ序列。结论 脊柱转移瘤的检测中可以将ＳＥ序列与反相ＥＧ序列结合起来，即可高敏感性地检测出转移病灶，也可减少检查时间。     

2型糖尿病及并发症患者血小板参数测定的临床价值

目的 探讨血小板参数在２型糖尿病及并发症患者中的临床价值。方法 采用全自动血细胞分析仪测定２型糖尿病及并发症患者和健康人血小板四项参数的变化。结果 ２型糖尿病并无并发症组ＴＧ、ＦＰＧ显著高于正常对照组（ｐ〈０．０５,ｐ〈０．０１）,而ＭＰＶ、ＰＣＴ、ＰＤＷ、ＰＬＴ、ＴＣ无显著性差异（ｐ〉０．０５）;２型糖尿病合并微血管病变（ＤＮ,ＤＲ）组ＭＰＶ、ＰＤＷ、ＰＣＴ均显著地正常对照组和无并发症组（ｐ〈０     

周围动脉闭塞性疾病彩色多普勒超声检查

为评价ＣＤＵＳ在周围动脉闭塞性疾病检查中的应用价值。对５６例经血管造影对照或／和手术病理及临床住院确诊的患者进行ＣＤＵＳ、ＣＷ、ＰＰＧ和ＳＢＰ检查，男４６例，女１０例，年龄１９～８０岁。ＣＤＵＳ与出院诊断的符合率为９８．２％，ＣＤＵＳ、ＣＷ、ＰＰＧ、ＳＢＰ对１１４条（处）病变血管的显示符合率分别为：９７．４％、６３．２％、４２．１％、６４．０％。ＣＤＵＳ是周围动脉闭塞性疾病最佳无创伤检查方法之一。     

无先兆型偏头痛患者脑脊液γ－氨基丁酸含量变化的研究

本文应用放射受体分析法测定了１８例无先兆型偏头痛（ＭＷＡ）患者脑脊液（ＣＳＦ）中γ－氨基丁酸（ＧＡＢＡ）含量的变化，发现ＭＷＡ发作期ＣＳＦ中ＧＡＢＡ含量（３４．４８±２．８９ｐｍｏｌ／ｍｌ）显著高于间歇期（３０．９４±３．０１ｐｍｏｌ／ｍｌ），提示ＧＡＢＡ参与了ＭＷＡ的发病过程。     

四叠体池脂肪瘤的MRI诊断

四叠体池脂肪瘤是颅内少见疾病,本文报道３例如下。例１男,４９岁。因头疼头晕２０年就诊。头颅ＣＴ未见异常。ＭＲＩ检查：Ｔ１ＷＩ和ＦＬＡＩＲ显示四叠体池０－８ｃｍ×０－８ｃｍ高信号病灶,Ｔ２ＷＩ未见病变,ＳＰＩＲ和ＳＴＩＲ抑脂扫描病变呈低信号（图１、２）。诊断：脂肪瘤。图１　矢状位Ｔ１ＷＩ显示四叠体池高信号病灶,信号强度接近斜坡及颅骨内脂肪信号　图２　Ｔ１Ｗ／ＳＰＩＲ抑脂扫描,脂肪高信号被抑制,表现为低信号　例２男,７８岁。左侧肢体无力３天就诊。头颅ＣＴ提示四叠体池脂肪瘤,病灶ＣＴ值－９０ＨＵ。ＭＲ…     

计算机X线摄影对肺部球型病灶的诊断研究

目的：研究计算机X线摄影（CR）术在肺部球型病灶诊断的应用价值。材料与方法：经手术病理或临床证实66例肺部球型病灶。其中肺癌40例，球型肺炎11例，结核球10例，支气管肺囊肿4例，肺错构瘤1例。对病变的边缘、密度、周围情况、诊断率等进行CR和CXR对比研究。结果：CR对肺部球型病灶的特征显示率及鉴别诊断能力优于CXR。结论：CR对球型病灶具有临床诊断意义。     

天先兆型偏头痛患者脑脊液γ—氨基丁酸含量变化的研究

本文应用放射受体分析法测定了１８例无先兆型偏头痛（ＭＷＡ）患者脑脊液（ＣＳＦ）γ－氨基丁酸（ＧＡＢＡ）含量的变化，发现ＭＷＡ发作期ＣＳＦ中ＧＡＢＡ含量（３４．４８±２．８９ｐｍｏｌ／ｍｌ）显著高于间歇期（３０．９４±３．０１ｐｍｏｌ／ｍｌ）提示ＧＡＢＡ参与了ＭＷＡ的发病过程。     

DR双能量减影技术在胸部病变的诊断价值

目的探讨双能量减影在胸部直接数字化X线摄影技术的临床应用价值。方法随机抽取83例胸部双能量减影数字化X线摄影（DR）。83例病人均进行胸部后前位片的双能量减影的图像后处理,形成标准DR图像、软组织减影图像、骨骼减影图像各一幅即所谓的“骨肉分离”技术。结果由于双能量减影去除了骨性胸廓的干扰,增加肺部检出钙化的敏感性和准确性,增加肺结节的检出率,对肺部的良、恶性定性有意义;对骨性胸廓病变的诊断更加准确;对肺结节的检出率较普通胸片明显提高。双能量减影对显示骨性胸廓和中央气道的病变,如骨转移瘤、骨折、骨质破坏、钙化等较常规胸片、单纯直接数字化摄影均有明显提高,统计学有明显差异。双能量减影图像上肉眼判断有、无钙化非常可靠。结论双能量减影直接数字化X线摄影技术提供了更多的影像诊断信息,增加了诊断的准确性的信心,具有较高的实用临床价值和推广价值。     

Therapeutic monitoring of experimental invasive pulmonary aspergillosis by ultrafast computerized tomography, a novel, noninvasive method for measuring responses to antifungal therapy.

Pulmonary infiltrates in neutropenic hosts with invasive aspergillosis are due to vascular invasion and hemorrhagic infarction. In order to measure the effect of antifungal compounds on this organism-mediated tissue injury, we monitored the course of pulmonary infiltrates by serial ultrafast computerized tomography (UFCT) in persistently granulocytopenic rabbits with experimental invasive pulmonary aspergillosis. The course of pulmonary lesions measured by serial UFCT scans was compared with those measured by conventional chest radiography, histopathological resolution of lesions, and microbiological clearance of Aspergillus fumigatus. Treatment groups included either amphotericin B colloidal dispersion in dosages of 1, 5, and 10 mg/kg of body weight per day intravenously or conventional desoxycholate amphotericin B at 1 mg/kg/day intravenously. Therapeutic monitoring of pulmonary lesions by UFCT demonstrated a significant dose-response relationship. Lesions continued to progress in untreated controls, whereas lesions in treated rabbits initially increased and then decreased in response to antifungal therapy in a dosage-dependent manner (P < or = 0.05 to P < or = 0.005, depending upon the groups compared). This same trend of resolution of lesions in response to antifungal therapy was also demonstrated by postmortem examination and by microbiological clearance of the organism. These data indicated that amphotericin B colloidal dispersion at 5 and 10 mg/kg/day exerted a more rapid rate of clearance of lesions than conventional amphotericin B. UFCT was more sensitive than conventional chest radiography in detecting lesions due to invasive pulmonary aspergillosis (P < 0.05 to P < 0.005, depending upon the groups compared). These findings establish a correlation among UFCT-defined lesions, microbiological response, and resolution of pathologically defined lesions in experimental invasive pulmonary aspergillosis. Serial monitoring of UFCT-defined lesions of aspergillosis provides a novel system for determining the antifungal response of organism-mediated tissue injury.     

婴幼儿先天性心脏病伴肺动脉高压的X线表现

目的 探讨婴幼儿先天性心脏病伴肺动脉高压的X线表现,提高诊断正确率减少误诊。方法 65例先心伴肺动脉高压,都经过胸片、心电图、超声心动图、心导管及心血管造影检查,63例作了手术治疗。结果 VSD45例,VSD PDA16例,DPA 2例,65例均表现为胸廓前后径与胸廓横径比率及心胸比率扩大,而升主动脉宽径相对变窄,两肺呈弥漫型肺气肿。结论 两肺弥漫型肺气肿,右上肺血管扩张并相互重叠呈片状阴影,左侧下肺叶出现不张,左心房扩大是婴幼儿先天性心脏病伴肺动脉高压的主要X线表现。     

中央型肺癌的胸片、螺旋CT及多平面、三维重建的应用

目的：讨论中央型肺癌的胸片、CT影像及探讨螺旋CT多平面、三维重建的临床运用价值。方法：回顾性分析30例经纤维支气管镜病理证实为中央型肺癌的胸片、CT影像，并对其中14例在螺旋CT扫描后进行多平面（MPR），三维重建（3D－SSD）。结果：胸片、CT影像为肺门肿块，支气管壁增厚、狭窄，阻塞性肺炎、肺不张，纵隔淋巴结肿大。螺旋CT后处理可明确显示中央型肺癌肿块及狭窄、阻塞的支气管形态。组织学分类为鳞癌、小细胞未分化癌、腺癌。结论：胸片、CT是诊断中央型肺癌基础方法，螺旋CT多平面、三维重建可以帮助提高中央型肺癌的诊断。     

Diagnosis of benign solitary fibrous tumors by positron emission tomography

An 80-year-old male presented with dyspnea so severe that he could not perform the activities of daily living. Chest radiography and computed tomography of the chest demonstrated a 30-cm left chest mass extending inferiorly to displace the left kidney and spleen. Three incisional biopsies yielded inconclusive results. Positron emission tomography (PET) with fluorodeoxyglucose F 18 (FDG) ruled out malignancy, so a curative excisional biopsy was performed. We conclude that FDG PET is a crucial component of the initial evaluation of patients with solitary pulmonary masses. FDG PET has high sensitivity, specificity, positive predictive value, and negative predictive value in the diagnostic clarification of radiologically indeterminate pulmonary lesions.     

胸部低剂量CT与DR对肺部病变检出对比研究

目的对比胸部低剂量CT与胸部数字化X线摄影(DR)对肺部病灶的检出差别。方法回顾性分析重庆医科大学附属第一医院放射科216例48 h内先后行胸部低剂量CT及DR检查图像,由2位高年资医师双盲阅片,并对二者阅片结果进行肺内病变总体检出κ一致性检验;取一致性系数较高者数据,按肿块(直径>3.0 cm)、大结节(直径0.5~3.0 cm)、小结节(直径<0.5 cm)、渗出实变、纤维化及钙化、肺大泡及肺气肿、胸腔及胸膜病变分类,进行各分类病变κ一致性检验;以CT作为病变检出标准,评价DR摄片的病变漏检率、误检率和准确率,并分析主要原因。结果胸部CT双盲阅片可重复性评价的组内相关系数(ICC)=0.863,胸部DR双盲阅片ICC=0.910;阅片者1肺内病变总体检出一致性系数(κ=0.555,P<0.001)高于阅片者2(κ=0.448,P<0.001),取阅片者1胸部低剂量CT及DR数据;相对于低剂量CT,DR摄片漏检率、误检率和准确率为81.06%、22.81%和18.94%。病变大小、密度、位置等是肿块、结节及渗出实变病变漏诊及误诊的主要原因。结论相对于胸部低剂量CT,DR摄片漏检率较高,误检率及准确率较低,胸部低剂量CT检查对病变的检出优于DR。     

Cystic and cavitary lung diseases: focal and diffuse

Cysts and cavities are commonly encountered abnormalities on chest radiography and chest computed tomography. Occasionally, the underlying nature of the lesions can be readily apparent as in bullae associated with emphysema. Other times, cystic and cavitary lung lesions can be a diagnostic challenge. In such circumstances, distinguishing cysts (wall thickness < or = 4 mm) from cavities (wall thickness > 4 mm or a surrounding infiltrate or mass) and focal or multifocal disease from diffuse involvement facilitates the diagnostic process. Other radiological characteristics, including size, inner wall contour, nature of contents, and location, when correlated with the clinical context and tempo of the disease process provide the most helpful diagnostic clues. Focal or multifocal cystic lesions include blebs, bullae, pneumatoceles, congenital cystic lesions, traumatic lesions, and several infectious processes, including coccidioidomycosis, Pneumocystis carinii pneumonia, and hydatid disease. Malignant lesions including metastatic lesions may rarely present as cystic lesions. Focal or multifocal cavitary lesions include neoplasms such as bronchogenic carcinomas and lymphomas, many types of infections or abscesses, immunologic disorders such as Wegener granulomatosis and rheumatoid nodule, pulmonary infarct, septic embolism, progressive massive fibrosis with pneumoconiosis, lymphocytic interstitial pneumonia, localized bronchiectasis, and some congenital lesions. Diffuse involvement with cystic or cavitary lesions may be seen in pulmonary lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, honeycomb lung associated with advanced fibrosis, diffuse bronchiectasis, and, rarely, metastatic disease. High-resolution computed tomography of the chest frequently helps define morphologic features that may serve as important clues regarding the nature of cystic and cavitary lesions in the lung.     

AANA Journal course: update for nurse anesthetists--fundamentals of chest radiography: techniques and interpretation for the anesthetist.

The chest roentgenogram (chest x-ray) is an essential tool in the perioperative evaluation of high-risk surgical patients. It can provide information on chest pathologies that will influence the anesthetic or surgical plan. An understanding of chest radiography requires several steps. Knowledge of physics, or how the radiological images are produced, is essential. Basic components include radiographic density, geometric magnification, and radiographic technique. An awareness of physics will also permit correct identification and interpretation of chest anatomy and existing pathology. The clinician should use a systematic approach to interpretation. This consists of evaluating the overall quality of the film, followed by an examination of the anatomy, working from the periphery and moving toward the center to note any chest, pulmonary, or heart abnormalities. The air bronchogram and silhouette sign are indications of pathology and can assist the clinician in locating and identifying infiltrates or lesions. Once an abnormality or area of interest is identified, he or she can focus on a clinical interpretation of the pathology. Emphasis is placed on the identification of pulmonary infiltrates and the location of invasive medical devices commonly found in the perioperative patient.     

数字断层融合技术对肺内非钙化性结节灶检出能力评价

目的 探讨胸部数字断层融合摄影(DTS)与常规数字X线摄影(CDR)对肺部非钙化结节的检出能力。方法 对41例肺内非钙化结节患者行胸部DTS和CDR检查,以MDCT结果作为参照,分析胸部DTS和CDR对肺内不同直径的非钙化结节性病灶的显示结果。结果 41例患者经CT发现260个结节,胸部DTS发现238个,CDR发现74个。胸部DTS和CDR对直径3~5 mm、6~10 mm及>10 mm肺部非钙化结节的敏感度分别是86.36%(114/132)、95.60%(87/91)、100%(37/37)和10.61%(14/132)、37.36%(34/91)、70.27%(26/37)。对于直径≤10 mm的肺部非钙化结节,胸部DTS的检出能力明显优于CDR(P<0.01)。CDR对肺内非钙化结节性病灶总的敏感度为28.46%(74/260),胸部DTS则为91.54%(238/260),二者差异有统计学意义(P<0.01)。结论 对于检出肺部非钙化结节,胸部DTS比CDR更具优势,敏感度更高,特别对于直径≤10 mm的非钙化结节。     

胸部外伤CT与常规X线诊断价值的比较

目的：比较CT与常规X线在胸部外伤中的诊断价值。材料与方法：对71例胸部外伤病例分别进行胸部平片及CT检查,就其胸片与CT的诊断结果作比较分析。结果：CT诊断诸如肺挫伤、肺撕裂伤、外伤后肺不张、微量气胸、微量血胸、隐匿性肋骨骨折等胸部外伤性病变明显优于胸片。结论：对于胸片未能明确诊断的胸部外伤病例,为防止漏诊应加做CT扫描。