鼻丘和相邻结构的CT分析及临床运用价值

目的：运用高分辨率CT（HRCT）分析鼻丘及相邻结构的解剖形态和临床意义，方法：采用冠状位连续扫描，观察100例患者，其中慢性鼻炎患者40例，慢性鼻窦炎患者30例，无副鼻窦疾患患者30例，结果：大多数病例（99％）有气房，鼻丘的形态多样，与中鼻甲前部，筛泡和鼻泪管关系恒定，鼻丘向上气化程度与额窦关系密切，鼻丘炎症常见于多发前组鼻窦炎，结论：通过对鼻丘及其相邻结构的HRCT扫描，可以较好地显示其解剖形态及相互关系，为临床诊断和治疗提供重要信息。     

岩尖脑膜瘤术后并发症的护理

岩尖区是指从内听道到岩骨尖的这一狭小区域，毗邻海绵窦后壁，有岩上下窦与之交通，后方为脑干，邻近有Ⅲ、Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ等脑神经行走。随着显微神经外科的发展，岩尖脑膜瘤的手术病死率已明显下降，但术后并发症仍高达31％～70％，目前仍被认为是神经外科的高难项目之一。由于肿瘤生长部位的不同，临床表现、术后并发症存在着显著差异。本科从2000年2月-2006年6月共收治35例岩尖脑膜瘤，根据分型不同采取一般护理贯穿始终，重点突出并发症护理的方法，使术后住院日尽量缩短，取得较满意效果，现将护理措施总结如下。[第一段]     

骨样骨瘤的X线与CT诊断

目的：分析骨样骨瘤的X线及CT表现，提高其诊断正确率。方法：回顾性分析经手术病理证实的骨样骨瘤16例。所有病例均行X线检查，同时有CT扫描6例。分析X线和CT对瘤巢及瘤巢周围改变的显示能力。结果：X线和CT检查分别有13例和6例表现为一圆形或卵圆形〈2cm瘤巢，周围可有程度不一的骨质硬化、骨膜反应、软组织肿胀，X线和CT的诊断准确率分别为81％和100％。结论：大多数骨样骨瘤有X线特征表现，通过X线检查可得到诊断，CT对瘤巢定位更准确对提高本病诊断准确率有一定价值。     

中耳乳突炎和胆脂瘤的CT鉴别诊断

中耳炎大多由欧氏管功能失调,细菌或病毒感染所致。胆脂瘤是鳞状上皮内衬充满角质碎片的囊,随着角化屑片的不断堆积,逐渐增大形成,利用颞骨CT扫描,能提供重要的诊断依据,获得更多的软组织信息。本文着重讨论乳突炎和胆脂瘤的CT诊断及鉴别,并附20例病例分析。1临床资料1.1一般资料20例中,女8例年龄13～50岁。1.2方法CT扫描使用西门子螺旋CT,仰卧位,扫描基线与听眦线平行,自外耳道下缘向头顶侧以2mm层厚连续扫描至岩骨上缘。1.3CT表现乳突炎多表现为透亮度减低或密度增高,有时可见气液平;胆脂瘤多表现肉芽增生及窦腔扩大。2讨论2.1气化乳…     

浅析颞骨骨折

颞骨岩部为颅底的一部分，颞骨骨折的发生往往合并于严重的颅脑外伤，近一半的颅底骨折侵入颞骨岩部，依其骨折线分为纵行骨折、横行骨折及岩尖骨折三类，纵行骨折最多见。岩尖骨折最少见，纵行骨折预后较好。常由车祸撞击颞枕部、坠落等所致，是头颅外伤的一部分，并可伴有不同程度的颅内或胸、腹部等组织和器官损伤。     

一种新切口在肺尖癌手术中的应用

肺尖癌是一种少见的特殊型肺癌，占肺癌总数的3％－5％，治疗较为困难。常规后外侧切口难以接近肺尖癌，且有损伤邻近组织的危险性，特别是已侵犯到邻近组织的肺尖癌。我科从1994年5月-1999年10月采用一种新切口给7例肺尖癌患者进行了手术，效果较好，报道如下。1临床资料本组男5冽，女2例；年龄42－73岁。胸痛伴咳嗽6例，伴右肩背痛3例，伴上肢痛3例，伴上肢无力2例，上肢麻木2例。误诊为肩周炎2例，颈椎病2例，右上胸壁肿块1例。胸部X线体层摄片以及CT显示：右上肺尖肿块阴影4.0cm×6.0cm－5cm×7．35cm6例，左上肺尖肿块阴影6．0cm×9…     

16例岩尖斜坡区脑膜瘤术后并发症的观察与护理

岩尖斜坡区脑膜瘤由于位置深 ,周围神经和血管解剖结构复杂 ,一直是神经外科的难题 ;70年代手术死亡率高达5 0 % ,手术并发症大于 80 %。随着神经放射和颅底显微外科的发展 ,手术死亡率下降到 0 %～ 9%。但术后的各种并发症发生率仍在 39%～ 5 7%。我院 1995年 12月～ 1999年 6月采用显微外科手术切除岩尖斜坡肿瘤 16例 ,现就术后并发症的观察及护理体会报告如下。1　临床资料本组男 6例 ,女 10例 ;年龄 42～ 6 3岁 ,平均 5 1.1岁。病程最短 6个月 ,最长 3年 ,平均 1年 9个月。临床主要症状是头痛、面部麻木、复视、听力障碍和肢体无力。体…     

常规CT扫描的肋骨定位探讨

目的探讨常规CT扫描计数肋骨的方法。为骨折定位提供依据。方法观察42例有常规X线片和常规CT扫描肋骨骨折患者，依据肋骨的解剖学特点及对应关系作出定位诊断，并与常规X线胸片诊断结果对照。结果分别以第一肋骨，第十二肋骨作为起始标志，依次定位相应肋骨。本组病例CT的准确率为96．6％。胸片的准确率为94．9％。结论依据肋骨的解剖学特点及其分布规律，在常规CT检查中可以快速、准确地计数肋骨，完成病变的定位。     

肾移植术后肺部感染的影像诊断

目的：探讨肾移植术后肺部感染的影像学诊断价值。方法：回顾性分析158例肾移植术后肺部感染患者的影像学资料，所有患者均有X线胸片，28例患者行CT检查。由三名有经验的医生进行双盲法阅片，然后共同分析并达成一致意见。结果：肾移植术后肺部感染的发生率为13．8％，其中主要的病原菌依次为细菌、真菌和病毒。影像学诊断为正常者30例（19．0％），诊断为肺纹理增多增粗模糊者44例（27．8％），肺部感染者84例（53．2％）。结论：胸片与CT扫描在肾移植术后肺部感染并发症的诊断中具有很重要的价值。     

基底动脉尖综合征15例临床分析

目的：研究基底动脉尖综合征的临床特征和影响学特点。方法：对15例基底动脉尖综合征患者的临床资料进行回顾性分析。结果：病史和临床表现以心脑血管症状为主；CT或MRI检查：单侧或双侧丘脑蝶形梗死灶8例，枕叶梗死6例，颞叶梗死7例，中脑梗死8例，小脑梗死7例。结论：基底动脉尖综合征以意识障碍、瞳孔变化及眼球运动障碍为主要特征，结合CT或MRI的特点可以作出明确诊断。     

轴位CT减影血管成像技术在急性脑梗塞中的应用

目的　评价轴位CT减影血管成像技术在急性脑梗塞诊断中的作用。方法　对 9例急性脑梗塞的患者行常规CT扫描、CT灌注成像 ,由两名有经验的神经影像专家挑选出未增强的图像以及强化最明显的图像。经CT操作台上的简易叠加软件减影处理得到轴位CT减影图像 ,同时使用计算机通过配准、减影及增强技术处理得到彩色轴位CT减影血管图像。 2例患者在治疗后进行复查。结果　 9例患者彩色轴位CT减影血管成像均可显示梗塞灶的血管缺如状态 ,2例患者治疗后复查可以观察到病灶区血管影增加 ,P <0 .0 5。图像质量优于CT扫描机操作台的简易减影图像 ,P <0 .0 5。减影系数为 1的对比度增强彩色轴位CT减影血管成像可以完全消除背景 ;而减影系数为 0 .8伪彩色增强彩色轴位CT减影血管成像可以保留脑室等解剖背景。结论　结合CT灌注成像与CT减影血管成像 ,临床医生可以方便、迅速地更加全面、直观地观察急性脑梗塞灶。     

64层螺旋CT前瞻性与回顾性心电门控冠状动脉成像图像质量与辐射剂量比较的系统评价

目的对64层螺旋CT前瞻性心电门控与回顾性心电门控冠状动脉成像对照研究的文献进行Meta汇总分析,系统评价前瞻性心电门控的临床应用价值。方法通过电子检索中英文数据库(Medline、Pubmed、CNKI及万方数据库)和人工检索获取64层螺旋CT前瞻性心电门控与回顾性心电门控冠状动脉成像对照研究的文献。对符合条件的研究进行质量评估、异质性检验。计数资料及计量资料分别应用比值比及标准化差值作为效应量,根据异质性检验结果利用相符合的模型进行效应量合并。结果 64层螺旋CT前门控及后门控图像质量采用固定效应模型合并效应量(OR=1.10,95%CI=0.87～1.39)。认为前门控与后门控图像质量差异无统计学意义;64层螺旋CT前门控及后门控辐射剂量采用随机效应模型合并效应量[标准化均数差值(SMD)=-6.83,95%CI=-8.45～-5.22]。认为前门控与后门控图像质量差异有统计学意义。结论在低心率及心率变异的情况下,64层螺旋CT前瞻性心电门控冠状动脉成像同回顾性心电门控相比可以获得可用于诊断的图像质量,并且大幅减低辐射剂量。     

Gastric cancer detection using MDCT compared with 2D axial CT: diagnostic accuracy of three different reconstruction techniques

Purpose

To assess the diagnostic accuracy of different reconstruction techniques using MDCT for gastric cancer detection compared with 2D axial CT.

Materials and methods

During 7?months, we performed CT examinations of 104 consecutive patients with gastric cancer and of a control group composed of 35 patients without gastric disease. All gastric cancer was pathologically proven by endoscopy and surgery. Among 104 patients with gastric cancer, 63 patients had early gastric cancer (EGC). Two radiologists retrospectively and independently interpreted the axial CT and three different reconstruction techniques including multiplanar reformation (MPR), transparent imaging (TI), and virtual gastroscopy (VG), using a commercially available, 3D workstation. They graded the presence or absence of gastric cancer in each image sets using a five-point scale and, if present, they assessed its location. Diagnostic accuracy was compared using the area under the receiver operating characteristic curve (Az) for both gastric cancer and only EGC. Sensitivity and specificity were also calculated for each image technique. The k statistics were used to determine inter-observer agreement.

Results

The diagnostic accuracy for overall gastric cancer detection for each of the image sets was as follows: 2D axial CT (Az?=?0.858); MPR (Az?=?0.879); TI (Az?=?0.873); and VG (Az?=?0.928). VG had significantly better performance than 2D axial CT (p?=?0.016). The sensitivity and specificity were as follows: 76.7% and 82.9% in axial CT; 79.6% and 85.7% in MPR; 91.3% and 80% in TI; and 95.1% and 74.3% in VG. In EGC, the diagnostic performance for its detection was as follows: axial CT (Az?=?0.777); MPR (Az?=?0.811); TI (Az?=?0.825); and VG (Az?=?0.896). VG had significantly better performance than both 2D axial CT (P?=?0.006) and MRP (P?=?0.038). The sensitivity and specificity were as follows: 62.9% and 82.9% in axial CT; 67.7% and 85.7% in MPR; 85.5% and 80% in TI; and 91.9% and 74.3% in VG. The inter-observer agreement showed substantial agreement (κ?=?0.67–0.75).

Conclusion

Among the different reconstruction techniques, VG accurately detects gastric cancer and is especially useful for EGC compared with 2D axial CT.     

多排螺旋CT多平面重建技术在腰椎椎弓峡部裂诊断中的价值

目的 探讨多排螺旋CT多平面重建（multi-planar reconstruction,MPR）后处理技术诊断腰椎椎弓峡部裂的准确性。方法 36例腰椎椎弓峡部裂患者,行多排螺旋CT扫描后对原始数据进行MPR后处理,比较椎间盘CT轴位图像与MPR图像对腰椎椎弓峡部裂的显示率。结果 椎间盘CT轴位图像及MPR图像共发现椎弓峡部裂67个,峡部裂位于L32个,L424个,L541个;椎间盘CT轴位图像对椎弓峡部裂的显示率为68.66%（46/67）,MPR图像为100%,二者比较差异有统计学意义（P〈0.05）。结论 多排螺旋CT MPR技术可较好显示椎弓峡部裂特征,对指导治疗方案制订有重要价值。     

三叉神经岩骨嵴压迹的研究及临床应用

目的对原发性三叉神经痛患者做薄层CT及MRI扫描,观察三叉神经的跨越岩骨嵴处的解剖学特点找到原发性三叉神经痛可靠的CT定位的放疗靶点。方法我们对95例原发性三叉神经痛病人采用17~29 Gy的剂量进行X刀放疗,应用50例患者进行薄`层CT研究,扫描层厚为1.25 mm及0.625 mm,同时进行1.25 mm层厚MRI扫描,并进行CT和MRI图象融合研究。结果结果发现在1.25 mm层厚压迹发现率94%,0.625 mm压迹发现率100%,CT和MRI图象融合发现MRI图象显示的三叉神经穿越岩骨嵴形成的凹陷完全一致,准确率100%。放疗效果有效率为85.26%。结论三叉神经跨越岩骨嵴处存在压迹,这一骨性标志是原发性三叉神经痛放疗的可靠标志点。      

椎体血管瘤的比较影像学研究

目的：探讨X线平片、CT、MRI三种影像学检查方法对诊断椎体血管瘤的应用价值。方法：搜集13个椎体血管瘤病灶的X线平片、CT及MRI表现,对其影像特征进行对比研究。结果：X线检查显示10个病灶,骨小梁呈“栅栏状”改变;CT扫描显示12个病灶,横断面表现为蜂窝状或风状结构;MRI扫描显示全部13个病灶,10例显示为短T1、长T2的信号影,3例显示为长T1、长T2的信号影,并且清晰显示了脊髓情况。结论：椎体血管瘤在X线平片、CT及MRI上均有特征性影像学表现,CT、MRI对椎体血管瘤的检出率高于X线平片。MRI对椎体血管瘤的诊断、分型及指导治疗均具有十分重要的意义。     

Localization of needle tip with color doppler during pericardiocentesis: In vitro validation and initial clinical application.

This study evaluates a new device that uses color Doppler ultrasonography to enable real-time image guidance of the aspirating needle, which has not been possible until now. The ColorMark device (EchoCath Inc, Princeton, NJ) induces high-frequency, low-amplitude vibrations in the needle to enable localization with color Doppler. We studied this technique in 25 consecutive patients undergoing pericardiocentesis, and in vitro, in a urethane phantom with which the accuracy of color Doppler localization of the needle tip was compared with that obtained by direct measurement. Tip localization was excellent in vitro; errors axial to the ultrasound beam (velocity Doppler -0.13 +/- 0.90 mm, power Doppler -0.05 +/- 1.7 mm) were less than lateral errors (velocity -0.36 +/- 1.8 mm, power -0.02 +/- 2.8 mm). In 18 of 25 patients, the needle was identified and guided into the pericardial space with the ColorMark technique, and it allowed successful, uncomplicated drainage of fluid. Initial failures were the result of incorrect settings on the echocardiographic machine and inappropriate combinations of the needle puncture site and imaging window. This study demonstrates a novel color Doppler technique that is highly accurate at localizing a needle tip. The technique is feasible for guiding pericardiocentesis. Further clinical validation of this technique is required.     

双源CT对面神经管的显示及其临床应用价值

目的：探讨双源CT图像后处理技术对面神经管的显示能力及其在面神经管病变中的临床应用价值.材料与方法：回顾性分析30例正常人与12例患者的双源CT面神经管曲面重建（CPR）图像与多平面重建（MPR）图像,并对30例正常人双侧面神经管各段进行测量.结果：30例正常人的面神经管迷路段在轴位扫描图像上显示最佳,面神经管垂直段在矢状位重建MPR图像上显示最佳.曲面重建图像可同时显示双侧面神经管.12例患者中有11例能良好显示病变段面神经管.结论：双源CT图像后处理技术对面神经管的显示具有较高的准确性,对面瘫的定位诊断具有重要指导意义.     

iDose4双模型迭代重建算法对CT图像质量及扫描剂量影响的模体研究

目的：评价双模型迭代重建算法（iDose4）和滤波反投影算法（FBP）对CT图像质量的影响,探讨应用iDose4降低扫描剂量的潜力。方法：应用256层螺旋CT（Philips Brilliance iCT）,在120 kV管电压条件下分别采用200/180/160/140/120/100/80/60/40/20 mAs条件下扫描Catphan模体,采用FBP和iDose4 1-6重建横断图像,以200 mAs FBP重建图像作为参照,分析扫描条件、重建算法对图像质量的影响（CT值、图像噪声、信噪比以及低对比度分辨力）,并分析图像质量与扫描剂量的关系。结果：iDose4与FBP重建图像CT值有高度的一致性（P〉0.05）;iDose4级别1-6重建可以不同程度的降低图像噪声（9.46%-43.30%）;在管电流降低至初始值40%-50%时（80-100 mAs）,iDose4级别6重建图像与200 mAs FBP重建图像其图像噪声无统计学差异（P〉0.05）;管电流降低至初始值50%-60%情况下（100-120 mAs）,其低对比度分辨力基本维持不变。结论：iDose4可以显著降低图像噪声,提高信噪比,改善图像质量。相对于FBP重建图像,利用iDose4高级迭代重建技术可以在扫描剂量隆低至40%-50%情况下,维持图像质量不变。     

Anesthesia (15)

Use of computed tomography for maxillary nerve block in the treatment of trigeminal neuralgia. (Dokkyo University School of Medicine, Mibu, Tochigi, Japan) Reg Anesth Pain Med 2000;25:417–419.
A report of a 90-year-old woman who had a 30-year history of episodic pain in her right maxillary region is presented. An attempt to block the nerve with classic technique was made, but eliciting paresthesia could not identify the nerve. In addition, bleeding was noted after repeated attempts. To minimize complications and confirm the correct position of the needle tip, the block was planned with a suprazygomatic approach using computed tomography (CT) guidance. The needle was inserted without paresthesia. The CT scan showed the needle tip was placed at the entrance of the pterygopalatine fossa and the distribution of contrast medium spread appropriately around the pterygopalatine fossa. After confirming the clinical effect and lack of complications of the block using the local anesthetic, 0.5 mL of 7% phenol was injected. The technique resulted in complete sensory loss in the area innervated by the maxillary nerve and did so without complications.
Comment by Andrew D. Rosenberg, MD.
This is an interesting article in which the authors describe their technique for treating trigeminal neuralgia. The authors were faced with a significant problem, which was to perform a maxillary nerve block in a patient with difficult anatomy. The approach and technique were clearly thought out with an excellent result. The axial cuts demonstrate needle position under CT scan and the appropriate spread of contrast material through the pterygopalatine fossa.