MSCT在气管憩室诊断中的应用

目的 :探讨MSCT对气管憩室的诊断价值。方法 :回顾性分析2013年1—9月35例气管憩室的MSCT表现。结果 :CT表现为胸廓入口处气管旁的不规则或类圆形囊状气体影,连续横断薄层扫描或MPR等后处理技术可发现气囊与气管之间有一较细的管道相连,其中25例位于气管右后侧,5例位于气管左后侧,2例位于气管正后方,3例气管双侧均发现憩室。结论:CT是无创性检出气管憩室的可靠方法。     

胸腔入口平面气管右旁气囊影:临床与影像初步观察

目的探讨胸腔入口平面气管右旁气囊影(right paratracheal air cysts,RPAC)临床与影像特点及意义。资料与方法在PACS浏览近半年就诊患者临床及胸部MSCT信息,搜集其中MSCT发现的RPAC影像资料进行分析;并随机选取胸部MSCT无RPAC患者60例作为对照组,比较两者气管指数。结果 6213例患者发现RPAC 64例,发生率1.03%,63例在气管右后侧,1例在气管左后侧。水平直径:(1.26±0.64)cm,纵向直径:(2.02±1.21)cm;体积:(1.92±1.05)cm3,其中慢性支气管炎肺气肿组:(2.13±0.94)cm3,无慢性支气管炎无肺气肿组:(0.95±0.47)cm3(t=5.32,P<0.05);38例复查病例RPAC体积变化:(0.12±0.08)cm3(t=2.33,P>0.05)。RPAC发生率及所占比例随年龄增大而增加。气管指数平均值RPAC组:0.64±0.27,对照组:1.16±0.35(t=6.12,P<0.05)。RPAC与气管间细管状气道影常规厚层(7 mm)显示7例,亚毫米(0.75 mm)显示27例(t=8.62,P<0.01);3...     

老年性结肠多发憩室的MSCT诊断

【摘要】目的：分析老年性结肠多发憩室的多层螺旋CT表现,提高对老年性结肠多发憩室认识。方法：搜集40例结肠镜证实的老年性结肠多发憩室临床及CT资料,总结MSCT特征并与结肠镜表现相对照。结果：40例老年性结肠多发憩室患者中,发生于升结肠的21例,降结肠11例,乙状结肠5例,横结肠1例,全结肠2例。8例提示憩室黏膜炎。老年性结肠多发憩室的MSCT表现为多发、突出于肠壁轮廓外的小囊袋状突起,直径3.0～10.0mm,小囊袋状突起内容物为气体16例,液体11例,粪石13例;6例病变肠管周围脂肪间隙模糊。结论：老年性结肠多发憩室多层螺旋CT直接征象为多发、突出于肠轮廓外的囊带状突起,直径多小于1cm,受累肠管周围脂肪间隙模糊可提示合并憩室炎。     

肺原发性黏液表皮样癌的多层螺旋CT表现

目的 探讨肺原发性黏液表皮样癌(MEC)的多层螺旋CT(MSCT)表现.方法 回顾性分析经病理证实的24例肺原发性MEC的MSCT资料,所有患者术前均行CT平扫及增强扫描.结果 本组24例均表现为单发病灶.CT平扫显示中央型17例,其中腔内息肉型14例,合并阻塞性肺炎及肺不张11例;腔内外肿块型2例,合并阻塞性肺炎及肺气肿1例,合并肺泡积血1例;管腔全层浸润型1例,增厚的管壁可见散在钙化,气道轻度狭窄.外周型7例,3例见分叶及毛刺,3例见不规则厚壁空洞.增强后轻度强化4例,中度强化11例,明显强化9例.3例合并肺门及纵隔淋巴结转移,其中1例合并骨转移.结论 中央型肺MEC好发于年轻人,多表现为边缘光滑的圆形或类圆形腔内肿块,增强后中度或明显强化;而外周型MEC好发于中老年人,缺乏特征性CT表现,确诊最终依赖病理.     

回盲部憩室炎MSCT检查的临床价值

目的探讨回盲部憩室炎MSCT检查的临床价值。方法回顾性分析经手术或结肠镜检查证实的15例回盲部憩室炎,其中男9例,女6例,年龄42～82岁,平均63.8岁。术前均行常规盆腔CT扫描,8例行增强扫描和扫描后行冠状、矢状、平行髂骨和垂直髂骨四个方向的MPR重建。结果 15例病例中升结肠7例、盲肠4例、回肠末段3例、阑尾1例,其中4例为多发,共28个憩室,21个并发憩室炎;憩室内含液体19个、其中液气平面2个,含粪石或者不成形的高密度影9个;憩室大小5～56mm,平均为27mm;憩室壁增厚21个,毛糙21个;相邻肠管壁增厚9例;憩室周围脂肪炎性浸润6例。结论回盲部憩室炎MSCT检查对明确诊断提供重要的依据。     

MSCT对甲状腺微小乳头状癌的诊断价值

目的探讨128层CT对于甲状腺微小乳头状癌(PTMC)的诊断价值。方法回顾性分析和总结经手术和病理证实的34例(49个结节)PTMC的MSCT表现,所有病例均行平扫和三期增强扫描。结果单发22例,多发12例。直径为0.5~1cm结节43个,直径0.5cm的结节6个(其中2个瘤灶CT未明确显示)。病变多为圆形或类圆形,均匀低密度病灶,边界不清晰。合并钙化者17例,其中细颗粒状钙化8例,粗颗粒状钙化8例(7例为不规则结节状钙化,1例为不规则蛋壳状钙化),混合性钙化1例,钙化位于病灶中央14例,位于边缘3例。47个病灶强化程度低于正常甲状腺,38个呈渐进性填充式强化。14例出现淋巴结转移,其中10例Ⅵ区(中央组)出现淋巴结转移,且部分淋巴结直径5mm。增强扫描多为环形或不规则中等程度强化,中心坏死区域不强化。结论甲状腺微小乳头状癌的MSCT表现有一定特点,128层CT薄层扫描及多方位观察图像有助于准确评价原发病灶及发现淋巴结转移,延迟期扫描能更好的反映PTMC的强化特征。     

气管多发憩室一例

患者 男,78岁.因脑梗死于2010年5月2日入院.既往有肺癌手术史30年,冠心病病史15年,吸烟史60余年.胸部CT检查:双肺含气量增多且密度不均,双肺纹理增多、紊乱,肺内可见散在纤维索条状及小斑片状影,部分边界清楚,纵隔内未见肿大淋巴结.所见气管周边多发类圆形及不规则形、囊袋状膨出影,尤以气管左后方为多,最大者位于胸廓人口处气管左侧.该阴影开口于气管,其内密度与气管腔内密度相等,囊壁薄而均匀(图1～3).个别病变可见一细小颈部与气管相通连(图4).CT诊断:(1)慢性支气管炎、肺气肿,双肺局部纤维化;(2)气管旁多发病灶,考虑为气管多发憩室.     

膀胱憩室CT诊断

目的　探讨CT对膀胱憩室及并发症的诊断价值。方法　回顾性总结我院 7年以来经CT与B超诊断 2 4例膀胱憩室及合并症的影像学表现。结果　单发性膀胱憩室 18例 ,多发膀胱憩室 6例 ,膀胱憩室并发前列腺肥大增生 18例 ,前列腺肥大伴钙化13例 ,有 5例合并慢性膀胱炎 ,其中憩室合并结石 2例 ,膀胱憩室内并发癌 2例 ,均经手术病理证实。结论　CT能够较好地显示膀胱憩室的大小、部位、形态、开口及合并症。通过CT增强扫描能够及时发现憩室内早期的小肿瘤     

多层螺旋CT对气管憩室诊断的价值

目的探讨多层螺旋CT对气管憩室诊断应用价值。方法回顾性分析经临床证实的气管憩室92例CT表现。结果憩室大小0.3~3.5cm,平均约1.2cm,其中2.0cm以上19例。憩室形态不规则53例,类圆形17例,椭圆形14例,小泡状8例;憩室囊腔内呈分房样或蜂窝状改变并见嵴状、皱襞样结构或分隔线改变28例,憩室并发感染并见液平1例。结论多层螺旋CT对气管憩室诊断具有实用价值。     

肺内淋巴瘤的影像诊断

目的 研究肺淋巴瘤和肺假性淋巴瘤影像表现及诊断价值。方法 8例肺淋巴瘤均行X线胸片、腹部B超或CT检查,其中6例行胸部CT、2例行气管分叉体层和肺内病灶体层检查;2例肺假性淋巴瘤均X线胸片、气管分叉体层及肺内病灶体层检查。均经病理证实。结果 8例肺淋巴瘤均表现为单发或多发肺结节、肿块,7例病灶边缘呈棉絮状或周围呈磨玻璃样,2例灶内可见支气管气像,1例可见空洞。2例合并有双肺多发斑片,2例合并双肺细网状结构或磨玻璃样变,1例合并双肺多发粟粒结节。2例肺假性淋巴瘤表现为含支气管气像的双肺多发大片浸润实变,无纵膈、肺门淋巴结肿大。结论 肺淋巴瘤影像表现多样,结节或肿块型的病灶边缘棉絮状或其周围呈磨玻璃样,多合并肺内斑片、肺间质变。但最终诊断依靠病理。     

Right paratracheal air cysts in the thoracic inlet: clinical and radiologic significance.

OBJECTIVE: The purpose of our study was to determine the CT appearance and clinical significance of a right paratracheal air cyst at the level of the thoracic inlet. MATERIALS AND METHODS: Sixty-five consecutive patients with paratracheal air cysts were included in this study. The location, level, size, and shape of the paratracheal air cysts on CT were analyzed. The spirometric data, tracheal indexes, and CT-determined emphysema scores of these patients were compared with those of 60 consecutive patients in a control group. RESULTS: The air cysts were located at the right posterolateral aspect of the trachea in 64 (98%) of 65 patients and at T1-T2 vertebral levels in 57 (88%) of 65 patients. The mean diameter of the right paratracheal cysts was 10 mm in the axial plane and 14 mm in the vertical plane. CT showed a communicating channel with the trachea in five patients. The ratio of forced expiratory volume obtained in 1 sec to forced vital capacity, and forced expiratory flow between 25% and 75% of vital capacity in patients with paratracheal air cysts, were significantly lower than those of the control group (p < .05). Differences in the tracheal indexes and CT-determined emphysema scores between the study group and the control group were found to be statistically significant (p = .001). CONCLUSION: The most probable nature of a right paratracheal cyst in the thoracic inlet is tracheal diverticulum with a narrow stalk. The presence of a right paratracheal air cyst on CT could be a sign of obstructive lung disease clinically and of the presence of emphysema radiologically.     

原发性气管支气管淀粉样变的MSCT诊断

目的：探讨原发性气管支气管淀粉样变的 MSCT 表现。方法：搜集本院经病理证实的5例原发性气管支气管淀粉样变性的影像资料，对病变气管支气管壁厚度、密度、管腔形态及病变范围进行回顾性分析。结果：弥漫型4例，受累气管支气管壁环形增厚，呈连续性分布，管壁厚度3～6mm，其中气管至3级支气管2例，气管至4级支气管2例。2例气道壁呈片状及环状钙化，以支气管明显，2例为局灶性小钙化。局限型1例，表现为右侧中间段支气管管壁增厚，管腔狭窄，气道壁未见明显钙化，患侧肺门淋巴结肿大并伴有蛋壳样钙化。气道内膜凹凸不平4例，1例尚光滑。5例管腔均出现不同程度狭窄，1例2级支气管闭塞伴肺不张，1例气管至2级支气管狭窄，3～5级支气管管腔相对扩大，继发感染。结论：原发性气管支气管淀粉样变性 MSCT 主要表现为气道壁结节样增厚，局灶性或弥漫性分布，伴或不伴有钙化，气管壁后部可以受累。     

多层螺旋CT气管三维重组的临床应用

目的:评价多层螺旋CT(MSCT)气管三维重组的临床应用。方法:采用4层螺旋CT对145例经手术和/或病理证实的气管病变行准直1mm,螺距1.75,球管旋转0.5s/r的螺旋高分辨力扫描,高滤过算法重建,间隔0.6mm。中小气管病变加做视野为20cm的靶扫描,准直0.5mm,重建间隔0.1~0.3mm。在工作站上用种子技术行支气管表面遮盖显示(SSD)重组。结果:气管病变9例,表现为气管局限性、不规则缺损或偏心性狭窄。中央支气管病变64例,其中肺癌58例,表现为多种类型的支气管中断,或不同程度、形态的支气管狭窄;内膜结核3例、慢性炎症2例、纤维上皮性息肉1例。周围支气管病变70例,其中肺癌44例,表现为支气管到达肿块边缘截断、进入肿块后锥状中断或支气管在肿块内轻度扩张;支气管扩张10例,表现为多支支气管分支呈杵状扩张;炎性假瘤5例,见支气管在肿块内呈正常形态或断续开放状;结核球4例,见支气管在肿块边缘截断;良性肿瘤7例,见紧邻肿块的支气管呈偏侧光滑弧形狭窄或闭塞。弥漫性淀粉样变2例,表现为气管、支气管多处不同程度狭窄。结论:采用0.5~1.0mm准直的高分辨力MSCT扫描后行SSD重组能立体直观地显示病变支气管的部位、形态、范围和程度,提高细微病变的发现率,加深对病变的全面和整体理解。     

Tracheal and main bronchial diverticula: the role of CT

PURPOSE: This paper describes an asymptomatic and rarely diagnosed entity without a clear correlation with respiratory disease identified in 1%-2% of cases at spiral computed tomography (CT). MATERIALS AND METHODS: We retrospectively reviewed the CT features of air collections contiguous to the tracheal or main bronchial wall and communicating with the airway in 16 patients undergoing CT for other reasons. Four patients were also studied by virtual bronchoscopy and three by actual bronchoscopy. RESULTS: Thirteen of the 16 patients had a single diverticulum, whereas the remaining three had multiple diverticula. Only one patient had a bronchial diverticulum. The most frequent site was the right posterolateral wall of the trachea at the level of the second or third thoracic vertebral body. In 2/3 of patients, chronic obstructive pulmonary disease was not documented. CONCLUSIONS: CT was the most effective method for evaluating the presence and features of diverticula. A correlation between tracheobronchial diverticula and chronic respiratory disease was documented in 5/16 patients, whereas no respiratory disorder was identified in the remaining 11. Although chronic inflammatory tracheobronchial changes and increased endoluminal pressure may be important causes, we hypothesise that other, as yet unknown, aetiopathological factors could exist.     

胸部体检人群气管憩室变化的MSCT随访观察

目的:随访观察胸部体检人群气管憩室(TD)的MSCT表现变化,探讨其机制及意义。方法:搜集行胸部CT健康体检及MSCT随访复查的78例TD患者,对比观察憩室大小、分隔、憩室气管间隔(DTS)、憩室气管间气瘘管(AFDT)、气管指数(TI)及肺大泡改变。结果:TD位于气管右侧75例,左侧3例。随访复查显示TD体积增大者明显多于TD体积缩小者(χ^2值=4.51,P<0.05);首次检查和随访复查中,TD体积增大组与缩小组间的TD体积比较差异均有统计学意义(t值分别为4.35、5.72,P<0.05)。24例出现分隔,6例增粗,3例变细,11例变形。41例DTS宽度、长短或弯弧形态发生变化;首次检查和随访复查中,DTS宽度增大组与缩小组间的DTS宽度比较差异均有统计学意义(t值分别为4.23、4.87,P<0.05)。29例(37.18%)显示AFDT,复查消失9例,再现5例,走向变化17例。AFDT倾斜角随访变化量矢状面明显大于横轴面(t=6.35,P<0.05)。32例CTVE显示内口,最多者5个,随访消失3个,增多5个。44例TI比值增大患者中,31例TD增大,28例DTS变薄,32例AFDT形态走向发生变化,5例TD伴感染表现,6例新出现肺大泡。结论:TD形态和结构随访均可发生变化,关注TD变化有助于协同评估肺功能变化,对临床具有一定指导价值。     

多层螺旋CT诊断小儿支气管异物的临床应用

目的评价多层螺旋cT在诊断小儿支气管异物方面的临床价值。方法回顾性总结经支气管镜检查确诊为支气管异物的40例患儿资料。所有患者均行64层螺旋cT检查,图像后处理用多平面重建（MPR）、曲面重建（CPR）、最小密度投影（MIP）、容积再现（vR）等技术。结果异物位于气管及气管分叉7例,右侧支气管14例,左侧支气管10例,气管一左主支气管2例;坚果类异物16例,豆类4例,玉米3例,果蔬类4例,骨块5例,其他8例。间接伴随征象：肺气肿3例、肺不张1例、肺炎5例、纵隔气肿1例、皮下气肿1例、气胸1例、胸腔积液1例。结论多层螺旋cT诊断小儿支气管异物无创、准确性较高,有很高的实用价值。     

多層螺旋CT對十二指腸乳頭旁憩室的診斷價值及臨床意義

目的:探討多層螺旋CT(MSCT)對十二指腸乳頭旁憩室的診斷價值。方法:對經MSCT和上消化道鋇餐(GI)檢查確診的60例十二指腸憩室患者的臨床和影像資料進行回顧性分析。結果:60例患者共發現十二指腸憩室73個,其中乳頭旁憩室58個。73個憩室中,直徑小于10 mm者11個,10~20 mm者38個,大于20 mm者24個。十二指腸乳頭旁憩室表現為十二指腸腔外的囊狀突出,可呈液性囊狀影、液-氣囊狀影及氣囊狀影等,大部分位于十二指腸與胰頭之間。MSCT能發現小于10 mm的憩室。結論:MSCT能同時發現十二指腸乳頭旁憩室及其伴發的膽胰疾病,對判斷兩者的關系具有較重要的臨床價值。影像科醫師應重視對十二指腸乳頭旁憩室的診斷。     

气管支气管破裂的CT诊断

目的:探讨CT对气管支气管破裂的诊断价值水平。方法:回顾性分析22例气管支气管破裂患者的临床、胸片及CT影像资料,其中外伤性12例,自发性10例。结果:X线片诊断颈肩部皮下及纵隔气肿3例,可疑纵隔气肿8例,气胸4例,胸腔积液2例,肋骨骨折2例,均未能提示气管支气管破裂。CT诊断颈肩部皮下及纵隔气肿18例,气胸6例,胸腔积血4例,肋骨骨折2例,肺挫伤4例,肺气囊1例;CT发现气管或支气管破裂22例(23处);支气管破裂口宽1～3mm,气管破裂口宽1～12mm,涉及管腔周径均<50%,其中2例气管裂口纵径分别为28和40mm。破裂部位位于气管5例,其中外伤性2例,自发性3例;位于右主支气管8例(9处),位于右上叶后段支气管4例,位于左主支气管5例。10例外伤性支气管破裂均发生在右侧,自发性支气管破裂5例发生在左侧,2例发生在右侧;主支气管破裂均在隆突附近1.0～2.5cm范围内。结论:胸部CT对气管支气管破裂的定位明显优于胸片,对明确诊断有重要价值。     

Size and morphology of the trachea before and after lung volume reduction surgery

OBJECTIVE: The purpose of this investigation was to determine the effect of lung volume reduction surgery on measured tracheal features. MATERIALS AND METHODS: Twenty-four male and 19 female patients with emphysema underwent lung volume reduction surgery, pulmonary function testing, and repeated CT. The tracheal air column was segmented from axial images. The sagittal and coronal dimensions of the intrathoracic trachea were determined. Tracheal morphology was quantified using the tracheal (coronal and sagittal dimensions) and circularity indexes. The results were compared with pulmonary function test results. RESULTS: Morphologic appearance of the intrathoracic trachea was consistent before and 3 months after surgery. The group means of the tracheal length, mean area, and volume were 78.60 mm (+/- 16.88 mm), 283.84 mm(2) (+/- 61.47 mm(2)), and 22.59 cm(3) (+/- 7.69 cm(3)), respectively, before surgery and 67.53 mm (+/- 15.78 mm), 309.12 mm(2) (+/- 79.83 mm(2)), and 20.99 cm(3) (+/- 7.27 cm(3)), respectively, after surgery (p < 0.05). Mean tracheal indexes were 0.85 (+/- 0.11) before surgery and 0.82 (+/- 0.04) after surgery (p < 0.01). Mean circularity indexes were 0.91 (+/- 0.03) before surgery and 0.90 (+/- 0.04) after surgery (p < 0.05). The size of the trachea was significantly correlated with lung volume before and after surgery (p < 0.05). The changes in tracheal features and changes in pulmonary function were not correlated (p > 0.05), except for tracheal area (p < 0.05). CONCLUSION: Our data suggest that tracheal dimensions reflect the severity of emphysema as reflected by increased lung volumes. Tracheal features were poor predictors of changes in postsurgical pulmonary function parameters evaluated in this preliminary study.