CT多平面重组显示镫骨的方法及应用价值

目的探讨利用螺旋CT多平面重组(mu ltip lanar reform ation,MPR)技术显示镫骨整体结构的方法和临床价值。方法对50例无耳症状、体征的志愿者行平行枕眶线扫描,应用轴位图像行多方位的MPR。比较轴位MPR、冠状位MPR、矢状位MPR和镫骨斜位MPR显示镫骨整体结构的差异。测量镫骨斜位图像显示层面在轴位定位图像上与矢状面的夹角,在冠状位定位图像上与矢状面的夹角。先天性镫骨异常31例,全部病例经电测听检查均表现有不同程度的传音性耳聋,均行听骨链重建术。结果正常组轴位、冠状位、矢状位均未能显示镫骨弓的整体形态,镫骨斜位MPR图像均直观显示了镫骨弓的整体形态和结构。在轴位定位图像上,镫骨斜位MPR图像显示层面与矢状面的夹角为36°±8°,在冠状位定位图像上与矢状面的夹角为57°±6°。异常组31例,其中一侧小腿缺如3例;镫骨弓不发育3例;镫骨底板增厚与周围骨融合16例;镫骨底板上结构(小头、颈、小腿)完全缺如9例,斜位MPR图像均直观显示其病理改变,轴位、冠状位以及矢状位图像均不能准确显示镫骨发育不良的病理改变。结论镫骨斜位MPR图像,能显示正常镫骨整体结构和镫骨异常改变,对听骨链重建术的术前评价具有重要意义。     

CT多平面重组在镫骨病变诊断中的价值

目的：探讨Cr多平面重组(multi-plier reformation，MPR)在显示镫骨病变中的价值。方法：对106例(148耳)镫骨异常者行平行枕眶线扫描，应用轴位图像行多方位螺旋CT多平面重组。行听骨链重建术60例(66耳)，术中观察镫骨的形态、结构和破坏情况，并与MPRCT图像对照。结果：慢性中耳炎合并镫骨破坏71例(100耳)；先天性镫骨异常35例(48耳)，其中砧、镫骨分离6例(8耳)，镫骨头及足弓完全缺如10例(14耳)，镫骨足弓不完整、一侧足弓缺如4例(5耳)，镫骨板增厚与周围骨融合15例(21耳)。与术中所见比较，镫骨斜位MPR图像显示镫骨形态、结构异常的符合率为95．45％。结论：冠状位和镫骨斜位MPR显示镫骨足弓的形态和结构以及了解镫骨的破坏情况有重要价值，可准确做出镫骨病变的CT诊断。     

多层螺旋CT三维重组与轴位骨窗诊断颅骨骨折的价值

目的 比较多层螺旋CT(multi-slice computed tomography,MSCT)三维重组与轴位骨窗诊断颅骨骨折的价值.资料与方法 2009年5月至10月本院连续性颅脑外伤病例500例,颅脑CT扫描资料薄层重组后行容积再现(volume rendering,VR)、最大密度投影(maximum intensity projection,MIP)重组,盲法评估轴位骨窗、VR及MIP三维重组图像检出骨折的情况.结果 轴位骨窗、VR、MIP平均检出骨折例数分别为53例(10.60%,53/500),73例(14.60%,73/500),87例(17.40%,87/500),其中粉碎性骨折10例(2.00%,10/500),三种方法均可检出,三者检出骨折条数分别为86、139、210条(粉碎性骨折除外,不计其数量),无论是例数还是条数,轴位骨窗与MIP有统计学差异(P<0.05),而VR与MIP无统计学差异(P>0.05).与MIP相比轴位骨窗漏诊骨折34例(39.08%,34/87),124条(59.05%,124/210).MIP检出颅缝分离21例(4.2%,21/500),轴位骨窗检出2例,VR检出1例.结论 MSCT扫描MIP重组对颅骨骨折检出率高,轴位骨窗对颅骨骨折漏诊率高,VR重组显示颅骨解剖结构有优势,MSCT三维重组可作为颅骨骨折诊断的常规技术.     

多层螺旋CT对慢性化脓性中耳炎的诊断价值

目的 探讨多层螺旋CT及其图像后处理技术对慢性化脓性中耳炎(CSOM)诊断分型及临床治疗的价值.方法 对75例90耳CSOM病人行HRCT薄层扫描,将横断面图像、MPR图像(冠状位和矢状位)相结合,进行CSOM诊断分型,然后与临床诊断及手术病理结果进行对照分析.结果 经MSCT诊断的CSOM为单纯型14耳,肉芽肿型40耳,胆脂瘤型36耳,临床及手术诊断结果的分型分别为12耳、44耳、34耳,MSCT与临床手术分型准确率分别为97.8%、95.6%、97.8%,3型的灵敏度分别为100%,90.9%,100%.单纯型CSOM无骨质破坏;胆脂瘤型CSOM听骨链及中耳骨壁破坏较肉芽肿型范围广且程度重.轴位HRCT、MPR(冠状位和矢状位)图像对CSOM诊断分型能力基本相同,但对中耳细微解剖结构及病变的优显率有一定差异.结论 MSCT多种图像相结合有助于对CSOM的诊断分型及解剖变异、耳源性颅内外并发症的检出,对临床治疗方案的制订和手术入路方式的选择有重要意义.     

多层螺旋CT在诊断宫内节育器异位的应用

目的 探讨多层螺旋CT (multi-slice spiral CT,MSCT) 在诊断宫内节育器异位的应用价值.方法 回顾分析手术证实的宫内节育器异位33例的MSCT检查的原始资料,将轴位图像结合多平面重组技术(MPR)对宫内节育器异位的诊断及明确异位的宫内节育器与周围组织脏器关系的诊断能力进行分析.结果 33例经手术证实的宫内节育器异位,利用MSCT、MPR及CT肾盂造影多方位观察均能做出正确诊断.结论 MSCT对诊断宫内节育器异位具有较高临床应用价值.     

256层HRCT及重建技术在听骨链损伤术前评估中的应用

目的 探讨256层高分辨率CT(HRCT)及重建技术在听骨链损伤术前评估中的临床应用价值.方法 对106例颞骨外伤患者进行256层HRCT轴位扫描,收集其中听骨链损伤患者38例.用Philips工作站,行颞骨多平面重建(MPR)、听骨链的曲面重建(CPR)、3D容积再现(3D VR)观察分析听骨链损伤位置、类型及其相邻结构受累的情况,并进行随访.计算原始轴位(AX)、MPR、CPR、3D VR的显示率.结果 106例颞骨外伤患者中,38例(76耳)听骨链损伤,听小骨脱位43耳,其中锤砧关节脱位22耳,锤砧并砧镫关节脱位6耳,砧镫关节脱位3耳,听小骨转位11耳,镫骨前庭脱位1耳;听小骨骨折4耳,其中锤骨骨折2耳,砧骨骨折1耳,镫骨骨折1耳.38例听骨链损伤患者中11例行手术治疗,术后结果与影像诊断结果一致.AX、MPR、CPR、3D VR的显示率分别为97.87％、100％、97.87％、82.98％.结论 256层HRCT及重建技术能清晰显示听骨链损伤的情况,是术前评估的可靠方法.     

MSCT图像重组技术在眼眶上、下裂骨折的应用价值

目的探讨多层螺旋CT(MSCT)图像重组技术在眼眶上、下裂外伤诊断中的临床应用价值。方法对临床初诊有眼眶外伤患者470例行MSCT常规轴位扫描,获取容积描数据后,在图像后处理工作站进行MPR、VRT重组,对各种重组结果进行回顾性对比分析。结果 MSCT骨折直接征象为骨皮质不连续、碎骨片移位,间接征象为鼻窦粘膜增厚共计41例,粘膜血肿征共计11例、鼻窦积血积液59例,眶下裂泪滴征24例及小空泡征2例。在98例眶上裂骨折中,轴位、轴位+MPR、轴位+VRT重建技术对骨折的显示率分别为86.7%、100%、97.9%,(Χ~2值/P值轴位*轴位+MPR-13.923/0.000、Χ~2值/P~(值轴位*轴位+VRT)-8.735/0.003),差异有统计学价值。在59例眶下裂骨折中,轴位、轴位+MPR、轴位+VRT重建技术对骨折的显示率分别为81.4%、100%、94.9%,(Χ~2值/P值轴位*轴位+MPR-12.131/0.000、Χ~2值/P~(值轴位*轴位+VRT)-5.187/0.023),差异有统计学价值。结论多层螺旋CT轴位结合MPR、VR重建图像能辨析解剖形态,准确显示眶上裂、眶下裂骨折的分型、范围、程度,轴位+MPR显示率最高,多种重建技术能为临床诊断和治疗提供可靠的影像诊断依据。     

多层螺旋CT及后处理技术在机械性小肠梗阻诊断中的应用

目的 探讨MSCT检查及其后处理技术在机械性小肠梗阻诊断方面的价值.方法 回顾性分析30例经临床手术病理证实的机械性小肠梗阻患者资料,所有病例均行MSCT平扫及增强检查.分别依据平扫图像、增强图像、增强图像联合后处理图像对是否梗阻、梗阻部位、病因及是否合并肠缺血进行分析,并对梗阻部位的诊断信心评分(分3级)及显示病变的直观性评分(分3级).结果 MSCT增强检查较单纯平扫可以提高梗阻病因的诊断正确率(93.9%、80.0% vs 76.7%,P<0.05);增强轴位图像联合后处理图像明确梗阻部位的信心指数明显较高(P<0.05),同时后处理图像显示病变的直观性等级指数也较轴位图像 高(P<0.05),使病变部位显示更加清晰、直观.结论 增强MSCT检查及其后处理的应用在明确机械性小肠梗阻的部位、病因方面有重要的临床价值.     

SCT对慢性化脓性中耳炎诊断分型价值的研究

目的　探讨螺旋CT检查在慢性化脓性中耳炎诊断分型及治疗中的价值。方法　对 65例 79耳慢性化脓性中耳炎行螺旋CT检查 ,将轴位HRCT、冠状位MPR及听骨链 3D重建图像与手术结果对比分析。结果　轴位HRCT、冠状位MPR图像对慢性化脓性中耳炎诊断分型能力基本相同 ,但对中耳细微结构的显示有一定差异。 3DCT对锤、砧骨破坏的显示能力优于轴位HRCT及冠状位MPR图像 ,对蹬骨细微结构的显示则较后两者差 ,3DCT不能单独用于中耳炎的诊断分型 ,需与 2DCT图像结合 ,三者结合对中耳炎诊断分型与手术结果比较符合率高 (89.9%～ 97.5 % ) ,误诊率 (2 .9%～ 6.0 % )及漏诊率 (0～ 14 .6% )低。结论　螺旋CT 3种图像相结合有助于慢性化脓性中耳炎诊断分型及手术方案的制定。     

获得性钻镫关节分离的CT诊断

作者研究了15例经手术证实的因炎症或外伤所致钻镫骨关节后天性分离病例的CT检查。临床主要表现为传导性听觉障碍。15例中炎症性10例,外伤性5例。每例均作与OM线呈-10度的轴位与冠状位扫捕,层厚1.5mm,每次进床1mm行重叠扫描,必要时再补充另外的轴位层面。15例钻镫关节均可于轴位层面上显示,但冠状层面不能显示。13例开始即作出分离的诊断,2例回顾时作出。钻骨分体部、长突与短突。钻骨长突在鼓室内呈直角形成豆状突起,与镫骨小头形成钻镫关节,覆盖有关     

多层螺旋CTMPR技术对镫骨结构的显示及相关数据测量

目的用MPR技术重组镫骨斜位图像，观察该层面对镫骨结构的显示状况并进行相关数据测量。方法收集因搏动性耳鸣、眩晕等需行颞骨多层螺旋CT扫描的患者50例（100耳），利用CT多平面重组技术重建出镫骨斜位图像，观察该层面对镫骨显示状况，测量镫骨高度、镫骨闭孔纵径及横径、砧镫间夹角，观察镫骨前后脚粗细、镫骨闭孔的形态及镫骨小头；将测量结果采用SPSSl3．0统计软件分析数据，比较不同侧别间的测量值，并与文献中相关标本测量值进行比较。结果①100耳镫骨斜位图像上均可显示镫骨各结构，显示率为100％；②相关测量值：镫骨高度：左侧（3．31±0．22）cm、右侧（3．34±0．27）cm；镫骨闭孔纵径：左侧（1．73±0．29）cm、右侧（1．70±0．23）cm；镫骨闭孔横径：左侧（1．544±0．30）cm、右侧（1．58±0．26）cm；砧镫间角度：左侧（84．18±13．38）°、右侧（82．79±13．24）。；镫骨闭孔形态：三角形41耳（41％，41／100）、半圆形19耳（19％，19／lOO）、圆形及不规则形分别10耳（10％，lO／lOO）、卵圆形8耳（8％，8／lOO）、梯形及长方形各4耳（4％，4／100）、方形及半卵圆形各2耳（2％，2／100）；镫骨前后脚粗细：镫骨后脚粗于前脚者77耳（77％，77／100）、前脚粗于后脚者5耳（5％，5／100）、前后脚等粗者18耳（18％，18／100）；镫骨小头：镫骨小头向前脚倾斜者37耳（37％，37／100）、倾向后脚者13耳（13％，13／100）、正中位者50耳（50％，50／100）。左右侧镫骨高度、镫骨闭孔纵径及横径及砧镫间角度测量结果，差异无统计学意义（P〉0．05）。镫骨高度、镫骨闭孔纵径及横径测量结果与文献中相关标本上所得结果比较，差异均无统计学意义（P〉0．05）；砧镫问夹角测量结果不一致。结论镫骨斜位图像可准确、全面显示镫骨结构及形态，有利于镫骨各结构的显示。     

Current multiplanar imaging of the stapes

PURPOSE: CT analysis of the stapes is difficult in the axial plane (AP), because of its oblique orientation. Oblique axial reformations could provide a more precise analysis of the stapes in normal and pathologic conditions. MATERIALS AND METHODS: CT of the temporal bone was performed in 31 patients. Only the normal side was examined in the AP and oblique axial plane (OAP), in the plane of the stapes superstructure. Conspicuousness of each stapes component was evaluated in both planes by 2 independent readers. Reproducibility between the 2 readers (R1 and R2) and comparison of conspicuousness between the AP and the OAP in the analysis of the stapes crura were evaluated. The normal position of the stapes arch in relationship to the footplate was determined in the OAP by using biometric landmarks. RESULTS: Conspicuousness of the stapes crura was increased by using OAP. The conspicuousness of the anterior crus was enhanced in 38% with the OAP according to R1 (P < .05) and 32% according to R2 (P < .05). The conspicuousness of the posterior crus was enhanced in 35% with the OAP according to R1 (P < .05), but not significantly enhanced in 22% with the OAP according to R2 (P = .095). Analysis of conspicuousness of the stapes crura was reproducible according to the kappa test. A perpendicular line to the footplate intersecting its midportion crosses the stapes head and the long process of the incus in the OAP in normal patients. CONCLUSION: OAP could enhance the CT analysis of the stapes and provide useful biometric landmarks in pathologic conditions.     

Additional coronal images using low-milliamperage multidetector-row computed tomography: effectiveness in the diagnosis of bronchiectasis

PURPOSE: The aim of our study was to evaluate the effectiveness of additional coronal images using low-milliamperage multidetector-row computed tomography (CT) in the diagnosis of bronchiectasis. METHODS: Helical volumetric CT scans (120 kVp, 70 mA, 2.5-mm collimation, table speed of 15 mm/s, table rotation time of 1 second) using low-milliamperage multidetector-row CT were obtained through the thorax in 110 patients who were suspected of bronchiectasis. Both axial (2.5-mm section thickness) and coronal (1.3-2.0-mm section thickness) reformatted images were made and sent to picture archiving and communication system (PACS) monitors. Two independent observers assessed CT scans twice; with axial images only and with both axial and coronal images. The detection rates of bronchiectasis were compared between readings with axial images only and with both axial and coronal images by using a nonparametric method of clustered data. Confidence grades were given to the distribution and type of bronchiectasis. RESULTS: With axial images only, the detection rates of bronchiectasis on a per-patient basis were 97% (213/220 patients, kappa = 0.888) whereas with both axial and coronal images, the detection rates were 100% (220/220 patients, kappa = 1.000) (P = 0.0001). Confidence to the distribution of bronchiectasis was greater with both axial and coronal images than with axial images only (P = 0.008). CONCLUSIONS: Additional coronal images using low-milliamperage multidetector-row CT are effective in the diagnosis of bronchiectasis by providing enhanced detection rates and confidence to the distribution of lesions.     

MSCT及MRI对肝门胆管癌可切除性评价的对照研究

目的探讨多层螺旋CT(MSCT)及MRI对肝门胆管癌(hepatic hilum cholangiocarcinoma,HHC)的分型诊断与可切除性评价的价值。资料与方法搜集经手术病理证实且术前MSCT及MRI均定性诊断为HHC的患者25例,对MSCT轴位图像、多平面重组(MPR)、曲面重组(CPR)及MRI轴位、冠状位图像、磁共振胰胆管成像(MRCP)进行分析,分别评价肿瘤病灶的Bismuth-Corlette分型,并与术中结果进行对照分析。采用配对计数资料的卡方检验比较MSCT及MRI对HHC分型及可切除性评价的情况。结果25例中,Ⅰ型、Ⅱ型、Ⅲa型、Ⅲb型和Ⅳ型分别为2、4、3、9和7例;12例行根治性切除术,其中Ⅰ型、Ⅱ型、Ⅲa型、Ⅲb型和Ⅳ型分别为2、3、1、5和1例。MSCT评价肿瘤病灶的Bismuth-Corlette分型诊断准确性达84%(21/25),MRI诊断准确性达88%(22/25),两种方法的分型结果对照,差异无统计学意义(χ2=0.00,P>0.05)。MSCT及MRI对肿瘤术前可切除性评价与术中评价一致率均为80%(20/25),两种方法对照结果差异无统计学意义(χ2=0.50,...     

Temporal bone: comparison of isotropic helical CT and conventional direct axial and coronal CT.

OBJECTIVE: The objective of the study was to compare helical CT (with reformation of coronal images from the axial data set) with conventional direct axial and coronal CT of the temporal bones. SUBJECTS AND METHODS: Nineteen patients underwent both conventional 1-mm direct axial and coronal CT and helical 0.5-mm axial CT. The helical data set was reconstructed at 0.2-mm increments, and axial and coronal images were reconstructed in a plane similar to that of the conventional study, with a slice width of 0.5 mm and 0.5-mm increments. Forty small structures were evaluated independently by three observers, who were unaware of the method of imaging. Observers graded the 40 structures using a modified Likert scale. The graded differences between the two techniques were evaluated using a paired t test. Correlation between observers' gradings was evaluated using analysis of variance. RESULTS: The helical CT technique scored significantly higher than the conventional technique for many individual structures and groups of structures (scutum [p = .041], stapes footplate [p = .006], stapes crura [p = .004], oval window [p = .026], crista falciformis [p = .006], whole temporal bone [P = .012], middle ear [p = .033], inner ear [p = .021], ossicles [p = .044], and stapes [p = .010]). The correlation coefficient among observers was .91 for the whole temporal bone. CONCLUSION: Helical CT using 0.5-mm technique and reconstruction produces diagnostic images comparable with or superior to conventional 1-mm technique because helical CT can obtain thinner slices.     

多向调整多平面重组在听小骨显示中的作用评价

目的探讨多向调整多平面重组（MPR）技术全程显示听小骨及其关节的方位和方法。方法对50侧正常中耳行高分辨率CT各向同性扫描后再行多向调整MPR后处理，确定听小骨同层全程显示的基础显示方位、重组基线旋转中心点和旋转方向的定向解剖标志，测量重组基线旋转角度，对听小骨在轴面、冠状面、矢状面及多向调整MPR全程显示位4种方位上的全程显示程度进行分级，做Ridit分析和x^2检验。结果多向调整MPR锤骨、砧骨、镫骨的同层全程显示率均为100％（50侧中耳），多向调整MPR对于听小骨全程显示率明显高于轴面（镫骨6侧、锤骨0侧、砧骨0侧）、冠状面（锤骨3侧、镫骨0侧、砧骨0侧）、矢状面（锤骨0侧、砧骨0侧、镫骨0侧），差异有统计学意义（P〈0．01）。结论（1）各向同性扫描基础上的多向调整MPR技术提供了具有诊断意义的听小骨全程显示方法，具有重要临床应用价值。（2）只需1次扫描多次MPR后处理，就可取代多次多方位扫描，是听小骨多方位整体观察的必要途径之一。     

MR evaluation of Chiari I malformations at 0.15 T

Twelve patients with known or presumed Chiari I malformations and two with clinical diagnoses of multiple sclerosis were examined by magnetic resonance (MR) imaging. MR confirmed or established the diagnosis of Chiari I malformation in all 14 cases. The spin-echo technique with a short time to echo (TE = 40 msec) and a short time to recover (TR = 1000 msec) provided optimum imaging of tonsillar position, hydromyelia cavities, and cervicomedullary "kinking." Long TE (greater than 80 msec) and TR (greater than 2000 msec) increase the signal intensity of cerebrospinal fluid and may obscure the pathology. Sagittal, transaxial, and coronal images provided complementary data; sagittal and coronal views best imaged the abnormal spinal cord and tonsils, but slitlike cavities were best seen on transaxial images. Cervicomedullary kinking was found in 10 (71%) of 14 patients and in 90% of the hydromyelic patients. This high incidence suggests that in other radiologic techniques tonsillar herniation masks the kinking. Symptoms of the Chiari I malformation overlap those of demyelinating diseases and brain tumors. Our early experience suggests MR is the preferred noninvasive procedure for identifying Chiari I malformation. Moreover, the ability to portray the variable cavity morphology of hydromyelia directly offers the potential for improved shunt placement.     

慢性额窦炎额窦引流系统CT解剖特征及临床价值

目的 探讨慢性额窦炎额窦引流系统CT解剖特征及临床价值。方法 对50例慢性鼻窦炎患者应用螺旋CT作横断面扫描，然后经工作站作冠状和矢状面三维重建。结果 螺旋CT三维成像技术能清楚地显示钩突附着部位和类型，在：100侧钩突中，附着纸样板41侧(41％)、鼻丘后壁11侧(11％)、中鼻甲19侧(19％)、前颅底16侧(16％)、钩突分叉13侧(13％)。在额隐窝气房98侧中，终未气房28侧(28．6％)、鼻丘气房18侧(18．4％)、前筛气房18侧(18．4％)。额窦内气房98侧中，其中额气房22侧(22．4％)、眶上气房38侧(38．8％)、额窦中隔气房(M气房)16侧(32％)。发现不同类型的解剖变异与慢性炎症的关系。结论 慢性额窦炎额窦引流系统CT解剖特征的显示可为术前提供有价值的信息，对开展鼻内镜外科有重要的临床指导意义。     

多层螺旋CT在腹股沟区解剖中的应用

目的:探讨多层螺旋CT三维重建在腹股沟区解剖的应用.方法:回顾性分析20例行多层螺旋CT腹股沟区扫描的三维重建图像,观察在横断面、冠状面及矢状面上腹股沟韧带、腹壁下动脉、圆韧带或精索的显示情况.结果:20例病例中腹壁下动脉在3个轴面上均能显示,显示率100％.横断面不能很好的显示腹股沟韧带,圆韧带或精索的显示率为70％...