胰腺导管腺癌CT、MR相关研究进展

胰腺导管腺癌（pancreatic ductal adenocarcinoma，PDAC）是最常见的胰腺恶性肿瘤，其恶性程度高，患者生存率低。CT、MR是PDAC诊断最常用的影像检查，其不仅可以帮助PDAC进行诊断、鉴别，还能通过特殊序列来提供相应功能参数。此外，影像组学可以挖掘更多的影像信息供临床医生分析、预测患者术后生存率。CT、MR对于PDAC临床治疗具有重要的指导意义，故本文对PDAC相关CT、MR进展进行综述。     

磁共振结合高分辨率CT在中耳乳突炎患者术前评估中的临床应用

目的探讨磁共振结合高分辨率CT在中耳乳突炎患者术前评估中的临床应用。方法选取我院2018年11月~2020年12月接收患有中耳乳突炎的患者40例为研究对象,所有患者均采用磁共振以及高分辨率CT进行诊断检查,比较两组患者诊断后手术特征显示度。结果诊断后,磁共振联合高分辨率CT检查图像显示度高于单独使用磁共振或高分辨率CT诊断(P<0.05)。结论使用磁共振结合高分辨率CT对中耳乳突炎患者进行术前评估,显示度较高,提高诊断准确度,值得推广。     

使用棱镜重新定位双侧中心暗点患者视网膜物像的预试验

目的 本研究使用激光扫描检眼镜(SLO)评价双侧中央暗点患者使用棱镜后的眼球运动反应.方法 本预试验共招募6例有双侧中央暗点的年龄相关性黄斑变性(AMD)患者以及6例正常视力的志愿者.首先用Nidek MP-1微视野仪确认患者的中央暗点和优选视网膜注视点(PRL),然后用Rodenstock SLO,在将视标投射在优选视网膜注视点时拍下实时视网膜像,接着在受检者眼前加入6～8 PD的棱镜,要求受检者保持注视视标,这时通过视网膜标记来测量视网膜像的移位量,以及随后发生的优选视网膜注视点的再次注视.过程中平均移位量和再次注视时间通过图像软件(ImageJ software)来计算.结果 实验组再次注视时的移位量在3个像素点或11.66个弧分之内(x轴:2.90±3.92,y轴:2.53±4.18).对照组再次注视时的移位会准确些(x轴:0.33±1.15,y轴:0.89±2.50),但与实验组差异无统计学意义(tx=1.32,Px＞0.05;ty=0.80,Py＞0.05).对照组再次注视时间(0.98±0.19)s较实验组(2.83±1.63)s要短,差距有统计学意义(t=5.03,P＜0.01).其中有1例实验组受检者没有发生再次注视,其结果被排除并单独分析.结论 研究发现,双眼中央暗点患者对棱镜物像转移后的再注视反应与正常人接近,但实验组再注视明显较对照组慢,并有1例受检者没有发生再注视.该数据说明双侧中央暗点患者无论眼前有没有棱镜,都会利用相同的视网膜位置视物,因此,通过棱镜物像再定位的意义不大.     

基于肿瘤影像学异质性分析CT在诊断十二指肠恶性肿瘤的价值

目的 探讨十二指肠肿瘤血流量存在的异质性及容积灌注CT成像对降低肿瘤异质性的影响。方法 纳入我院2013年1月至2014年11月十二指肠结节病例的132例,其中腺癌48例,间质瘤52例,淋巴瘤32例。所有的病例均行单层面灌注CT和容积灌注CT成像扫描,比较两者对十二指肠恶性肿瘤的诊断效能,采用变异系数评价两者在影像学异质性的差异,评价肿瘤影像学异质性对十二指肠恶性肿瘤的影响。结果 容积灌注CT成像与单层面灌注CT诊断恶性结节的效能其敏感性、特异性、准确性、阴性预测值、阳性预测值比较均无明显差别(P0.05);中高分化组及低分化组两个亚组的容积灌注CT成像的变异系数也均小于单层面灌注CT的变异系数,组间相比具有统计学差异(P0.05);血流量差异性的大小相比具有统计学差异(P0.05)。结论 容积灌注CT成像与单层面灌注CT检查在诊断效能上无明显差异,稳定性好,肿瘤影像学异质性对评价十二指肠肿瘤血流量有着一定影响,容积灌注CT成像能够降低肿瘤异质性的影响。     

Manejo y seguimiento radiológico del paciente post-COVID-19

Most of the patients who overcome the SARS-CoV-2 infection do not present complications and do not require a specific follow-up, but a significant proportion (especially those with moderate / severe clinical forms of the disease) require clinicalradiological follow-up. Although there are hardly any references or clinical guidelines regarding the long-term follow-up of post-COVID-19 patients, radiological exams are being performed and monographic surveillance consultations are being set up in most of the hospitals to meet their needs. The purpose of this work is to share our experience in the management of the post-COVID-19 patient in two institutions thathave had a high incidence of COVID-19 and to propose general follow-uprecommendations from a clinical and radiological perspective.     

多层螺旋CT定量评估慢性阻塞性肺疾病病情的价值

目的探讨多层螺旋CT(MSCT)定量评估慢性阻塞性肺疾病病情的价值。方法选取2017年8月～2018年7月在湖州市第一人民医院就诊的73例慢性阻塞性肺疾病(COPD)患者作为研究对象,按照病情轻重分为Ⅰ组(轻度患者17例)、Ⅱ组(中度患者32例)、Ⅲ组(重度患者24例),并选取同期于该院体检的健康者20例为对照组。所有研究对象均行MSCT低剂量扫描,观察比较各组管腔面积(Ai)、支气管壁面积百分比(WA%)、管壁厚度与体表面积比值(T/BSA)、壁厚度与直径比值(TDR),同时予以肺功能检查,采用定量CT气道分析软件分别测量气道相关参数,并用Siemens Pulmo软件Pearson定量分析其相关性。结果对照组、Ⅰ组、Ⅱ组、Ⅲ组的FEV1均呈逐渐下降趋势,FEV1/FVC呈逐渐上升趋势,差异均有统计学意义(P0.05)。对照组、Ⅰ组、Ⅱ组、Ⅲ组的WA%、T/BSA、TDR比较,均呈逐渐上升趋势,Ai呈下降趋势,差异均有统计学意义(P0.05)。FEV1与WA%、TDR之间呈负相关(r=-0.291,P=0.000;r=-0.473,P=0.000),FEV1/FVC与WA%、TDR之间呈正相关(r=0.285,P=0.000;r=0.472,P=0.000)。结论 MSCT扫描及定量分析可为COPD患者气道病变情况提供可靠的评估信息。     

Analysis of radiation exposure data from common radiological procedures in Dutch hospitals

IntroductionIn the Netherlands, Diagnostic Reference Levels (DRLs) have not been based on a national survey as proposed by ICRP. Instead, local exposure data, expert judgment and the international scientific literature were used as sources. This study investigated whether the current DRLs are reasonable for Dutch radiological practice.MethodsA national project was set up, in which radiography students carried out dose measurements in hospitals supervised by medical physicists. The project ran from 2014 to 2017 and dose values were analysed for a trend over time. In the absence of such a trend, the joint yearly data sets were considered a single data set and were analysed together. In this way the national project mimicked a national survey.ResultsFor six out of eleven radiological procedures enough data was collected for further analysis. In the first step of the analysis no trend was found over time for any of these procedures. In the second step the joint analysis lead to suggestions for five new DRL values that are far below the current ones. The new DRLs are based on the 75 percentile values of the distributions of all dose data per procedure.ConclusionThe results show that the current DRLs are too high for five of the six procedures that have been analysed. For the other five procedures more data needs to be collected. Moreover, the mean weights of the patients are higher than expected. This introduces bias when these are not recorded and the mean weight is assumed to be 77 kg.Implications for practiceThe current checking of doses for compliance with the DRLs needs to be changed. Both the procedure (regarding weights) and the values of the DRLs should be updated.     

A novel technique to measure severity of pediatric pectus excavatum using white light scanning.

Background/purpose

Computed tomography (CT) derived Haller Index (HI) remains the standard for quantifying severity in patient with pectus excavatum (PE). Optical scanning described in literature reports optimistic results and new indices that correlate with HI. This study assessed the feasibility of a handheld White Light Scanner (WLS) to obtain 3D measurements and indices of PE deformity.