MSCT参数优化和图像质量的相关性研究

目的探讨多层螺旋CT（MSCT）诸扫描参数对图像质量的影响，以进一步提高MSCT图像的质量。方法固定扫描条件，分别对两种不同密度材料的质量控制体模进行扫描。在质量控制体模的左、中、右各选取1个431．43mm2的感兴趣区（ROI），改变其中某个扫描条件（如层厚、电压、曝光量、螺距），对质量控制模各扫描10次，计算CT值（X±SD），并比较各条件下两种质量控制体模的CT值。结果在固定扫描条件下，随曝光量、层厚的增加，CT图像对应各材料的平均CT值变化不明显，而SD明显减小；随着管电压的升高，CT图像对应各材料的平均CT值和SD明显减小；随着螺距的增大，CT图像对应各材料的平均CT值无明显变化，而SD增加较为明显。结论CT图像质量与扫描参数密切相关，并且各扫捕参数之间既相互影响，又相互制约。     

肾结核的影像诊断

目的探讨X线、B超和CT对肾结核的诊断价值。方法对我院2007年1月～2012年1月临床手术病理证实肾结核的28例病历从发生机理及病理基础上进行分析，结合其病理基础讨论。肾结核的X线、B超和CT表现及其鉴别诊断。结果中晚期肾结核病例，不宜做膀胱镜或输尿管插管，诊断不明确，可选CT扫描。多层螺旋CT（MSCT）能清晰地显示病变部位、累及范围、腔内外改变以及肾功能情况，是诊断肾结核的一种很好的影像方法。结论X线、B超和CT对肾结核检查有明显的诊断价值。曲面重建（CPR）对病变的显示及诊断很实用。     

Accuracy of two midsagittal planes in three-dimensional analysis and their measurement in patients with skeletal mandibular deviation: a comparative study

Our aim was to evaluate the accuracy of two midsagittal planes (MSP) to provide a better reference plane for studying the 3-dimensional structural symmetry in patients with skeletal mandibular deviation. Thirty adult patients with facial asymmetry were admitted to the Department of Orthodontics, Hospital of Stomatology, between January 2015 and 2017. The DICOM data were collected and reconstructed using ProPlan CMF^® 2.0 (Materialise). Two sets of reference planes were set up. In the orbital margin plane group, the plane crossing the nasion (N) point and perpendicular to the frontozygomatic (FZ) suture line was used as the MSP. In the skull base plane group, the MSP was established using the sella turcica (S), N, and basion (Ba). The distances from the craniofacial skeletal and soft tissue midline landmarks to the two MSP were separately measured, and the significance of differences between measurements corresponding to two reference planes were assessed using the paired t test. Except for the posterior nasal spine (PNS)-MSP, the distances from other soft and hard tissue landmarks to the MSP in the orbital margin plane group were significantly shorter than those in the skull base plane group. In the 3-dimensional measurement analysis, the skeletal and soft tissue anatomical midline landmarks were closer to the MSP in the orbital margin plane group. The MSP crossing point N, perpendicular to the FZ suture line, was more accurate and suitable.     

Amygdala hypersensitivity in response to emotional faces in Tourette's patients

Abstract

Objectives. Tourette's syndrome is characterised by motor and vocal tics as well as a high level of impulsivity and emotional dysregulation. Neuroimaging studies point to structural changes of the basal ganglia, prefrontal cortex and parts of the limbic system. However, there is no link between behavioural symptoms and the structural changes in the amygdala. One aspect of daily social interaction is the perception of emotional facial expressions, closely linked to amgydala function. Methods. We therefore investigated via fMRI the implicit discrimination of six emotional facial expressions in 19 adult Tourette's patients. Results. In comparison to healthy control group, Tourette's patients showed significantly higher amygdala activation, especially pronounced for fearful, angry and neutral expressions. The BOLD-activity of the left amygdala correlated negatively with the personality trait extraversion. Conclusions. We will discuss these findings as a result of either deficient frontal inhibition due to structural changes or a desynchronization in the interaction of the cortico-striato-thalamo-cortical network within structures of the limbic system. Our data show an altered pattern of implicit emotion discrimination and emphasize the need to consider motor and non-motor symptoms in Tourette's syndrome in the choice of both behavioural and pharmacological treatment.     

Intracardiac Eustachian Valve Cyst in an Adult Detected with Other Cardiac Anomalies: Usefulness of Multidetector CT in Diagnosis

We present an unusual case of an intracardiac Eustachian valve cyst observed concurrently with atresia of the coronary sinus ostium, a persistent left superior vena cava (LSVC) and a bicuspid aortic valve. There have been several echocardiographic reports of Eustachian valve cysts; however, there is no report of multidetector computed tomography (MDCT) findings related to a Eustachian valve cyst. Recently, we observed a Eustachian valve cyst diagnosed on MDCT showing a hypodense cyst at the characteristic location of the Eustachian valve (the junction of the right atrium and inferior vena cava). MDCT also demonstrated additional cardiovascular anomalies including atresia of the coronary sinus ostium and a persistent LSVC and bicuspid aortic valve.     

64层螺旋CT在肿瘤调强放射治疗定位中的应用及分析

目的：探讨64层螺旋CT在肿瘤调强放射治疗定位中的临床应用及CT扫描床的误差分析。方法：收集我院2010年6月-2011年6月在TOSHIBA Aquiiion 64层螺旋CT机上进行肿瘤调强放疗定位CT扫描患者25例。其中，男13例，女10例，年龄35—73岁，平均年龄55岁。头颈部肿瘤10例，胸部肿瘤5例，腹部肿瘤6例，盆腔肿瘤4例。CT定位图像经DICOM3．0接口传输到XVI软件中，在Workstation上进行治疗床与定位床的误差分析。结果：组内数据符合统计学意义（P〈0．05），误差值X轴为（0．968±0．910）°，Y轴为（0．508±2．09）°，Z轴为（0．3±2．62）°。除X轴外，旋转误差均不符合国标GB／T17589—1998。结论：64层螺旋CT碳纤维平板床在肿瘤调强放疗定位中误差已超过阈值，不适合做精确调强放射治疗定位。     

Ultrastructure of the normal human organ of Corti. New anatomical findings in surgical specimens

Conclusion A thorough scanning electron microscopy (SEM) investigation of immediately fixed human adult cochleae obtained during surgery for petro-clival meningiomas conveyed new information about morphology.

Objective To investigate the ultrastructure of human adult cochleae using SEM.

Material and methods Two human cochleae were decalcified, fixed with glutaraldehyde and osmium and prepared for SEM.

Results The excellently preserved morphology showed the pathways of nerve fibres through the organ of Corti. Undulating lateral cell membranes of Hensen and Claudius cells created an enlarged surface that may be important for homoeostasis. The distal attachment of the tectorial membrane to the reticular lamina was present in the shape of a marginal net, which was extended through marginal pillars. Stereocilia imprints extended as far as the distal end of the marginal pillars. The presence of an irregularly distributed fourth row of outer hair cells attached to the marginal pillars raises questions about differences in the excitation of the last row of outer hair cells as a result of differences in the composition of the tectorial membrane.     

Effect of deep insertion of the cochlear implant electrode array on pitch estimation and speech perception

Conclusion. Deeply inserted electrodes offer the possibility that apical stimulation may improve speech performances. Therefore, deep insertion is reasonable and should be performed in patients with profound or total hearing loss. Objectives. To evaluate the importance of insertion depth beyond 25 mm in a group of cochlear implant patients with deeply inserted electrodes up to 32 mm. Patients and methods. In the first part of the study patients were asked to perform a pitch estimation for channels across the whole length of the electrode array. We evaluated whether pitch discrimination was possible along the whole cochlea and especially in its apical part. Then, the audiological performances of 10 patients were tested in 5 conditions, in which we artificially varied the insertion depth in each patient by activating and deactivating channels. The patients were tested immediately in the new condition to avoid adaptation. Results. The results showed that activating the electrodes in the uppermost region of the cochlea improves speech perception significantly. Furthermore it could be demonstrated that the pitch perceived in the cochlea with electrical stimulation decreases with increasing insertion depth along the whole length of deeply inserted electrode arrays.     

MDCT在肾盂癌和肾癌鉴别诊断中的价值

目的探讨多层螺旋CT(MDCT)三期增强扫描在肾盂癌和肾癌鉴别诊断中的价值,以期提高术前诊断的准确性。方法回顾性分析经病理证实的11例[男9例,女2例;平均年龄(70.2±11.7)岁]肾盂癌及26例[男21例,女5例;平均年龄(67.3±11.7)岁]肾癌,所有病人术前均行64层螺旋CT平扫及三期增强扫描。分析病人的CT表现,测量并计算病人各期肿瘤/皮质CT比值及肿瘤-皮质CT差值,并采用独立样本t检验比较2组间各期CT参数值的差异。结果肾盂癌病人动脉期及实质期的肿瘤/皮质CT比值均低于肾癌病人(均P0.05),2组病人平扫及排泄期的肿瘤/皮质CT比值差异均无统计学意义(均P0.05)。肾盂癌病人实质期的肿瘤-皮质CT差值低于肾癌病人(P0.05),而2组病人平扫、动脉期及排泄期的肿瘤-皮质CT差值差异无统计学意义(均P0.05)。结论肾盂癌及肾癌的三期增强扫描CT参数存在明显差异。肿瘤/皮质CT比值对两者具有更好的鉴别诊断能力。     

多层螺旋 CT血管造影在原发性肝癌肝动脉－门静脉瘘诊断中的应用

目的 分析多层螺旋CT血管造影(MSCTA)诊断原发性肝癌(PHC)病人肝动脉-门静脉瘘(HAPVF)的价值及影响HAPVF发生危险因素.方法 选择无锡市第五人民医院2017年9月至2019年4月收治的129例PHC病人作为研究对象,根据是否并发HAPVF分为HAPVF组和非HAPVF组.统计PHC病人HAPVF的发生情况,并以DSA检查结果为"金标准",分析MSCTA评估PHC病人HAPVF的准确性,此外分析与HAPVF发生相关的危险因素.结果 129例PHC病人经DSA检查检查共发现40例HAPVF(占31.0％),其中周围型17例(占42.5％),中央型23例(占57.5％);经MSCTA检查37例HAPVF病人获得了正确分型诊断,诊断准确率为92.5％(37/40),与DSA检查结果表现出良好的一致性(Kappa=0.85);单因素分析初步筛选出了4个(肝功能Child-Pugh分级、肿瘤数目、肿瘤最大径、合并肝硬化)与PHC病人并发HAPVF有关的因素;多因素logistic回归分析显示肝功能Child-Pugh分级(OR=10.341,P<0.001)、肿瘤最大径(OR=3.385,P=0.037)、合并肝硬化(OR=4.440,P=0.028)为PHC病人并发HAPVF的危险因素.结论 PHC病人出现HAPVF的发生率高,MACTA可发现HAPVF并对其分型做出正确评估,能用于指导治疗.此外,肝功能Child-Pugh分级、肿瘤最大径、合并肝硬化等均为影响PHC病人并发HAPVF的危险因素.