128层螺旋CT冠状动脉成像在冠心病诊断中的应用价值

目的评价128层螺旋CT(128-SCT)冠状动脉成像在冠心病诊断中的应用价值。方法入选临床诊断为冠心病并行128-SCT冠脉成像检查的患者60例,在128-SCT检查后的4周内行冠状动脉造影(CAG)检查。以CAG检查结果为金标准,以冠状动脉节段为单位,对比分析各节段128-SCT及CAG检查结果,评估128-SCT诊断冠状动脉狭窄程度的准确性,同时计算128-SCT诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值、诊断指数、诊断符合率及Kappa值等统计学指标。结果共评估60例患者的715个冠状动脉节段,对比CAG的结果,128-SCT有664个节段检查结果与CAG相符合,符合率达92.87%。128-SCT诊断冠心病的灵敏度为79.05%,特异度为98.52%,阳性预测值为90.22%,阴性预测值为96.47%,诊断符合率为95.66%,Kappa值为0.818。结论 128-SCT冠状动脉成像检出冠心病准确性较好,可作为诊断与排除冠心病的无创性检查方法。     

Association of Epicardial Adipose Tissue With Progression of Coronary Artery Calcification Is More Pronounced in the Early Phase of Atherosclerosis: Results From the Heinz Nixdorf Recall Study

ObjectivesThis study sought to determine whether epicardial adipose tissue (EAT) volume predicts the progression of coronary artery calcification (CAC) score in the general population.BackgroundEAT predicts coronary events and is suggested to influence the development of atherosclerosis.MethodsWe included 3,367 subjects (mean age 59 ± 8 years; 47% male) from the population-based Heinz Nixdorf Recall study without known coronary artery disease at baseline. CAC was quantified from noncontrast cardiac electron beam computed tomography at baseline and after 5 years. EAT was defined as fat volume inside the pericardial sac and was quantified from axial computed tomography images. Association of EAT volume with CAC progression (log[CAC(follow-up) + 1] − log[CAC(baseline) + 1]) was depicted as percent progression of CAC + 1 per SD of EAT.ResultsSubjects with progression of CAC above the median had higher EAT volume than subjects with less CAC change (101.1 ± 47.1 ml vs. 84.4 ± 43.4 ml; p < 0.0001). In regression analysis, 6.3% (95% confidence interval [CI]: 2.3% to 10.4%; p = 0.0019) of progression of CAC + 1 was attributable to 1 SD of EAT, which persisted after adjustment for risk factors (6.1% [95% CI: 1.2% to 11.2%]; p = 0.014). For subjects with a CAC score of >0 to ≤100, progression of CAC + 1 by 20% (95% CI: 11% to 31%; p < 0.0001) was attributable to 1 SD of EAT. Effect sizes decreased with CAC at baseline, with no relevant link for subjects with a CAC score ≥400 (0.2% [95% CI: −3.5% to 4.2%]; p = 0.9). Likewise, subjects age <55 years at baseline showed the strongest association of EAT with CAC progression (20.6% [95% CI: 9.7% to 32.5%]; p < 0.0001). Interestingly, the effect of EAT on CAC progression was more pronounced in subjects with low body mass index (BMI), and decreased with degree of adiposity (BMI ≤25 kg/m²: 19.8% [95% CI: 9.2% to 31.4%]; p = 0.0001, BMI >40 kg/m²: 0.8% [95% CI: −26.7% to 38.9%]; p = 0.96).ConclusionsEAT is associated with the progression of CAC, especially in young subjects and subjects with low CAC score, suggesting that EAT may promote early atherosclerosis development.     

Tensile Properties and Fracture Behavior of Aluminum Alloy Foam Fabricated from Die Castings without Using Blowing Agent by Friction Stir Processing Route

Al foam has been used in a wide range of applications owing to its light weight, high energy absorption and high sound insulation. One of the promising processes for fabricating Al foam involves the use of a foamable precursor. In this study, ADC12 Al foams with porosities of 67%–78% were fabricated from Al alloy die castings without using a blowing agent by the friction stir processing route. The pore structure and tensile properties of the ADC12 foams were investigated and compared with those of commercially available ALPORAS. From X-ray computed tomography (X-ray CT) observations of the pore structure of ADC12 foams, it was found that they have smaller pores with a narrower distribution than those in ALPORAS. Tensile tests on the ADC12 foams indicated that as their porosity increased, the tensile strength and tensile strain decreased, with strong relation between the porosity, tensile strength, and tensile strain. ADC12 foams exhibited brittle fracture, whereas ALPORAS exhibited ductile fracture, which is due to the nature of the Al alloy used as the base material of the foams. By image-based finite element (FE) analysis using X-ray CT images corresponding to the tensile tests on ADC12 foams, it was shown that the fracture path of ADC12 foams observed in tensile tests and the regions of high stress obtained from FE analysis correspond to each other. Therefore, it is considered that the fracture behavior of ADC12 foams in relation to their pore structure distribution can be investigated by image-based FE analysis.     

特发性肺间质纤维化患者HRCT特征分析

目的分析特发性肺间质纤维化(IPF)患者高分辨CT(HRCT)的特征。方法选择我院经支气管镜病理活检诊断为IPF的患者56例,对其进行普通CT扫描及HRCT扫描,观察其病变情况及影像表现,分析其特征。结果普通CT显示,56例患者病变部位均呈弥漫性分布,均可见胸膜下间质网状影或线影,多分布于双肺下肺野,可见囊状、蜂窝状影及磨玻璃密度影或实变影;HRCT显示,56例患者均为双肺受累,病变部位多数分布对称,病变多分布于肺尖肺底方向上(以下肺野为主)和轴位上(以周边分布为主),偶见上肺野或随机分布HRCT影像学结果均见胸膜下间质网状影或线影,多数见肺气肿以及网状或蜂窝征,部分可见磨玻璃密度和两下肺牵拉支气管扩张。结论IPF患者HRCT具有一定特征,但应注意联合各征象与其他肺部间质疾病区别,准确诊断,尽早治疗。     

经皮胸穿活检的临床应用及并发症探讨

目的探讨在CT引导下应用半自动同轴活检枪对胸部占位性病变经皮穿刺活检的临床可行性及安全性。方法56例胸部占位性病变的患者,采用半自动同轴活检枪在CT引导下行经皮穿刺活检术并送病理检查,统计穿刺活检的成功率及病理检查结果;术后行CT扫描,统计穿刺活检的并发症及穿刺活检的安全性。结果半自动同轴活检枪穿刺活检的成功率为92.9%(52/56);病理检查结果:穿刺成功的52例患者中,腺癌18例、鳞癌10例、小细胞癌9例、淋巴瘤2例、胸腺瘤2例、转移癌8例、真菌感染1例、肉芽肿性炎2例;穿刺活检的并发症:合并出血和或咯血的发生率32%(18/56)、气胸发生率19.6%(11/56)、死亡率1.8%(1/56);未发生穿刺点感染、针道种植转移等其他并发症。结论半自动同轴活检枪在CT引导下对胸部占位性病变经皮穿刺活检术是一种创伤小、相对安全、确诊率高的诊断方法,可在胸部占位性疾病临床诊断中广泛推广应用。     

普通型与重型新型冠状病毒肺炎患者临床分析

目的 分析严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome coronavirus 2, SARS-CoV-2）感染引起新型冠状病毒肺炎（coronavirus disease 2019, COVID-19）患者普通型与重型的流行病学、实验室检查及影像学特征,为COVID-19防治提供经验依据。 方法 选取2020年1—2月在池州市人民医院、皖南医学院第一附属医院隔离病房收治的23例COVID-19患者为研究对象。将患者分为普通型（19例）、重型（4例）两组,根据两组流行病学、血生化、血常规等实验室数据,比较和分析两组患者血清中上述各指标变化的规律及其与疾病预后的关系。 结果 COVID-19患者普通型与重型无性别与年龄差异,2例重型患者合并有基础疾病,为2型糖尿病;重型患者发病至就诊的平均时间为（10.00±6.67）d,长于普通型（3.73±2.97）d（P<0.05）;实验室结果显示重型患者的淋巴细胞比值为（10.20±7.19）%,低于普通型患者淋巴细胞比值为（28.06±9.47）%（P<0.05）;两组的CRP结果,普通型为(16.46±19.24)mg/L,重型为(73.65±44.96)mg/L（P<0.05）;COVID-19患者典型的CT表现为单发或多发的斑片状磨玻璃影,伴有小叶间隔增厚。疾病进展为重型时病灶增多、范围扩大,磨玻璃影与实变影或条索影共存,部分重症患者表现为双肺弥漫性病变。 结论 对于新型冠状病毒肺炎患者如果合并有基础病,就诊时间长;实验室检查示淋巴细胞绝对值下降,CRP升高等,建议短期复查HRCT,防止普通型向重型发展。