全息影像术中导航在泌尿外科腹腔镜和机器人手术中的应用价值

目的探讨全息影像术中导航在泌尿外科腹腔镜和机器人手术中的应用价值。方法回顾性分析2019年1—12月北京和睦家医院等19家医疗中心收治的86例患者的病例资料,临床诊断包括肾肿瘤78例,膀胱癌2例,肾上腺肿瘤2例,肾囊肿1例,前列腺癌1例,汗腺癌淋巴结转移1例,根治性膀胱切除术后盆腔转移瘤1例。其中,32例接受标准腹腔镜手术,分别为肾部分切除术(LPN)27例,根治性前列腺切除术1例,根治性膀胱切除术2例,肾上腺肿瘤切除术2例;54例接受达芬奇机器人手术,分别为肾部分切除术(RAPN)51例,腹膜后淋巴结清扫术1例,双侧肾囊肿去顶减压术1例,盆腔转移肿瘤切除术1例。两种术式的肾部分切除术患者中41例有可统计的临床数据,其中RAPN 23例,LPN 18例。男26例,女15例;中位年龄53.5(24~76)岁;中位R.E.N.A.L评分7.8(4~11)分。专业工程师根据86例术前增强CT检查图像和诊断报告重建全息影像。术前,全息影像可帮助术者对供应肿瘤或手术切除部位的动静脉血管、淋巴结和神经的立体空间结构及相互关系有更直观的认识,协助术前手术规划。在术中将全息影像与腹腔镜监视器中的术野图像进行实时追踪和融合,实现术中导航。结果本组86例手术均顺利完成。术中通过人工调整全息影像,可提示重要血管如肾动脉和肾静脉在体内的投影位置,帮助术者定位血管、淋巴结和其他重要解剖结构的位置,便于精准分离。本研究采用标准腹腔镜手术和达芬奇机器人手术的肾部分切除术患者中共41例有可统计的临床数据。41例中位手术时间140(50~225)min,其中RAPN为140(50~215)min,LPN为160(80~225)min;中位热缺血时间23(14~60)min,其中RAPN为21(17~40)min,LPN为25(14~60)min;中位出血量80(5~1200)ml,其中RAPN为150(30~1200)ml,LPN为50(5~1200)ml。术中无周围重要脏器损伤。2例LPN患者出现ClavienⅡ级并发症,1例出血1200 ml给予输血,另一例血肿未予处理,自行吸收。此2例分别为前、后肾门肿瘤,R.E.N.A.L评分均为11分。结论全息影像术中导航可协助术者在腹腔镜和机器人手术中对重要的解剖结构进行定位、识别,在减少术中组织和器官损伤、降低手术并发症和提高手术成功率方面有重要的应用价值。     

自动管电流调节技术在胸部低剂量CT筛查中的临床价值

目的 探讨16层螺旋CT自动管电流调节(ATCM)技术在胸部低剂量CT筛查中的临床价值.方法 94名常规体检人员分为两组:A组45名,扫描方案为固定噪声指数(NI)为14,应用ATCM技术自动调节管电流(20～200 mA);B组49名,扫描方案为固定管电流40 mAs.两名医师采用双盲法对肺尖、中肺、下肺图像进行图像质量评分(IQS),测量图像标准差(SD)值,记录加权CT剂量指数(CTDIw),并进行统计学分析.结果 肺尖、中肺、下肺SD值:A组为13.62±2.07、11.70±0.85、11.89±1.26,B组为17.20±2.66、11.29±2.32、12.82±2.49;IQS:A组为1.82±0.36、1.58±0.38、1.66±0.34,B组为2.30±0.47、1.67±0.42、1.74±0.48.在肺尖,A组的SD值和IQS低于B组(P＜0.05).A、B两组CTDIw比较:受检者体质量指数(BMI)≤27 kg/m2时,A、B两组差异无统计学意义;BMI＞27 kg/m2时,A组高于B组(P＜0.05).结论 胸部低剂量CT筛查中,应用ATCM技术可在更大的密度衰减范围和体质量较大的人群中得到更高质量的图像.     

神经白塞病临床特点分析并文献复习

目的 分析神经白塞病(neuro-Behcet's disease,NBD)的临床特点及治疗.方法 回顾分析航天中心医院2006年1月至2018年1月12例NBD患者的临床表现、实验室检查、影像学资料、治疗及预后.结果 12例患者,男7例,女5例;诊断NBD时的年龄16～55岁,平均(30±12)岁;均有白塞病(Behcet's disease,BD)的基本临床表现;口腔溃疡11例,生殖器溃疡7例,眼部病变5例,针刺反应阳性5例,结节红斑5例,发热4例.83％(10例)患者神经系统症状出现在BD其他系统首发表现之后平均(52±31)个月.神经系统症状以肢体无力(7例,58％)、头痛(6例,50％)、肢体活动障碍(5例,42％)、感觉障碍(4例,33％)、视力下降(3例,25％)等最为常见.9例患者行腰椎穿刺检查,3例存在脑脊液压力升高(33％).MRI可见长T1或等T1、长T2的异常信号,Flair像呈高信号.病灶可累及半球(50％)、脑干(25％)、小脑(8.3％)、脊髓(8.3％)、颅内静脉窦(8.3％))等多个部位.糖皮质激素联合免疫抑制剂治疗有效,好转9例(75％),病情反复3例(25％).结论 NBD临床表现多样,以累及中枢神经系统为主,肢体无力、头痛、感觉障碍为主要症状,需早期识别、及时诊断,经积极治疗后,大多预后良好.     

白血病肺部感染CT诊断——附96例分析

目的 分析、探讨白血病肺部感染的CT表现特点。方法回顾性分析本院经临床证实的白血病并肺部感染96例的肺部CT表现。结果病变以多叶、多段分布为特征（91．7％），形态多样，主要表现为“磨玻璃”密度影（75％）、“磨玻璃”密度影及实变影（50％）、内壁光滑小空洞影（25％），可有胸腔积液（16．7％）、心包积液（25％）。结论白血病肺部感染有一定影像学特点，结合临床，可以作出诊断。HRCT能显示出更多病变影像学特征。     

低剂量间接法CT静脉成像在下肢静脉曲张中的价值研究

目的:探讨间接法CT静脉成像(CTV)在下肢静脉曲张中的可行性和价值研究。方法:本研究收集因下肢静脉曲张而准备行介入或手术治疗的患者共37例(F/M,21/16,年龄29~65岁)行下肢CTV成像,所有原始图像均进行血管重建。由两名放射科医师分别对轴位、VR和MPR图像进行综合评价,其中量化参数指标为血管强化程度,包括大隐静脉(GSV)和VV的CT值,信噪比(SNR)和对比噪声比(CNR),并记录两者的主观图像质量评分。将直径>2 mm的穿支静脉标记,取P<0.05有统计学意义。结果:37例下肢静脉曲张患者患肢为单侧者23例,双侧者14例。所有患者的GSV显示均达到诊断要求,且GSV近端与静脉曲张的客观评价指标比较无统计学差异,平均SI,SNR和CNR分别为(121.7±15.9)vs.(124.6±20.3),(8.97±2.16)vs.(9.01±3.02),(3.98±1.99)vs.(4.06±2.17)。主观评价指标中,图像质量好为27例(73.4%),一般为9例(24.3%),1例(2.3%)图像质量差。共14支交通静脉被检出,平均直径为(2.97±0.92)mm,并在后续手术中证实。结论:间接法下肢CTV成像可以显示曲张静脉的回流路径,对穿支静脉的显示具有可行性,具有术前指导意义。     

1例局部晚期前列腺癌的多学科病案讨论

正1参加人员主持人:北京大学航天中心医院张保教授病例汇报人:北京大学航天中心医院史玉强医师讨论嘉宾:北京大学航天中心医院泌尿外科高强教授北京大学航天中心医院泌尿外科徐震教授北京大学航天中心医院超声影像科郭君教授北京大学航天中心医院放射科于海涛教授中国医学科学院肿瘤医院放疗科刘跃平教授     

慢性肾脏病透析患者继发转移性钙化的临床相关因素

目的 分析慢性肾病透析后继发性甲状旁腺功能亢进性骨病患者转移性钙化的临床相关因素。方法 回顾性分析36例临床确诊为终末期肾病继发甲状旁腺功能亢进性骨病合并转移性钙化患者的资料,透析时间<10年者19例（短期透析组）,透析时间≥10年者17例（长期透析组）。计算并比较两组患者转移性钙化发生率,采用简单相关分析检验转移性钙化与透析时间、血钙、血磷、钙磷乘积和血全段甲状旁腺素（iPTH）的相关性。绘制ROC曲线评价透析时间、血钙、血磷、血iPTH预测转移性钙化的效能。结果 短期透析组软组织钙化15.26%(29/190)]和血管钙化发生率[22.11%(42/190)]均低于长期透析组[22.35%(38/170)、31.76%(54/170),P均<0.05]。软组织钙化数、血管钙化数及钙化总数短期透析组中与透析时间呈正相关(r=0.49、0.40、0.53,P均<0.05),长期透析组中与透析时间无相关性(P>0.05),两组中软组织钙化数、血管钙化数及钙化总数与血钙、血磷、钙磷乘积、血iPTH均无明显相关性(P均>0.05)。透析时间和血iPTH预测转移性钙化效能较高,ROC曲线下面积(AUC)为0.97和0.88(P均<0.05),血钙和血磷预测转移性钙化效能较低,AUC分别为0.67和0.48(P均>0.05)。结论 终末期肾病患者中透析时间是影响继发性甲状旁腺功能亢进性骨病转移性钙化重要因素。     

中国汉族正常成人垂体的高分辨率MRI研究

Objective To study the morphological characteristics of pituitary glands in healthy adult of the Han nationality on the High-resolution MRI and provide morphological data of pituitary glands for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.Nine hundred and seventy eight Chinese healthy volunteers (age range = 18 to 70) recruited from 16 hospitals were divided into 5 groups, i.e., Group A ( age range = 18 to 30), B ( age range = 31 to 40), C ( age range = 41 to 50), D ( age range = 51 to 60 ), and E ( age range = 61 to 70).All of the volunteers were scanned by MR using T, weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence.By Multiplan reconstruction with 3D software, the pituitary gland's volume, size, and inclination of pituitary stalk were measured and the differences between sexualities and among age groups were compared by analysis of variance using SPSS13.0; those among five age groups were compared pair-wised by Tukey analysis; and the differences between male and female were analyzed by independent t test, and the differences of measurements of typing of pituitary glands were analyzed by Chi-square analysis.Results( 1 ) Volume of pituitary glands: the mean volume of male and female among 5 age groups were ( 1142±290), (996±223), (979 ±178), (971 ±174), (930 ±189) and (1247 ±210), (1199 ±216),( 1108 ± 196), ( 1059 ± 212 ), (984 ± 177 ) mm3 respectively.There were significant differences among the age groups(F = 13.811,27.091 ,P <0.01), the volume tended to decrease after 30 years old in male and 40 years old in female.Female has bigger volume than man in the same age group (P < 0.05).There were statistically correlation between sexes, age, typing, heights in middle sagittal width in coronal MR and anteroposterior diameter in middle sagittal MR.(2) The size of pituitary giands:the mean heights on middle sagittal MR images of male and female among 5 age groups were(6.6±1.5), (6.0±1.4), (5.6±1.1 ),(5.0±1.2), (4.9±1.4)and (7.9±1.6), (6.4±2.0), (5.6±1.7), (5.1±1.7), (4.4±1.4)mm respectively.There were significant difference among the age groups ( F = 24.582,62.978, P < 0.01 ).Females demonstrated larger pituitary glands than men in the age from 18 to 30 year old groups ( P < 0.01 ).The pituitary height tended to decline after 30 years old, minimum after 50 years old group in male and 40 years old in female.The heights were statistically correlated with sexes and age.The mean width in coronal MR images of male and female among 5 age groups were( 14.8± 1.8), ( 14.7 ± 1.4), ( 14.2±1.9), (14.3 ±2.1), (13.8 ±2.4) and (14.9±1.8), (15.8±1.7), (15.5±2.1), (15.6±2.2),( 14.9±2.1 ) mm respectively.There were significant difference among the age groups( F = 4.566,4.233,P<0.05),The width of pituitary before 30 years old and after 60 years old were smaller than the other groups (P <0.05 ), but man did not show this relationship.The widths were statistically correlation with sexes, age and weight.The mean anteroposterior diameter in middle sagittal images of male and female among 5 age groups were (11.2±1.2), (11.8±1.3), (11.8±1.5), (12.3±1.8), (12.2±2.0) and (11.9±1.3), (12.5±1.5), (12.4±1.5), (12.9±1.6), (12.7±1.6)mm respectively.There were significant difference among the age groups ( F = 7.270, 5.903, P < 0.01 ).Before 60 year old, the anteroposterior diameter was smaller in male than all female groups (P < 0.05 ), and there was a tendency to grow downwards with age.The anteroposterior diameter was statistically correlated with sexes and age.(3)The angle of inclination of pituitary stalks: on reconstructed coronal MRI imaging, the angle of inclination of pituitary stalk were in the middle, no significant differences in the angle measurements were found between male and female among 5 age groups ( P > 0.05).(4) The typing of pituitary glands in middle sagittal MR images : there were significant differences between each typing ( χ2 = 44.212, 107.518, P < 0.01 ), there was a tendency of pituitary upper border to depressed when age increased.Conclusions With highresolution MRI and 3D volumetric analytic software, volume and size of pituitary glands and the angle of inclination of pituitary stalks were accurately measured, and that provide morphological data of pituitary glands for the construction of database for Chinese Standard Brain.     

医院影像胶片与报告自助打印设计与应用

介绍了传统的影像胶片与报告流程存在很多问题。通过改进流程,构建虚拟打印服务器网络并推行自助式影像胶片与报告打印服务模式,可缩减患者检查后等候时间,降低影像科报告胶片核对错误率,节省成本并提高影像科的工作效率。