放射性喉的放射学表现:预期变化

在照射野内的喉、下咽和颈部区域均有放射性反应。放射诊断医师必须知道原发病灶及其周围放疗的预期变化,避免错误解释复发或残存病变征象。作者描述了喉鳞状细胞癌放疗后喉内预期放射学变化。61例中T_2和T_3声门上癌18例,T_2和T_3声门癌38     

双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用

Objective To evaluate low-dose CT coronary angiography with prospective electrocardiogram (ECG)-triggering using dual-source CT scanner.Methods Sixty-eight patients who underwent coronary CT angiography using a dual-source CT scanner were divided into 2 groups: group A (38 cases) and group B (30 cases).Prospective ECG-triggering sequence scan mode was employed for group A.Inclusion criteria included: heart rate <70 bpm, sinus rhythm, and heart rate fluctuation less than 10 bpm.Data acquisition was set at 70% of the RR-interval.Retrospective ECG-gating helical scan was performed for group B.Inclusion criteria included heart rates < 70 bpm and sinus rhythm.The exclusion criteria included heart failure and serious arrhythmias.In both groups, patients with a BMI≥24 kg/m2 were examined with a tube voltage of 120 kV, whereas patients with a BMI <24 kg/m2 were examined with a tube voltage of 100 kV.All images were transferred to a workstation for further processing and analysis.The imaging quality was evaluated.The imaging quality of coronary artery segments were compared with rank sum test between the two groups, and the radiation dose were compared with t test.Results A total of 476 coronary artery segments were evaluated in group A and 372 segments were evaluated in group B.The mean score of imaging quality for coronary artery segments in group A was 3.48±0.59 and that in group B was 3.53±0.58.There was no statistical difference in imaging quality between the two groups (Z=-1.432, P=0.187).The effective dose was on average (2.51±0.54) mSv (range 1.3--3.3 mSv) in group A, whereas on average (14.55±3.54) rosy (range 7.1--20.2 mSv) in group B.There was a statistical difference between the two groups (t=18.484, P=0.000).Conclusions Low-dose prospective ECG-triggering sequence scan in dual-source CT coronary angiography is feasible in patients with low heart rate and regular cardiac rhythm.This scan mode can substantially reduce radiation doses while preserving good diagnostic image quality.     

腹型过敏性紫癜1例报告

女性，37岁。患于6天前无明显诱因持续上腹部隐痛，阵发性加剧，3天前进食，水约1-2小时后出现恶心、呕吐、呕吐物为胃内容物，含有鲜红色血丝。以“上消化道出血”收入院。入院当天排柏泊样便2次，总量约50ml，仍感腹痛，饮食欠佳、尿少，无水肿。查体：心肺（-），腹软，上腹压痛，肠鸣音活跃，未见皮疹。     

螺旋CT血管成像对主动脉夹层的诊断

目的评价螺旋CT血管成像（SCTA）对主动脉夹层的诊断价值。方法回顾性分析经手术或DSA证实，或与MRI、超声检查结合诊断的27例主动脉夹层患者的螺旋CT血管成像资料。SCTA技术包括二维横断面图像、最大密度投影、多平面重建及CT仿真内窥镜图像。影像分析包括观察内膜破口的位置、夹层的范围、分支血管受累情况等。结果SCTA显示双腔主动脉和内膜片27例（100%），主动脉内膜钙化内移11例（40.7%），内膜破口22例（84.6%），DeBakey Ⅰ型及Ⅱ型AD显示破口5例（55.56%），DeBakey Ⅲ型显示破口17例（100%），28支分支血管受累。SCTA对2例被膜支架介入治疗后患者随访，显示1例有内支架移位。结论SCTA对主动脉夹层的诊断和相关改变的评价是准确和可靠的，SCTA对Ⅲ型AD的诊断价值更优于Ⅰ型及Ⅱ型AD。     

甲状腺滤泡癌的巨大颅骨转移瘤1例报告

患者,女,47岁。13年前左颈部出现一无痛性结节,曾在某院以甲状腺肿物行切除术。10年前右头顶部发现一硬性肿物,无不适感。5年前甲状腺峡部再次出现结节性肿物,在外院切除,病理报告为“甲状     

双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用

Objective To evaluate low-dose CT coronary angiography with prospective electrocardiogram (ECG)-triggering using dual-source CT scanner.Methods Sixty-eight patients who underwent coronary CT angiography using a dual-source CT scanner were divided into 2 groups: group A (38 cases) and group B (30 cases).Prospective ECG-triggering sequence scan mode was employed for group A.Inclusion criteria included: heart rate <70 bpm, sinus rhythm, and heart rate fluctuation less than 10 bpm.Data acquisition was set at 70% of the RR-interval.Retrospective ECG-gating helical scan was performed for group B.Inclusion criteria included heart rates < 70 bpm and sinus rhythm.The exclusion criteria included heart failure and serious arrhythmias.In both groups, patients with a BMI≥24 kg/m2 were examined with a tube voltage of 120 kV, whereas patients with a BMI <24 kg/m2 were examined with a tube voltage of 100 kV.All images were transferred to a workstation for further processing and analysis.The imaging quality was evaluated.The imaging quality of coronary artery segments were compared with rank sum test between the two groups, and the radiation dose were compared with t test.Results A total of 476 coronary artery segments were evaluated in group A and 372 segments were evaluated in group B.The mean score of imaging quality for coronary artery segments in group A was 3.48±0.59 and that in group B was 3.53±0.58.There was no statistical difference in imaging quality between the two groups (Z=-1.432, P=0.187).The effective dose was on average (2.51±0.54) mSv (range 1.3--3.3 mSv) in group A, whereas on average (14.55±3.54) rosy (range 7.1--20.2 mSv) in group B.There was a statistical difference between the two groups (t=18.484, P=0.000).Conclusions Low-dose prospective ECG-triggering sequence scan in dual-source CT coronary angiography is feasible in patients with low heart rate and regular cardiac rhythm.This scan mode can substantially reduce radiation doses while preserving good diagnostic image quality.     

低剂量增强多层螺旋CT对陈旧性心肌梗死心肌活性的评价

目的 前瞻性评价低剂量增强多层螺旋CT(MSCT)显示陈旧性心肌梗死心肌活性的可行性和可靠性,并与MR心肌灌注和心肌活性成像进行对照研究.方法 对32例临床明确诊断为陈旧性心肌梗死的患者行前瞻性首过和延迟增强64层MSCT及MR心肌灌注成像,在短轴面上将左心室分为16个心肌段进行分析,所有患者的MSCT和MR影像资料被双盲分析,确定早期心肌灌注缺损区和晚期延迟增强区的大小及范围.采用一致性检验的Kappa检验,评价两种方法对显示心肌活性的一致性.结果 32例患者,首过灌注期MSCT提示灌注缺损为41个节段,无灌注缺损为471个节段;首过灌沣期MRI提示灌注缺损为47个节段,无灌注缺损为465个节段,两种方法一致性Kappa值为0.650,符合率为94.5%(484/512).延迟期MSCT显示延迟增强为135个节段,其中非透壁性梗死为50个节段,透壁性梗死为85个节段,未出现延迟增强为377个节段;延迟期MRI显示延迟增强为120个节段,其中非透壁性梗死为56个节段,透壁性梗死为64个节段,未出现延迟增强为392个节段,两种方法一致性Kappa值为0.609,符合率为80.7%(413/512).结论 低剂量增强螺旋MSCT与MRI对心肌活性的评价有较好的相关性,MSCT对陈旧性心肌梗死的存活心肌和非存活心肌的检测是呵行和可靠的,减少不必要的X线辐射剂量是该研究的重要方面.     

快速动态增强CT对恶性肝肿瘤的诊断价值

目的：本文目的是确立快速动态增强ＣＴ对恶性肝肿瘤的诊断价值。材料和方法：有快速动态增强ＣＴ检查的３０例肝恶性肿瘤病人同平扫和延迟扫描进行回顾性比较研究。结果：平扫ＣＴ肿瘤呈低密度２２例，等密度８例。快速动态增强ＣＴ显示肿瘤２９例，１例肿瘤呈等密度强化。延迟扫描显示肿瘤２７例，３例肿瘤呈等密度强化。结论：对门静脉瘤栓、肿瘤包膜和原发肿瘤显示上，增强ＣＴ显示优于平扫，我们认为快速动态增强ＣＴ与平扫ＣＴ和延迟扫描比是发现肝肿瘤最敏感的方法，应该成为标准ＣＴ检查方法。     

磁共振T1 mapping成像评价肥厚型和扩张型心肌病弥漫性心肌纤维化

目的 探讨磁共振纵向弛豫时间定量(T1 mapping)成像评价肥厚型心肌病(HCM)和扩张型心肌病(DCM)心肌纤维化的价值,及心肌纤维化与左心室射血分数的关系。方法 收集经临床诊断证实的30例HCM患者(HCM组)、27例DCM患者(DCM)和符合纳入标准的33例患者(对照组)。对所有受检者均行心脏电影成像、对比增强前、后T1 mapping成像、延迟对比增强(LGE)成像。测量不同受检者增强前、后左心室平均T1值及心功能参数并进行统计学分析,分析心肌平均T1值与心功能指标的相关性。结果 HCM组22例(22/30,73.33%)患者存在延迟强化,DCM组15例(15/27,55.56%)患者存在延迟强化,对照组无延迟强化。比增强前,HCM组[(1294.79±85.22)ms]、DCM组[(1312.88±59.57)ms]左心室心肌T1值均较对照组[(1266.56±57.33)ms]显著增加(P均<0.05);对比增强后,HCM组[(491.31±121.59)ms]、DCM组[(466.77±126.34)ms]左心室心肌T1均值较对照组[(534.09±92.73)]显著减低(P均<0.05)。HCM患者左心室心肌增强前T1值与左心室射血分数呈负相关(r=-0.58,P<0.05),增强后T1值与其呈正相关(r=0.59,P<0.05);DCM患者左心室心肌增强前T1值与左心室射血分数呈负相关(r=-0.55,P<0.05),增强后T1值与其呈正相关(r=0.51,P<0.05)。结论 HCM和DCM患者心肌纤维化与心功能相关;T1 mapping成像有助于评价HCM和DCM患者心肌纤维化。     

慢性B型主动脉夹层腔内修复术84例

目的 总结主动脉腔内修复术(TEVAR)治疗慢性B型主动脉夹层的临床经验.方法 2001年6月至2007年9月,84例慢性B型主动脉夹层病人接受了 TEVAR.从起病至实施TEVAR为1～120个月,平均(13.9±22.0)个月.随访6～86个月,平均(33.2±19.2)个月.结果 腔内修复术中,破口被完全封闭77例,内漏发生率为8.3%.1个月的病死率为1.2%.1例在术后1个月发生逆行A型主动脉夹层,行急诊升主动脉和主动脉弓置换术.4例实施了第2次TEVAR,其中3例为封堵内漏,另1例是覆膜支架远端出现新的内膜撕裂.7例在随访期内死亡(8.4%),其中3例死于内漏引起的胸主动脉破裂,1例腹主动脉持续性扩张导致降主动脉破裂死亡,另2例死因与主动脉夹层无关,还有1例死因不详.K-M生存曲线分析显示7年生存率为84.4%.结论 早期和中期随访结果显示,TEVAR治疗慢性B型主动脉夹层是有效的.内漏是随访期的主要死因.随着外科医师经验的积累以及覆膜支架的改进,TEVAR会有更好的疗效.