64层螺旋CT正常上尿路造影：腹带加压、增加延迟时间及大量饮水对显影的价值

目的:通过比较64层螺旋CT泌尿系统造影,几种方法对正常上尿路显影的效果,探讨最佳显影方法.方法:76例泌尿系统正常者,随机采用以下延迟扫描方法:5M(minute,M)延迟、腹带加压、8M延迟,大量饮水,上尿路分为5段(肾盏,肾盂,近、中、远段输尿管),对每段显影程度予以评分,采用SPSS11.0统计软件行方差分析.结果:①各组对肾盂显影评分无显著差异;②腹带加压对近段输尿管显影显著优于5M组.8M组对输尿管的显影显著优于5M,对中段输尿管的显影显著优于腹带加压.大量饮水对肾盏、输尿管的显影显著优于5M,对肾盏显著优于腹带加压.但8M组与大量饮水的差异无显著性.结论:腹带加压对上尿路显影效果有限,且禁忌症较多不宜使用.8M及大量饮水显影效果较好、简单易行,尤其是增加延迟时间较为安全宜推广应用.     

多层螺旋CT尿路造影在泌尿系统病变诊断中的价值

目的：探讨多层螺旋CT尿路造影（MSCTU）对泌尿系病变的诊断价值。方法：收集经KUB、IVU检查单侧输尿管显示欠佳或不显影患者38例，健康志愿者4例，行CT平扫、肾脏增强双期扫描及尿路造影，将平扫及尿路造影资料传送至工作站，进行最大强度投影（MIP）、多平面重建（MPR）及容积重建（volume-rendering），获得完整尿路影像。结果：所有病例在14-2s内完成全尿路扫描。24例输尿管结石，重建图像能清晰显示结石位置及上段积水情况；2例肾肿瘤及1例输尿管切开取石术后患者显示输尿管内多发血块；2例术后输尿管粘连及肿胀至输尿管梗阻；1例结肠癌淋巴结转移侵犯输尿管；3例肾盂输尿管重复畸形清晰显示输尿管汇合部位；1例尿瘘可见尿湖位于输尿管中段，肾盂瘘口与之相连；1例先天性巨输尿管和1例腔静脉后输尿管完整显示其形态和走行。结论：多层螺旋CT具有超高速、大范围、薄层扫描能力，应用于尿路造影有其独特优势，可作为临床一种新的辅助诊断手段。     

128层螺旋CT尿路造影对上尿路梗阻性疾病的诊断价值

随着多层螺旋CT尿路造影(multi-slice CT urography,MSCTU)的广泛应用,这一技术日趋成熟,使得通过一次检查就给泌尿系疾病的诊断提供了丰富可靠的诊断依据。本文分析30例上尿路梗阻患者128-slice spiral CTU检查的结果,通过各种重建方法,评价其临床应用价值。     

64层螺旋CT血管造影对烟雾病的诊断价值

目的：探讨64层螺旋CT血管造影（CTA）在Moyamoya病诊断中的应用价值。方法：21例Moyamoya病患者均行CT平扫和MSCTA检查,在ADW4．2工作站上作容积再现（VR）、最大密度投影（MIP）和多平面容积重建（MPVR）。结果：MSCTA均清晰显示发生狭窄、闭塞的颈内动脉、Willis环血管近侧端以及明显增多、扩张的脑底部侧支血管影,其中双侧颈内动脉闭塞7例,单侧颈内动脉闭塞伴同侧大脑后动脉狭窄1例,单侧大脑中动脉闭塞12例,侧支血管表现为相应血管及其分支的粗大、增多、迂曲延长。结论：MSCTA可以清晰显示Moyamoya病血管改变特点,检查方法简单、快捷,重建图像直观显示病变周围空间结构关系,可为诊断和临床治疗提供重要的参考依据。     

64层螺旋CT脑动脉造影方法研究

目的:探讨应用64层螺旋CT进行脑动脉造影(CTA)检查扫描的最佳时相和方法,优化图像后处理,为脑动脉畸形及脑动脉瘤等脑血管病变提供可靠的依据。方法:使用西门子公司Sensation 64层螺旋CT及后处理工作站,应用相应的4D后处理软件及血管对比剂自动跟踪触发扫描软件(BOLUS软件)。选取临床诊断蛛网膜下腔出血及怀疑脑血管畸形的患者38例,采用Bolus跟踪与目测颈动脉对比剂浓度相结合的方法进行脑动脉CT造影检查。结果:38例患者中达到诊断标准34例,扫描失败3例,经延迟补救扫描后成功1例,其中6例行DSA造影,5例符合,1例行DSA造影时未发现动脉瘤,再行CTA检查确切检出动脉瘤。符合率83.3%。结论:使用64层螺旋CT,采用BOLUS跟踪与目测颈动脉对比剂浓度相结合的方法进行脑动脉CT造影检查可准确区分脑动-静脉血管,在诊断脑血管疾病方面可以作为常规方法使用。     

64层螺旋CT冠状动脉造影图像质量影响因素分析

目的 分析不同心率下影响64层螺旋CT冠状动脉造影(CTCA)图像质量的因素.方法 对283例临床怀疑或确诊冠心病的患者进行CTCA检查.入选患者按照心率快慢分为5组;按照心率波动幅度分为3组.结果 (1)除心率为66～70次/min组和心率为71～75次/min组间冠状动脉可评估率差异无统计学意义(χ2=1.164,P=0.281)外,其余各组间差异均有统计学意义(P<0.005).(2)在心率≤75次/min时,导致冠状动脉无法评价的原因主要为钙化,在心率＞75次/min时,导致冠状动脉无法评价的原因主要为运动伪影,其次为钙化.(3)不同心率波动组中,当心率波动幅度＞10次/min时,冠状动脉的可评估率明显减低.(4)在心率≤65次/min时,冠状动脉各节段的最佳重建时相主要在75%时相,随着心率的增加冠状动脉各节段的最佳重建时相逐渐趋于45%～50%时相,当心率>80次/min时,冠状动脉各节段的最佳重建时相主要位于50%时相.结论 导致冠状动脉无法评价的原因在心率较低时主要为钙化掩盖血管腔和钙化导致的伪影所致,在心率较高时主要为运动伪影,其次为钙化.     

64层螺旋CT对主动脉夹层的应用价值

目的:探讨64层螺旋CT诊断主动脉夹层的临床价值。方法:39例拟诊为主动脉病变的患者作为本组研究对象,对所有患者行CT平扫及增强扫描。CT平扫图像上观察内膜钙化的移位、主动脉直径扩大、心包和/或纵隔积血、胸腔积液/血。并对A型和B型主动脉夹层的平扫征象进行统计学比较。CT增强图像上观察低密度的内膜瓣、破口(入口和再入口)、真假腔及主要动脉分支受累情况。结果:21例主动脉夹层中,CT平扫观察到钙化的内膜瓣移位9例(42.9%),主动脉直径增宽8例(38.1%),心包和/或纵隔积血8例(38.1%),胸腔积液/血5例(19.0%)。CT增强扫描对主动脉夹层内膜瓣的显示率达100%(21/21),对真、假腔的显示率为100%(21/21),对破口的显示率为85.7%(18/21)。8例(38.1%)弓上血管受累,5例(19.0%)内脏血管受累。结论:64层螺旋CT对主动脉夹层有较高的诊断价值,能较好的显示夹层的真假腔、内膜瓣及破口,并且可以显示主要动脉受累情况,为外科的手术治疗提供重要信息。     

多层螺旋CT尿路造影在尿路梗阻性疾病中的临床应用

目的探讨多层螺旋CT尿路造影在泌尿系梗阻性疾病诊断中的应用价值。方法对48例泌尿系统梗阻性疾病者,分别进行多层螺旋CT平扫及多时相期CT增强扫描。对增强后各期图像进行相关处理,以不同的三维重建方式获得CTA、CTU影像。所有病例均经临床及手术证实。结果48例中肾脏及输尿管先天畸形者15例;输尿管阴性结石致肾盂输尿管积水者4例;泌尿系炎症者5例;肾及输尿管、膀胱结核6例;外源性压迫导致肾盂及输尿管积水者8例;泌尿系肿瘤者10例。结论多层螺旋CT泌尿系造影对尿路梗阻性疾病的诊断具有很高的应用价值。     

CT尿路造影在泌尿系统疾病的诊断价值

目的：探讨IVU后CT尿路造影（CTU）在诊断泌尿系统疾病及评估IVU不显影肾的肾功能应用价值。方法：对IVU 120min单侧肾不显影或IVU显示泌尿系统形态结构异常，但不能确诊的60例作IVU后CT扫描。结果：CTU对IVU不显影或不能确诊的疾病做出明确诊断；对IVU不显影的梗阻肾的肾功能做出进一步评估。结论：IVU后CT尿路造影把IVU与CT结合为一体，可作为IVU的一种重要补充检查方法，具有重要的临床应用价值。     

64层螺旋CT冠状动脉血管成像与冠脉造影结果对照研究

目的:评价多层螺旋CT(MSCT)冠状动脉血管成像方法显示管腔≥50%狭窄的准确性,分析改善成像质量的方法.方法:对72例临床诊断或可疑冠心病的患者在心电门控下采用64层螺旋CT进行冠状动脉血管成像.其中56例在2周内行导管法冠状动脉造影.结果:本组56例与冠状动脉造影结果相对照,冠状动脉血管成像诊断≥50%血管狭窄的敏感性为91.5%,特异性为97.5%,阳性预测值为82.3%,阴性预测值为98.9%.结论:64层螺旋CT冠状动脉血管成像具有较高的敏感性和特异性,同时具有无创和简便的特点,可以作为临床对高危人群筛查的首选方法.     

CT urography: a comparison of strategies for upper urinary tract opacification

A consensus is yet to be reached regarding the best strategy for ensuring maximum ureteric delineation during CT urography (CTU). In this study we have compared various CTU protocols to try to establish the best method for ureteric delineation. Saline infusion in the supine position, saline infusion in the prone position, furosemide administration (10 mg, iv) and buscopan administration (20 mg iv) with saline infusion in the prone position were tried in four groups, each having 15 patients who were undergoing CTU. The pelvicalyceal system and ureter were divided into six segments, to each of which an opacification score was assigned (0, unopacified segment; 1, less than 50% opacified segment; 2, 50–99% of the segment opacified; or 3, completely opacified segment) and the results compared. Furosemide administration resulted in complete opacification of 93% of the ureters (28 of 30). In the distal (below the sciatic notch) ureter, the mean score with furosemide was 2.9, while that with saline, supine and prone positioning was 1.87 and 1.83, respectively, and this difference was highly significant (P = 0.0002 and P = 0.0001). It was also significantly higher than the buscopan group (score 2.3, P = 0.002). Also in the lower (the iliac crest to the sciatic notch) and upper (above the iliac crest) ureter, furosemide had significantly higher scores than saline infusion in either position. Saline infusion in the supine and prone positions had very similar scores in all segments that were less than the buscopan group, but this difference was not statistically significant. During CT urography, furosemide administration in low doses is the most effective and convenient technique for ureteric opacification.     

CT尿路造影对上尿路梗阻性疾病的诊断价值

目的 探讨CT尿路造影（CTU） 在上尿路梗阻性疾病中的应用价值.方法 66例临床可疑有上尿路梗阻性疾病患者,分别在常规平扫、动脉期及静脉期扫描后行分泌期扫描,在图像工作站对获得图像进行最大密度投影（MIP）、多平面重建（MPR）及容积再现（VR）等三维后处理,获得泌尿系立体图像.由2名主治医师以上专家进行影像诊断,并追踪病理及治疗结果.结果 所有病例都成功重建出双肾、输尿管及膀胱三维图像,图像能清晰显示泌尿系统整体和局部细微结构.结论 CTU通过MPR、MIP、VR技术多角度清晰显示上尿路梗阻的病变及其形态,可提高诊断水平,更好地满足临床需要,在上尿路梗阻病变诊断方面有独特优势.     

仰卧和俯卧位心脏对肺压迫作用的CT探讨

目的：探讨俯卧位改善肺通气功能的机理。方法：对7例健康成人行仰卧位、俯卧位高分辨率CT扫描，选取气管隆突下、左心房、左心室上、左心室下4个层面，分别测量位于心脏下方肺组织的体积，用配对t检验进行统计分析。结果：仰卧位时左肺的8.2%-44.7%，右肺的5.5%-10.8%位于心脏下区；俯卧位时左肺的0.1%-1.9%，右肺的0.8%-4.2%位于心脏下区。俯卧位时心脏下受压肺组织明显减少（P＜0.01）。结论：俯卧位时可明显改善人体的肺换气功能。     

Comparison of quality of urinary bladder filling in CT urography with different doses of furosemide in the work-up of patients with macroscopic hematuria

IntroductionThe protocol for preparation of computed tomography urography (CTU) examinations at our hospital was changed in 2013 to improve the quality of urinary bladder filling in the excretory phase. The aim of this study was to evaluate the quality of urinary bladder filling on CTU after different doses of furosemide were administered to patients with macroscopic hematuria.MethodsThe cohort was 215 patients who underwent elective CTU due to macroscopic hematuria between 2014 and 2018. 5 mg furosemide were administrated to 100 patients, 2.5 mg to 100 patients and 0 mg to 15 patients. Contrast medium layered bladders were excluded, leaving 193 patients: 92, 89 and 12 in each group. Urinary bladder volume was calculated in corticomedullary (CMP) and excretory phase (EP). Bladder distension was classified as satisfactory or not. Attenuation of bladder content in EP was noted.ResultsAverage volume in EP was 370 ± 224 ml (28–1052) after 5 mg furosemide, 274 ± 120 ml (43–628) after 2.5 mg and 180 ± 104 ml (53–351) after 0 mg. 85% of the bladders were satisfactory distended after 5 mg, 80% after 2.5 mg and 58% after 0 mg. Average attenuation was 266 ± 89 HU (103–524) after 5 mg, 362 ± 156 HU (118–948) after 2.5 mg and 761 ± 331 HU (347–1206) after 0 mg. The differences in volume and attenuation were significant.Conclusion5 mg furosemide is preferred rather than 2.5 mg in preparation for CTU examinations of patients with macroscopic hematuria. There was no difference between the doses concerning rate of satisfactory bladder distension, but the higher dose resulted in larger bladder volume and more suitable attenuation of bladder content.Implications for practiceDevelopment of CTU-image quality could improve bladder cancer diagnostics.     

多层螺旋CT尿路成像在尿漏中的诊断作用

目的：探讨多层螺旋CT尿路成像（MSCTU）在肾盂、输尿管、膀胱尿漏中的诊断价值。方法：对15例经临床证实发生尿漏的患者进行三期MSCTU检查,采用多种CT图像后处理技术（MPR、MIP、VR）综合分析其MSCTU表现特点。结果：15例尿漏患者中,肾盂尿漏5例,输尿管漏8例,膀胱漏2例。尿漏患者MSCTU的排泄期表现为对比剂外溢,MIP、VR并结合MPR可以清晰显示漏口的部位及范围,并可显示伴发的肾实质破裂,肾包膜下血肿、肾周间隙积液、原发肿瘤（宫颈癌转移瘤侵及右输尿管）及泌尿系先天畸形等。结论：多层螺旋CT尿路成像（MSCTU）能清晰显示尿漏的部位、漏口并初步判断尿漏发生的原因,可以作为诊断尿漏的首选方法。     

Influence of bladder distension on opacification of urinary collecting system during CT urography

The purpose of the study was to evaluate and compare opacification of the renal collecting system and ureters detected by computed tomographic urography (CTU) performed 20 min and 1 h after the ingestion of 1,000 ml of water. CTU was performed on 89 patients (55 men, 34 women; age 28–77 years) and 168 collecting systems and ureters were evaluated. A 16-detector-row scanner (Sensation 16, Siemens) was used; a two-phase protocol with a split bolus of contrast agent (total 120 ml) was applied. A combined nephrographic-excretory phase was obtained 100 s after the second injection. Three-dimensional reconstructions of the excretory phase were created and used to evaluate the degree of opacification of the collecting system and ureters. In 44 patients, water was administered 20 min before examination, and in 45 patients, 1 h before examination. CTU performed 1 h after water ingestion demonstrated complete opacification of calices in 87.5%, of renal pelvis in 97.5%, of upper ureter in 91.8% and of lower ureter in 87.5% of patients. CTU performed 20 min after water ingestion demonstrated complete opacification of calices in 79.5%, of renal pelvis in 85%, of upper ureter in 62.5% and of lower ureter in 54.5% of patients. Complete opacification of the proximal and distal ureter in the group with a 1-h delay was statistically higher (P < 0.01). CTU performed on the distended bladder, 1 h after the oral ingestion of water, enables excellent opacification of collecting system, including distal ureters.     

CT值与上尿路结石气压弹道碎石易碎生关系初探

目的 探讨非增强螺旋CT值与上尿路结石气压弹道碎石(PL)易碎性的关系,为临床上选择合理的治疗方法提供更多依据.方法 93例行PL治疗的上尿路结石患者,按结石PL次数分成A、B、C 3组.将3组的平均CT值分别进行比较分析.结果 A、B、C 3组间的平均CT值差异均有统计学意义(F=3.271,P=0.000).结论 术前患者上尿路结石的平均CT值可以估计碎石的难易程度.在选择治疗方案和时机时要综合分析结石部位、数量、医师操作水平、设备性能、患者耐受性等因素.在结石易碎性因素上,建议对于CT值＜900 HU且结石大小适宜(最大直径＜2 cm)者首选PL治疗,而CT值＞1200HU且体积较大(最大直径＞2.5 cm)或超过4枚的多发结石者应选择手术取石.     

CT尿路造影对非结石性尿路梗阻疾病的诊断作用

目的评价CT尿路造影(CTU)对非结石性尿路梗阻疾病的诊断作用。方法40例非结石性尿路梗阻病例给予实质期、分泌期增强螺旋扫描。分泌期数据经第2次重建后在工作站以三维方式获得CTU影像。结果40例中，24例良性梗阻呈轻度或重度积水。18例先天畸形CTU呈现各自特征；4例输尿管炎表现为鸟嘴样狭窄，2例前列腺增生可见膀胱后壁压迹。16例肿瘤患者梗阻端呈截断或锥状狭窄伴局部软组织影，12例尿路中度积水，4例重度积水。其中4例呈双侧积水。对6例一侧无分泌功能者，可采用最小强度投影等予以显示，并与对侧最大强度投影像等整合。结论CTU对非结石性尿路梗阻疾病的诊断具有良好的效果。