高频超声特征性表现在痛风性关节炎 病变早期诊断价值

目的探讨高频超声特征性表现在痛风性关节炎病变早期诊断中的价值。方法选取自2017年1月至2018年11月北部战区总医院收治的32例痛风性关节炎患者为B组,另选取同期在我院就诊的临床确诊为类风湿性关节炎或骨性关节炎的28例患者作为A组。两组患者均进行超声检查,记录并比较患者的全部受累关节的关节腔积液、滑膜增生、骨侵蚀及关节周围的尿酸盐沉积、双轨征、痛风石的检出率。结果两组患者关节腔积液、滑膜增生及骨侵蚀的检出率比较,差异无统计学意义(P>0.05)。B组双轨征、尿酸盐沉积、痛风石的检出率均高于A组,组间比较,差异均有统计学意义(P<0.05)。结论双轨征、尿酸盐沉积、痛风石为痛风性关节炎超声特征性表现,高频超声检查对痛风性关节炎具有较高诊断价值。     

痛风性关节炎超声检查病理基础及临床应用现状

痛风性关节炎(gouty arthritis)是因嘌呤高代谢或肾脏中尿酸钠(monosodium urate,MSU)排出减少,导致血清尿酸钠(serum uric acid,SUA)浓度升高,MSU晶体沉积于关节及其周围诱发的进展性炎性疾病,晚期可出现关节畸形及功能障碍,早期诊断和及时干预治疗能显著改善预后,提高患者...     

痛风性关节炎的X线诊断

目的:探讨痛风性关节炎的X线特征。方法:回顾性分析28例确诊为痛风性关节炎患者的临床和X线资料。结果:痛风性关节炎多见于成年男性。常侵犯手、足小关节,其中以第1跖趾关节最为好发。早期X线常无阳性表现,中晚期可见典型X线表现:①位于关节边缘骨端的穿凿样骨质破坏;②)继发性退行性骨关节病;③软组织偏心性肿胀和痛风结节的形成。结论:痛风性关节炎的X线表现有一定的特征性,早期诊断须密切结合临床。     

关节炎超声诊断的研究进展

关节炎是临床常见疾病之一，关节炎种类众多，其影像学表现也不尽相同。超声检查是诊断关节炎及治疗后随访常用的影像学检查方法，超声检查无创简便，可重复性好，对关节病变中的滑膜炎、腱鞘炎、滑囊炎、附着端炎及骨侵蚀的诊断具有独特优势。本文主要对超声检查在关节炎诊断中的应用进行综述。     

假痛风性关节炎1例

假痛风性关节炎是一种少见的代谢性骨关节病，我院遇见1例，现报告如下。     

急性痛风性关节炎19例诊治体会

2000年1月～2005年12月,我们共收治急性痛风性关节炎19例。现报告如下。     

痛风性关节炎误诊1例

<正> 病人,男,38岁。1988年2月无明显诱因出现右膝关节疼痛,无发热头痛及全身不适;行X线摄片检查示右膝关节未见异常,给予布洛芬0.2 g,3次/d口服,疼痛症状缓解。其间因行走不便右膝关节扭伤后出现肿胀。患者既往体健,无遗传家族病史,个人有饮酒嗜好。当时查体:右膝     

Assessment of thoracic aortic conformational changes by four-dimensional computed tomography angiography in patients with chronic aortic dissection type b

To characterize the heartbeat-related distension of dissected and non-dissected thoracic aortic segments in chronic aortic dissection type b (CADB) ECG-gated computed tomography angiography was performed in ten CADB patients. For 20 time points of the R–R interval, multiplanar reformations were taken at non-dissected (A, B) and dissected (C) aorta: ascending aorta (A), aortic vertex (B), 10 cm distal to left subclavian (Ct, true channel; Cf, false channel). Relative amplitudes of aortic area and major and minor axis diameter changes were quantified. Area amplitudes were 12.9 ± 3.7%, 11.4 ± 1.8%, 16.5 ± 5.9% and 10.5 ± 5.7% at A, B, Ct and Cf, respectively. Area amplitudes were significantly greater at Ct than at Cf and B (p < 0.05). Major axis diameter amplitudes were 7.7 ± 1.9%, 6.2 ± 1.3%, 5.9 ± 2.0% and 6.1 ± 3.6% at A, B, Ct and Cf, respectively. There were no differences in major axis diameter amplitudes. Minor axis diameter amplitudes were 6.7 ± 2.1%, 8.4 ± 1.9%, 12.7 ± 6.3% and 6.0 ± 2.2% at A, B, Ct and Cf, respectively. Minor axis diameter amplitudes were significantly the greatest at Ct (p < 0.05). In CADB, the heartbeat-related distension of aortic area and diameter is evenly distributed over the non-dissected aortic arch. As a result from different blood flow properties, there are significantly greater conformational changes in the true channel of the dissected aorta. Tim F. Weber and Maria-Katharina Ganten contributed equally     

螺旋CT血管造影术在夹层动脉瘤诊断中的应用

目的评价螺旋CT血管造影技术在夹层动脉瘤诊断中的临床应用价值。方法21例夹层动脉瘤行螺旋CT连续容积增强扫描，并将获得的数据传至工作站行三维重建，结合横断面及三维重建图像进行分析。结果根据Debakey分型，De．bakeyⅠ型10例，DebakeyⅢ型11例，两型中不典型夹层各2例。典型夹层动脉瘤的CT征象主要是分离移位的内膜、真假腔、主动脉壁增厚、钙化、主动脉不规则扩张；不典型主动脉夹层动脉瘤的征象为主动脉壁呈半月状或环状增厚，伴或不伴有内膜钙化内移。结论螺旋CT血管造影检查在诊断主动脉夹层动脉瘤中是一种安全有效的便于治疗后观察对比的方法。     

主动脉夹层螺旋CT血管造影成像的方法与技巧

目的：探讨在主动脉夹层中进行SCTA影像后处理的方法与技巧。方法：选择成功进行SCTA的47例主动脉夹层病例，扫描层厚4－8mm，重建间隔2－3mm，螺距1．25－1．75，数据输入工作站，采用MPR、MIP、SSD及VR等方式进行影像后处理。结果：影像后处理方法有技巧需要在VQ工作站上反复摸索方能熟练掌握；不同的后处理方式得到的图像有不同的显示特点；通过采用不同的显示技术或多种技术相结合；主动脉夹层真假腔、内膜片等得到全面、立体、良好地显示。结论：除了合理地制定扫描计划、选择扫描参数等扫描因素之外，影像后处理方法及技巧的熟练掌握亦是成功获取高质量主动脉夹层图像必不可少的要素。     

螺旋CT血管造影及三维重建在主动脉夹层诊断中的应用

目的:评价螺旋CT血管造影(SCTA)及三维重建在主动脉夹层诊断中的临床应用。方法:对21例主动脉夹层患者进行了SCTA成像及三维重建,并与手术及血管造影对照。结果:SCTA能清楚显示主动脉夹层病变及其复杂的解剖关系,如双腔、内膜片及累及的范围等。与血管造影及手术对照,SCTA的诊断符合率达100％。结论:SCTA二维与三维重建的联合应用,有助于主动脉夹层的诊断并可指导手术,且有望取代传统血管造影。     

64层螺旋CT血管成像在主动脉夹层诊断中的临床价值

目的:探讨64层螺旋CT血管成像(CTA)在主动脉夹层(AD)诊断及术前评价中的应用价值。方法:58例连续性AD患者行64层螺旋CTA,对所有数据进行MPR、MIP、VR等重建分析。结果:CTA结果显示依据DeBakey分类法,Ⅰ型夹层14例,Ⅱ型2例,Ⅲ型42例。所有患者均存在明确的撕裂内膜片及真假腔,动脉期真腔平均CT值较假腔高,差异有统计学意义(P=0.000<0.05)。所有患者均明确显示了初始破口的位置,55例显示了一个或多个再破口,3例Ⅲ型患者未显示再破口。39例Ⅲ型患者初始破口位于主动脉弓降部或降胸主动脉近端,其近端瘤颈长度、宽度分别为0.4～10.8cm(平均3.5cm)、2.2～3.6cm(平均2.8cm),瘤体最大径为3.2～9.2cm(平均5.4cm)。图像准确显示了所有患者主动脉重要分支受累以及假腔内血栓形成情况。结论:64层螺旋CT血管成像具有无创、快速、准确性高等优点,是主动脉夹层诊断及术前评价的可靠影像学检查方法之一。     

Multi-detector computed tomography in the diagnosis and management of acute aortic syndromes

Acute aortic syndrome (AAS) is a spectrum of conditions, which may ultimately progress to potentially life-threatening aortic rupture. This syndrome encompasses aortic dissection (AD), intramural haematoma, penetrating atherosclerotic ulcer and unstable thoracic aortic aneurysms. Multi-detector CT (MDCT) is crucial for the diagnosis of AAS, especially in the emergency setting due to its speed, accuracy and ready availability. This review attends to the value of appropriate imaging protocols in obtaining good quality images that can permit a confident diagnosis of AAS. AD is the most commonly encountered AAS and also the one with maximum potential to cause catastrophic outcome if not diagnosed and managed promptly. Hence, this review briefly addresses certain relevant clinical perspectives on this condition. Differentiating the false from the true lumen in AD is often essential; a spectrum of CT findings, e.g., “beak sign”, aortic “cobwebs” that allows such differentiation have been described with explicit illustrations. The value of non enhanced CT scans, especially useful in the diagnosis of an intramural hematoma has also been illustrated. Overlap in the clinical and imaging features of the various conditions presenting as AAS is not unusual. However, on most instances MDCT enables the right diagnosis. On select occasions MRI or trans-esophageal echocardiography may be required as a problem solving tool.     

Computer tomography versus aortography in diagnosis of aortic dissection

The use of computed tomography (CT) versus aortography is evaluated in a limited study of 17 cases of aortic dissection (AD). With the constraints of the present state of the technology and lack of availability of CT scanners at some centers, aortography remains the premier and often the only diagnostic test to choose in an emergency. CT, however, may be an asset in the diagnosis of AD when: (1) atypical or misleading clinical presentations are evident that do not require aortography; (2) aortography is contraindicated in a weakened patient, when there is no emergency; (3) aortography is a risk while there is a strong suggestion of AD; (4) patency of a false channel must be confirmed. These circumstances were encountered in five patients. In addition, a localized infrarenal AD was fortuitously discovered in two patients presenting with abdominal visceral cancer. On patient follow-up, CT is less invasive and may be performed in asymptomatic patients undergoing treatment, thereby facilitating the early detection of complications. Detailed computed tomograms often yield superior diagnostic information only if the CT study includes rapid sequential scans immediately following a fast intravenous bolus of contrast material.     

多层螺旋CT血管成像技术对主动脉夹层的诊断价值

目的探讨多层螺旋CT血管成像技术对主动脉夹层的诊断价值。方法主动脉夹层(AD)患者17例全部经螺旋CT平扫加增强扫描,并结合二维三维图像重建技术观察。结果本组17例按DeBakey分型,Ⅰ型3例,Ⅱ型1例,Ⅲ型13例。多层螺旋CT血管成像技术的敏感性,特异性较高,能直观、立体地显示真假腔、破裂口、内膜瓣、夹层累及范围和主动脉各分支情况。结论多层螺旋CT血管成像技术可以迅速准确诊断主动脉夹层,是最实用的并值得首选的影像检查方法。