16排螺旋CT检查后处理技术在肋骨骨折中的诊断价值

肋骨骨折是胸部外伤中最常见的损伤,在临床治疗及法医学鉴定中,及时、准确诊断肋骨骨折非常重要。目前主要依赖胸部x线摄片诊断肋骨骨折,但x线检查对细小或隐匿性骨折容易漏诊且定位困难。多层螺旋CT的问世及后处理技术的发展为肋骨骨折的诊断提供了一种新的客观的检查手段。作者采用16层螺旋CT及后处理技术对40例肋骨骨折患者的影像资料进行分析,旨在探讨16排螺旋CT不同后处理技术在肋骨骨折中的诊断价值。     

多层螺旋CT图像后处理技术在主动脉疾病中的应用

医学影像技术是诊疗系统的关键手段,影像的三维重建和图像后处理技术为临床诊断及治疗提供了可靠的影像学依据.本文简要介绍了多层螺旋CT(MSCT)图像后处理技术在主动脉疾病中的应用,并对其在临床应用的研究进展进行了总结和展望.     

螺旋CT图像后处理技术在结肠的应用价值

目的探讨螺旋CT不同成像技术对结肠疾病的诊断价值。方法采用GE HiSpeed DX／i螺旋CT机，对25例疑结肠疾病患者进行容积扫描，将图像传至工作站，进行多平面容积重建（MPVR）、三维重建（3D）和CT仿真内窥镜（CTVE）显示。结果CT横断面图像和三种后处理图像在显示结肠的解剖及病变方面相互弥补。结论螺旋CT多种图像重建后处理技术能从不同方面反映结肠病变，有利于对疾病的整体观察。     

多层螺旋CT扫描及图像后处理技术在小儿气道异物诊断中的应用观察

2012年7月~2014年7月我院共接收确诊为支气管异物患儿80例,将其随机分为观察组和对照组各40例,对照组患儿气道异物用X线诊断,观察组患儿在此基础用多层螺旋CT扫描及图像后处理技术诊断,并对两组患儿气道异物诊断准确率进行比较。两组患者经检查后,采用MPR、CTVB图像后处理技术,后进行支气管镜检查。两组患者经不同方法诊断后,对照组的符合率(57.50%)远远低于观察组的符合率(95.00%);对照组的总误诊率(45.00%)远远高于观察组的总误诊率(5.00%),差异均具有统计学意义(P<0.05)。多层螺旋CT扫描及图像后处理技术在小儿气道异物诊断中的应用价值具有很高的准确率,可推广其临床应用。     

16层螺旋CT在冠心病诊断中的应用

目的：探讨16层螺旋CT及其心电门控CT冠状动脉造影（multi—slice spiral CT coronary angiography.MSCTA）在冠心病中的诊断应用。方法：52例患者均行16层螺旋CT冠状动脉造影及经皮导管法冠状动脉造影，图象质量分为可评估冠脉和不可评估冠脉，并逐支逐段进行分析，以冠脉血管狭窄大于50％为阳性，     

多层螺旋CT在骨创伤诊断中的临床价值

本文回顾分析了在我院进行多层螺旋ＣＴ扫描的 4 3例患者的影像资料 ,探讨ＭＳＣＴ在骨创伤诊断中的临床应用价值。1　材料与方法本文 4 3例有明确外伤史患者 ,男2 8例 ,女 15例 ,平均 36岁 ,其中 33例Ｘ线平片已明确骨折的诊断 ,10例Ｘ线平片可疑骨折 ,为进一步了解骨折的情况和明确诊断 ,做多层螺旋ＣＴ扫描。使用ＧＥＬｉｇｈｔｓｐｅｅｄＰｌｕｓ多层螺旋ＣＴ机 ,扫描参数 :选择高质量 (ＨＱ)扫描 ,3∶1的螺距 ,Ｘ线准直宽 2 .5ｍｍ ,有效层厚 2 .5～ 5 .0ｍｍ ,重建间隔 1.2～ 2 .5ｍｍ ,仰卧位扫描 ,采集原始二维图像。 4 3例原始二维…     

多排螺旋CT与图像后处理技术在外伤骨折中的诊断价值

目的探讨10排螺旋CT(10-MSCT)对外伤骨折的诊断价值及治疗的指导意义。方法对23例骨关节创伤病例X线平片检查后,应用10-MSCT扫描,在工作站上运用多平面重建(MPR)、三维重建(3D)等技术进行图像后处理,并对其进行诊断和分析。结果 5例X线平片显示局部骨皮质模糊或骨结构不清的病例,多排螺旋CT扫描后确诊骨折;2例X线平片诊断骨折可疑病例,MSCT扫描后排除骨折;4例X线平片未见明显骨折的病例,多排螺旋CT扫描后运用MPR、3D图像后处理技术后诊断为骨折;12例X线平片诊断为粉碎性骨折的病例,多排螺旋CT扫描后运用MPR、3D技术能从多方向显示各个骨折线的形态、方向、走形,撕脱、游离骨片的形态、大小以及骨折的移位、成角。结论 10-MSCT结合多种图像后处理技术可提高外伤骨折诊断的准确性,多排螺旋CT重建能清楚显示传统X线摄片所不能直接显示的骨折,对于术前的骨折分类、治疗方案的制定和手术路径的选择有一定的指导意义。     

16排螺旋CT三维重建技术在骨关节创伤性骨折中的应用价值

目的:探讨16排螺旋CT三维重建技术在骨关节创伤性骨折中的诊断价值,为临床治疗提供更可靠的影像学依据。材料与方法:把从2006年7月以来的197例骨关节创伤骨折的患者进行CR及16排螺旋CT三维重建检查,对图像进行分析对比。结果:28例患者CR检查为阴性,而被三维重建重新定性明确;65例患者CR检查阳性,但其中较小骨折未显示,CT三维重建显示清晰,104例患者检查为阳性,而骨折局部细微改变显示不明确,CT三维重建均显示清晰明确。结论:16排螺旋CT三维重建技术明显提高了阳性率及准确率,特别对关节内复杂骨折显示清晰,从而说明其在骨关节创伤骨折中更具实用价值。     

16层螺旋CT机行颅脑非螺旋扫描成人颅脑的条件选择

将我院2014年3月~2015年6月体检中心进行体检的400名健康人员为例,随机平均分为四组,对其进行16层螺旋CT机行颅脑非螺旋扫描,其中,第一组采用常规剂量(120 k W,颅顶部200m As、颅底部240m As)扫描,而第2~4组采用低剂量(120 k W,200m As、160m As、100m As)扫描。由两名放射科医师独立对各组图像进行主观评分,运用Kappa一致性检验评价结果的一致性。分析图像质量主观评分与扫描剂量的关系,记录各组DLP与CTDI vol值,并计算相对第一组,第2~4组DLP与CTDI vol值下降的比例。结果经研究发现:(1)两名放射科医师评分一致性好(K=0.860,P=0.017)。(2)图像质量主观评分与扫描剂量关系呈正相关性(r=0.512,P0.05)。(3)相比于第一组,第2~4组的DLP与CTDI vol值都有所下降,各组的DLP值与第一组相比,差异比较显著,具有统计学意义(P0.05)。而第四组图像质量下降最明显,与第一组相比图像质量下降明显(P0.01),具有统计学意义。对成人颅脑进行16层螺旋CT机行颅脑非螺旋扫描时,采用100m As的管电流,可以有效降低低剂量CT扫描的辐射剂量,对成人颅脑解剖结构的观察与诊断不会造成影响。     

16层螺旋CT在输尿管小结石诊断中的应用

目的探讨16层螺旋C T在输尿管小结石诊断中的应用价值。方法60例均经平扫,2例行增强扫描,所有病例都经后处理重建处理。结果共证实小结石59例（98．33％）,其中左侧25例,右侧34例,输尿管上段14例,输尿管中段6例,输尿管下段39例。结论多层螺旋C T 可以及时、准确直观地显示结石的形态和解剖关系、位置及输尿管梗阻扩张程度,对输尿管小结石诊断具有重要价值。     

High-yield Selection Criteria for Cranial Computed Tomography after Acute Trauma

OBJECTIVE: To develop and prospectively evaluate criteria for selecting head-injured patients requiring cranial CT. METHODS: A two-phased prospective observational study design was implemented at a university ED. Physicians completed a form with 51 variables for 540 patients in Phase I. Ten high-yield variables were identified and prospectively tested on 273 patients in Phase II. Prediction rule performance for identification of patients with abnormal CT scans was determined. RESULTS: The combined criteria had a sensitivity of 97% for CT-scan abnormalities in Phase I; sensitivity was 96% in Phase II. Negative predictive values were 97% and 94%, respectively. Prevalence of disease in Phase I was 17%; prevalence in Phase II was 16%. Had the Phase I criteria been implemented during Phase II, 43 of 273 patients (16%) would not have been scanned, including two patients with positive results who did not require operative intervention. CONCLUSIONS: Fifty-one clinical variables from head-injured patients were narrowed to ten of statistical significance and consistent interpretation for prospective evaluation. Patients with none of these criteria were found to be at low risk of having sustained significant head injury.     

64层CT多种成像后处理技术在急诊膝关节创伤诊断中的应用

目的：探讨64层螺旋CT多种图像后处理技术在急诊膝关节创伤诊断中的价值。材料与方法：利用64层CT对26例急诊膝关节损伤患者行快速扫描,将获得的原始数据分别通过不同算法得出骨窗及软组织窗（显示膝关节周围软组织及膝关节韧带）薄层图像,然后行多种图像后处理技术功能成像（包括MPR、MIP以及VRT成像,必要时辅以SSD图像）。结果：26例急诊行64层螺旋CT检查的急诊膝关节创伤患者,其中发现骨折39处（包括隐匿性骨折7处）;髌及胫腓侧韧带、前后交叉韧带损伤34处,此外25例患者伴有软组织损伤及23例合并有关节腔积液,所有病例最终经过临床证实。结论：64层螺旋CT在急诊膝关节创伤诊断中有非常重要的意义和实际应用价值,可以作为急诊膝关节创伤的首选手段。     

64层螺旋CT冠状动脉成像对冠心病的诊断价值

目的：评价64层螺旋CT对冠心病的诊断价值。方法：对25例典型病例的CT图片进行分析、总结,观察64层螺旋CT对冠状动脉的管腔狭窄程度及冠脉内斑块性质的显示能力,并对桥血管和支架通畅性进行观察。结果：近端冠脉中度以上狭窄的敏感度、准确度、阳性预测值分别为93.5%,90.3%,88.5%,对左主干及前降支病变诊断价值较高;对冠状动脉内软斑块显示较佳;对桥血管及支架通畅和有无再狭窄显示良好。结论：MSCT冠状动脉成像在冠心病筛查及冠状动脉支架术后和搭桥术后的随访发挥重要作用。     

The Value of Single-photon Emission Computed Tomography/Computed Tomography in the Evaluation of Herniation Pits

The potential role of the nuclear medicine diagnostic bone scan in identifying herniation pits of the femoral neck is yet to be adequately described. The following cases show incidental findings of subcortical cavities of the femoral neck detected on bone scans. These findings highlight the potential role of the bone scan as a useful imaging modality in identifying and stratifying herniation pits based on physiology, particularly with the addition of single-photon emission computed tomography/computed tomography to the armamentarium.     

Impact of Helical Computed Tomography on the Outcomes of Emergency Department Patients with Suspected Appendicitis

OBJECTIVES: To assess the impact of an emergency department (ED) guideline employing selective use of helical computed tomography (CT) on clinical outcomes of female patients with suspected appendicitis. METHODS: All patients presenting with suspected appendicitis were prospectively enrolled and managed in accordance with a guideline incorporating selective use of helical CT. Although not the objective of this investigation, male patients were included for purposes of comparison. Patients with clinically evident appendicitis were referred to the surgical service, and patients with equivocal presentations were studied with helical CT. Patients were followed to final surgical or clinical outcomes. Outcome measures included time from ED presentation to laparotomy and rate of appendiceal perforation. These measures were compared with those of a historical cohort of patients preceding the use of helical CT. RESULTS: A total of 310 consecutive patients with suspected appendicitis were enrolled; 92 had appendicitis. Sixty patients were referred to the surgical service without helical CT, and 41 had appendicitis (68%). Helical CT was performed on 250 patients; 51 had appendicitis (20%). For males, the mean interval from ED presentation to laparotomy was 559 minutes (95% CI = 444 to 674 minutes) during guideline use and 480 minutes (95% CI = 405 to 555 minutes) before. This interval for females was 433 minutes (95% CI = 326 to 540 minutes) during guideline use and 710 minutes (95% CI = 558 to 862 minutes) before. Appendiceal perforation rate for males was 0.25 (95% CI = 0.14 to 0.36) during guideline use and 0.38 (95% CI = 0.29 to 0.47) before; perforation rate for females was 0.06 (95% CI = -0.05 to 0.17) during guideline use and 0.23 (95% CI = 0.14 to 0.32) before. Helical CT had 92% sensitivity, 97% specificity, and 96% accuracy in diagnosing appendicitis. CONCLUSIONS: Helical CT is highly accurate in detecting appendicitis in patients with equivocal ED presentations. The use of a guideline employing selective helical CT was associated with a decline in the time from ED presentation to operative intervention in females.     

Isolated Intraperitoneal Fluid on Abdominal Computed Tomography in Children with Blunt Trauma

OBJECTIVE: To determine the frequency of isolated intraperitoneal fluid (IIF) on abdominal computed tomography (CT) in pediatric blunt trauma patients and the association between IIF and clinically identifiable intra-abdominal injuries (IAIs) in these patients. METHODS: The authors conducted a prospective observational study of consecutive children <16 years old with blunt torso trauma who underwent abdominal CT scanning while in the emergency department (ED). All patients were evaluated by a faculty emergency physician who documented the patient's physical examination. All CTs were interpreted by a single faculty radiologist masked to clinical data. The volume of intraperitoneal fluid was quantified (small, moderate, large) and the presence of organ injury visible on CT was noted. Patients were considered to have IIF if the CT demonstrated intraperitoneal fluid and no solid organ injury. Patients with IIF were followed through their hospitalizations or telephoned in one week if discharged home from the ED. RESULTS: Five hundred twenty-seven children with blunt trauma were enrolled into the study. The mean age (+/-SD) was 7.4 +/- 4.7 years, and the median pediatric trauma score was 10 (range -2 to 12). Eighty-eight patients (17%; 95% CI = 14% to 20%) had intraperitoneal fluid on CT scan and 42 (48%; 95% CI = 37% to 59%) of these patients had IIF. Of the 42 patients with IIF, five patients (all without abdominal tenderness and with a small amount of IIF on CT scan) were discharged to home from the ED and were well at telephone follow-up; the remaining 37 patients were hospitalized. Of the 42 patients with IIF, 7 patients (17%, 95% CI = 7 to 31%) had IAIs subsequently identified (all gastrointestinal injuries) during their evaluations. Six of the seven patients with IIF and subsequently identified IAIs had abdominal tenderness on examination in the ED. The remaining patient had a decreased level of consciousness. CONCLUSIONS: Isolated intraperitoneal fluid occurs in 8% of pediatric blunt trauma patients undergoing abdominal CT, and IAIs are subsequently identified in 17% of these patients. Patients with a small amount of IIF on CT who lack abdominal tenderness and have a normal level of consciousness are at low risk for subsequently identified IAIs.     

脂肪肝患者64层螺旋CT灌注成像的研究

目的采用64层螺旋CT灌注技术测定脂肪肝患者的血流灌注参数的变化,分析其血流动力学的改变。方法 64层螺旋CT肝血流灌注成像15例,其中脂肪肝患者13例,健康志愿者2例,观察分析肝脏血流灌注各参数。结果脂肪肝患者的血流灌注参数与正常组组间相比,肝动脉灌注值（Art.Perf）、肝门静脉灌注值（Port.Perf）、总灌注值（Tortal.Perf）下降程度明显;随着脂肪肝组组内病变严重度增加,Art.Perf与Tortal.Perf参数值亦有明显下降;肝动脉灌注指数（HPI）值各组无明显相关性。结论肝脏CT灌注成像可反映脂肪肝的血流改变,并且对脂肪肝患者的血供情况加以评估,为临床提供更多的诊断依据。     

正电子发射计算机断层显像在脑梗死治疗中的应用进展

脑梗死系由各种原因所致的局部脑组织血液供应障碍,导致脑组织缺血缺氧性病变坏死,进而产生临床上对应的神经功能缺失表现。本文对正电子发射计算机断层显像在脑梗死治疗中的应用进行总结。     

胸部外伤CT与常规X线诊断价值的比较

目的：比较CT与常规X线在胸部外伤中的诊断价值。材料与方法：对71例胸部外伤病例分别进行胸部平片及CT检查,就其胸片与CT的诊断结果作比较分析。结果：CT诊断诸如肺挫伤、肺撕裂伤、外伤后肺不张、微量气胸、微量血胸、隐匿性肋骨骨折等胸部外伤性病变明显优于胸片。结论：对于胸片未能明确诊断的胸部外伤病例,为防止漏诊应加做CT扫描。     

Computed Tomographic Localization of Malposition of Pacing Electrodes: The Value of Cardiovascular Computed Tomography

Three patients with uncertain pacemaker electrode position on plain film radiography were studied with fast cine cardiovascular computed tomography (CT) imaging. The value of this new technique in determining the position of pacing electrodes is discussed.