多排螺旋CT在肺动脉高压诊断中的价值

目的探讨多排螺旋CT在肺动脉高压(pulmonary arterial hypertension,PAH)诊断中的价值。资料与方法对42例经多普勒超声心动图检查诊断为PAH的患者及48名肺动脉压力正常者进行CT肺动脉造影(CT pul-monary angiography,CTPA),分析其影像学表现,并进行统计学分析。结果 PAH组和对照组CT测量主肺动脉直径分别为(3.37±0.51)cm、(2.58±0.26)cm。主肺动脉直径≥2.9 cm诊断PAH的敏感性、特异性、阳性预测值、阴性预测值分别为85.7%、87.5%、85.7%、87.5%。主肺动脉直径与PAH的程度呈正相关(r=0.68)。PAH组及对照组的主肺动脉/升主动脉直径比分别为1.06±0.16、0.82±0.13,主肺动脉/降主动脉直径分别为1.34±0.22、1.01±0.14。两者差异具有统计学意义(P<0.05)。CTPA诊断PAH的准确性为85.7%。结论 CTPA可准确诊断PAH,并为病因诊断提供有效信息。     

CTPA在急性肺动脉栓塞合并肺动脉高压诊断中的价值

目的探讨CTPA在急性肺动脉栓塞（acutepulmonaryembolism,APE）合并肺动脉高压（pulmonaryarterialhypertension,PAH）诊断中的临床应用价值。方法选择108例临床拟诊APE的患者进行超声心动图及cTPA检查,以肺动脉收缩压~30mmHg为PAH诊断标准,分成PAH组46例,其余肺动脉压〈30mmHg者62例作为对照组,分别在CTPA轴位图像上进行相关测量及影像学表现分析,并进行统计学处理。结果主肺动脉直径、主肺动脉与升主动脉直径比值、主肺动脉与降主动脉直径比值与肺动脉高压程度呈正相关,以主肺动脉直径≥2．9cm诊断PAH的敏感度、特异度均较高（分别为95．65％和88．71％）。主肺动脉与升主动脉直径比值〉1、主肺动脉与降主动脉直径比值〉1．1诊断PAH敏感度分别为53．33％和91．48％,特异度分别为92．41％和65．57％,三者联合诊断PAH的敏感度和特异度分别为56．85％、96．85％。结论CTPA能够对PAH做出较为准确的判断,对评价APE严重程度及预后提供重要依据。     

健康人胸部大血管径线的MSCT测量

目的 测量健康人胸部大血管直径并计算其比值,探讨不同年龄、不同性别间胸部大血管直径正常值和比值的变化规律.方法 应用多层螺旋CT(MSCT)测量356例16～80岁之间主肺动脉、升主动脉、降主动脉、主动脉根部直径,并计算主肺动脉/升主动脉、主肺动脉/降主动脉、升主动脉/降主动脉比值.结果 不同年龄段各大血管直径有明显差异,P<0.05;不同性别间各大血管直径有明显差异P<0.05;不同年龄段主肺动脉/升主动脉比值、主肺动脉/降主动脉比值存在差异,P＜0.05,升主动脉/降主动脉比值无差异,P＞0.05;不同性别间主肺动脉/降主动脉、升主动脉/降主动脉有差异,P＜0.05,主肺动脉/升主动脉比值无差异,P＞0.05.结论 随着年龄增长,胸部大血管管径增宽,表现为增龄性改变;男性胸部大血管直径明显大于女性;主肺动脉/升主动脉、主肺动脉/降主动脉比值随着年龄增长表现为递减趋势.     

慢性阻塞性肺部疾病病程与肺动脉直径变化关系的多层螺旋CT评价

目的 评估慢性阻塞性肺部疾病(COPD)病程与肺动脉直径变化的关系.方法 在CT图像上测量66例COPD病人主肺动脉、右肺动脉、左肺动脉直径、主肺动脉/升主动脉直径比以及主肺动脉/降主动脉直径比,并分析其与COPD病程、肺功能的相互关系.结果 (1)COPD病程与肺动脉直径变化的关系:随着COPD的病程增加,肺动脉及其分支的直径增大,对照组和发病10年以上者主肺动脉直径差异有统计学意义,和发病20年以上者右肺动脉直径差异有统计学意义,和发病30年以上者左肺动脉直径差异有统计学意义,和发病10年以下者主肺动脉/主动脉直径比差异有统计学意义.(2)肺动脉与COPD分级的关系:对照组、COPDⅡ级、Ⅲ级、IV级各组间主肺动脉/降主动脉直径比两两比较,差异均有统计学意义.结论 肺动脉直径的变化与COPD病程进展程度有关.主肺动脉直径和主肺动脉/主动脉直径比是评价COPD进程及程度敏感的CT监测指标.主肺动脉/降主动脉直径比是最好的指标.     

多层螺旋CT肺动脉成像评价急性肺栓塞严重性的初步研究

目的:探讨多层螺旋CT肺动脉成像(CTPA)在评价肺栓塞(PE)严重性方面的价值。方法:23例急性PE患者行16层螺旋CT肺动脉和下肢静脉血管成像。根据超声心动图的检查结果,将患者分为右室劳损组(A组,7例)和无右室劳损组(B组,16例)。在CTPA心腔短轴位图像上测量右室最大横径(RVMMA)、左室最大横径(LVMMA)、主肺动脉(PA)直径、升主动脉(AO)直径,观察室间隔移位、下腔静脉对比剂反流情况,并计算RVMMA/LVMMA和PA/AO值及肺动脉阻塞指数。结果:A组与B组比较,差异有显著性意义的参数包括肺动脉阻塞指数(分别为46.79%、25.31%,P=0.024),RVMMA(分别为4.9和3.51cm,P<0.001),LVMMA(分别为3.34和4.07cm,P=0.046),RVMMA/LVMMA(分别为1.56、0.88,P=0.002),主肺动脉直径(分别为3.31和2.67cm,P=0.01),PA/AO(分别为1.03、0.75,P=0.011),室间隔移位比(分别为4/7、1/16,P=0.017)。以肺动脉阻塞指数为47%作为阈值时,诊断右心室劳损的敏感度为57%,特异度为75%;以RVMMA/LVMMA为1.4作为阈值,诊断右心室劳损的敏感度为71%,特异度为100%。结论:CTPA不仅可以诊断PE,并且可以提示急性PE的严重性。     

肺结节的不均匀灌注

目的 利用16及64层螺旋CT评价孤立性肺结节容积灌注是否均匀.方法 85例孤立性肺结节(直径≤4.0 cm,57例恶性结节,15例活动性炎症,13例良性结节)患者,在增强前、后采用16层(30例)及64层(55例)螺旋CT进行同层动态扫描.注入对比剂后11-41 s,每秒扫描1次;90 s扫描1次.16层螺旋CT扫描层厚:病灶直径3.0～4.0 cm时8.0 mm;2.0～3.0 cm时6.0 mm;1.5～2.0 cm时4.0 mm;1.0～1.5 cm时3.0 mm;<1.0 cm时2.0 mm(其中病灶直径3.0 cm时,层厚8.0 mm;2.0 cm时,6.0mm;1.5 cm时,4.0 mm).64层螺旋CT扫描层厚:病灶直径3.0～4.0 cm时5.0mm;<3.0 cm时2.5 mm.记录孤立肺结节增强前后各时相的CT值.分别计算肺结节3个中央有效层面强化值、灌注值、结节一主动脉强化值比、平均通过时间.使用均数间方差检验进行统计学分析.结果 3个中央层面强化CT值分别为(30.95±14.53)、(25.10±13.32)、(32.37±15.85)HU、灌注值分别为(33.01±21.35)、(23.70±12.87)、(29.00±15.47)ml·min-1·100 g-1,结节-主动脉强化值比分别为(13.58±6.41)%、(10.95±5.76)%、(13.64±6.20)%,平均通过时间分别为(11.61±5.74)、(11.97±3.55)、(13.44±3.74)s,差异均有统计学意义(F值分别为5.913、6.464、5.333、3.837,P值分别为0.003、0.002、0.005、0.023).平扫的CT值差异无统计学意义(F=0.032,P=0.968).结论 孤立肺结节容积灌注是不均匀的,推荐采用CT容积灌注成像的方式对孤立肺结节血流模式进行研究.     

40层螺旋CT冠状动脉成像方法的探讨

目的 探讨40层螺旋CT冠状动脉的成像方法.资料与方法 应用40层螺旋CT进行冠状动脉成像,将113例患者分为两组,一组心率＜75次/min(90例),另一组心率≥75次/min(23例),将对比剂追踪自动触发感兴趣区(ROI)分别设定在肺动脉主干平面的升主动脉段和降主动脉段,探讨最佳冠状动脉成像的方法.结果 将ROI设置在肺动脉平面主干的降主动脉比升主动脉能获得更好的冠状动脉图像.结论 40层螺旋CT对心率＜75次/min、选择肺动脉主干平面的降主动脉段作为对比剂追踪自动触发ROI,能够获得高质量的冠状动脉图像.     

64层螺旋CT血管成像在主动脉夹层术前的评价与应用

目的 评价64层螺旋CT血管造影(64-slice spiral CT angiography,64-SCTA)在主动脉夹层术前的应用价值.方法 回顾性分析63例主动脉夹层的64-SCTA征象,并与数字减影血管造影(digital subtraction angiography, DSA)结果进行了比较.结果 De BakeyⅠ型8例,De BakeyⅡ型2例,De BakeyⅢ型45例,主动脉壁内血肿8例.主动脉腔内见线状低密度内膜瓣影55例,将主动脉分成真假两腔, 64-SCTA显示破入口位于升主动脉10例,距动脉瓣平均(5.65±2.93)cm,位于弓降部左锁骨下动脉开口以远44例,瘤颈长度平均(2.69±2.03)cm;瘤颈直径平均(2.86±6.06)cm.64-SCTA精确显示夹层破入口25例,DSA精确显示19例,两者有明显差异(P＜0.05).结论 64-SCTA在主动脉夹层术前有很高的应用价值,不但能明确诊断,还可为治疗方法的选择提供可靠依据,应作为首选检查方法.     

适应性统计迭代重建技术降低胸部CT扫描剂量的初步临床研究

目的:分析适应性统计迭代(adaptive statistical iterative reconstruction,ASIR)重建技术降低胸部CT扫描中的X线剂量的作用.材料和方法:解放军总医院放射科胸部CT扫描的30名受检者,在2～14个月先后行64层MDCT和宝石探测器HDCT 2次胸部CT检查,调取PACS系统两次胸部检查的剂量核查报表.64层MDCT图像重建为传统的滤过反投影法(filtered back projection,FBP),HDCT扫描中用适应性统计迭代重建(ASIR)技术,50%ASIR值重建图像.比较两种重建技术的肺动脉干平面降主动脉内CT值与标准差,测量比较两次检查胸部剂量CTDI与DLP.结果:30例受检者FBP重建法CTDI(CT Dose Index)为13.0±2.7mGy,DLP(Dose Lenghth Product)440.4±97.3mGy·cm;ASIR重建法平均CTDI6.2±1.5mGy,DLP207.2±53.1mGy·cm,两次检查的剂量差异有统计学意义(P<0.001).肺动脉干平面降主动脉CT值分别为37.4±8.3Hu和38.1±9.8Hu,差异无统计学意义.结论:与传统CT重建图像的滤波反投影法相比,适应性统计迭代重建(ASIR)法胸部扫描中辐射剂量可降低50%以上,而图像噪声无明显提高.     

CT定量分析脂肪肝的临床应用初探

目的:探讨CT定量分析方法对于脂肪肝诊断的临床应用价值.材料和方法:选取¨2例临床明确诊断的非酒精性脂肪肝病例做肝脏螺旋CT平扫,分别测量肝、脾、降主动脉和下腔静脉的CT值,用CT值阈值和肝内血管相对密度及肝/脾、肝/降主动脉、肝/下腔静脉的比值分别进行定量分析.结果:82例轻度脂肪肝平均CT值47.0Hu(37～56Hu),75例表现为肝血管湮没,2例表现为肝血管基本正常显示,5例表现为肝血管反转显示,肝/降主动脉CT值比值1.07±0.11,肝/下腔静脉CT值比值1.11±0.12.23例中度脂肪肝平均CT值32.6Hu(28～39Hu),1例表现为肝血管湮没,22例表现为肝血管反转显示,肝/降主动脉CT值比值0.74±0.12,肝/下腔静脉CT值比值0.77±0.12.7例重度脂肪肝平均CT值17.0Hu(9～26Hu),均表现为肝血管明显反转显示,肝/降主动脉CT值比值0.43±0.12,肝/下腔静脉CT值比值0.44±0.13.结论:CT值阈值定量诊断脂肪肝的准确性较差,肝血管相对密度定量诊断的准确性较好,肝/降主动脉的CT值比值和肝/下腔静脉的CT值比值也可作为定量诊断脂肪肝的参考指标.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.