99例腰椎间盘真空现象的临床CT分析

椎间盘内气体聚集的影像学征像即所谓椎间盘“真空现象”（ＶａｃｕｕｍＰｈｅｎｏｍｅｎａ，简称ＶＰ）。ＣＴ是检查和发现ＶＰ的重要手段。本文着重探讨ＣＴ特征，分布及与相关病变。材料与方法本组９９例患者男３５例，女６４例。男女比为１：１．８２。年龄２５岁～７４岁，平均５３岁。５０岁以上８２例，占８２．８％。本组病例ＣＴ检查均用日立Ｗ９５ＯＳＲ型ＣＴ机。扫描平面与椎间隙平行。一般常规扫描Ｌ３～Ｓ１三个椎间隙，层厚５ｍｍ，间隔５ｍｍ，每个椎间隙扫３～４层，必要时再加层扫描或向上加扫Ｌ１～Ｌ３。常规照骨窗和软…     

老年人脑干损伤的CT征象与预后分析

老年人脑干损伤常台并颅内其他损伤,病情发展快,预后差。我院近６年来经ＣＴ证实５９例,现对其影像学特征与预后的关系进行分析。资料与方法１．一般资料：本组男４１例,女１８例;年龄６０～８４岁,平均６７．５岁。致伤原因：车祸伤３５例,跌伤１３例,重物击伤８例,坠落伤３例。伤后ＧＣＳ３～５分１５例,６～８分１８例,≥９分２６例。２．头颅ＣＴ检查：伤后０．５～３小时３２例,４～２４小时２７例。常规层距层厚１０ｍｍ平扫,对可疑部位薄扫。部分病例随访复查。结果１．ＣＴ表现：本组病例除有脑干损伤的ＣＴ征象外,均…     

颅脑CT检查的漏误诊分析

目前临床已将颅脑ＣＴ扫描检查作为颅脑疾病的诊断常规,但是由于人为因素和机器因素影响,使我们在诊断过程出现了漏诊和误诊。现就我院９５年至９７年ＣＴ颅脑检查３４３０例中发现漏、误诊共３７例作一原因分析。材料和方法本组漏、误诊共３７例,男性３１例,女性６例,年龄９岁～８３岁。均为首次颅脑平扫病人,患者均有神志不清或昏迷。有外伤诱因２３例,临床怀疑脑血管病变７例,其他７例。描扫机器为ＳｏｍａｔｏｍＤＲＨＣＴ机,扫描条件为１２５ＫＶ,５ｓ,４１０５ｍＡＳ,层厚８ｍｍ,层距１０ｍｍ。听眦线为常规扫描基线。结…     

含气腰椎间盘突出症

腰椎间盘突出症是一极其常见的疾病，然而含气的腰椎间盘突出症却甚为少见。笔者从１９９０～１９９８年共遇９例，现简介如下。１　材料与方法９例患者，男６例，女３例。年龄４２～７０岁，平均５８岁。发病时间８个月～１０年。以腰痛合并腿痛为主要症状者６例，单纯腰痛者１例，腰痛并下肢麻木无力者２例。体检：４例有下肢感觉减退，６例直腿抬高试验（２０°～６５°）和加强试验阳性。５例同时摄取Ｘ线平片和ＣＴ扫描检查，４例仅做ＣＴ检查。ＣＴ检查常规扫描Ｌ３～４、Ｌ４～５、Ｌ５～Ｓ１椎间盘，扫描层厚５ｍｍ，层距５ｍｍ，每…     

脑干出血65例临床表现和CT诊断分析

1992～ 1 999年 ,我们经ＣＴ诊断原发性脑干出血65例 ,为提高对本病的认识 ,现对其临床表现和ＣＴ征象进行分析。1　临床资料1 1　一般情况　本组男 4 6例 ,女 1 9例 ;年龄 31～ 84岁 ,平均 61 8岁。既往有高血压病史 4 9例 ,冠心病史1 2例 ,糖尿病史 6例。均为急性起病 ,在活动中发病52例 ,安静状态下发病 1 3例 ,发病至就诊时间 0 5～1 2ｈ。1 2　ＣＴ检查　均于就诊时行头颅ＣＴ扫描 ,部位从ＯＭ线至头顶 ,常规层距 1 0ｍｍ平扫 ,对可疑部位加扫 2ｍｍ或 5ｍｍ ,少数病例酌情行ＣＴ复查 ,并分析其临床表现和ＣＴ征象及预后。1 3　临…     

肝破裂的CT诊断（附五例报告）

肝破裂的ＣＴ诊断（附五例报告）关长群，刘振春，郑明，张蓓，阎洪峰ＣＴ检查方法：５例均经日立Ｗ－４型ＣＴ机检查。以剑突为基线向下扫描，层厚１０ｍｍ，间隔５ｍｍ。其中４例为连续快速扫描。Ｉ例为普通扫描。扫描前对重症病人先经静脉注射安定１０～２０ｍｇ，待有...     

颈部转移淋巴结的CT、B超扫描与病理对照研究(Ⅰ. 转移淋巴结的诊断标准)

目的：根据ＣＴ、Ｂ超及两者结合的表现，评价颈部淋巴结转移的诊断标准。材料与方法：对６０例颈淋巴结清扫术的患者做术前前瞻性ＣＴ、Ｂ超检查，术后与病理对照，并进行双盲法分析。结果：以最小径≥８ｍｍ为颈静脉链周围（Ⅱ～Ⅳ区）转移淋巴结的ＣＴ诊断指标，敏感性９１．６７％，特异性９８．６１％；以淋巴结最小径≥８ｍｍ作为其Ｂ超诊断指标，敏感性８３．３３％、特异性９７．２２％。以淋巴结最小径≥５ｍｍ为气管食管沟区转移淋巴结的ＣＴ诊断阈，敏感性６９．２３％，特异性１００％。增强ＣＴ扫描４４个淋巴结区域显示淋巴结边缘强化伴中心低密度区，经病理证实全部为转移淋巴结，特异性为１００％。结论：增强ＣＴ扫描是评价颈部转移淋巴结的最基本的影像学检查方法。淋巴结的最小径≥８ｍｍ可作为评估颈静脉链淋巴结转移的诊断指标；气管食管沟淋巴结最小径≥５ｍｍ时可诊断为转移。如有原发肿瘤病史，淋巴结边缘强化伴中心坏死是诊断颈部淋巴结转移最可靠的征象。     

正常的肺韧带和膈神经在胸片上能看到吗?

探讨正常人胸透上膈顶尖角状突起影的解剖学基础。材料与方法,胸透正常人２０４３例,对膈顶有尖角状影者其中１３例行胸部正侧位摄片和ＨＲＣＴ扫描对照。复习１１７例正常胸部常规ＣＴ扫描肺窗片。用间距５ｍｍ的ＨＲＣＴ扫描２０例正常人胸部。结果胸透膈顶尖角状影检为率：男３．５％,女７．０％。结论胸透（片）膈顶尖角状突起影ＣＴ上显示为肺韧带或膈神经。     

胸膜凹陷征的病理基础及其HRCT诊断价值

目的：为了从ＨＲＣＴ角度评价胸膜凹陷征的病理基础及其在周围型小肺癌中的诊断价值，提高对完整胸膜凹陷的认识水平。材料和方法：搜集经手术和／或病理证实的周围型小肺癌１０１例，其中５２例为ＨＲＣＴ前瞻性研究组，简称“前瞻”组；４９例为回顾性常规ＣＴ薄扫组，简称“薄扫”组；良性小结节４８例（３０例为ＨＲＣＴ扫描）。比较观察“前瞻”组、“薄扫”组、良性对照组及术后标本胸膜凹陷ＨＲＣＴ表现。结果：通过比较分析，经统计发现完整胸膜凹陷在“前瞻”组见３０例（５７．７％）；“薄扫”仅１例（２％）；对照组２例（４．２％）。研究发现，ＨＲＣＴ扫描技术是显示完整胸膜凹陷的关键，良、恶性组之间完整胸膜凹陷的发生率有明显差异。胸膜凹陷的中心位置与肿瘤生长的部位相关。结论：胸膜凹陷的形成除了与肿瘤内的瘢痕收缩等因素有关外，还与肿瘤发生的部位及其所致的节段性肺不张有关，ＨＲＣＴ像上完整胸膜凹陷征系周围型小肺癌的重要诊断依据之一     

甲胎蛋白,B超,肝扫描和CT诊断原发性肝癌的价值

对应用ＡＦＰ、Ｂ超和ＣＴ及肝扫描（ＲＮ）检查确诊的９８例原发性肝癌（ＨＣＣ）患者的检查结果作对比分析，旨在探讨几种检查在ＨＣＣ诊断中的价值及互补作用。１　材料和方法１－１　临床资料　ＨＣＣ患者９８例，男９２例，女６例，年龄１６～７５岁。患者均为我院住院者和门诊患者，全部患者均有慢性病毒性肝炎病史，乙肝病毒感染标志物（ＨＢＶｍ）持续阳性，其中１６例经手术病理证实，巨块型３例，阳性率１８％（３／１６）；结节型８例，阳性率５０％（８／１６）；弥漫型５例，阳性率３１％（５／１６）。其余根据临床诊断。１－…     

眼球损伤的CT诊断

目的 :探讨眼球损伤 CT诊断的价值。方法 :回顾 48例 CT及眼科证实的眼球损伤患者。 CT检查常规 3mm横断扫描 ,14例加作冠状扫描 ,31例加作冠状和 /或矢状重建。手术 45例。结果 :48例中 ,球内金属异物 19只占 40 % ,球后金属异物 9只占 19% ;眼环一处或多处断裂 38只占 78% ;晶状体脱位 3只占 6 % ,晶状体膨大、密度减低 5只占 10 % ;晶状体脱落 5只占 10 % ,眼球增大 3只占 6 % ,眼球缩小 9只占 19% ,眼环增厚 16只占 33% ;前房变浅 2只占 4% ,前房加深 8只占 17% ;玻璃体内出血 9只占19% ;视网膜下积血 2只占 4%。结论 :CT扫描能明确眼球损伤的范围 ,准确诊断损伤的程度 ,因而是诊断眼球损伤的重要方法之一     

An MRI analysis of brain-stem and cerebellar lesions and olivary hypertrophy

We describe the relations between primary brain stem or cerebellar infarct or haemorrhage and secondary inferior olivary pseudohypertrophy (OPH). We identified 17 patients (43.6%) among 39 with brain stem or cerebellar vascular disease who had MRI follow-up more than 3 months after their ictus, with OPH. The primary lesions in the 22 cases without OPH were 11 haemorrhages, including 8 medial cerebellar and 3 brain stem lesions, and 11 infarcts: 4 brain stem lesions without accompanying cerebellar involvement, 2 cerebellar infarcts with brain stem extension, and 5 cerebellar lesions without a brain stem infarct. The causative lesion in the 17 patients with OPH included 5 brain stem and 7 cerebellar haemorrhages and 5 brain stem infarcts; no cerebellar infarcts without brain stem involvement were found to cause OPH. Primary involvement of the tegmentum of the brain stem was closely related to secondary OPH, but we could not characterise MRI differences in the cerebellar lesions between the patients with or without OPH.     

缩鼻黏膜药物在慢性鼻炎鼻窦炎性病变CT诊断中应用价值

目的进一步探讨缩鼻黏膜药物在慢性鼻炎鼻窦炎性病变CT诊断中应用价值。方法31例临床疑有鼻炎鼻窦炎患者均经CT冠状位扫描,层厚、层距5mm。首次扫描后,如鼻腔或鼻道有实变,在实变侧鼻孔滴入1％麻黄碱滴鼻液3-4滴,体位引流、擤出鼻涕。再行鼻窦扫描,体位、参数同前。CT表现按照改良法分为6型：Ⅰ型漏斗型,Ⅱ型鼻道窦口复合体型,Ⅲ型蝶筛隐窝型,Ⅳ型息肉型,Ⅴ型特发型,Ⅵ型混合型。结果31例中CT表现为：Ⅰ型、Ⅲ型、Ⅴ型各3例,Ⅱ型8例,Ⅳ型5例,Ⅵ型4例。慢性鼻炎5例,伴有中下鼻甲肥大12例,鼻中隔偏曲9例,上颌窦黏膜下囊肿、右侧筛窦黏液囊肿、霉菌性上颌窦炎各2例。使用滴鼻液前,20例鼻腔或鼻道有分泌物影响观察。使用滴鼻液后,鼻腔、鼻甲黏膜收缩,分泌物排出,可明确判定有无息肉存在。2例用药前后扫捕分型改变。9例用药前后扫描无明显变化。结论在慢性鼻炎鼻窦炎性病变CT扫描前给予缩鼻黏膜药物,使分泌物排出、黏膜收缩,有助于息肉的显示。     

宫腔镜及B超联合诊治绝经后出血的临床价值

目的:探讨宫腔镜及B超联合诊治技术对于绝经后出血患者的临床价值。方法:对我科2000年2月~2005年8月收治的167例绝经后出血患者进行了宫腔镜及B超联合诊治。所有患者均先进行B超检查,之后行宫腔镜诊治,必要时辅以B超引导监护。结果:167例中84例内膜厚度<5mm,5~10mm者64例,>10mm者19例;同时提示宫腔内病变者12例。出血的病因依次为子宫内膜炎54例(32.3%)、子宫粘膜下肌瘤38例(22.8%)、子宫内膜息肉32例(19.2%)、子宫内膜癌22例(13.2%)、子宫内膜增生11例(6.6%)、宫颈息肉6例(3.6%),其它4例(2.3%)。保守治疗11例,化疗1例,31例同时进行了宫腔镜下治疗,99例实施宫腔镜电切手术,25例开腹手术,病理学诊断总的符合率为80.8%。结论:宫腔镜检查联合B超应作为绝经后出血患者的首选,内膜厚度<5mm者应慎行刮宫术。宫腔镜联合B超进行宫腔内病变治疗及电切手术对于老年宫腔内良性疾患的治疗具有重要临床价值。     

结节性硬化的MRI诊断

目的：报导11例脑结节性硬化并总结本病MRI特点。材料和方法：11例儿童结节性硬化患者。年5个月～14岁.均以癫痫为主要症状就诊，8例合并皮肤病变．2例胸部和肾脏分别受累，4例智力低下。采用Toshiba 0.35T超导型MRI系统以自旋回波T3加权T1 WI)500／25及T2加权(T2 WI)2000／80．横断面及矢状面平扫，层厚5-10mm.结果：MRI特点：(1)室管膜下结节11例，共55个结节．以侧脑室外侧壁分布最多51个，第三脑室旁1个，第四脑室旁3个，T1 WI上结节与脑实质呈等信号．与脑脊液形成对比，是发现室管膜下结节的最好办法。(2)皮层与皮层下结节10例，9例分布于额顶叶，1例以脑干小脑为主。在T1WI及T2Wl上结节均呈等信号．但在T2WI上结节周围有高信号环围绕（7例70%)具诊断特征性。结论：脑结节性硬化MRI检查中有典型征象，在本病协断中起重要作用。     

Late CT manifestations in spontaneous putaminal haemorrhage

Summary Serial CT studies were performed on 61 patients with putaminal haemorrhage, to determine outcome. The average duration of the follow-up was 2 years and 5 months. Several types of late CT change were identified, including disappearance of the haematoma without a trace of haemorrhage, a residual cavity, deformity of the lateral ventricle, atrophy of the head of the caudate, white matter degeneration and linear pseudocalcification around the cavity. Small haematomas, comma-shaped and less than 2 cm wide might disappear without leaving any trace. A slit or small rounded residual cavity was a frequent result of elliptical or irregular haematomas with little mass effect. With prominent ventricular compression, there were distortion and dilatation of the lateral ventricle and atrophy of the head of the caudate nucleus, which might be accompanied by white matter degeneration and pseudocalcification around the cavity. Five cases (8%) were left with no trace of previous haemorrhage, 32 (52%) with a slit cavity, 10 (16%) with a small round cavity, 8 (13%) with a large cavity, 5 (8%) with no residual cavity but with ventricular deformity, and 1 (3%) with only pseudocalcification at the site of the haemorrhage.     

Forensic pathological observations on fatal injuries to the brain stem and/or upper cervical spinal cord in traffic accidents

A retrospective study was performed on 149 forensic autopsy cases (12 in Kanazawa and 137 in Munich) of brain stem and/or upper cervical spinal cord (UCSC) injuries as a result of traffic accidents. Pedestrians were the most common type of victims, followed by car drivers. Eleven of the 12 Kanazawa victims were pedestrians. The total ratio of pedestrian victims gradually increased with age. The ponto-medullary junction was the most frequently injured site. A total of 146 cases demonstrated basal skull fractures and/or dislocation of the upper cervical joints: atlanto-occipital joint, atlanto-axial joint, or the joint between the 2nd and 3rd cervical vertebrae. However, in three cases, hyperextension of the neck unexpectedly caused brain stem injury neither associated with basal skull fracture nor with cervical dislocation. Intraventricular haemorrhage was found in 96 cases, suggesting a common feature associated with brain stem and/or UCSC injury. A tear of the basilar artery and that of the carotid artery was found in 17 and 20 cases respectively. A total of 39 victims demonstrated a blood alcohol concentration of over 0.5 mg/ml, and hyperextension of the neck occurred more frequently in these cases. In spite of the marked predominance of immediate death (138 cases), 11 cases (nine of brain stem injury and two of UCSC injury) had unexpected survival times of from 45 min to 12 h.     

Choledochal cysts: roentgenographic techniques.

Twenty-four cases of choledochal cysts were reviewed. Only 7 cases were definitely diagnosed preoperatively: 3 by 131I rose bengal scanning, 2 by intravenous cholangiography, 1 by oral cholecystography, and 1 by 99mTc sulfur colloid scanning followed by angiography. The highest percentage of definitive positive examinations was found in the 131I rose bengal scan (3 of 4), but the study most helpful in suggesting the diagnosis in a general way was the upper gastrointestinal series. The more frequent use of 131I rose bengal scanning and ultrasound should increase diagnostic accuracy.     

腰椎间盘前突的CT诊断及其临床意义

目的：探讨腰椎间盘前突或／和侧前突的CT诊断及其一临床意义。方法：回顾性分析56例腰椎间盘前突或／和侧前突合并腰大肌和前纵韧带受累的CT表现。所有病例有腰背痛或腰腿痛，均行腰椎间隙横断面CT薄层平扫。结果：56例共有71个腰椎间盘前突或／和侧前突，多发生于L3-4，共51个；发生于L4-5有16个；其它部位4个。腰大肌受累31例，前纵韧带受累15例，两者均受累10例。结论：腰椎间盘前突或／和侧前突可挤压推移腰大肌或前纵韧带，加上其化学或免疫的作用可导致腰背痛或腰腿痛。CT能较好地反映这些影像学改变，并具有临床治疗指导价值。     

腹腔痛觉信息在脑干的表达

目的:研究腹腔痛觉的中枢传导路。方法:将1％乙酸注入大鼠腹膜腔造成腹痛模型,用免疫组织化学ABC法检查了脑干内FOS阳性神经元的分布。结果:FOS阳性神经元呈双侧分布,主要分布于延髓的孤束核、腹外侧网状核;脑桥的臂旁核、蓝斑核,中脑的导水管周围灰质和中缝背核。结论:上述神经组织均参与腹腔痛觉信息的传递和调控。