CT扫描体位设计在桡骨头骨折分型中的作用

目的 对比分析、研究50例桡骨头骨折患者的计算机X线摄影（CR）平片、CT冠状面和轴面体位扫描影像。设计确定桡骨头骨折CT扫描的常规体位。方法 选用50例临床拟诊桡骨头骨折的患者，分别摄取桡骨头部位CR平片、冠状面和轴面CT扫描影像。按临床采用的Mason分型，对全部桡骨头骨折影像进行Ⅰ-Ⅳ分型。结果 50例桡骨头骨折患者的CT扫描诊断阳性率为96％（48例）；CR平片诊断阳性率为78％（39例）。经CT冠状面体位设计扫描，确定分型者占94％（47例）。经CT轴面体位设计扫描，确定分型者占82％（41例）。结论 CT扫描体位设计对于桡骨头骨折分型意义明确。采用冠状面扫描体位可以满足常规临床影像诊断分型的需要，对于Ⅲ和Ⅳ型骨折应加扫轴面和进行三维重组。     

CR与CT对MasonⅠ型桡骨小头骨折的诊断价值

目的 评价CR与CT对桡骨小头Mason Ⅰ型骨折的诊断价值,为临床医师选择合适的检查提出建设性意见.方法 回顾性分析56例经临床确诊为桡骨小头Mason Ⅰ型骨折患者的CR、CT及临床资料,对桡骨小头是否存在骨折、骨折部位、骨折线数量、有无累及关节面、关节面是否塌陷进行重点观察并作简要统计学分析.结果 56例患者外伤8h内均行CR及CT检查,CR诊断桡骨小头骨折38例,怀疑10例,阴性8例,诊断准确率67.86％,阳性率85.71％,漏诊率14.29％;单纯CT轴位明确诊断47例,诊断准确率83.93％,漏诊或不确定骨折9例,漏诊率16.07％;CT薄层重建结合后处理技术诊断53例,怀疑3例,无漏诊病例,诊断准确率94.64％,阳性率为100％.结论 CR对桡骨小头Mason Ⅰ型骨折有较高的检出率,仍可作为首选的检查方式,但伴有肘部脂肪垫翘起及临床有明显的疼痛症状而CR检查阴性或怀疑时,应选择CT检查,薄层重建和CT后处理技术的综合运用是避免漏诊的关键.     

小儿胸部冠状位CT扫描的应用

目的探讨小儿胸部冠状位CT扫描的方法及临床应用价值。方法对16例经临床证实患气道疾患及肺部病变的患儿行冠状位扫描,年龄3个月~5岁。采用美国PICKER-ULTRAZ型螺旋CT机,机架孔径70 cm,最大倾斜角度30°。扫描条件:120 kV,200 mA,0.9 s,螺距1.5,层厚2 mm,重建间隔1.5 mm。结果16例患儿全部获得清晰的胸部冠状位图像,气管、气管分叉、左右主支气管、中间段支气管、叶支气管及其部分分支全貌显示。其中12例显示支气管腔内异物(均经支气管镜证实),1例显示支气管腔内肿瘤(手术证实为腺瘤),1例显示肺发育异常(病理为肺囊腺瘤样畸形)。8例显示伴有肺部炎症,5例显示伴有肺不张,10例显示伴有局部肺气肿。结论小儿胸部冠状位CT扫描图像,能清晰显示气管、支气管结构的全貌,对小儿支气管异物,气管、支气管腔内肿瘤,以及气管、支气管的肺发育异常等的诊断具有一定的价值。     

单层螺旋CT骶髂关节冠状位扫描成像技术的临床应用及诊断价值

骶髂关节CT扫描成像技术一般采用横断位扫描后利用多平面重建（MPR）技术来完成冠状面重建,目前国内采用单层螺旋CT机直接骶髂关节冠状位扫描成像技术的文献报道较少,     

视神经管的CT扫描技术

目的探讨视神经管的CT扫描方式及影像表现。方法分别对体外神经管模型和8例疑有神经管损伤的患者进行视神经管的轴位和冠状位扫描。结果在轴位图像上,视神经管呈轨道状;在冠状位图像上,视神经管呈“蝶眼状”。结论CT轴位 冠状位扫描,可清楚显示视神经管大小、形状及邻近结构,故在临床上有一定的应用价值。     

双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用

目的 研究双源CT低剂量前瞻性心电触发序列扫描技术在冠状动脉CTA的应用,并评价其图像质量.方法 将68例行冠状动脉CTA检查的患者分为2组,A组38例行前瞻性心电触发序列扫描,入组标准为心率70次/min(bpm)以下,窦性心律,心率波动范围在10 bpm以内.排除标准为心率不能控制在70 bpm以内及心律不齐患者、屏气不佳者以及冠状动脉存在严重钙化及明显狭窄者.采集期相70%R-R间期.B组30例为常规回顾性心电门控螺旋扫描,人组标准为心率70 bpm以下,窦性心律且规整.排除标准为心律不齐患者、屏气不佳者以及冠状动脉存在严重钙化及明显狭窄者.2组中管电压均随体质量指数(BMI)调整,BMI≥24 ks/m2管电压采用120 kV,BMI<24 ks/m2管电压采用100 kV.对2组扫描的冠状动脉分别做图像处理,应用秩和检验比较2组患者冠状动脉段图像质量评分,应用两独立样本t检验比较2组患者辐射剂量.结果 A组评价476段冠状动脉,B组评价372段冠状动脉.A组冠状动脉段图像质量评分为(3.48±0.59)分,B组均值为(3.53±0.58)分,2组之间比较差异无统计学意义(Z=-1.432,P=0.187).A组平均有效剂量为(2.51±0.54)mSv;B组平均有效剂量为(14.55±3.54)mSv,2组之间平均有效剂量比较差异有统计学意义(t=18.484,P=0.000).结论 在严格掌握心率及心律的基础上,可成功实现前瞻性触发序列扫描,该技术能显著降低辐射剂量而保证诊断所需图像质量.     

能谱CT成像结合低浓度对比剂用于冠状动脉CT血管成像的初步研究

目的 探讨能谱CT成像结合低浓度对比剂在冠状动脉CT血管成像(CCTA)中应用的可行性.方法 60例疑诊冠心病的患者采用随机数字表法随机分为3组,行CCTA检查,每组20例.A组使用含碘350 mg/ml对比剂进行120kVp前瞻性心电门控扫描,B、C组分别使用含碘350和270 mg/ml对比剂进行宝石CT能谱成像扫描,并通过调节不同keV水平分别分为5个亚组(60、65、70、75、80 keV),分别记为B1～B5、C1～C5组.测量主动脉窦部(AS)、左主干(LMA)、左前降支近段(LAD-p)、左回旋支近段(LCX-p)、右冠状动脉近段(RCA-p)、心包脂肪的CT值及主动脉窦部噪声,计算信噪比(SNR)和对比噪声比(CNR).采用单因素方差分析比较A组与B组客观评价指标,两两比较采用LSD法,选择最佳keV.采用独立样本t检验比较A组与C组最佳keV各项指标的差异.结果 使用相同浓度对比剂(含碘350 mg/ml)时,B1～B5组CNR分别为21.2±3.4、21.5±4.0、21.5±4.0、21.8±4.2、20.7±3.5,较A组(16.6±3.8)升高且差异均有统计学意义(P＜0.01),其中B1～ B4组进行组间两两比较,差异均无统计学意义(P值均＞0.05);A组各目标血管CT值为(393.6±45.1)、(384.8±56.0)、(375.6±37.7)、(366.4±70.8)、(369.1±66.8)HU,噪声为(31.1±9.9)HU,B2组各目标血管CT值[(481.4±43.2)、(466.7±69.3)、(434.1±48.8)、(436.3±42.5)、(427.4±48.6) HU)]较A组增高(P值均＜0.01),且噪声[(28.2±7.3)HU]较A组减低(P＜0.01);即65 keV为最佳keV.C2组(270 mg/ml对比剂GSI扫描65 keV)目标血管CT值[(396.3±76.3)、(390.4±74.4)、(359.5±83.1)、(358.3±67.7)、(365.4±68.2) HU)]及图像噪声[(29.1±5.6)HU]、信噪比(14.6±4.2)、对比噪声比(18.4±4.8)与A组比较差异均无统计学意义(t值为-1.29～1.40,P值均＞0.05).结论 宝石CT能谱成像65 keV水平图像结合含碘270 mg/ml对比剂行冠状动脉CT血管成像检查时,在降低患者碘摄入量时,仍可获得与常规120 kVp前门控扫描相当的客观图像质量.     

双源CT低剂量适应性序列扫描对高心率冠状动脉成像的初步研究

目的 研究双源CT低剂量适应性序列扫描技术在高心率患者冠状动脉CTA的应用,并评价其图像质量.方法 将72例心率70次/min(bpm)以上行冠状动脉CTA检查的患者按扫描方式分为2组.A组40例行适应性序列扫描.B组32例行常规回顾性心电门控螺旋扫描.对2组扫描的冠状动脉分别做图像处理,应用秩和检验比较2组患者冠状动脉段图像质量总体评分,应用两独立样本t检验比较2组患者辐射剂量.结果 A组评价501段冠状动脉,B组评价400段冠状动脉.可评价的冠状动脉段图像质量评分平均秩次,A组为475.42,B组为420.41,2组间比较差异有统计学意义(Z=-3.509,P=0.000).平均有效剂量A组为(6.2±0.9)mSv,B组为(14.7 ±1.9)mSv,2组间差异有统计学意义(t=-27.011,P=0.000).结论 适应性序列扫描对高心率患者冠状动脉CTA检查具有可行性,该技术能显著降低辐射剂量而保证诊断所需图像质量.     

双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用

Objective To evaluate low-dose CT coronary angiography with prospective electrocardiogram (ECG)-triggering using dual-source CT scanner.Methods Sixty-eight patients who underwent coronary CT angiography using a dual-source CT scanner were divided into 2 groups: group A (38 cases) and group B (30 cases).Prospective ECG-triggering sequence scan mode was employed for group A.Inclusion criteria included: heart rate <70 bpm, sinus rhythm, and heart rate fluctuation less than 10 bpm.Data acquisition was set at 70% of the RR-interval.Retrospective ECG-gating helical scan was performed for group B.Inclusion criteria included heart rates < 70 bpm and sinus rhythm.The exclusion criteria included heart failure and serious arrhythmias.In both groups, patients with a BMI≥24 kg/m2 were examined with a tube voltage of 120 kV, whereas patients with a BMI <24 kg/m2 were examined with a tube voltage of 100 kV.All images were transferred to a workstation for further processing and analysis.The imaging quality was evaluated.The imaging quality of coronary artery segments were compared with rank sum test between the two groups, and the radiation dose were compared with t test.Results A total of 476 coronary artery segments were evaluated in group A and 372 segments were evaluated in group B.The mean score of imaging quality for coronary artery segments in group A was 3.48±0.59 and that in group B was 3.53±0.58.There was no statistical difference in imaging quality between the two groups (Z=-1.432, P=0.187).The effective dose was on average (2.51±0.54) mSv (range 1.3--3.3 mSv) in group A, whereas on average (14.55±3.54) rosy (range 7.1--20.2 mSv) in group B.There was a statistical difference between the two groups (t=18.484, P=0.000).Conclusions Low-dose prospective ECG-triggering sequence scan in dual-source CT coronary angiography is feasible in patients with low heart rate and regular cardiac rhythm.This scan mode can substantially reduce radiation doses while preserving good diagnostic image quality.     

双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用

Objective To evaluate low-dose CT coronary angiography with prospective electrocardiogram (ECG)-triggering using dual-source CT scanner.Methods Sixty-eight patients who underwent coronary CT angiography using a dual-source CT scanner were divided into 2 groups: group A (38 cases) and group B (30 cases).Prospective ECG-triggering sequence scan mode was employed for group A.Inclusion criteria included: heart rate <70 bpm, sinus rhythm, and heart rate fluctuation less than 10 bpm.Data acquisition was set at 70% of the RR-interval.Retrospective ECG-gating helical scan was performed for group B.Inclusion criteria included heart rates < 70 bpm and sinus rhythm.The exclusion criteria included heart failure and serious arrhythmias.In both groups, patients with a BMI≥24 kg/m2 were examined with a tube voltage of 120 kV, whereas patients with a BMI <24 kg/m2 were examined with a tube voltage of 100 kV.All images were transferred to a workstation for further processing and analysis.The imaging quality was evaluated.The imaging quality of coronary artery segments were compared with rank sum test between the two groups, and the radiation dose were compared with t test.Results A total of 476 coronary artery segments were evaluated in group A and 372 segments were evaluated in group B.The mean score of imaging quality for coronary artery segments in group A was 3.48±0.59 and that in group B was 3.53±0.58.There was no statistical difference in imaging quality between the two groups (Z=-1.432, P=0.187).The effective dose was on average (2.51±0.54) mSv (range 1.3--3.3 mSv) in group A, whereas on average (14.55±3.54) rosy (range 7.1--20.2 mSv) in group B.There was a statistical difference between the two groups (t=18.484, P=0.000).Conclusions Low-dose prospective ECG-triggering sequence scan in dual-source CT coronary angiography is feasible in patients with low heart rate and regular cardiac rhythm.This scan mode can substantially reduce radiation doses while preserving good diagnostic image quality.     

多层螺旋CT后处理技术在鼻骨骨折的应用价值

目的探讨多层螺旋CT后处理技术在鼻骨骨折的诊断价值。方法对115例鼻外伤患者的CT原始图像进行MPR和VR后处理,将鼻骨骨折分为单纯Ⅰ型(骨折线无移位),单纯Ⅱ型(骨折线伴移位),粉碎型骨折(单一或双侧鼻骨碎成三块及以上,即两条或两条以上贯通骨折线),复合型骨折(鼻骨骨折合并周围骨骨折),骨缝分离型(骨缝大于2mm或缝隙骨两端错位),将单纯的鼻泪管和上颌骨额突骨折也纳入统计。结果鼻骨骨折患者91例。单纯Ⅰ型9例;单纯Ⅱ型6例;粉碎型骨折5例;复合型骨折57例,其中合并眶骨骨折32例、鼻中隔骨折9例、鼻泪管骨折8例和上颌骨额突骨折44例;骨缝分离型23例,其中额颌缝分离1例,鼻颌缝分离22例;单纯上颌骨额突骨折11例;骨折累及鼻骨孔2例,骨折累及上颌骨额突根部神经小孔3例;眼肌损伤1例,球后出血1例。结论骨算法VR图像可以更真实显示颌面部骨缝及骨孔,多平面重组图像结合骨算法VR图像可以更加准确直观的显示鼻骨骨折。     

桡骨远端骨折的诊治进展

桡骨远端骨折是全身最常见的骨折之一,但近些年随着对于桡骨远端骨折研究的深入,伴随固定材料的不断改进,治疗方法也不断进步。根据个体情况选择合适的治疗方案,预防和减少并发症,提高患者生活质量仍是医生面临的重要问题。     

脊柱骨折的CT诊断

目的:探讨西藏高原地区脊柱骨折的CT影像表现和诊断价值。方法:对45例脊柱外伤的CT扫描影像表现进行了回顾性的分析。男38例,女7例,年龄21～72岁。结果:CT能够准确地发现脊柱骨折的部位,三柱的损伤情况,椎管狭窄的程度,椎体骨折的类型。本组病例中,颈椎骨折的发生率最低,胸腰椎骨折的发生率最高。结论:在脊柱外伤中CT作为重要的首选检查方法,可快速准确地作出诊断,为临床提供治疗依据。     

X线和CT在桡骨远端粉碎骨折诊断和治疗中的应用价值比较

目的探讨X线检查与CT扫描在桡骨远端粉碎性骨折患者诊治中的作用差异。方法笔者对2011年3月~2014年9月收治的70例(70侧患肢)桡骨远端粉碎性骨折患者分别进行X线及CT扫描检查,对两种方法的检查判定结果进行统计分析。结果 X线共检查出关节面分离患者26例(37.14%),显著少于CT检出率67.14%(P0.05);同时CT检查发现关节面分离程度[(7.4±3.6)mm]显著高于X线[(5.3±2.9)mm],且差异具有统计学意义(P0.05);CT检出关节面压缩塌陷患者32例(45.71%),显著高于X线检出率24.29%;CT检查关节面压缩塌陷距离(7.3±3.9)mm,显著高于X线(P0.05);CT共检出61例关节面粉碎性骨块≥3块的患者,检出率显著高于X线(P0.05)。CT与X线诊断掌侧半脱位的检出率差异不显著(P0.05),背侧半脱位的检出率显著高于X线(P0.05);CT和X线在桡骨缩短5mm、掌倾角改变、尺偏角改变患者的检出率中差异不具有统计学意义(P0.05)。结论对于桡骨远端粉碎性骨折患者,CT检查对患者损伤的严重程度、骨折类型等细节的诊断优于X线,这有利于明确诊断,帮助临床医师制定正确的治疗方案。     

Gait analysis of patients with distal radius fracture by using a novel laser Timed Up-and-Go system

BackgroundPostmenopausal women are at risk of fall and fracture with the physical decline. Distal radius fracture (DRF) is considered as the primary fragility fracture, and women with this fracture showed poor results in the usual Timed Up-and-Go (TUG) test, indicating a decline in balance and physical ability. The detailed physical characteristics of female DRF patients have not been extensively examined.Research questionIs the novel laser TUG system able to detect and analyze the detailed gait characteristics in patients with DRF whose physical ability has tended to decline?MethodsIn this cross-sectional case control study, the gait characteristics of 32 female patients with DRF who had undergone surgery were evaluated at 2 weeks postoperatively with a laser TUG system to analyze the detailed leg motion during normal TUG test. Forty-three age- and sex-matched non-fractured women were evaluated by the laser TUG system as controls. Lifestyle and present illness were corrected at the time of TUG measurement. Detailed data during laser TUG in both groups were compared statistically, and odds ratio and thread shod of the fracture was elucidated through a logistic regression analysis.ResultsDRF patients showed slower speed and had to do more steps to complete the TUG test. Furthermore, asymmetric trajectory and significantly further distance from the marker were observed. Thirteen steps to complete the TUG test was the thread shod of DRF.SignificanceDetailed gait characteristics of patients with DRF were detected by the laser TUG system. The gait decline and abnormality could be one of the reasons of consecutive fragility fracture. To prevent secondary fragility fractures, this system can be useful for screening.     

扫描野中不同位置对螺旋CT图像Z轴空间分辨率影响的实验研究

目的:研究扫描野中不同位置对螺旋CT图像Z轴空间分辨率的影响。方法:使用Smatiom Sensation 64层螺旋CT。把delta模体沿X轴依次固定于CT机架的中心、偏心10cm、偏心20cm位置处,使用腹部螺旋扫描模式:120kV,160mAs,重建卷积核B31f medium smooth,重建间隔0.1mm,重建层厚0.6mm,Pitch=1时进行扫描和重建。然后制作各位置图像序列的层敏感度曲线(SSP),测试其有效层厚,并对各图像序列的SSP进行傅里叶变换得到调制传递函数(MTF)。结果:对于重建层厚0.6mm,Pitch=1时,中心点、偏心10cm和偏心20cm处的有效层厚是0.66、0.74、0.93mm。测试的SSP形状在中心点和偏心10cm处时近似钟形,左右分布基本对称,没有延伸较长的尾部,偏心20cm处SSP发生明显的偏移,不再接近正态分布。用delta测试的5%MTF的分辨率在中心点、偏心10cm和偏心20cm处分别是14.11、13.83、10.72LP/cm。结论:对于Sensation 64层螺旋CT,扫描野中不同位置对SSP、有效层厚和MTF都有影响,建议在病人扫描时尽量将扫描部位放置于中心点左右10cm内,在此范围内边缘和中心点可获得接近一致的空间分辨率。     

128层螺旋CT在外伤性肋骨骨折中的应用价值

目的探讨128层螺旋CT在外伤性肋骨骨折中的应用价值及限度。方法回顾分析50例疑似肋骨骨折患者128层螺旋CT扫描资料,利用容积再现volumerendering,VR）及薄层多平面重组（thin—sectionmulti．planarreconstruction,TSMPR）技术对肋骨骨折进行分析。结果50例患者中,VR发现肋骨骨折142处,TSMPR发现肋骨骨折151处,8例复查患者中,2例共发现3处原来未显示的肋骨骨折。VR显示骨折的空间解剖有优势。TSMPR显示肋骨骨折的细节效果好。结论128层螺旋CT的VR结合TSMPR是准确诊断肋骨骨折较可靠的方法,但各自均有一定的局限性,在工作中应予以重视。     

影像学在桡骨远端骨折中的应用进展

桡骨远端骨折是各种上肢骨折类型中最为常见的一种,由于日常生活中腕关节的活动频率非常高,所以对于其损伤的明确诊断、治疗方式的选择及后续功能的恢复具有很高的要求,而影像学检查是桡骨远端骨折临床诊断和观察疗效的主要手段。本文就影像学在桡骨远端骨折诊断、治疗方式选择及观察疗效中的应用进展进行综述。     

CT在结肠肿瘤诊断中的应用

应用CT扫描对结肠癌患者进行前瞻性研究，旨在提高CT在结肠癌诊治中的价值。通过对结肠癌病人进行CT扫描。并对轴位图像和重建的4-D、VR、MIP及仿真内窥镜图像进行观察分析，分别对各病例进行诊断及术前评估。CT对结肠肿瘤的分期和术前评估的准确性明显优于其它检查方法。CT尤其是MSCT动态强化扫描在结肠癌的诊治中，具有独特的优越性。