Role of computed tomography in the postoperative evaluation of infantile hydrocephalus

Summary The value of CT for the diagnosis and followup of infantile hydrocephalus is discussed. The ventricular volume, subependymal periventricular hypodensity, sbudural hygroma or hematoma, position of catheter in the ventricles, ependymal inflammation and other occasional findings are considered.     

肺动脉栓塞的螺旋CT血管造影的诊断研究(附七例报告)

目的评价螺旋ＣＴ血管造影（ＳＣＴＡ）诊断肺动脉栓塞（ＰＥ）的可信性。方法对７例临床怀疑ＰＥ的患者行螺旋ＣＴ血管造影,其中６例在溶栓治疗２０天后进行了复查。结果７例患者累及２０处肺动脉及其分支。栓子表现为肺动脉腔内柱状、丘状及不规则形充盈缺损。７例均有肺动脉高压,其中６例中心肺动脉扩张呈“残根征”改变。６例经溶栓治疗后,４例栓子完全消失,１例明显缩小,１例略有缩小。结论螺旋ＣＴ血管造影是诊断中心性肺动脉栓塞可靠而直观的检查方法,并可较准确地判断溶栓疗效。     

育龄期妇女盆腔假性囊肿的临床及CT表现(附12例分析)

目的：回顾分析育龄期妇女盆腔假性囊肿的的临床症状、CT表现、手术所见及病因,以提高对该病的认识。方法：12例经病理或临床证实盆腔假性囊肿,年龄23-41岁,其中8例有盆腔或下腹部手术史,2例有引产史。结果：育龄期妇女盆腔假性囊肿的CT表现不典型,误诊率较高,临床及超声检查也同样有较高的误诊率。结论：对于育龄期妇女盆腔囊性肿块,娟 盆腔或下腹部手术史者,应想到假性囊肿的可能性,多次复查并结合临床症状分析,则可以作出正确诊断。     

The value of CT for the diagnosis of pituitary microadenomas in children

Summary Three cases of prepuberal hypopituitary dwarfism regarded as idiopathic, are reported. In two of them the skull X-rays showed questionable minimal alterations of the sella turcica; in the remaining child the examination was completely negative. All three children were found to have a pituitary intrasellar microadenoma on the CT scan. The diagnosis was confirmed during surgery. The postoperative followup demonstrated the relation of the lesion with growth retardation and the indication for surgical treatment.     

Iofetamine HCI I-123 brain scanning in stroke: a comparison with transmission CT

Although IMP scans fail to show fine anatomical details of the brain, because of poor resolution of a single head rotational system, adequate information is offered by the scans to localize most perfusion defects caused by stroke. The following conclusions can be drawn from our study: 1. The planar IMP brain scans processed through the computer are sensitive in the early diagnosis of acute stroke except for small and deeply localized lesions. 2. The SPECT IMP imaging is more sensitive than the planar or transmission CT scans in the early diagnosis of stroke. Semiquantitative evaluations are feasible with IMP SPECT. 3. Neither transmission CT nor IMP SPECT are sensitive in the detection of acute lacunar infarcts. 4. In acute infarction, the transmission CT is usually negative or minimally positive in the early stages, while impaired uptake of IMP occurs immediately after the onset of the stroke. In acute stroke, the extent of the perfusion defect on IMP is usually greater than the abnormality seen on the transmission CT. 5. On followup studies, IMP scans show improved perfusion reflecting physiologic changes, while transmission CT scans show further dense anatomical changes when compared to the initial studies. 6. Hyperemic changes are likely due to collateral circulation or luxury perfusion. This finding suggests that the IMP reflects local cerebral blood flow in strokes.     

机械性肠梗阻CT诊断

目的：总结机械性肠梗阻CT表现及诊断价值。方法：分析30例经手术（16例）及临床（14例）证实的肠梗阻CT及临床资料,比较腹部平片与CT对肠梗阻存在、定位、病因、有否绞窄以及治疗方法选择的价值。结果：CT证实肠梗阻存在100%,平片的70%;病因诊断准确性CT为96%,平片13%;CT能对肠肿瘤及时发现并分期（9例）,及早诊断肠绞窄（2例）及发现肠外肿块（4例）,有助于及早选择外科治疗,结核、局限炎症、肠套叠等首选保守治疗,常规CT检查发现肠管异常扩张应扩大扫描范围,往往能发现引起肠梗阻的病因（本组因此偶然发现肠肿瘤3例）。结论：肠梗阻或疑有肠梗阻的病人在平片、B超诊断信息不足时尽早CT检查对于明确病因,治疗选择及改善预后有较大意义。     

The diagnostic value of CT for radiotherapy of cerebral tumors

Summary The paper deals with CT followup studies on 73 patients with cerebral tumors who received radiotherapy. The value of CT for the indication of radiotherapy, for followup therapy and for the demonstration of therapeutic success are discussed. Since the cerebral tumors become visualized by means of CT in their entire extent and can be differentiated from perifocal edema, the question arises whether radiotherapy should consist of higher doses in the future. It is also suggested that the clinical malignancy may be used to compare the behavior of cerebral tumors when there is no exact histological classification. The possible histopathological effects of radiotherapy (edema, necrosis) and their demonstration by CT are discussed.Supported by the Deutsche Forschungsgemeinschaft     

Migration of prostate brachytherapy seeds to the vertebral venous plexus

PURPOSE: We report two cases of seed migration to the vertebral venous plexus after iodine-125 (I-125) transperineal interstitial permanent prostate brachytherapy. METHODS AND MATERIALS: Case 1: A 67-year-old Japanese man underwent percutaneous transperineal interstitial permanent prostate brachytherapy at our institution. Three months after brachytherapy, routine followup kidney-urinary bladder (KUB) radiography showed two seeds that had migrated to the pelvic area and were overlapped by sacral bone. It was very difficult to detect the seeds by visceral CT, because seeds were in contact with to vertebral bone, and seeds and bone were of the same CT value in visceral CT. But bone CT could distinguish seeds and bone, and it showed seed migration to the vertebral venous plexus in the sacral vertebral canal. Case 2: A 75-year-old Japanese man underwent percutaneous transperineal interstitial permanent prostate brachytherapy at our institution. The day after seed implantation, routine followup KUB radiography showed that a seed had migrated to the pelvic area and was overlapped by sacral bone. Bone CT clearly showed seed migration to the vertebral venous plexus in the vertebral canal in comparison with visceral CT. RESULTS: Seeds that have migrated to the vertebral venous plexus are difficult to be detected by visceral CT or KUB radiography. In visceral CT, it is difficult to distinguish seed and bone, especially when they are touching each other because they have the same CT value in visceral CT. It is therefore necessary to perform bone CT to detect such migrating seeds. CONCLUSIONS: To our knowledge, this is the first report of seed migration to the vertebral venous plexus after prostate brachytherapy. We thought that seeds migrate to the vertebral plexus via the pelvic venous pathway. If seed migration to the pelvic area and the overlapped sacral bone area is found after brachytherapy, bone CT should be performed, especially when it is difficult to detect the seed in visceral CT.     

20例肾结核临床诊治分析

目的探讨肾结核的临床特征及有效治疗方法。方法对20例肾结核患者的临床资料进行回顾性分析。结果18例尿常规异常（90％）,10例血沉异常（50％）,尿液查找抗酸杆菌12例呈阳性（60％）,B超提示肾脏结核12例（60％）,CT检查10例诊断肾结核（50％）,IVP检查诊断肾结核14例（70）。14例患者手术后经病理确诊为肾结核,随访1-2年治疗效果稳定,未发现尿路结核。结论肾结核的临床表现不典型,其诊断应在结合临床表现的前提下以实验室检查与影像学诊断为主。治疗仍以手术切除肾脏为主,应尽可能切除患侧全程输尿管。     

Thalamic bleeding

Summary Isolated thalamic bleeding without involvement of the internal capsule or other neighboring structures is extremely rare. Thalamic hemorrhage often leads to bleeding into the ventricular system. The extent of the bleeding is not a valid criterion for prognosis. The chance of survival was found to be poorest in initially comatose patients. CT is eminently suitable for determining the size and position of the hemorrhage and also for the followup of thalamic bleeding. No significant correlation was found between the clinical and CT outcome.     

64层螺旋CTA在颅内动脉瘤术前及术后的应用价值

目的：探讨64层螺旋CT血管造影（CTA）对颅内动脉瘤术前诊断及术后评价的应用价值。方法：回顾性分析临床怀疑为颅内动脉瘤患者25例,行64层螺旋CTA检查,其中21例诊断为动脉瘤,并经手术证实,术后亦行CTA复查,通过比较两次CTA结果评价动脉瘤夹闭情况。结果：在25例患者中共发现21例25个动脉瘤,CTA可清楚显示的动脉瘤位置、大小形态及与周围结构的关系,与手术所见一致（符合率100％）;术后CTA能够清楚显示动脉瘤体消失,载瘤动脉与动脉瘤夹之间关系及动脉瘤夹的数量和位置。结论：64层CTA在诊断颅内动脉瘤及动脉瘤术后随访中具有重要临床价值。     

CT灌注成像在脑内缺血性疾病中的初步应用

目的 评价ＣＴ灌注成像在脑内缺血性疾病的作用。方法 对２４例缺血性中风发作２小时至２个月的患者及１０例开颅术后的患者行常规ＣＴ扫描及ＣＴ灌注成像,２８例进行ＭＲＩ检查,６例行ＤＳＡ检查及单光子发射计算机体层成像（ｓｉｎｇｌｅ ｐｈｏｔｏｎｅｍｉｓｓｉｏｎ ｃｏｍｐｕｔｅｄ ｔｏｍｏｇｒａｐｈｙ,ＳＰＥＣＴ）。结果 ３４例患者ＣＴ扫共检出３０个缺血及梗死灶,ＣＴ灌注成像共检出４１个病灶,均经随访Ｃ     

The course of partial anterior cruciate ligament ruptures

In a prospective study 21 consecutive patients were followed up for an average of 6 years after partial tear of the anterior cruciate ligament (ACL) diagnosed by clinical examination and arthroscopy. The ACL tear was treated conservatively and associated lesions were sutured. At followup a knee function score was recorded. The maximum possible score was 100 points. The mean score at followup was 93 +/- 6 points. All patients were classified as good or excellent. Three knees were unstable at followup, but the score was not impaired. With a partial tear of the ACL the course is benign and the long-term result good, in contrast to total ruptures of ACLs. It is, therefore, important to make an accurate diagnosis in order to choose the proper treatment.     

MR diagnosis of dural venous sinus thrombosis complicating L-asparaginase therapy

Dural venous sinus thrombosis is an important complication of L-asparaginase chemotherapy. The diagnosis and followup of this condition, using spin echo and fast imaging techniques, is described in three patients. Magnetic Resonance (MR) imaging is a rapid, noninvasive technique for diagnosis and follow-up of this condition. Fast imaging techniques can improve the assessment of these patients.     

CT与MRI下Bosniak分级对肾脏囊性病变诊断性能的对比研究

目的 比较CT下Bosniak分级和MRI下Bosniak分级对肾脏囊性病变的诊断性能.方法 回顾性分析30例(共42个肾脏囊性病灶)同时具备CT和MRI影像资料,并以术后病理或临床随访作为最终诊断,采用ROC曲线比较二种检查模式的诊断性能.结果 CT下Bosniak分级Ⅰ～Ⅳ级分别为6个、24个、9个、3个,对照病理结果其假阳性病灶数0个,假阴性病灶数14个.MRI下Bosniak分级Ⅰ～Ⅳ级分别8个、18个、10个、6个,对照病理结果其假阳性病灶数0个,假阴性病灶数11个.MRI下Bosniak分级的曲线下面积大于CT下Bosniak分级,前者的特异度和敏感度均高于后者.结论 MRI下Bosniak分级对于肾脏囊性病变的诊断性能高于CT下Bosniak分级,在条件允许的情况下应首先采用MRI下Bosniak分级.     

急腹症的CT诊断

目的：评价CT对急腹症的诊断价值．材料和方法：对60例急腹症病人的急诊CT进行回顾性分析，并对他们的初步临床诊断、CT诊断及最终诊断作对比研究。结果：初步临床诊断符合最终诊断者仅21例(35％)，但CT的定位和定性正确诊断率则分别为100%和90%。许多病人CT检查前临床表现不典型．而CT表现却十分明显和具特征性，从而CT诊断常令人感到意外。结论：急腹症病人的临床定位体征及症状有时可能误导，而CT对这些病人的诊断能起重要作用，因此CT可作为这些病人诊断的首选方法。由于CT检查费用相对昂贵，因此根据本分析结果，提出了对急腹症病人合理应用CT的意见。     

Percutaneous needle evaluation of intradural extramedullary lesions of the lumbar spine

Summary A total of eight patients in whom five intradural extramedullary lesions and three epidural lesions were present were evaluated by percutaneous needle biopsy. In four patients the level of aspiration biopsy was determined using the initial myelogram and in those patients fluoroscopic guided percutaneous needle biopsies were performed. Three of these patients had large intradural extramedullary masses (above 1 cm); one patient had an epidural lesion. Diagnostic material was obtained in all cases (medulloblastoma, astrocytoma, small cell carcinoma, adenocarcinoma). Immediate post procedure CT and clinical followup showed no complications. In three patients with small lesions (below 1 cm), post myelographic CT was used to determine the level of aspiration. Post myelographic CT showed an intradural extramedullary mass in one patient and epidural lesions in two cases. Plain CT showed a high attenuation lesion in one patient. CT guided percutaneous needle biopsies in these four patients yielded diagnostic specimens (neurofibroma, uroepithelial carcinoma, hematoma, Thorotrast deposit). Clinical follow up showed no complications. Our experience indicates that percutaneous needle biopsy of intradural extramedullary and epidural lesions of the lumbar spine is safe and efficacious. Depending upon the size of the lesions, myelography or CT can be utilized to determine the level of aspiration.     

Growth rate of lung cancer recognized as small solid nodule on initial CT findings

Introduction

To study the characteristics of lung cancer, appearing as small solid nodules on initial computed tomography (CT) findings, and to determine an appropriate follow-up duration so as to differentiate between malignancy and benign tumor.

Methods

We analyzed the records of 34 patients who had undergone surgical resection of lung cancer, which appeared as small solid nodules on initial CT findings. We studied the CT findings, volume doubling times (VDT), follow-up durations, pathological and clinical findings.

Results

VDT is classified as follows: (1) slow growth group (SGG), with a VDT of more than 700 days and (2) rapid growth group (RGG), with a VDT of less than 700 days. The median VDT of the SGG was 1083 days, and the RGG was 256 days (p < 0.01). The median duration for follow-up of the SGG was 1218 days, and 179 days for the RGG. A statistical difference was noted in the follow-up durations (p < 0.01). There were no statistical differences in the preoperative thin-section CT (TSCT) findings, or in the pathological findings. The RGG included more patients with smoking histories. The CT findings of RGG tended to reveal changed in base lung field such as emphysema, and lung fibrosis.

Conclusions

Generally, lung cancer appearing as small solid nodules on initial CT findings grew rapidly, but there were some cases which displayed slow growth patterns. These cases required follow up for over two years, before diagnosis was possible. We concluded the appropriate maximum followup duration is three years.     

Appropriateness of selection criteria for CT examinations performed at an emergency department

In the diagnosis of traumatic and nontraumatic emergencies, computed tomography (CT) is the most frequently performed procedure. The aims of this study were to find out whether CT report results can be used as a reliable tool for the diagnosis and management of patients at an emergency department and to evaluate the appropriateness of the selection criteria for CT examinations. For this reason, we analysed the emergency CT procedures according to the diagnostic hypothesis written on CT request forms, the results of the CT reports and the final diagnosis of the patients. One thousand consecutive CT procedures in the emergency department of a research hospital were retrospectively analysed. When the CT reports and the final diagnosis were evaluated, the sensitivity and specifity of the CT were found to be 0.81 and 0.85. According to the analysis of the CT reports, 55.8 % of all the patients were reported to be normal. When the patient files were examined for the final diagnosis of the patients, 55.7 % of the patients did not receive a final diagnosis related to the diagnostic hypothesis. The lowest correlation was found between the diagnostic hypothesis, the CT reports and the final diagnosis of the patients who underwent cranial CT procedure for trauma. The results of the CT reports can be used as a reliable parameter for the diagnosis and management of the patients at emergency departments. On the other hand, a high negative rate of CT reports was noted especially for the cranial CT examinations. CT selection criteria for the head trauma patients should be reconsidered. Since CT is a procedure involving ionising radiation, it is important that it is performed with the correct indications and the relevant clinical information is specified on the CT request forms.     

胰腺炎脾脏并发症的CT分析

目的：明确胰腺炎脾脏并发症与预后。材料与方法：从我院７年间收治的２３２例急性胰腺炎和慢性胰腺炎急性发作的病例中选出有脾脏并发症的病便作为研究对象,共计８例。对照出现脾脏并发症前后ＣＴ所见和变化,着重分析脾脏病变ＣＴ特点,演变过程以及与胰腺炎病变和临床的联系。结果：ＣＴ示７例并发脾梗塞,２例有脾包膜下积液。脾梗塞单发二３例,多发小病灶２例,大病灶１例,弥漫型１例。脾包膜下积液轻、中等量各１例。上述脾