颅内病灶经CT体表定位方法

目的：寻找一种简便易行，精确度高的体表定位方法，供颅内血肿穿刺引流及颅内肿瘤局部放疗前准确体表定位。方法：采用CT定位平扫方法，获得自颅顶头皮外缘至颅内病灶的CT图像。病灶中心距颅顶的重要距离、距颅前（或后）缘的前后距离及距颅外的左右距离可精确测量。用自制带拐角的测量尺根据所测数值来确定病灶中心定位点。结果与评价：经19例临床验证，此法简便，易于操作，精确度高，具有较高临床意义。     

CT及CT定位架在脑瘤放疗设野中的应用

作者自行设计研制一“ＣＴ脑体表投影定位架”（简称定位架），经定位精度模拟试验证实，应用该定位架作颅内病灶颅表定位设野的精度为２．０ｍｍ。本文对６４例脑瘤患者作了带定位架ＣＴ扫描后颅内病灶颅表定位设野放疗，探讨了ＣＴ在脑瘤放疗设野中的应用方法。文中重点介绍了定位架的构造、ＣＴ扫描及颅表定位设野的方法，对本法的定位设野原理及临床应用价值作了简要讨论。作者认为，带定位架作ＣＴ扫描后行脑瘤的颅外体表定位设野能提高ＣＴ在脑瘤放疗中颅表定位设野的精确性。     

CT引导下体表区域定位法穿刺活检术(附126例分析)

目的 :探讨用自制简易栅栏定位装置体表区域定位 ,CT引导下穿刺活检的优缺点。方法 :把废旧导管剪成2cm长 10节 ,间距 1cm固定于 2cm× 16cm的长胶布上制成简易栅栏条定位器。将栅栏条放置在将要穿刺区 ,使栅栏条纵形与人体长轴平行 ,然后定位及轴位扫描 ,使病灶中心与栅栏条断面在同几层面上出现 ,这样 ,栅栏单条长及多根横行排列的栅条加CT扫描的断面可同时在Z、X、Y轴上显示病灶 ,确定穿刺点。结果 :病灶刺中率为 10 0 % ,一次刺中率为 92 .1% ,未发生严重并发症及后遗症。结论 :用栅栏条体表区域定位CT活检是一种简单、安全、可靠的方法     

不可触及乳腺病变的术前X线引导下导丝定位

目的 比较全视野数字乳腺X线摄影引导下导丝定位与体表定位切除不可触及乳腺病灶的准确性.资料与方法 回顾性分析采用导丝定位和体表定位患者各50例,比较两组患者术前定位、手术及病理结果,分析两种定位方法的准确性.结果 50例导丝定位患者中成功定位49例,1例导丝移位未切到病灶,1例出现迷走神经反应.50例体表定位患者中病灶切除40例,10例未切到病灶,准确性为80％,无明显并发症.结论 全视野数字乳腺X线摄影引导下导丝定位较体表定位准确性高,适用于不可触及乳腺病变的术前定位.     

一种新研制磁共振体表定位贴临床应用价值

目的探讨磁共振体表定位贴定位体内病灶的临床应用效果。方法收集51例体内病变的患者,从中随机选取31例患者作为研究组,使用新研制的磁共振体表定位贴进行定位,另20例患者为对照组,采用常规方法进行定位;两组均参照定位图像确定病变位置并设计手术方案,评价两种定位方法的可靠性、成功率。结果使用新研制磁共振病灶体表定位贴、常规方法定位病灶的可靠性分别为100%、90%,其中一次切口成功率分别为95.2%(20/21)、80%(16/20),平均误差分别(0.54±0.29)cm、(1.25±0.49)cm,一次穿刺成功率分别为85%(9/10)、50%(2/4)。结论新研制的磁共振病灶体表定位贴具有定位准确、可靠性高的特点,可应用于临床指导手术切口或穿刺入路的选择。     

CT导引穿刺定位装置的研制和实验研究

【摘要】 目的 实验评价一种新型穿刺定位装置在CT导引下经皮穿刺定位的精度。方法 采用体积约25 cm×20 cm×15 cm猪肉模拟正常人体肌肉组织,黏土制作数个棱长分别为5 mm、10 mm、15 mm的正方体模拟病灶,计划距体表深度分别为30 mm、50 mm、80 mm,将模拟病灶根据大小、深度分散放置在模拟正常肌肉组织的猪肉内,在同层面内计划进针角度为0°、25°、50°。对比CT导引下徒手穿刺与定位装置穿刺模拟病灶的进针角度误差和穿刺准确率。结果 CT导引下徒手穿刺、定位装置穿刺模拟病灶共578次。定位装置穿刺、徒手穿刺的准确率分别为94.8%、51.7%,进针角度误差分别为1°（0°,1°）、3°（1°,7°）,定位装置穿刺均显著优于徒手穿刺（P＜0.01）。结论 应用新型定位装置辅助穿刺可明显提高CT导引下穿刺准确率,提高穿刺精度。     

X-刀治疗颅内病变的CT定位

目的 :探讨 X-刀治疗颅内病变 CT定位的方法。方法 :CT定位 X-刀治疗颅内肿瘤及动静脉畸形 337例 ,采用 FN-89或 Fischer立体定向仪 ,Somatom- DR CT机扫描定位 ,X-刀治疗软件根据 CT系列图像自动优化计划治疗。结果 :所有 X-刀治疗的病灶均采用 CT定位 ,靶点确定均一次到位。结论 :CT定位行 X-刀治疗颅内肿瘤及动静脉畸形是一种安全有效的方法     

CT对颅内小病灶的简易体表定位

颅内小病灶是指直径≤３ｃｍ的病灶,在神经外科手术前如不在体表准确定位就可能造成创口过大或进入颅内找不到病灶等不良后果。本文简介了我院１０余年来ＣＴ扫描时所用的四种简易体表定位方法。作者单位　昆明医学院第一附属医院ＣＴ室,昆明　６５００３２１　材料和方法１－１　ＳＩＥＭＥＮＳＤＲ３和ＧＥＳｙｔｅｃ３０００ｉＣＴ机,扫描技术条件为：１２０ｋＶ,８０～１００ｍＡｓ,５１２×５１２矩阵,层厚３～１０ｍｍ。用７６％泛影葡胺４０ｍｌ行增强扫描,窗宽１００,窗中心３５～４５Ｈｕ。１－２　四种简易体表定位方法（…     

螺旋CT定位伽玛刀治疗颅内疾病的体会

目的：探讨OUR—XGD旋转式伽玛刀螺旋CT定位的方法和优越性。 方法：应用Leksell—G型立体定向框架和螺旋CT扫描机对35例颅内病变进行CT定位。 结果：本组35例均采用德国西门子PLUS-4A型螺旋CT．扫描机定位，保证了治疗靶点的准确性。 结论：螺旋CT定位是旋转式伽玛刀治疗颅内病变精确有效的影像手段。     

原发性肠系膜占位性病变的CT定位诊断

目的　评价CT扫描在原发性肠系膜占位性病变定位诊断中的价值。方法　 3 5例经CT检查并手术病理证实的原发性肠系膜占位性病变 ,分析其CT定位征象。结果　CT定位正确率 62 .9% ;阳性预测值 78.6%。有助于定位的征象包括 :(1)病灶与肠管关系密切 ,病灶周围有肠管绕行且绕行的肠管位置较恒定 ,而管腔内一般无充盈缺损征 ,本组 2 5例 ;(2 )腹膜后主要脏器受前方病灶压迫而变形、轴位旋转 ,本组 15例 ;(3 )病灶与腹膜后脏器之间及与腹壁之间存在脂肪间隙 ,本组 11例 ;(4 )病灶后缘压迫腹部大血管根部或病灶后缘有大血管包绕现象 ,本组 9例。病灶较大CT定位正确率较低。结论　CT扫描对原发性肠系膜占位性病变的定位诊断有重要价值。结合多种检查结果及临床表现有助于提高诊断正确率     

CT引导下微创颅内血肿清除术的临床应用

目的通过CT引导下微创颅内血肿清除术的临床应用,提高救治疗效。方法本组在CT引导下进入颅内血肿腔抽吸,并配合注射药物使血肿液化,同时留置引流管持续清除血肿。结果21例治愈,1例好转自动出院,3例放弃治疗,5例死亡。结论CT引导下微创颅内血肿清除术定位准确,操作简便,损伤程度小,治愈率高,住院时间短,可作为颅内血肿首选治疗方法。     

CT引导下微弹簧圈定位在肺小结节胸腔镜术中的临床应用

目的 探讨电视胸腔镜手术(VATS)前CT引导下微弹簧圈定位肺小结节(SPN)对精准切除病灶的临床价值.方法 回顾性分析2014年6月至2016年5月,90例行VATS切除孤立性SPN患者的资料.其中45例患者术前行微弹簧圈定位(A组),45例患者未行术前定位(B组).统计分析两组VATS肺叶楔形切除时间、转开胸手术率、术后住院时间,以及微弹簧圈定位病灶的成功率、并发症等,评价术前微弹簧圈定位病灶的安全性及其对VATS术的增益价值.结果 A组VATS术成功率100％;SPN病灶定位成功率95.6％,术后出现气胸5例、肺表面出血6例、弹簧圈脱落2例等并发症.B组VATS手术成功率84.4％,中转开胸率15.6％.A组VATS手术时间(17.7±2.8) min、术后住院时间(6.2±1.7)d及中转开胸0例明显低于B组,差异具有统计学意义(P＜0.05).结论 CT引导下微弹簧圈定位,可辅助VATS快速、精确切除肺内小病灶,能有效降低中转开胸率、缩短VATS手术时间及术后住院时间.     

CT引导下经皮肺穿刺活检对周围型肺部病变的诊断价值

目的探讨CT引导下经皮肺穿刺活检对周围型肺部病变的诊断价值及其安全性。方法对58例周围型肺部病变的患者,在CT引导下行经皮肺穿刺活检。结果 58例患者中穿刺标本经组织病理学检查确诊病例48例,确诊率为82.8%,其中恶性肿瘤32例,良性病变16例。术后出现有症状并发症7例,其中咯血2例,气胸4例,高热伴脓胸1例,总发生率为12.1%。结论 CT引导下经皮肺穿刺活检定位准确,成功率高,安全可靠,在周围型肺部病变诊断中具有较高的应用价值。     

CT引导下经皮穿刺钢丝爪钩定位技术在肺部小结节电视胸腔镜手术前的应用

目的：于电视胸腔镜手术（VATS）前使用CT引导下经皮穿刺钢丝爪钩定位技术对肺部小结节进行精准定位,分析该技术对术中切除病灶的准确性与安全性的指导作用。 方法：选取2016年3月至2018年3月普洱市人民医院收治的孤立性肺部小结节患者36例,在CT引导下经皮穿刺钢丝爪钩定位针对肺部小结节进行穿刺定位,定位完成后再行VATS切除病灶,分析该方法的穿刺成功率、定位时间及并发症发生情况。 结果：36例患者的肺部小结节直径为（15±10）mm,CT引导下穿刺定位成功率100%（36/36）,定位时间为（17.0±2.6）min。4例患者在定位后行全肺扫描见少量气胸,肺压缩<5%;7例患者出现少量定位区域出血,出血量<10 ml,未行特殊处理;所有患者在局麻失效后均出现穿刺点异物感或呼吸时轻微刺痛;均未出现剧烈疼痛、血气胸、咯血、剧烈咳嗽和空气栓塞等严重并发症。定位完成后VATS术中探查定位针无脱落和移位。 结论：肺部小结节切除术前使用CT引导下经皮穿刺钢丝爪钩定位技术对病灶进行定位安全可靠,可有效提高肺小结节VATS术中病灶切除的准确性。     

Magnetic resonance imaging of intracranial neoplasms at 0.02 tesla

Sixty-five patients with single or multiple intracranial neoplasms were examined with an MR imager operating at 0.02 tesla. In 56 patients the diagnosis was histologically confirmed. All patients had an abnormal CT finding. MR images were positive in 59 cases, while the lesion remained undetected or equivocal in 6 cases (2 pituitary adenomas and 4 meningiomas). The MR signal intensity of several meningiomas was equal to that of normal brain tissue. Some astrocytomas were better delineated on MRI than on CT. For the study of pituitary lesions, the spatial resolution was unsatisfactory. The ultralow field MR imager was found to be sensitive for the detection of other intracranial neoplasms.     

CT-guided biopsy of focal lesions in patients with multiple myeloma may reveal new and more aggressive cytogenetic abnormalities

BACKGROUND AND PURPOSE: Cytogenetic abnormalities, especially chromosome 13 deletion, are high-risk factors for multiple myeloma. Attaining the highest detection rates of cytogenetic abnormalities is important to provide accurate prognostic information to the referring oncologist. The purpose of this study was to use CT-guided percutaneous fine-needle aspiration bone biopsy (CT-guided FNA) of MR-detected focal lesions in patients with multiple myeloma to increase identification of abnormal cytogenetics. METHODS: Patients enrolled in two clinical trials for myeloma therapy underwent MR imaging of the entire spine and pelvis. CT-guided FNA biopsy samples obtained from MR-detected focal lesions in these patients were sent for cytogenetic analysis. FNA results were then compared with random bone marrow sampling of the iliac crest done at or near the same time as the FNA to provide the data revealed in this study. RESULTS: Forty-one patients (47 lesions) in one of the trials and 37 patients (38 lesions) in the other trial had biopsies performed. CT-guided FNA revealed cytogenetic abnormalities in 21% of the total patient population and new information in nearly 10% of the patients in one trial and in 20% of those in the other trial. CONCLUSION: CT-guided biopsy of MR-detected focal lesions is a safe technique that can provide important cytogenetic information in a significant number of patients with multiple myeloma not identified during random marrow sampling.     

CT-guided needle placement in the central nervous system: results in 146 consecutive patients

The authors present their experiences with 185 computed tomography (CT)-guided needle placement procedures in 146 consecutive patients. There was 100% accuracy in first-pass entry into the lesion using a needle guide; 100% success in drainage of intracranial abscesses; 100% success in palliative decompression of intracranial cystic lesions including tumor cysts; and 97% accuracy in histologic diagnosis of unknown lesions. CT-guided aspiration biopsy corrected clinically incorrect diagnoses and altered patient management in 23% of all cases biopsied. Tabulation of complications revealed 0% incidence of scalp infection, bone infection, dissemination of tumor, or dissemination of infection; 13.5% incidence of clinically insignificant postprocedural bleeding; and 0.5% incidence of serious postprocedural hemorrhage leading to death (one patient only). Transient hemipareses were observed in three of 22 procedures for implantation of 192Ir but in none of 163 procedures for aspiration biopsy alone.     

Purposeful Creation of a Pneumothorax and Chest Tube Placement to Facilitate CT-Guided Coil Localization of Lung Nodules before Video-Assisted Thoracoscopic Surgical Wedge Resection

PurposeTo evaluate the feasibility and efficacy of pneumothorax creation and chest tube insertion before computed tomography (CT)–guided coil localization of small peripheral lung nodules for video-assisted thoracoscopic surgical (VATS) wedge resection.Materials and MethodsFrom May 2011 to October 2013, 21 consecutive patients (seven men; mean age, 62 y; range, 42–76 y) scheduled for VATS wedge resection required CT-guided coil localization for small, likely nonpalpable peripheral lung lesions at a single institution. Outcomes were evaluated retrospectively for technical success and complications.ResultsThere were 12 nodules and nine ground-glass opacities. Mean lesion distance from the pleural surface was 15 mm (range, 5–35 mm), and average size was 13 mm (range, 7–30 mm). A pneumothorax was successfully created in all patients with a Veress needle, and a chest tube was inserted. All target lesions were marked successfully, leaving one end of the coil within/beyond the lesion and the other end of the coil in the pleural space. The inserted chest tube was used to insufflate air to widen the pleural space during coil positioning and to aspirate any residual air before transfer of the patient to the operating room holding area. Intraparenchymal hemorrhages smaller than 7 cm in diameter developed in two patients during coil placement. All lesions were successfully resected with VATS. Histologic examinaiton revealed 13 primary adenocarcinomas, four metastases, and four benign lesions.ConclusionsPneumothorax creation and chest tube placement before CT-guided coil localization of peripheral lung nodules for VATS wedge resection facilitates the deployment of the peripheral end of the coil in the pleural space and provides effective management of procedure-related pneumothorax until surgery.     

Value of CT volume imaging for optimal placement of radiofrequency ablation probes in liver lesions

PURPOSE: To determine the value of multiplanar and volume-rendered modes of analysis versus axial imaging for the optimal placement of probes in spiral image computed tomography (CT)-guided radiofrequency (RF) ablation of liver lesions. MATERIALS AND METHODS: Thirty-two malignant hepatic lesions in 21 patients with hepatocellular carcinoma (n = 10) or metastases (n = 11) were treated with percutaneous RF ablation. After axial CT-guided placement (biopsy mode) of the probe in the tumor, a contrast-enhanced spiral image set was obtained and data were viewed in contiguous axial sections and the multiplanar and volume-rendered modes. The position of the probe was characterized as "central," "marginal," or "outside," corresponding with its position in the lesion. Outside positioning was corrected before ablation was performed and, in cases of "marginal" positioning, the probe was redirected after initial ablative therapy in the same session. RESULTS: Multiplanar and volume-rendered analysis reclassified the needle position before 14 of 32 RF ablation procedures (44%; P =.0034, McNemar test). In 10 cases, probe positions considered "central" on biopsy-mode images were found to be "marginal" with multiplanar/volume-rendered analysis. In three cases, probe positions considered "marginal" on biopsy-mode images were found to be "outside" with multiplanar/volume-rendered analysis. In one lesion, multiplanar/volume-rendered analysis upgraded the probe position from "marginal" to "central." Comparison of multiplanar and volume-rendered analysis revealed no difference in probe positioning. The time requirements to obtain additional data were 159 seconds +/- 49 for multiplanar analysis and 434 seconds +/- 78 for volume-rendered analysis. CONCLUSION: A contrast-enhanced spiral CT image data set with multiplanar reformations to verify an optimal probe location after axial CT-guided needle placement should be obtained before RF ablation of liver lesions.     

肝动脉化疗栓塞联合CT引导射频消融序贯治疗中小肝癌的临床应用

目的探讨肝动脉化疗栓塞(TACE)联合CT引导射频消融(RFA)序贯治疗原发性中小肝癌的临床应用。方法对59例肝细胞性中小肝癌患者实施TACE联合CT引导RFA序贯治疗。结果 59例患者初次治疗,共80枚病灶,行TACE和RFA序贯治疗技术成功率100%。术后随访6～24个月,21例患者有病灶残余,再次行RFA或序贯治疗,3例再次联合放射性125I粒子植入治疗后,病灶控制良好。并发症有胆汁瘤合并胆道感染1例、门静脉分支血栓1例。结论 TACE联合CT引导RFA序贯治疗中小肝癌是一种微创、有效的方法,同时注意手术操作细节,对提高手术成功率,降低手术并发症有重要意义。