高血压重症基底节－丘脑区血肿CT分型与手术选择

目的：利用高血压重症基底节－丘脑区血肿ＣＴ影像；探讨ＣＴ分型与手术适应症、手术方式选择的关系。材料与方法：回顾性分析１１３例高血压重症基底节－丘脑区血肿的ＣＴ分型与手术预后。分型：Ⅰ型（ｎ＝４２），位于内囊外侧，很少破入脑室；Ⅱ型（ｎ＝２４），扩延到内囊，可破入脑室；Ⅲ型（ｎ＝１４），同时扩延到内囊和丘脑或下丘脑，破入脑室；Ⅳ型（ｎ＝２３），以丘脑出血为主，向基底节扩延，总量＜３０ｍｌ，破入脑室；Ⅴ型（ｎ＝１０），扩延到中脑或桥脑，破入脑室。手术预后以患者术后半年日常生活能力评价。结果：手术总死亡率３２．７４％，其中Ⅰ型１４．２９％，Ⅱ型２５％，Ⅲ型７８．５７％，Ⅳ型１７．３９％，Ⅴ型１００％，Ｐ＜０．００１。结论：作者认为Ⅰ、Ⅱ型力争早期手术，早期出现上消化道出血之Ⅲ型慎用手术，Ⅳ型仅作脑室外引流即可，Ⅴ型无手术指征。ＣＴ分型为手术选择提供了可靠依据。     

脾外伤的CT诊断与分型

目的：探讨ＣＴ检查对脾外伤的诊断与分型以及对临床的价值。材料与方法：对１００例脾外伤的临床及ＣＴ表现进行回顾性分析。结果：根据ＣＴＧ针脾外伤分为３型：Ⅰ型（包膜下积血（包膜下积血）１８例;Ⅱ型（脾实质破裂）３６例,其中局限性破裂３０例,广泛性破裂６例;Ⅲ型（混合型）４６例,其中局限性实质破裂伴包膜下积血２５例,广泛性实质破裂伴包膜下积血２１例。结论：ＣＴ能明确作出脾外伤的诊断与分型,为临床是否做手     

DNA含量的异质性与神经胶质瘤的关系

目的：探讨神经胶质瘤中最常见的星形胶质细胞瘤的复杂的生物学特性。方法：采用流式细胞分析技术对２１例星形胶质细胞瘤中ＤＮＡ含量进行了检测。结果：２１例星形胶质细胞癌中ＤＮＡ含量异质的１２例（５７％）;星形Ｉ级的异质率为２９％,Ⅱ级为５７％,Ⅲ、Ⅳ级为８６％。其中Ⅱ级和Ｉ、Ⅲ级,Ⅳ级和Ⅱ级之间无显著性差异（Ｐ〉０．０５）,Ⅲ、Ⅳ级Ｉ级之间则有显著差异（Ｐ〈０．０５）。结论：星形胶质细胞瘤的不同部位有Ｎ     

CT扫描在胸腰椎骨折诊断中的价值

目的：探讨胸腰椎骨折的ＣＴ扫描价值。材料与方法：回顾性分析７０例胸腰椎管骨折的ＣＴ扫描资料。结果：７０例９８节胸腰椎骨折中，单椎体骨折４８例，多椎体骨折２２例，ＣＴ诊断准确率为９８％，以爆例型（５４．１％）和压缩型（３５．７％）骨折多见，三柱受累中以前中柱（２２．４％）和前中后柱（５５．１％）多见，椎管狭窄发生率高达３５．１％，结论：ＣＴ扫描对胸腰椎骨折的诊断，分类，判断脊柱失稳，评价脊髓损伤及行     

外伤性脑梗塞的CT诊断

目的：探讨外伤性脑梗塞的分型与ＣＴ表现。方法：分析３５例外伤性脑梗塞的临床与ＣＴ表现。结果：根据其临床和ＣＴ表现分为二型：Ⅰ型（２１例）,轻微外伤型;Ⅱ型（１４例）,严重外伤型。Ⅰ型见于小儿,特别是婴儿,外伤轻微,ＣＴ表现为基底节区腔隙性梗塞灶,８１％（１７／２１）双侧豆状核点状钙化灶。Ⅱ型多见于成人,小儿少见,有严重的颅脑损伤,ＣＴ表现为基底节区或／和脑叶梗塞及颅脑损伤的征象,如脑内水肿,挫伤和颅内血肿等。结论：ＣＴ对外伤性脑梗塞有很大的诊断价值,两型可能有不同的发生机制,Ⅰ型主要是潜在性血管病变及血管痉挛所致,Ⅱ型主要与血管的损伤和受压有关     

利用磁共振胰胆管成像对晚期医原性肝外胆管狭窄进行术前评估

目的：探讨磁共振胰胆管成像（MRCP）对晚期医源性肝外胆管狭窄的磁共振胆胰管成像的术前评估价值。方法：对18例MRCP诊断为晚期医源性肝外胆管狭窄并经手术病理证实的患者进行分型及术后手术方式选择，并与手术记录对照分析。结果：18例中能够按照Bismuth分型法进行分型者17例，其中I型3例，Ⅱ型7例，Ⅲ型3例，Ⅳ型3例，1例Ⅱ型狭窄被误分为Ⅲ型，MRCP分型准确16例。根据术前MRCP提供的信息，术中16例采取了正确的手术方法，2例未能采用预期的手术方式。MRCP术前手术方式选择准确16例。结论：MRCP对晚期医源性外胆管狭窄的术前评估有重要价值。     

肾盂癌的CT诊断(附33例报告)

本文报道３３例经手术病理证实的肾盂癌ＣＴ检查结果。着重讨论了肾盂癌ＣＴ表现及分型、ＣＴ鉴别诊断，肾盂癌影像诊断的选择和ＣＴ诊断价值。肾盂癌ＣＴ表现可分为三型：Ⅰ型（肿瘤局限肾盂型）；Ⅱ型（肿瘤广泛浸润肾实质型）；及Ⅲ型（肾盂壁增厚积水型）。Ⅰ型要注意防止小肿瘤的漏检。Ⅱ型要与肾细胞癌鉴别。Ⅲ型要与其他原因引起的肾盂积水鉴别     

乳腺肿块的动态CT扫描

目的：应用动态ＣＴ检查乳腺肿块，分析各种乳腺病变的时间－密度曲线，探讨其诊断价值。材料与方法：对３６例乳腺肿块患者作了前瞻性动态ＣＴ扫描，其中经手术病理证实者３２例（乳癌１５例，纤维腺瘤９例，增生性乳腺病７例，脂肪坏死１例）。结果：根据肿块的增强密度在时间上的变化，得出３种时间－密度曲线：Ｉ型：速升－平台－缓降型；Ⅱ型：渐进上升型；Ⅲ型：曲线起伏较小型。Ｉ型曲线为乳癌所特有，Ⅱ型多见于纤维腺瘤和Ⅲ     

青少年腰椎间盘突出症临床与CT观察(附34例报告)

目的：分析青少年腰椎间盘突出症的临床和ＣＴ表现特点。材料与方法：ＣＴ检出青少年腰椎间盘突出症３４例,均经手术病理或临床随访证实。结果：本病占所有腰椎间盘突出症的１．２％,临床特点是症状轻而体征重。本病与创伤关系密切。常见突出类型为中央型（７１．４３％）,多伴有先天发育性椎管和侧隐窝狭窄。３例合并椎体后缘软骨结节。结论：青少年腰椎间盘突出症的临床和ＣＴ表现与成人不同。ＣＴ为本病的早期、准确诊断提供了保证。     

青少年腰椎间盘突出症临床与CT观察

目的：分析青少年腰椎间盘突出症的临床和ＣＴ表现特点。材料与方法：ＣＴ检出青少年腰椎间盘突出症３４例，均经手术病理或临床随访证实。结果：本病占所有腰椎间盘突出症的１．２％，临床特点是症状轻面体征重。本病与创作关系密切。常见突出类型为中央型（＆１．４３％），多伴有先天发育性椎管和侧隐窝狭窄。３例合并椎体后缘软骨结节。结论：青少年腰椎间盘突出症的临床和ＣＴ表现与成人不同。ＣＴＯ 本病的早期、准确诊断提供     

腰椎退行性病变CT分型(附1180例分析)

目的综合分析腰椎退行性病变的CT表现。方法分析1180例退变性腰腿痛患者的腰椎CT表现,按腰椎相关结构对其表现分类,结合临床表现,对腰椎退变的影像表现进行分型诊断。结果腰椎退变存在6种类型,即:椎间盘退变型,退变率65.3%;骨质退变型,退变率48.1%;椎小关节退变型,退变率36.0%;韧带退变型,退变率25.4%;退变性腰椎管狭窄,退变率44.0%;退变性腰椎失稳,退变率25%。前4种为原发性腰椎退变型,后2种为继发性腰椎退变型。结论腰椎退行性病变的CT分型有利于临床治疗。     

腰椎体后缘软骨结节椎管狭窄的CT诊断

目的 :探讨腰椎后缘软骨结节 (LPMN)椎管狭窄的CT诊断价值。材料和方法 :回顾性分析 2 7例腰椎后缘软骨结节的临床及CT表现。结果 :LPMN的CT表现为 :( 1)椎体后上缘或下缘局限性骨缺损 ,缺损区周围骨质硬化 ;( 2 )缺损区后突入椎管内的骨块 ;( 3 )在矢状位上见骨块“翘起”征 ,缺损区呈“V”形或类三角形 ;( 4 )椎管狭窄 ,多伴有椎间盘突出。结论 :CT能明确诊断LPMN导致的椎管狭窄 ,并为手术治疗提供可靠依据。     

多层螺旋CT对腰椎后缘软骨结节的诊断及临床应用

目的:探讨多层螺旋CT(MSCT)对腰椎后缘软骨结节的诊断及临床应用价值。方法:使用MSCT容积薄层扫描68例腰椎后缘软骨结节患者,并行多断面重组(MPR)和表面遮盖显示(SSD)。回顾性分析其CT征象,并将轴位及多断面重组图像进行对比分析。结果:68例患者共75个病变,61例单发,7例多发。其中中央型25个,旁中央型46个,椎间孔型4个;伴椎管轻度狭窄39个,中度狭窄31个,重度狭窄5个。病灶在L5、S1椎体后上缘较其他部位更常见(76.0%)。MPR是对轴位的良好补充,可准确判断椎管内细节和椎管狭窄程度(r=0.927,P<0.001;k=0.885,P<0.001)。SSD对椎管狭窄程度的判断存在明显低估(r=0.505,P=0.02;k=0.234,P=0.087)。结论:MSCT可清晰显示病变,准确判断椎管狭窄程度及游离骨块和椎管内容物的关系,具有重要的临床价值。     

Postoperative bony stenosis of the lumbar spinal canal: evaluation of 164 symptomatic patients with axial radiography.

Computed tomography (CT) and transverse axial tomography (TAT) were used to study the lumbar spines of 164 patients with persistent or recurrent low back pain and/or radiculopathy. Of those patients with previous spinal fusion and of those with previous disectomy, 43% and 28%, respectively, demonstrated bony stenosis of the lumbar spinal canal. Of the patients who underwent surgery for this narrowed canal, 91% showed clinical improvement.     

Lumbar herniated disk disease and canal stenosis: prospective evaluation by surface coil MR, CT, and myelography

Sixty patients with suspected lumbar herniated disk and/or canal stenosis were studied prospectively with surface coil MRI, CT, and/or myelography, and the results were compared with the surgically confirmed abnormality. Forty-eight patients had lumbar surgery at 62 levels. There were no negative explorations. Thirty-nine patients had a myelogram and CT. Thirty of the CTs were performed following the injection of metrizamide for myelography. Nine patients had a CT without intrathecal contrast material 1 to several days before the myelogram. Six patients had myelography only, and three patients had CT only. All studies were evaluated for the location and type of disease in a forced choice fashion. Independent of the surgically correlated levels, there was 86.8% agreement between the MR and CT studies in all patients at 151 levels and 87.2% agreement between MR and myelography at 218 levels. At the operative levels, there was 82.6% agreement between MR and surgical findings for both type and location of disease; 83% agreement between CT and surgical findings; and 71.8% agreement between myelography and surgical findings. There was 92.5% agreement when MR and CT were used jointly, and 89.4% agreement when CT and myelography were used jointly. The results of this study indicate that a technically adequate MR examination was equivalent to CT and myelography in the diagnosis of lumbar canal stenosis and herniated disk disease. CT and MR can be complementary studies, and surface coil MR can be viewed as an alternative to myelography.     

腰椎间盘突出症手术常见并发症MRI随访观察

目的:分析腰椎间盘突出症手术常见并发症MRI及MRM(脊髓成像)表现,探讨其与临床手术效果的关系。方法:对35例腰椎手术常见并发症患者的MRI进行分析,找出初次手术失败的病因,再次手术得到证实。结果:腰椎间盘突出合并椎管狭窄松解不彻底14例,椎管内硬膜外瘢痕粘连致椎管狭窄9例,粘连性蛛网膜炎10例,脑脊液漏假性脊膜突出2例。结论:MRI检查可多平面直接成像,可清晰了解椎管术后改变及脊髓、神经受压原因,能直观立体的全面评价手术效果,对手术残存症状的治疗、确定再次手术的适应证有非常重要的指导作用。     

Gas in the spinal canal in association with the lumbosacral vacuum phenomenon: CT findings

Summary Twenty-two of 79 patients examined for lumbar spinal stenosis with CT showed the vacuum phenomenon. Three of these cases also had free gas in the spinal canal. The CT findings of vacuum phenomena and free gas in the spinal canal are discussed.     

腰椎椎体后缘骨内软骨结节所致腰椎管狭窄症的影像诊断

目的　总结腰椎椎体后缘骨内软骨结节 (LPMN)所致腰椎管狭窄症临床、影像诊断 ,探讨有关的发病因素。方法　对经手术证实的 16例PLMN所致腰椎管狭窄症的临床表现、影像学特征、手术方式进行回顾性分析总结。结果　典型的影像改变为 :( 1)椎体后上缘类圆形骨质缺损 ,边缘较致密硬化 ;( 2 )缺损后方有一骨块突入椎管 (游离或部分与椎体相连 ) ;( 3)硬膜囊及神经根受压 ,可伴有椎间盘突出。结论　影像学检查能明确诊断腰椎椎体后缘骨内软骨结节 (LPMN)所致腰椎管狭窄症 ,并为制订治疗方案提供可靠依据。     

Bifid mandibular canals: cone beam computed tomography evaluation

Objectives

For surgical procedures involving the posterior mandible, it is important to be familiar with the details of the bifid mandibular canal. To our knowledge, there have been no systematic studies evaluating the bifid mandibular canal using sectional imaging. The purpose of this study is to evaluate the incidence and configuration of the bifid mandibular canal using cone beam CT.

Methods

252 patients (301 mandible sides) underwent cone beam CT between October 2004 and September 2005 and were included in this study. The cone beam CT images were evaluated for the presence and configuration of the bifid mandibular canal. The patterns of bifurcation were classified into four types according to the classification of Nortjé et al (Variations in the normal anatomy of the inferior dental (mandibular) canal: a retrospective study of panoramic radiographs from 3612 routine dental patients. Br J Oral Surg 1977; 15: 55–63). The diameter of the accessory canal was classified into two categories: 50% or more and less than 50% of the diameter of the main mandibular canal.

Results

Of the 301 subjects, 47 (15.6%) demonstrated a bifid mandibular canal. They were Type I in 2, Type II in 40, Type III in 0, and Type IV in 5 cases. The diameter of the accessory canal was greater than or equal to 50% of the main canal in 23, and less than 50% in 24 cases.

Conclusions

On the basis of the cone beam CT, a bifid mandibular canal was found in 15.6% of cases, a markedly higher proportion than found in previous reports using panoramic images. Cone beam CT is considered a suitable modality for detailed evaluation of bifid mandibular canals.     

腰椎间盘手术后症状复发CT表现

目的：对腰椎间盘突出术后症状复发病人的ＣＴ表现进行了分析,以了解复发情况。方法：３７ 例腰椎间盘突出手术病人,术后均有不同程度反复发作的腰腿痛。其中４例呈痉挛性疼痛。２７ 例作全椎板切除,１０例作半椎板切除。４例平扫加增强扫描。１０例ＣＴＭ 扫描。结果：术后椎管表现正常６例（１６．１％ ）,椎间盘突出复发者１６例（４３．２％ ）,硬膜外纤维疤痕形成２１例（５６．９％ ）,侧椎管狭窄１８例（４８％ ）,化脓性椎间盘炎４例（１．１％ ）。结论：腰椎间盘突出术后症状复发病人ＣＴ扫描,可以解释症状发生的原因。