磁共振胰胆管成像对胆道梗阻性疾病定位与定性诊断的价值

目的：探讨磁共振胰胆管成像（MRCP）对胆道梗阻性疾患定位和定性诊断的价值。方法：对85例梗阻性黄疸病人的MRCP进行分析，并与CT、US、直接胆道造影和临床手术病理结果对照。结果：全部病例MRCP检查均一次成功，其中48例行直接胆道造影，与MRCP对照，二者所获图像极其相似。且对ERCP或PTC显示不完全的病例MRCP可补充有价值的诊断信息。MRCP对梗阻定位诊断准确率为100％。对梗阻定性诊断准确率为89．4％，结合MRI可提高至95．3％。结论：MRCP对梗阻性黄疸定位诊断与定性诊断准确率均高于CT及US。MRCP图像与直接胆道造影图像基本一致。方便易行无损伤，应列为胆道梗阻性疾病的术前常规检查方法。     

先天性胆管扩张症40例影像学诊断分析

目的：本文分析了先天性胆管扩张症的影像学表现,旨在对不同影像学检查价值进行探讨。方法：对40例先天性胆管扩张症病例的US、CT、MRCP检查结果进行分析。结果：先天性胆管扩张症因影像学检查方法不同其表现有所不同,术前诊断准确率分别为US 83.8%、CT 86.7%、MRCP 93.9%。结论：先天性胆管扩张症的影像学检查US应为首选,MRCP有助于其临床分型及术式的选择。     

CT、US、ERCP对梗阻性黄疸病因诊断的价值

目的 比较CT、US、ERCP对梗阻性黄疸的定性诊断准确性以评估三者的特点。方法 收集有CT、US、ERCP影像检查资料且经手术或病理证实的梗阻性黄疸病例75例，所有病例做了US检查和上腹部CT扫描，其中51例行ERCP造影成功。回顾性分析每1病例的影像资料，并与术前CT、US、ERCP诊断进行比较。结果 (1)50例胆总管下端结石，CT术前诊断48例，敏感性96％；US术前诊断46例．敏感性92％；其中行ERCP的36例术前诊断31例；(2)21例胆胰管十二指肠连接区肿瘤，CT术前诊断15例，准确性70．5％。US术前诊断6例．准确性28．2％，其中行ERCP的13例术前诊断8例；(3)4例胆总管炎性狭窄，CT术前诊断2例，US术前诊断1例。其中行ERCP的2例术前诊断1例：(4)CT、US、ERCP对梗阻性黄疸的梗阻原因的诊断准确性分别为86．6％，70．6％，78．4％。结论 US仍是梗阻性黄疸的首选检查方法：CT对梗阻性黄疸梗阻原因的诊断准确率高于US；ERCP作为一种侵入性检查方法可选择性地作为US、CT检查的补充。     

盆腔内妇科肿瘤的CT与超声比较观察

CT在妇科肿瘤诊断中的意义说法不一[1]。本文通过CT、超声（B型，US）检查与手术、病理结果比较，讨论了CT、US在妇科肿瘤诊断中的相对价值、各自优势及选择CT的指证。1一般资料共收集资料完整的28例（19例为解放军301医院资料），其中5例为“灭性包块”做对照分析。年龄19～68岁，平均47．5岁。主要临床表现：盆腔肿块16例，下腹不适10例次，不规则出血6例次，无症状5例，术后复发4例。全部病例均行盆腔US、CT土C检查，其中12例还做了腹部（肝胆胰牌等）US、CT土C检查。22例手术病理证实，3例活俭或涂片诊断，3例临床追随最后诊…     

US和CT对甲状腺癌定性和淋巴结转移的比较

目的：评价超声（US）和CT检查对甲状腺癌的诊断价值。方法：我们回顾性分析42例甲状腺癌的US和CT表现。42例均行US和CT检查，CT都用对比增强扫描和多平面重建（MPR）来鉴别原发性肿瘤和颈部转移淋巴结。结果：US和CT诊断结果与病理结果进行对比分析。US诊断甲状腺癌的符合率为64．3％，CT为83．3％。对于颈部淋巴结转移诊断US的符合率为75．0％，CT为50．0％。结论：CT对甲状腺癌定性诊断正确率高于US检查，但是US对于怀疑颈部淋巴结转移的晚期病人评价要优于CT。US和CT结合可以提高诊断甲状腺癌的准确性。     

CT、MRI及MRCP诊断胆总管结石临床价值评价

胆道结石是国人常见病、多发病,超声检查可以诊断肝内胆管结石,而肝外胆管结石由于受肠道气体干扰,超声诊断价值有限。CT可以明确诊断高密度结石,对各种等密度或低密度结石CT诊断也有困难,往往需要MRI或MRCP进一步检查,为评价CT、MRI或MRCP诊断胆总管结石的临床价值,分析3种检查方法的优势与限度,笔者对50例临床、超声疑诊胆总管结石同时经CT、MRI和MRCP检查的患者行回顾性评价,根据手术所见对比分析CT、MRI和MRCP的诊断能力和价值。1资料与方法1.1临床资料临床、超声疑诊胆总管结石患者共50例,其中男21例,女29例,平均49.5…     

MR胰胆管造影表现为四管征的慢性胰腺炎

目的：探讨MR胰胆管造影（MRCP）表现为四管征的慢性胰腺炎。材料与方法回顾性分析经手术病理证实的4例慢性胰腺炎的临床及影像学资料,4例术前均进行了CT增强扫描以及MRCP检查,其中1例进行了MRI增强扫描。结果4例中3例为胰头部肿块型,1例未见明确肿块,CT增强各期显示病变与正常实质相比呈稍低密度肿块2例,呈等密度肿块1例,1例未见异常对比增强,1例MRI增强各期显示病变与正常实质相比呈稍低信号肿块,门静脉期可见胰管穿通征。4例MRCP均表现为四管征。结论慢性胰腺炎MRCP可表现为四管征,且以肿块型胰腺炎多见,四管征并非胰头癌特异征象,定性诊断有赖于CT或MRI增强扫描。     

MRCP诊断胆胰系疾病的价值评价及ROC分析

目的:通过ROC分析,以及按病变部位、性质进行的亚组分析来评价US、CT和MRCP对胆胰系疾病的诊断价值,并简要介绍ROC的原理和应用。方法:收集疑胆胰系疾患接受MRCP检查患者105例,其中同时做US检查者65例。另有同期CT资料59例,其中同时做US检查者31例。每诊断一处病变计作一次诊断过程。病理检查、术中所见或临床、实验室检查结果作为诊断金标准。盲法与金标准对比,计算出各诊断方法的真阳性率和假阳性率,ROC分析其诊断效能。同时按病变部位、性质分别计算MRCP、US及CT的敏感度、特异度和似然比等指标,进行比较显著性检验统计。结果:ROC分析显示,MRCP的曲线最靠近左上角,US次之,CT在最下面,三者的曲线下面积(AZ)分别为0.985,0.981,0.901,均>0.9,MRCP与CT间离均差(Z)为0.75,双侧P>0.25。MRCP、US和CT诊断胆胰系恶性占位、结石的敏感度分别为100%、83%、82%;92%、71%、76%。经检验,MRCP与US和CT间有显著性差异,P<0.05。诊断胆总管结石3种方法差异较显著,敏感度分别为92%、39%、62%,经检验MRCP与US有显著性差别(χ2=17.412,P<0.001)。结论:ROC曲线分析是比较、评价2种或2种以上影像诊断方法效能差异性的客观标准。MRCP在诊断恶性胆道梗阻、胆道结石病变中较CT和US具有高的诊断效能。     

169例脑血管病的诊断与分析

本文就笔者经治的169例脑血管病的诊断问题报告如下。临床资料169例病人均在发病后5天内作了头部CT检查。其中脑出血58例，脑梗塞111例。本组169例病入男112例、女57例，年龄23～80岁，169例中风病人入院时查体均有偏瘫体征。结果58例脑出血病人CT都发现了高密度病灶，其中有4例曾疑诊脑梗塞（因临床表现很轻巨腰穿脑脊液外观无色透明），CT所见．脑出血58例中亮校出血40例，脑叶出血8例，丘脑出血7例，脑干出血3例。111例脑梗塞病人有5例经2-3次CT无异常所见。100例心电图检查有42例属不正常心电图。讨论由于CT及磁共振成象（MRI）相…     

320排螺旋CT、MRI及MRCP诊断胆道梗阻性疾病的价值对比探究

目的:研究320排螺旋CT、MRI及MRCP诊断胆道梗阻性疾病的临床价值。方法:回顾性分析我院2019年2月—2020年7月82例胆道梗阻性疾病患者的临床资料,术前分别采用320排螺旋CT检查、MRI检查、MRCP检查,以手术病理结果作为金标准,对比分析:①三种检查方法的诊断效能(包括定位诊断和定性诊断);②MRI+MRCP,CT+MRI+MRCP的诊断效能(包括定位诊断和定性诊断)。结果:①CT检查:定位诊断符合率100%、定性诊断符合率80.49%;MRI检查:定位诊断符合率100%、定性诊断符合率85.37%;MRCP检查:定位诊断符合率100%、定性诊断符合率76.83%;三种检查方法的定位诊断符合率均为100%,MRI的定性诊断符合率高于其他两种检查方法,但组间差异(P 1=0.2382,P 2=0.0726)均无统计学意义;②MRI+MRCP:定位诊断符合率100%、定性诊断符合率90.24%;CT+MRI+MRCP:定位诊断符合率100%、定性诊断符合率95.12%;三项检查联合诊断的符合率明显高于任意单项检查,P 3=0.0041,P 4=0.0352,P 5=0.0007,有统计学意义;亦高于MRI+MRCP,但无统计学意义(P 6=0.2303),同时与金标准比较接近,P 7=0.1288,无统计学意义。结论CT、MRI、MRCP在单独使用时均有一定局限性,而联合应用则可以获得更为精准、可靠的诊断依据,有利于医生凭此制定符合患者个体情况的治疗方案。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.