肋骨骨折的CT扫描方法及检出率与肋骨平片的对照研究

随机选取本院在2011年1月~2013年12月收治的72例肋骨骨折患者为对象,均同时进行肋骨骨折CT扫描以及肋骨平片检查,对比较两种诊断方法的检出率。膈上肋骨骨折患者CT检查的检出率为96.7%,高于平片检查的76.7%;膈下肋骨骨折患者CT检查检出率为100.0%,高于平片检查的71.4%,比较差异均有统计学意义(P0.05)。采用CT扫描对肋骨骨折患者实施临床诊断和检查,具有较高的检出率,误诊率以及疑似率相对较低,值得推广和普及。     

螺旋CT容积再现和表面遮盖显示技术在肋骨转移瘤中的临床对比分析

目的:对比分析螺旋CT容积再现和表面遮盖显示技术在肋骨转移瘤中的临床效果.方法:选取本院于2018年1月—2020年12月收治的肋骨转移瘤患者57例作为研究对象,所有患者均接受多层螺旋C T检查,并采用容积再现和表面遮盖显示技术处理,评价两种技术的诊断准确率.结果:容积再现技术诊断成骨转移病灶准确率97.32％、溶骨性...     

Couinaud肝段在CT图像上的划分

为给肝内占位性病变的ＣＴ定位提供解剖学依据，利用２０例腹部连续横断层标本和１０例活体正常肝的ＣＴ图像，研究了Ｃｏｕｉｎａｕｄ肝段在ＣＴ图像上的划分。正中裂为下腔静脉左前壁至肝中静脉或胆囊的连线；左叶间裂的上部为左叶间静脉至下腔静脉左前壁的连线，门静脉左支脐部和肝圆韧带裂是其中、下部的天然标志；肝左静脉行于左段间裂内；右叶间裂为肝右静脉至下腔静脉左前壁的连线；肝门或门静脉右支是右段间裂的标志；背裂为下腔静脉右缘至静脉韧带裂右端或门静脉的连线。本文还探讨了易致错分肝段的一些因素。     

Couinaud肝段在CT图像上的划分

为给肝内占位性病变的ＣＴ定位提供解剖学依据，利用２０例腹部连续横断标本和１０例活体正常肝的ＣＴ图像，研究了Ｃｏｕｉｎａｕｄ肝段在ＣＴ图像上的划分。正中裂为下腔静脉左前壁至肝中静脉或胆囊的连线；左中境 上部为左叶间静脉至下腔静脉左前壁的连线，门静脉左支脐部和肝圆韧带裂是其中、下部的天然标志；肝左静脉行于左段间裂内；右叶间裂为肝右静脉至下腔静脉左前壁的连线；肝门或站中支是右段间 标志；背裂为下腔脉右绷     

尘肺小阴影在CT和高分辨率CT上的表现

目的探讨尘肺阴影在CT和高分辨率CT（HRCT）上的表现,为尘肺的早期诊断提供依据。方法选择某钢铁企业73例粉尘作业工人,其中观察对象15例,Ⅰ期36例,Ⅱ期17例,Ⅲ期5例。进行常规CT和HRCT扫描,观察各期尘肺小阴影在CT及HRCT下的形态、分布特点。结果在HRCT上,圆形小阴影更为明确,且相对独立,以小叶中心、支气管血管束及胸膜下较为显著;除圆形小阴影外还有细小分支状影,有较多的支气管血管束呈串珠样改变。不规则小阴影主要表现为双肺线状影、小叶中心气肿及小叶中心分支状影、小叶间隔增厚及网织影、蜂窝影以及肺大泡。大阴影的CT值在95~115HU之间,周围有气肿及大疱,且大阴影的上下层面均有相当数量的q影、r影。结论CT尤其是HRCT在显示小阴影的分布、形态、大小方面有着重要的价值,对大阴影的早期改变以及大阴影的内部病变和外围情况的显示上优于X线平片。因此在尘肺的诊断,尤其是鉴别诊断中,CT有着独特的优势。     

CT在鼻咽癌诊断和治疗上的应用

本文通过病例分析和典型病例介绍,就鼻咽癌在 CT 片上的显示,CT在鼻咽癌诊断和治疗上的应用价值进行了初步探讨。     

蝶筛窦形态变异及其在Waters′和侧位片上投影(附250 例CT、X 线平片对照分析)

近年来鼻内窥镜手术、鼻窦ＣＴ冠状位及轴位扫描加深了对鼻腔和鼻窦的解剖的了解 ,在此基础上对照鼻窦Ｗａ ｔｅｒｓ′位和侧位平片对变异较大的蝶筛窦在上述位置的投影的认识无疑可提高对蝶筛窦病变的诊断。本文收集了一组2 5 0例鼻窦ＣＴ和平片齐全的病例 ,进行对照分析 ,以期在平片上对蝶筛窦某些发育形态变异及其临床意义有所认识。1　材料与方法1993— 1999年我院鼻窦ＣＴ、Ｘ线Ｗａｔｅｒｓ′位 鼻窦侧位平片 2 5 0例。男 10 5例 ,女 145例 ;最大年龄 78岁 ,最小 13岁 ,平均 33岁。所有患者均摄有鼻窦Ｗａｔｅｒｓ′位和侧位平片及鼻…     

基于域对齐的深度学习方法在急性缺血性卒中的CT/MRI影像分割上的应用

目的  基于平扫CT提出一种域对齐方法来显著提高急性缺血性卒中(AIS)的早期快速诊断能力。方法  回顾性分析南方医科大学第三附属医院神经内科和神经外科2020年1月~2022年12月收治的入院后3 d内同时接受平扫头颅CT和MRI/DWI、ADC以及T2-Flair序列扫描的AIS患者,构建了一个由318例AIS病例组成的成对CT/MRI影像数据集,分别对每一组配对的教师-学生影像特征进行归一化;再以8∶2的比例随机分为训练集和验证集。设计一种新的生成性对抗性网络来对齐特征层上的跨模式输入,将细节丰富的MRI图像中的语义知识传递到CT图像中进行AIS分割,开发了一种新的域适应算法（Our DA）。结果  与目前性能表现较优异的医学影像分割模型nnUNet相比,Our DA明显优于nnU-Net,每一层验证集之间的分割精度提升约15%。结论  本研究构建的Our DA模型基于MRI/DWI序列的影像特征并迁移到平扫头颅CT上,对平扫头颅CT上的AIS病灶具有较高的自动分割性能,有助于早期自动识别AIS病灶。     

Observation and measurement of applied anatomical features for thoracic intervertebral foramen puncture on computed tomography images

BACKGROUNDThoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia. The anatomical features of the thoracic spine are complex, and puncture injury to the pleura, blood vessels, spinal cord, and other tissues may cause serious complications. The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.AIMTo observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.METHODSA total of 88 patients (41 males and 47 females) who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included. Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected. The width of the intertransverse space (D_P), the height of the rib neck/head above the lower transverse process (D_R), the width of the lateral border of the articular process/lamina (W_P), and the width of the posterior border of the vertebral body (W_V) were measured. At the upper 1/3 of the intervertebral foramina, the horizontal inclination angle (α) from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured. The ratios D_R/D_P and W_P/W_V were calculated. The intervertebral foramen parameters were compared between segments.RESULTSNo rib head/neck occlusion (D_R/D_P > 0) was found in the intertransverse spaces of T1-2 and T12-L1. The incidence of occlusion for the upper thoracic segments (T1-5, n = 138), middle thoracic segments (T5-9, n = 116), and lower thoracic segments (T9-L1, n = 80) were 76.81%, 100%, and 82.50%, respectively. The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments (P < 0.05). The incidence of > 1/2 occlusion (D_R/D_P > 1/2) for the upper, middle, and lower thoracic segments was 7.97%, 74.14%, and 32.50%, respectively. The incidence of > 1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments (P < 0.05). W_P was longer than W_V on T1-2 to T9-10 and shorter than W_V on T10-11 to T12-L1. The horizontal puncture angle (α) into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion (left: r = 0.772, P < 0.01; right: r = 0.771, P < 0.01), and the horizontal inclination angle for T11-12 and T12-L1 was 90°.CONCLUSIONIt is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.     

劈胸骨柄同时锁骨部分离断上胸段胸椎前入路的应用解剖学

目的：为临床经劈胸骨同时锁骨部分离断显露脊柱上胸段提供解剖学依据。方法对30例经福尔马林固定、红色乳胶灌注的成人尸体标本采用劈胸骨柄,同时锁骨部分切断术（左侧径路）进行解剖,观察术中遇到的部分重要解剖结构。结果左头臂静脉属支有颈内静脉、锁骨下静脉、椎静脉、甲状腺下静脉、左第1肋间静脉、左肋间最上静脉、胸廓内静脉。左胸膜顶内侧部借疏松结缔组织、胸内筋膜与胸骨柄相连,易分离。左喉返神经较右喉返神经行程长,与气管食管交角小。胸导管大部分在 T4至T 6椎体平面越过中线（20例,66．6％）,从右侧向左侧斜行跨过椎体。胸交感干和星状神经节位置固定。结论对局部解剖的熟悉程度及术中正确辨认前述解剖结构是手术成功的关键。     

Triaging of COVID-19 patients using low dose chest CT: Incidence and factor analysis of lung involvement on CT images

IntroductionDespite an increase in CT studies to evaluate patients with coronavirus disease 2019 (COVID-19), their indication in triage is not well-established. The purpose was to investigate the incidence of lung involvement and analyzed factors related to lung involvement on CT images for establishment of the indication for CT scans in the triaging of COVID-19 patients.MethodsIncluded were 192 COVID-19 patients who had undergone CT scans and blood tests for triaging. Two radiologists reviewed the CT images and recorded the incidence of lung involvement. The prediction model for lung involvement on CT images using clinico-laboratory variables [age, gender, body mass index, oxygen saturation of the peripheral artery (SpO₂), comorbidities, symptoms, and blood data] were developed by multivariate logistic regression with cross-validation.ResultsIn 120 of the 192 patients (62.5%), CT revealed lung involvement.The patient age (odds ratio [OR]; 4.95, 95% confidence interval [CI]; 0.93–26.49), albumin (OR; 4.66, 95%CI; 1.37–15.84), lactate dehydrogenase (OR; 5.79, 95%CI; 1.43–23.38) and C-reactive protein (OR; 8.93, 95%CI; 4.13–19.29) were selected for the final prediction model for lung involvement on CT images. The cross-validated area under the receiver operating characteristics (ROC) curve was 0.83.ConclusionsThe high incidence of lung involvement (62.5%) was confirmed on CT images. The proposed prediction model that includes the patient age, albumin, lactate dehydrogenase, and C-reactive protein may be useful for predicting lung involvement on CT images and may assist in deciding whether triaged COVID-19 patients should undergo CT.     

Utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies

Background

Chest radiography is the initial choice for thoracic imaging. However, the wide availability of computed tomography (CT) has led to a substantial increase in its use in the emergency department (ED). We evaluated the utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies, and determined if the diagnosis and management decision changed after CT.

Segmentation of the heart and great vessels in CT images using a model-based adaptation framework

Recently, model-based methods for the automatic segmentation of the heart chambers have been proposed. An important application of these methods is the characterization of the heart function. Heart models are, however, increasingly used for interventional guidance making it necessary to also extract the attached great vessels. It is, for instance, important to extract the left atrium and the proximal part of the pulmonary veins to support guidance of ablation procedures for atrial fibrillation treatment. For cardiac resynchronization therapy, a heart model including the coronary sinus is needed.We present a heart model comprising the four heart chambers and the attached great vessels. By assigning individual linear transformations to the heart chambers and to short tubular segments building the great vessels, variable sizes of the heart chambers and bending of the vessels can be described in a consistent way. A configurable algorithmic framework that we call adaptation engine matches the heart model automatically to cardiac CT angiography images in a multi-stage process. First, the heart is detected using a Generalized Hough Transformation. Subsequently, the heart chambers are adapted. This stage uses parametric as well as deformable mesh adaptation techniques. In the final stage, segments of the large vascular structures are successively activated and adapted. To optimize the computational performance, the adaptation engine can vary the mesh resolution and freeze already adapted mesh parts.The data used for validation were independent from the data used for model-building. Ground truth segmentations were generated for 37 CT data sets reconstructed at several cardiac phases from 17 patients. Segmentation errors were assessed for anatomical sub-structures resulting in a mean surface-to-surface error ranging 0.50–0.82 mm for the heart chambers and 0.60–1.32 mm for the parts of the great vessels visible in the images.     

调整窗宽/窗位对卷积神经网络模型自动筛选胰腺肿瘤CT图像性能的影响

目的 观察调整窗宽/宽位对卷积神经网络（CNN）模型自动筛选胰腺肿瘤CT图像性能的影响。方法 按6 ∶ 4比例将医学图像分割十项全能挑战赛中的胰腺CT数据集（包含281例胰腺肿瘤CT图像共26 719幅）数据分为训练集和测试集；训练集共15 346幅，33.96%（5 212/15 346）存在胰腺肿瘤，测试集共11 373幅，34.26%（3 896/11 373）存在胰腺肿瘤。采用调窗方法，分别设置窗位为30、40及50 HU，以120、300和500 HU为窗宽范围端点，经组合配对形成9组参数，调整原始数据集窗宽/窗位，将原始数据直接映射到0~255像素灰度值，共得到10组数据，分别将其导入Alexnet-V1、Alexnet-V2、Resnet-V1及Resnet-V2共4个CNN模型进行训练，于相应测试集中筛选胰腺肿瘤图像，以准确率（Acc）、敏感度（Sen）及特异度（Spe）评价其效能。结果 不同CNN模型用于筛选测试集无调窗数据胰腺肿瘤图像的Acc均为34.26%，Sen均为100%，Spe均为0。调整测试集图像窗位均为30 HU时，CNN模型对于窗宽300 HU图像的Acc及Spe最高，分别为（84.17±1.89）%及（77.91±1.96）%；窗位为40 HU及50 HU时，CNN模型在窗宽300 HU图像中的Acc、Sen及Spe分别为（85.98±2.66）%、（97.19±1.41）%及（82.12±3.44）%和（84.29±2.38）%、（97.68±1.65）%及（77.52±5.35）%，均高于120 HU和500 HU。结论 通过调整窗宽/窗位可在CNN自动筛选胰腺肿瘤图像预处理过程中初步排除冗余信息；合理设置窗宽/窗位能有效提高CNN模型的筛选性能。     

Feasibility of CT-CT fusion imaging for evaluation of the cryoablation margins in visible hepatocellular carcinoma on unenhanced CT images: Initial experience

ObjectiveTo demonstrate the feasibility of CT-CT fusion imaging for assessment of the cryoablation margins in visible hepatocellular carcinoma (HCC) on unenhanced CT images.MethodsThis retrospective study analyzed 14 patients with 14 HCC lesions treated with CT-guided cryoablation. Nine lesions in nine patients who developed local tumor progression (LTP) during the follow-up period of at least 8 months were reviewed. The unenhanced CT data were used to retrospectively create fusion images of the intraoperative CT images on a workstation. The minimal ablative margin (MAM) was assessed on the fusion images. The concordance between the site of LTP and the MAM area was also assessed.ResultsEight of the nine lesions with LTP were in the subcapsular region of the liver. Seven of the nine cases were treated by cryoablation combined with transcatheter arterial chemoembolization. The median time required to fuse the images for the nine lesions was 5:17 min (range, 5:04–7:37 min). The site of LTP relative to the HCC lesion was craniocaudal in nine, dorsoventral in six, and lateral in seven lesions. In all lesions, the site of LTP was congruent with the MAM area.ConclusionsCT-CT fusion imaging enables a real-time intraoperative treatment evaluation for HCC lesions visible on unenhanced CT images. Fused imaging evaluation has proved to be an accurate and useful tool for assessment of the cryoablation margins.     

短暂性脑缺血发作126例的临床与CT研究

目的：探讨短暂性脑缺血发作（ＴＩＡ）患者脑梗死的发生率及可能相关的因素。方法：对１２６例颈内动脉系统ＴＩＡ的临床与ＣＴ资料进行分析。结果：脑ＣＴ扫描后发现７２例显示梗死灶,占５７．１％。其中：单发新鲜梗死灶３８例,多发新鲜梗死灶１８例,新旧梗死灶并存１６例。以腔隙性梗死灶最为多见（９７．５％）,多数病灶与本次ＴＩＡ症状无关,与本次ＴＩＡ临床症状相对应的责任病灶仅占２６．４％。局限性脑功能障碍持续的     

特发性肺含铁血黄素沉着症的X线和CT诊断

目的 探讨特发性肺含铁血黄素沉着症（IPH）的X线和CT诊断。方法 收集2000年1月-2004年12月我院诊治的IPH15例，所有病例均行X线胸片及CT常规检查。其中10例加行HRCT检查。回顾性分析其X线和CT影像表现。结果 X线表现：9例表现为双肺小片状阴影或（和）磨玻璃样改变。8例表现为肺内弥漫性分布的片絮状阴影，6例表现为肺内弥漫分布网格影，4例表现为双肺散在分布的粟粒状、结节状阴影。CT表现：6例表现为双肺广泛结节及小片状阴影，5例表现为双肺不同程度纤维化。结论 IPH的X线和CT表现多样化，不具有特征性，当l艋床具有反复咳嗽咯血、呼吸困难和不明原因缺铁性贫血时，应考虑本病的诊断。     

320排CT灌注成像时间间隔增加对缺血性脑卒中患者放射剂量的影响

目的 研究增加急性缺血性脑卒中患者320排灌注CT(PCT)扫描时间间隔对放射剂量及灌注参数值的影响.方法 回顾性分析23例急性缺血性脑卒中患者的PCT资料,在后处理工作站上分别采用2种不同数据重建方法:①全部数据法:选用全部预设的20个容积数据单元重建;②间隔数据法:间隔选取一个容积数据单元,共10个.分别测量梗死区及对侧镜像区灌注参数图(C BV、CBF、MTT)兴趣区绝对值及同层梗死面积范围,并计算二种数据重建方法产生的有效放射剂量值.比较二种重建方法测量的主要灌注参数值和梗死面积的差异、相关性及放射剂量.结果 两种方法计算的CBV、CBF、MTT差异无统计学意义(P＞0.05);两种方法测量CBV、CBF、MTT相关性有统计学意义(P=0.01,r=0.55).全部数据法、间隔数据法产生有效放射剂量分别为12.04mSV和6.24mSV,后者相当于前者的52％.结论 增加320排PCT成像时间间隔对灌注参数值及梗死面积无显著性影响,并且可以明显减少放射剂量.