胸椎无骨折脱位型脊髓损伤

报告１２例胸椎无骨折脱位型脊髓损伤。男８例，女４例，２．５－１１岁７例，２３－２５岁５例。伤因：绞伤１例，辗压伤８例，坠落伤２例，砸伤１例。１０例伤后立即瘫痪，２例伤后２－３天延迟瘫痪。瘫痪特点：弛缓性，大小便失禁。Ｘ线及ＣＴ照片胸椎无骨折脱位；ＭＲＩ：损伤平面早期脊髓水肿，晚期伤段以下脊髓普遍变细，脊髓选择性血管造影脊髓前动脉不显影。术中检查见胸６－８以下脊髓普遍变细，脊髓占椎管１／３，脊髓苍白     

胸椎管狭窄的影像学诊断

本文报告１７例胸椎管狭窄，对其在胸椎平片，脊髓造影，ＣＴ和ＣＴＭ上的表现进行了观察和分析。引起本病的主要原因是椎板小关节的增生肥大、间盘疝，黄韧带和后纵韧带的肥厚和骨化，同颈和腰椎管狭窄相化，胸椎管狭窄具有如下特点：（１）发病率低；（２）临床症状出现晚，进展缓慢，呈进行性加重；（３）狭窄部位主要位于间盘－椎间关节平面，（４）韧带骨化更明显，范围更广泛，对不同影像学检查方法的价值和早期诊断的重要性进     

白塞氏病的胸部CT表现

目的；探讨白塞氏病胸部ＣＴ表现。材料与方法；回顾性分析了１５例白塞氏病患者的胸部ＣＴ表现。结果：１５例中１１例胸部ＣＴ可见不同程度的异常改变，其中２例肺部肿块ＣＴ增强扫描为肺动脉瘤；１例上腔静脉狭窄血栓形成致胸壁侧支循环形成；１例肺动脉高压及肺间质病变；其他异常包括胸腔积液、胸膜增厚、肺灌注不良、肺间质病变及纵隔淋巴结肿大。结论：ＣＴ对白塞氏病患者胸部病变尤其是肺动脉脉瘤的诊断具有重要的价值。     

胸腰椎骨折的CT诊断

目的：讨论胸腰椎骨折的ＣＴ诊断价值。材料和方法：分析５２例同时作ＣＴ和Ｘ线平片检查的胸腰椎骨折病例。结果：本组３７例为单椎体骨折，１５例为多椎体骨折，压缩型骨折占３８９％，爆裂型骨折占４５８％，骨折脱位型占１０％，安全带型占５６％。结论：ＣＴ对胸腰椎骨折诊断、分型及了解合并损伤方面有重要临床价值     

胸椎黄韧带骨化性椎管狭窄的MRI和CT对比研究

目的:本文对54例胸椎黄韧带骨化性椎管狭窄患者进行MR和CT对比研究。 材料和方法:男性43例,女性11例,年龄32～78岁。全部患者采用1.0T超导磁共振机,全身CT扫描机,行矢状T_1和T_2W1扫描,T_1W1病变区或/和T_2W1横轴扫描及相似层面的CT横断对照扫描。 结果:54例(108椎间)胸椎黄韧带骨化性椎管狭窄,单椎间发生者14例,多椎间40例(94椎间)。MR主要表现为黄韧带附着区丁T_1W1和T_2W1像增厚的异常低信号影,CT则全部表现为不同程度的骨样密度吸收区。 结论:MR是显示胸椎黄韧带骨化和脊髓受压情况的最佳方法,CT在诊断胸椎黄韧带骨化性椎管狭窄所合并的其他脊柱退行性变方面优于MRI。MRI结合CT平扫为诊断胸椎黄韧带骨化性椎管狭窄的最佳方法。     

Radiology of terror injuries: the American University of Beirut Medical Center experience

OBJECTIVE: This study aimed to report our experience with regard to imaging of mass casualty incidents (MCIs). SUBJECTS AND METHODS: Following a bomb attack, 150 casualties were referred to our hospital. Radiographs and nonenhanced CT scans were performed in 28 individuals. RESULTS: Major injuries were seen in 12 individuals, which were limited only to the brain (n=2), facial bones (n=2), and extremities and soft tissues (n=8). CONCLUSION: In MCIs, imaging should be fast, in order to help identify major injuries that need immediate management and to help in the triage of injured individuals.     

Digital radiography of crush thoracic trauma in the Sichuan earthquake

AIM:To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography(CDR).METHODS:We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake.Patient age ranged from 0.5 to 103 years.CDR was performed between May 12,2008 and June 7,2008.We looked for injury to the thoracic cage,pulmonary parenchyma and the pleura.obtained in 349 patients,the remaining 423 patients underwent only AP CDR.Thoracic cage fractures,pulmonary contusion and pleural injuries were noted in 331(42.9%;95% CI:39.4%-46.4%),67 and 135 patients,respectively.Of the 256 patients with rib fractures,the mean number of fractured ribs per patient was 3.Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib.Rib fractures had a significant positive association with non-rib thoracic fractures,pulmonary contusion and pleural injuries(P < 0.001).The number of rib fractures and pulmonary contusions were significant factors associated with patient death.CONCLUSION:Earthquake-related crush thoracic trauma has the potential for multiple fractures.The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment.     

CT导引下同轴穿刺针胸部病变穿刺活检(附48例分析)

目的：探讨同轴穿刺针在胸部病变检中的应用。材料与方法：应用仿Ｇｒｅｅｎ针改制的２０Ｇ同轴穿刺针对４８例胸部病变患者在ＣＴ导向下穿刺活检。其中３８例结节或肿块性病变大小为１．５￣４．２ｃｍ×２．８￣１０．５ｃｍ,平均２．６ｃｍ×５．８ｃｍ;肺实变１０例。结果：４８例病灶共取材１１０次,平均２．３次。组织学标本获取率９３．８％（４５／４８）,恶性病变诊断准确率１００％（２１／２１）,良性病变诊断准确率     

Thoracic helical CT: influence of subsecond scan time and thin collimation on evaluation of peripheral pulmonary arteries

The objective of this study was to analyze the influence of collimation on the identification of peripheral pulmonary arteries on helical CT scans. Three hundred sixty of 370 consecutive helical CT angiograms of the pulmonary circulation obtained during an 18-month investigation period were considered as technically acceptable for the detection of acute pulmonary embolism and were retrospectively analyzed. Patients in group A (n = 274) underwent CT with 2-mm collimation and pitch of 2; those in group B (n = 86) underwent CT with 3-mm collimation and pitch 1.7; a 0.75-s rotation time was systematically used. A total of 2160 segmental (six arterial zones per patient) and 2160 subsegmental (six arterial zones per patient) arterial zones were assessed. Whereas the percentage of segmental arteries was not significantly different between group A (86 %) and group B (89 %), the percentage of analyzable subsegmental arteries was greater in group A (65 %) than in group B (43 %) (P < 0.001). The causes of inadequately depicted subsegmental arterial zones were partial-volume effects (group A, n = 302; 52 %; group B, n = 197; 67 %; P < 0.001), suboptimal enhancement (group A, n = 145; 25 %; group B, n = 43; 15 %; P < 0.05), motion artifacts (group A, n = 113; 20 %; group B, n = 30; 10 %), and unincluded arteries (group A, n = 20; 3 %; group B, n = 25; 8 %). Helical CT with 2-mm collimation at 0.75 s per revolution enables marked improvement in the analysis of subsegmental arteries in routine clinical practice. Received: 25 January 2000; Revised: 28 March 2000; Accepted: 30 March 2000     

CT imaging in acute pulmonary embolism: diagnostic strategies

Computed tomography pulmonary angiography (CTA) has increasingly become accepted as a widely available, safe, cost-effective, and accurate method for a quick and comprehensive diagnosis of acute pulmonary embolism (PE). Pulmonary catheter angiography is still considered the gold standard and final imaging method in many diagnostic algorithms. However, spiral CTA has become established as the first imaging test in clinical routine due to its high negative predictive value for clinically relevant PE. Despite the direct visualization of clot material, depiction of cardiac and pulmonary function in combination with the quantification of pulmonary obstruction helps to grade the severity of PE for further risk stratification and to monitor the effect of thrombolytic therapy. Because PE and deep venous thrombosis are two different aspects of the same disease, additional indirect CT venography may be a valuable addition to the initial diagnostic algorithm—if this was positive for PE—and demonstration of the extent and localization of deep venous thrombosis has an impact on clinical management. Additional and alternate diagnoses add to the usefulness of this method. Using advanced multislice spiral CT technology, some practitioners have advocated CTA as the sole imaging tool for routine clinical assessment in suspected acute PE. This will simplify standards of practice in the near future.     

Pulmonary hypertension in patients with chronic pulmonary thromboembolism: chest radiograph and CT evaluation before and after surgery

The purpose of this study was to assess the value of morphometric data on conventional radiography and CT predicting the presence and degree of pulmonary hypertension and to assess the reversibility after surgery. On preoperative X-ray films and CT scans of 50 patients with pulmonary hypertension secondary to chronic thromboembolism, we measured the cardiothoracic ratio, basal diameter, length of cardiac contact to sternum, pulmonary trunk, right and left descending pulmonary artery, and the septum angle. These data were correlated with pulmonary arterial pressure. In 14 X-ray patients and 18 CT patients, with follow-up after surgical thromboendarterectomy the reversibility of these changes was assessed. A dilated pulmonary trunk was the most common abnormality (96% each on X-ray and CT). Pulmonary arteries were dilated on X-ray in 40% (right) and 14% (left), and on CT in 92% (right) and 96% (left). The best correlation with mean arterial pressure was found measuring the pulmonary trunk on CT (r = 0.43, p < 0.01). After surgery, reversibility was most significant for the pulmonary trunk on CT (p < 0.0001). In patients with chronic pulmonary embolism, pulmonary hypertension can best be predicted by assessing the diameter of the pulmonary trunk both on X-ray and CT. No close correlation is present between the extent of any parameter and the level of the pulmonary pressure.Correspondence to: H. C. Schmidt     

COVID-19 in the radiology department: What radiographers need to know

ObjectivesThe aim is to review current literature related to the diagnosis, management, and follow-up of suspected and confirmed Covid-19 cases.Key findingsMedical Imaging plays an important auxiliary role in the diagnosis of Covid-19 patients, mainly those most seriously affected. Practice differs widely among different countries, mainly due to the variability of access to resources (viral testing and imaging equipment, specialised staff, protective equipment). It has been now well-documented that chest radiographs should be the first-line imaging tool and chest CT should only be reserved for critically ill patients, or when chest radiograph and clinical presentation may be inconclusive.ConclusionAs radiographers work on the frontline, they should be aware of the potential risks associated with Covid-19 and engage in optimal strategies to reduce these. Their role in vetting, conducting and often reporting the imaging examinations is vital, as well as their contribution in patient safety and care. Medical Imaging should be limited to critically ill patients, and where it may have an impact on the patient management plan.Implications for practiceAt the time of publication, this review offers the most up-to-date recommendations for clinical practitioners in radiology departments, including radiographers. Radiography practice has to significantly adjust to these new requirements to support optimal and safe imaging practices for the diagnosis of Covid-19. The adoption of low dose CT, rigorous infection control protocols and optimal use of personal protective equipment may reduce the potential risks of radiation exposure and infection, respectively, within Radiology departments.     

Thoracic aortic stent graft: comparison of contrast-enhanced MR angiography and CT angiography in the follow-up: initial results

The objective of this study was to compare contrast-enhanced magnetic resonance angiography (CE MRA) and multislice computed tomographic angiography (MS CTA) in the follow-up of thoracic stent-graft placement. The CE MRA and MS CTA were performed following nitinol stent-graft treatment due to thoracic aneurysm (n=4), intramural bleeding (n=2) and type-B aortic dissection (n=5). Corresponding evaluation of arterial-phase imaging characteristics focused on the stent-graft morphology and leakage assessment. Stent-graft and aneurysm extensions were comparable between both techniques. Complete exclusion (aneurysm, n=4; dissection, n=2) was assessed with high confidence with CE MRA and MS CTA. Incomplete exclusion (intramural bleeding, n=2; dissection, n=3) was assigned to lower confidence scores on CE MRA compared with MS CTA. On CE MRA the stent-graft lumen demonstrated an inhomogeneous signal, the stent struts could not be assessed. The CE MRA can be used as alternative non-invasive imaging for follow-up of nitinol stent grafts. Arterial-phase leak assessment can be less evident in CE MRA compared with MS CTA studies; therefore, the use of late-phase imaging seems to be necessary. The diagnostic gap of stent-graft fracture evaluation using MRA may be filled with plain radiographs.     

Imaging Appearances of Congenital Thoracic Lesions Presenting in Adulthood

Many congenital lesions of the thorax are detected for the first time in adulthood when they can simulate a wide range of pathologies, including infection and neoplasia. They can be broadly classified into tracheobronchial, parenchymal, vascular, and combined parenchymal/vascular abnormalities. An awareness of their typical imaging features enables a confident diagnosis and helps direct appropriate patient management.