COVID-19肺炎：胸部病灶在恢复期的CT影像演变特征

【摘要】目的：探讨胸部CT影像上COVID-19肺炎患者恢复期病灶密度和范围的演变特征。方法：回顾性分析经3~6次胸部CT复查及临床均提示肺炎有好转并最终出院的68例COVID-19患者（RT-PCR或抗体阳性）的病例资料,病例年龄31~81岁,平均51.6岁。分别汇总138个不同病灶多次复查的胸部CT影像,其中包括病灶相邻两次CT复查影像290组。由两位胸部影像诊断医师（年资分别为4年及10年）针对好转病灶的密度及范围变化特点,分析病灶动态演变模式和对比病灶恢复早期（第一次显示好转的胸部CT）和恢复晚期（最后一次胸部CT）的演变情况。结果：290组好转胸部CT图像上,显示病灶的吸收好转主要有5种模式：①病灶范围基本不变伴密度明显减低者占46.1%;②病灶范围明显减小伴密度明显减低者占35.2%;③病灶范围明显减小伴密度局部减低、合并条索灶形成者占9.0%;④病灶范围基本不变伴密度局部减低合并条索灶形成8.3%;⑤病灶范围明显减小伴密度基本不变者占1.4%。138例病灶纵向研究发现,实性及混合病灶恢复早期多表现为密度明显减低（69.4%）,晚期多表现为范围缩小伴条索影形成（52.0%）;纯磨玻璃病灶恢复期主要表现为密度及范围同步递减（67.8%）。结论：COVID-19患者CT图像上病灶在恢复期的变化具有一定特点,在恢复早期和晚期不同病灶的密度及范围变化分别具有一定的规律,多数病灶密度逐渐减低是主要的特征性改变。     

严重急性呼吸综合征的临床与影像学表现

目的　研究SARS患者不同阶段的临床与影像学改变。方法　对 12 3例住院患者进行影像与临床分析。结果　影像改变 :早期 ,病灶多发或单发 ,表现多种多样 ,肺实质改变不明显 ;进展期 ,病变迅速发展 ,范围扩大 ,病灶数目明显增多 ,影像表现呈多样性 ;吸收期 ,病灶明显缩小、变淡 ,部分有纤维化表现。胸部CR、DR与HRCT影像学表现相似 ,但HRCT更敏感。临床表现 :早期 ,发热、全身及关节酸痛 ,咳嗽 ,白细胞正常或偏低 ;进展期 ,在上述症状加重的基础上出现血氧饱和度下降 ,有 2 0 %的患者发展为ARDS ;恢复期 ,80 %的患者好转康复出院。结论　SARS的影像表现与其它肺炎相似 ,特异性不强 ,肺部病变的变化与临床表现无明显相关性。但是影像学仍是作为治疗、了解病变的重要依据。     

人感染H7N9禽流感病毒性重症肺炎的影像学表现及动态变化特点

【摘要】目的：探讨人感染H7N9禽流感病毒性重症肺炎的影像学检查方法及胸部X线、CT影像表现及动态变化特点。方法：对17例(男9例,女8例)确诊人感染H7N9禽流感病毒性重症肺炎患者行胸部X线摄片和薄层CT扫描检查,由2名影像学专家对其影像表现及动态变化进行评价分析。结果:①早期病变位于一侧肺下叶15例,位于上肺叶者2例。进展期病变累及双侧肺16例（16/17,94.1％）,累及一侧肺叶1例（1/17,5.9％）,病变累及4～6个肺叶共16例（94.1％）。②早期和进展期影像学表现见磨玻璃样影和/或肺实变影17例(17/17,100%);13例患者出现胸膜腔积液(13/17,76.5%)。③恢复期主要表现为多发小斑片影（14例）、片状磨玻璃影（9例）、条索状影（16例）及肺气囊（3例）。出院前胸部CT检查以网格状及胸膜下线影（6例）间隔旁肺气肿、瘢痕型肺气肿及纵隔旁胸膜下肺大疱等（4例）为主。2例合并有鲍曼不动杆菌感染,其中1例还合并双侧股骨头缺血坏死。有15例符合最早出现的病灶晚吸收,较晚出现的病灶最早吸收的特点。结论:人感染H7N9禽流感病毒性重症肺炎患者具有明显磨玻璃样影及肺实变表现,病灶以两下叶及背部为著,变化快且广泛,病灶吸收缓慢,恢复期见肺纤维化等特点。影像学的动态观察对指导临床诊断、治疗以及判断预后有一定价值。     

新型冠状病毒肺炎不同时期CT表现及中性粒细胞/淋巴细胞比值、T淋巴细胞亚群变化

【摘要】目的：探讨新型冠状病毒肺炎（COVID-19）不同时期CT特征及与中性粒细胞/淋巴细胞比值（NLR）、外周血T淋巴细胞亚群的关系,提高对NCP的认识和诊治水平。方法：回顾性分析56例COVID-19患者的CT资料,对其急性期、恢复期（重症期）CT表现进行分析,并对其NLR及T淋巴细胞亚群计数进行对比分析。结果：56例COVID-19中,普通型38例,影像上急性期表现以肺中外带、磨玻璃影为主,恢复期肺内病灶治疗后5例（13.16%）完全吸收,18例（47.37%）明显吸收,15例（39.47%）部分吸收;重型11例,急性期表现为双肺广泛的磨玻璃影和（或）大片状实变影,恢复期明显吸收的7例（63.64%）,部分吸收的4例（36.36%）;危重型7例,急性期亚实变、实变为主混合磨玻璃影,恢复期明显吸收的1例（14.29%）,部分吸收的3例（42.86%）,死亡3例,且均为重症期,呈“白肺”改变。普通型组、重型组、危重型组NLR及CD4+T淋巴细胞计数在急性期、恢复期（重症期）组间差异具有统计学意义（P＜0.05)。结论：COVID-19普通型以磨玻璃密度影及斑片状阴影为主,部分实变,重型、危重型以亚实变、实变为主,影像表现多样。治疗后普通型患者多明显吸收,重型、危重型患者多残留间质增生及纤维化。NRL、T淋巴细胞计数对早期识别NCP重型、危重型患者及预后有重要意义。     

近十年来中风CT表现的研究现状

<正> 中风病是老年人常见病、多发病,其发病急骤,病情危重,死亡率和致残率都很高。中医学对中风有独特而深刻的理论认识,通过数千年的临床实践,在预防、治疗、康复方面,具有较为显著的疗效与优势。而现代影像学无疑能成为中风诊治一大帮手,成为其望诊的延伸,中风病辨证分型与CT影像在病变性质、病变位置、病变的大小范围等的显示上均有紧密的关系。本文将根据目前对中风病的分期     

中风先兆期(证)CT研究进展

目前中医学将中风病分为中风先兆期、中风急性期、中风康复期三期。中风先兆证属中风先兆期发病处于前驱状态的一组临床症候群,预示着中风的发生,由先兆证到中风发作可视为一个由量变到质变的过程。以中医学“未病先防,既病防变”的“治未病”思想,在中风病先兆期或早期给予明确诊断,并加以积极有效的干预治疗,可明显阻断或延缓中风的发展,改善患者症状,提高生存质量。     

脾脏窦岸细胞血管瘤的影像表现

目的 探讨脾脏窦岸细胞血管瘤的影像特征.方法 回顾性分析10例经手术病理证实的脾脏窦岸细胞血管瘤患者的CT及MRI表现及临床资料,总结其影像表现特征.结果 10例脾脏窦岸细胞血管瘤中,9例临床上表现为脾脏肿大和(或)脾功能亢进.影像上表现为多发结节,大小不等.MR T2WI及DWI上病灶多呈高信号.CT和MR平扫病灶不易显示;病灶对比增强扫描明显强化,强化方式为向心性强化,延迟期病灶不易显示,观察瘤灶数目最佳时期是对比增强扫描的门静脉期.结论 脾脏窦岸细胞血管瘤的CT及MRI表现具有一定特征性,尤其是DWI表现,可为窦岸细胞血管瘤的鉴别诊治提供帮助.     

中风急性期各证头颅CT征象的研究

目的:通过对161例中风病患者头颅CT表现和临床辨证分型研究,探索中风病各证型头颅CT征象的规律性。方法:采用前瞻性及双盲法对161例中医辨证为中风病各证的患者,行头部CT平扫,观察、记录病变的性质、密度,病灶的大小、部位、周围水肿情况,出血量的多少,脑室的改变(包括脑室受压改变和出血破入脑室)和中线移位情况等,并进行统计学处理。结果:中经络与中脏腑证在病变性质、出血量、范围上有极显著差异,病变部位有显著差异,病变周围情况也明显不同。中脏腑闭证、脱证在脑出血发生率、大病灶发生率、脑出血量上有显著性差异。结论:中风病患者急性期头部CT表现可为中经络与中脏腑临床辨证提供参考,并指导临床治疗,估计预后。     

小儿手足口病合并脑干脑炎的MRI特征与临床预后评估

目的:探讨MRI对小儿手足口病合并脑干脑炎的诊断、预后评估价值及临床指导意义。方法:回顾性分析42例小儿手足口病合并脑干脑炎的临床及影像资料,对比分析其入院及出院时的MRI表现及临床治疗效果。结果:根据入院时MRI表现,将患儿分为2组:31例病灶边界模糊型和11例病灶边界清晰型。边界模糊型病灶MRI表现为脑干背侧不同厚度T1WI呈等或稍低信号,T2WI稍高信号;出院时复查MRI均表现正常,30例临床完全康复,1例遗留眼球运动障碍。边界清晰型MRI表现为脑干内斑片状或对称性斑点状、条状T1WI低信号,T2WI高信号;出院复查MRI,7例表现正常,6例临床完全康复,4例遗留不同程度后遗症,其中,2例遗留桥脑延髓交界区病灶,1例遗留延髓病灶,1例遗留脊髓前角病灶,1例死亡。结论:小儿手足口病边界模糊型明显比边界清晰型预后好,以MRI表现进行分型有助于临床预后判断。     

急性混合性气体中毒影像学特征及分析

目的:探讨急性群体混合性气体中毒的影像学特征及远期随访价值.方法:对我院收治的35例急性群体混合性气体中毒患者行常规胸部CT扫描,并选择部分病例行1～4次胸部CT扫描复查病变变化情况;23例行胸部CR检查;28例行头部常规CT扫描.1年后全部病例胸部正侧位CR照片复查远期变化.结果:胸部CT扫描阳性28例(80%),阴性7例(20%),主要表现为支气管炎、支气管周围炎、肺炎、肺水肿及胸腔积液;胸部CR片检查23例,阳性8例(35%),阴性15例(65%),主要表现为两肺纹理增多,双下肺及左下肺小片状模糊影;头部CT 28例均显示正常;1年后胸部正侧位CR片复查,肺部病灶吸收消失,肺纹理恢复到正常人群水平,胸腔积液消失.结论:急性群体混合性气体中毒影像学表现有一定特征性,远期复查意义重大,可为临床诊治提供重要信息.     

CT脑灌注成像结合CTA对脑梗死前期诊断的研究

目的 探讨64层容积CT脑灌注成像结合头颈部血管成像对脑梗死前期诊断的临床应用价值.资料与方法 对45例临床诊断为急性缺血性脑血管病而常规CT平扫未发现异常的病例进行脑灌注成像及头颈部血管成像检查.测量脑内感兴趣区(region of interest,ROI)的局部脑血流量(regional cerebral blood flow,rCBF)、局部脑血容量(regional cerebral blood volume,rCBV)、平均通过时间(mean transit time,MTT)、最大峰值时间(time to peak,TTP),并根据脑梗死前期的分期标准进行分析;对颈部及颅内病变血管按照北美症状性颈动脉内膜切除术试验(NASCET)标准计算狭窄率.结果 发现脑灌注异常42例,其中Ⅰ_1,期6例、Ⅰ_2期16例、Ⅱ_1期12例、Ⅱ_2期8例,其中7例同时有两个部位发现异常灌注区,分别处于Ⅰ_2期和Ⅱ_1期,3例未发现异常灌注区.患侧TTP、MTT与对侧镜像比较差异有统计学意义.45例行CTA检查,发现60支颈内动脉狭窄,24支椎动脉狭窄,27例颅内动脉血管不同程度狭窄,各期患者分布情况与相应供血动脉狭窄程度呈正相关.结论 64层容积CT脑灌注成像结合头颈部血管成像能清楚显示脑梗死前期的血流动力学异常及相应的血管狭窄程度,具有重要的临床应用价值.     

Diagnostic use of isotropic diffusion-weighted MRI in patients with ischaemic stroke: detection of the lesion responsible for the clinical deficit

We examined the diagnostic use of isotropic diffusion-weighted (DW) MRI in 140 consecutive patients suspected of or diagnosed as having an ischaemic stroke. Isotropic DW imaging could demonstrate the lesion responsible for the clinical deficit in patients with multiple cerebral infarts at an early stage, even small lesions without a perifocal oedema or mass effect. Accurate diagnosis by DW images may, however, be difficult about 2 weeks after the onset of stroke. Received: 15 November 1998 Accepted: 12 February 1999     

Development of brain infarct volume as assessed by magnetic resonance imaging (MRI): follow-up of diffusion-weighted MRI lesions

PURPOSE: To investigate the development of ischemic brain lesions, as present in the acute stroke phase, by diffusion-weighted magnetic resonance imaging (DWI), and in the subacute and chronic phases until up to four months after stroke, in fluid-attenuated inversion recovery (FLAIR)- and T2-weighted (T2W) magnetic resonance (MR) images. MATERIALS AND METHODS: Twelve consecutive patients with their first middle cerebral artery (MCA) infarction were included. Lesion volumes were assessed on T2W images recorded with a turbo spin echo (TSE) and on images recorded with the FLAIR sequence on average on day 8 and after about four months. They were compared with acute lesion volumes in perfusion and DWI images taken within 24 hours of stroke onset. RESULTS: On day 8, lesion volumes in images obtained with FLAIR exceeded the acute infarct volumes in DWI. The chronic lesion volumes were almost identical in T2W and FLAIR images but significantly reduced compared with the acute DWI lesions. The lesion volumes assessed on DWI images correlated highly with the lesions in the images obtained with TSE or FLAIR, as did the lesions in the images obtained with FLAIR and TSE. The secondary lesion shrinkage was accompanied by ventricular enlargement and perilesional sulcal widening, as most clearly visible in the images obtained with FLAIR. CONCLUSION: Our results show that the acute DWI lesions are highly predictive for the infarct lesion in the chronic stage after stroke despite a dynamic lesion evolution most evident in MR images obtained with FLAIR.     

Diffusion tensor imaging as a prognostic biomarker for motor recovery and rehabilitation after stroke

Purpose

Despite improved acute treatment and new tools to facilitate recovery, most patients have motor deficits after stroke, often causing disability. However, motor impairment varies considerably among patients, and recovery in the acute/subacute phase is difficult to predict using clinical measures alone, particularly in severely impaired patients. Accurate early prediction of recovery would help rationalize rehabilitation goals and improve the design of trials testing strategies to facilitate recovery.

Methods

We review the role of diffusion tensor imaging (DTI) in predicting motor recovery after stroke, in monitoring treatment response, and in evaluating white matter remodeling. We critically appraise DTI studies and discuss their limitations, and we explore directions for future study.

Results

Growing evidence suggests that combining clinical scores with information about corticospinal tract (CST) integrity can improve predictions about motor outcome. The extent of CST damage on DTI and/or the overlap between the CST and a lesion are key prognostic factor that determines motor performance and outcome. Three main strategies to quantify stroke-related CST damage have been proposed: (i) measuring FA distal to the stroke area, (ii) measuring the number of fibers that go through the stroke with tractography, and (iii) measuring the overlap between the stroke and a CST map derived from healthy age- and gender-matched controls.

Conclusion

Recovery of motor function probably involves remodeling of the CST proper and/or a greater reliance on alternative motor tracts through spontaneous and treatment-induced plasticity. DTI-metrics represent promising clinical biomarkers to predict motor recovery and to monitor and predict the response to neurorehabilitative interventions.

     

脑梗死功能连接在个体化功能康复中的应用进展

脑梗死可引起脑组织受损进而造成功能受损。目前常采用功能MRI评价脑梗死功能网络的损害，通过功能连接（FC）的分析方法能够很好地观察脑网络的功能障碍和功能重组，最常用的分析方法包括基于种子点的FC和图论。早期评价脑梗死功能网络的变化，有利于评估神经功能以及制定合理的康复方案。就FC在脑梗死病灶位置和梗死时间分析中的应用，及其在评估功能康复和个体化精准干预中的应用进展作一综述。     

Prognostication of recovery following stroke using the comparison of CT and technetium-99m HM-PAO SPECT

This study investigated the possibility that a relationship between the anatomic defects observed on computed tomography (CT) and the functional defects observed on single photon emission computed tomography (SPECT) might be used as an outcome measure to predict clinical recovery from the neurologic deficits induced by stroke. Twenty-seven patients with stroke location limited primarily to cerebral cortex were included in the study: each patient underwent a cranial CT scan, 99mTc hexamethylpropyleneamineoxime SPECT cerebral perfusion scan, and an initial and 1-yr follow-up neurologic examination. A strongly positive correlation between the ratio of the SPECT to CT volume defect sizes (SPECT divided by CT) and recovery following stroke was found, such that the greater the SPECT to CT ratio, the better the subsequent recovery of neurological deficits. Discriminant function analysis revealed that the best predictor of clinical outcome following stroke was the log-transformation of SPECT divided by CT. The results suggest that the relationship between the perfusion defects and tissue loss measured by SPECT and CT imaging may have prognostic utility following stroke limited primarily to cerebral cortex.     

规范三级康复治疗中不同时期卒中患者运动功能改善规律的分析

目的:探索规范的三级康复治疗后,卒中偏瘫患者运动功能的改善规律.方法:卒中52例患者在脑梗塞和脑出血两个层次上随机分为康复组和对照组,康复组给予规范的三级康复治疗,对照组则不给于规范的三级康复治疗,但常规内科治疗同治疗组.分别于入选时,发病后第1个月月末、第3个月月末和第6个月月末采用功能综合评定量表进行运动相评分.结果:康复组在入选后各阶段的评分明显高于对照组(P＜0.001),康复组各阶段运动功能评分积分差值明显高于对照组(P＜0.05).对患者各阶段运动功能进行自身前后对比,发现康复组患者各阶段运动功能积分之间存在显著差异(P＜0.01),对照组除第3个月月末和第6个月月末的运动功能积分间不存在明显差别,其余均存在明显差别(P＜0.05).另外,从患者康复各阶段运动功能变化上可以看出,康复组在各阶段的积分明显高于对照组,且积分在各阶段的增长趋势明显快于对照组.结论:规范三级康复治疗早期能够加速患者的恢复进程,后期康复治疗仍有利于患者运动功能的改善,但是速度变慢,然而相对于对照组功能恢复仍然较为明显.     

Neuroradiologic and clinical features of arterial dissection of the anterior cerebral artery

BACKGROUND AND PURPOSE: Case reports of nontraumatic arterial dissection of the anterior cerebral artery (ACA) have recently increased. The aim of this study was to investigate the neuroradiologic and clinical features of ACA dissection based on a series of collected cases. METHODS: The cases of 18 patients with a diagnosis of ACA dissection based on clinical signs and neuroradiologic findings from 46 stroke centers during a 5-year period were collected. The neuroradiologic and clinical records were analyzed. RESULTS: The mean patient age was 52.8 +/- 9.8 years. Five cases presented with subarachnoid hemorrhage, nine with cerebral ischemia, and four with both ischemic symptoms and subarachnoid hemorrhage. In cases presenting with ischemia, the main site of the lesion was the A2 portion and the main angiographic finding was stenosis with or without dilation. Follow-up angiography showed progression of the stenosis in the acute stage and resolution of the stenosis in the chronic stage. Hyperintensity around the flow void due to intramural hematoma on T1-weighted MR images was often seen during the second week. In all cases, the findings of MR angiography corresponded to the findings of cerebral angiography. Eight of nine cases showed a good prognosis. In three of the patients with bleeding, in whom the site of the lesion was at the A1 portion, a diffuse thick subarachnoid hemorrhage was present and surgical treatment was required but resulted in a poor prognosis. In the other patients with bleeding, in whom the site of the lesion was at the distal ACA, the prognosis was good and no rebleeding or need for surgical treatment occurred. CONCLUSION: ACA dissection presenting with ischemia has several identifiable neuroradiologic and clinical characteristics, which suggests that it may be classified as a unique clinical entity.     

Comparison of perfusion computed tomography with diffusion-weighted magnetic resonance imaging in hyperacute ischemic stroke

OBJECTIVE: In this study, perfusion CT and diffusion-weighted magnetic resonance imaging (DWI) were compared as means of assessing the ischemic brain in hyperacute stroke. METHODS: Twenty patients with ischemic stroke underwent perfusion computed tomography (CT) and magnetic resonance imaging (MRI) studies <3 hours after stroke onset. Cerebral blood flow thresholds were used to delineate the ischemic lesion, penumbra, and infarct. Correlations between the volume of the hypoperfused areas, the abnormality volume in admission DWI and follow-up CT/MRI studies, and the clinical National Institutes of Health Stroke Scale (NIHSS) scores were performed. RESULTS: The volume of the ischemic (core and penumbra) lesion on admission perfusion CT was correlated with the volume of admission DWI abnormalities (r=0.89, P=0.001). The infarcted core tissue volume (on admission CT) correlated more strongly (r=0.77, P=0.0001) than the admission DWI abnormality volume (r=0.69, P=0.002) with the follow-up infarct volume on fluid-attenuated inversion recovery images. A correlation was demonstrated between infarct volume in perfusion CT and follow-up DWI abnormality volume (r=0.89, r=0.77, P=0.002). Significant correlations were found between ischemic and infarct region volumes in perfusion CT and NIHSS admission and follow-up scores (P < or = 0.01). CONCLUSIONS: Both imaging modalities provide a sufficient assessment of the hyperacute brain infarct, with significant correlation between them and the clinical condition at admission. Perfusion CT allows differentiation of the penumbra and infarct core region with significant predictive value of follow-up infarct volume and clinical outcome.     

MRI of brain infarction

MRI of twenty patients with cerebral infarction were reported with their X-CT. MRI with long SE mode clearly showed the ischemic lesion at 18 hours after insult, whereas X-CT performed immediately after MRI scanning showed no abnormality. The signal contrast of the lesion with long SE mode seemed to increase slightly during the patient's course, for a period of several months. The MRI images with long SE at the chronic stage were varied: small lesions appeared as hot areas, whereas large lesions appeared as cold areas and were accompanied with signal enhancement in the surrounding areas. A phantom study was also performed and it was determined that MRI was superior to X-CT in its ability to detect tissue water. One of the reasons for the high diagnostic capability of MRI for acute stroke was, therefore, attributed to this experimental result.