CT引导下乙醇消融术治疗肝转移瘤

目的 探讨CT引导下无水乙醇消融术(PEI)在肝转移性肿瘤治疗中的价值.方法 53例肝转移性肿瘤,共计87个病灶.18个病灶直径≤1 cm;56个病灶直径1～3 cm;13个病灶直径3～5 cm.采用CT引导下无水乙醇瘤内注射进行治疗,经过1次或多次治疗,观察肝转移瘤的坏死情况.结果 PEI治疗后1个月MR或CT复查,18个直径≤1 cm的病灶完全坏死率为100%;直径1～3 cm 56个病灶完全坏死率为87.5%,再次治疗后完全坏死;13个病灶直径3～5 cm的病灶完全坏死率为61.5%,经过2～3次治疗,病灶彻底坏死.结论 CT引导下无水乙醇消融术治疗肝转移性肿瘤疗效满意,尤其适用于直径≤3 cm的单个病灶.     

CT导引经皮注射无水乙醇治疗甲状腺腺瘤

目的评价CT导引经皮注射无水乙醇(CT-PEI)治疗甲状腺腺瘤的安全性和疗效.方法54例病人,共73个结节,经穿刺细胞学检查证实为甲状腺腺瘤.三碘甲状腺原氨酸(T3)、血清甲状腺素(T4)、促甲状腺激素(TSH)检查正常.CT-PEI治疗甲状腺腺瘤.73个结节内共行PEI115次,平均(1.58±0.78)次/结节,结节体积的乙醇注入量为0.3～2.5ml/cm3.结果治疗后3～6个月行CT复查,肿瘤完全消失者37个,体积缩小在80%以上者28个,体积缩小50%～80%者7个,1个体积缩小28.9%.54例病人中1例出现一过性声音嘶哑,2例出现局部红肿疼痛、烧灼感.结论CT-PEI治疗甲状腺腺瘤是一种安全、有效、副作用少、微创的手术方法.     

CT导引下经皮穿刺肾囊肿注射无水酒精治疗的应用

目的 探讨CT导引下经皮穿刺肾囊肿并注射无水酒精(PEI)的治疗技术、疗效、适应证及并发症，总结其操作特点。方法 在CT导引下对125例肾囊肿中的221个行PEI治疗，其中单发囊肿77例，多发囊肿47例，多囊肾1例。半年后复查并观察疗效。对其并发症对症治疗。结果 疗效0级-Ⅲ级分别为1．36％(3个)，86％（19个)，20．8％(46个)，69．2％(153个)，总有效率约98．6％。临床症状明显减轻或消失者84例，约67．2％，并发症12例，结论 CT导引下PEI是一种简单、安全、高效、低价的治疗方法。其关键在于成功注入酒精。其操作重点在于减轻或减少注入酒精时的疼痛。     

CT-guided transthoracic percutaneous ethanol injection for hepatocellular carcinoma not detectable with US

PURPOSE: To evaluate the safety and effectiveness of computed tomography (CT)-guided percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) not detectable with ultrasonography (US). MATERIALS AND METHODS: Between April 1994 and January 2001, 51 patients with 57 HCC nodules not detectable with US underwent CT-guided transthoracic PEI. Complications associated with the transthoracic approach, effectiveness of transthoracic PEI, and prognosis of the patients were evaluated. RESULTS: Seventy-one PEI sessions were performed for 57 nodules. Complications included pneumothorax in 21 sessions (30%) for 19 nodules (33%), moderate pleural effusion in four sessions (6%) for four nodules (7%), and hemoptysis in three sessions (4%) for two nodules (4%). A chest tube was required for pneumothorax in five sessions (7%) for five nodules (9%), and pleural effusion drainage was performed in two sessions (3%) for two nodules (4%). Apparent tumor necrosis was noted at CT in 51 nodules (89%). During follow-up (range, 3 months to 5(1/2) years; mean, 29 months +/- 18 [SD]), local recurrence was seen in seven nodules (12%), three of which received repeat treatment with transthoracic PEI. Twenty-six patients survived, and 25 patients died of multiple tumors, hepatic failure, or rupture of esophageal varices. CONCLUSION: Transthoracic PEI seems to be relatively safe and effective for the treatment of HCC not detectable with US.     

Computed tomography of the thymus gland in myasthenia gravis

Sixteen consecutive patients with myasthenia gravis were examined by computed tomography (CT) before thymectomy. Surgical and histologic findings were compared with those obtained at CT. The results, like those of most other recent studies, indicate that CT is a reliable method for identifying thymoma. In all three patients with thymoma, and in five out of eight patients with hyperplasia, the lesion was observed at CT, giving an overall accuracy of 80 per cent. Although thymic hyperplasia is a basically histologic diagnosis an enlarged gland may give a correct diagnosis of this abnormality.     

CT引导下经皮穿刺注射乙醇治疗甲状旁腺腺瘤

目的 探讨CT引导下经皮穿刺乙醇注射(PEI)治疗甲状旁腺腺瘤所致甲状旁腺功能亢进的疗效。方法 1例经活检证实的甲状旁腺腺瘤，在CT引导下用22G细针从前外方穿入病灶，在病灶多点、分次注射无水乙醇。结果 经过2次CT引导下PEI治疗，6个月后复查CT，示病灶体积显著缩小、由显著强化转变为无强化，治疗结束后2d至12个月，血甲状旁腺素、血钙、血磷均恢复至正常水平，临床症状显著改善。结论 CT引导下PEI治疗甲状旁腺功能亢进症疗效佳、创伤小，可作为手术治疗的重要补充。     

CT引导下经皮无水乙醇注射治疗肝癌门静脉瘤栓

目的探讨CT引导下经皮无水乙醇注射治疗肝癌门静脉瘤栓的疗效。方法对20例肝癌伴门静脉瘤栓患者,进行CT引导下门静脉瘤栓内无水乙醇注射治疗。每周1～2次,1～3次为一疗程,每例1～2个疗程,疗程间隔1个月,治疗后随访6个月～5年。结果20例中,17例(85%)瘤栓有不同程度改善,其中2例(10%)瘤栓消失,15例(75%)瘤栓缩小或无进展,3例(15%)无效。结论CT引导下经皮注射无水乙醇治疗门静脉瘤栓是一种有效治疗方法,治疗病例的选择是取得良好疗效的关键。     

CT导向下经皮穿刺冰醋酸治疗肝脏转移性肿瘤

目的 总结经皮穿刺刺冰醋酸注射治疗（PAI）肝脏转移性肿瘤的效果。方法 搜集1997年1月至1999年6月在CT导向下经皮穿刺冰醋酸注射治疗（PAI）的肝脏转移性肿瘤患者35例（病灶40个），病灶直径2－4cm。经CT定位后穿刺，注入4－10ml的30％冰醋酸，且冰醋酸内中加入1ml对比剂，每个病灶1周注射2次，一般持续2－3周。结果 本组35例共40个病灶，其中肿瘤缩小者为23个，占57.5%；肿瘤大小无变化者12个，占30％；肿瘤增大者5个，占12.5%；决有效率为87.5%。所有患者随访3个月至3年及以上，1年生存22例，生存率达62.9%；2年14例，生存率为40.0%；3年及以上者8例，生存率为22.9%。结论 经皮穿刺冰醋酸注射治疗肝脏转移性肿瘤是1种有效的治疗方法。     

CT引导下经皮穿刺卵圆孔行阿霉素阻滞治疗三叉神经痛

目的 探讨CT引导下经皮穿刺卵圆孔注射阿霉素毁损疗法治疗三叉神经痛的技术及临床应用价值。方法 63例三叉神经痛患者，男24例，女39例；年龄43～77岁，平均59岁。右侧疼痛41例，左侧22例。所有患者均有典型的三叉神经支配区域疼痛病史及服用苯妥英钠或卡马西平史，其中27例患者曾接受三叉神经周围分支化学毁损术，7例接受过半月神经节射频热凝毁损术，4例为微血管减压术后复发病例。结果 63例CT引导经皮穿刺卵圆孔全部引导成功。确定针尖在卵圆孔神经节内时，分次缓慢注射阿霉素0．2～0．5ml。治疗后，即刻疼痛完全缓解者61例(96．8％)，明显缓解1例，轻度缓解1例。治疗后行6、12个月随访观察，有效率分别为84．1％，79．4％。并发症少而轻微，无严重并发症。结论 CT引导下经皮穿刺卵圆孔疗法对三叉神经痛具有定位准确，无痛苦，操作简单、安全，并发症少的优点，具有临床推广应用价值。     

CT引导下弯针穿刺乙醇消融术治疗肝动脉化疗栓塞后残存肝癌

原发性肝癌起病隐匿,临床发现时多已为中晚期,失去了手术切除的机会,非手术治疗肝癌成为研究热点。肝动脉化疗栓塞（transarterial chemoembolization,TACE）和无水乙醇瘤内注射（percutaneous ethanol injection,PEI）是目前临床最为广泛应用的非手术疗法,疗效明显。然而,实践表明单独应用均有一定的局限性,联合应用可提高疗效,因而肝癌综合治疗成为趋势。我们针对TACE治疗后残存活性肝癌病灶,采用CT引导下弯针穿刺无水乙醇消融治疗,取得了满意疗效,现将结果报道如下。     

Neoplastic seeding complicating percutaneous ethanol injection for treatment of hepatocellular carcinoma.

The authors describe a case of subcutaneous neoplastic seeding in the abdominal wall in a 67-year-old man with posthepatitic liver cirrhosis complicated by a single nodule of well-differentiated hepatocellular carcinoma. He was treated with percutaneous ethanol injection (PEI) performed under ultrasound guidance. The neoplastic seeding developed along the needle track used to carry out fine-needle biopsy and PEI and was diagnosed 6 months after the beginning of treatment.     

What does radiologic diagnosis of the thymus gland accomplish in myasthenia gravis?

Radiologic imaging in myasthenia gravis is used for the evaluation of pathologic changes of the thymus gland. Computed tomography can demonstrate tumors of the anterior mediastinum in nearly 90% and is therefore superior to conventional radiography. Because of the variety of size and shape of the normal thymus gland, differentiation between normal thymus, follicular hyperplasia and thymoma is rarely possible especially in younger patients. In elderly patients with myasthenia gravis and involution of the thymus gland tumors of the thymus are reliably detected by computed tomography, whereas the ability of computed tomography to predict the histological diagnosis is poor even with intravenous administration of contrast media.     

重症肌无力患者胸腺CT表现与年龄的关系

目的：探讨重症肌无力（MG）患者胸腺CT表现在各年龄组的分布特点。方法：回顾性分析2005年1月～2008年7月住院诊治的241例MG患者的胸部CT影像资料及病理结果。按患者发病年龄分为4组,统计胸腺各种改变在不同年龄组中分布情况。结果：胸腺正常者118例（48．96％）;胸腺增生者34例（14．10％）;胸腺瘤89例（36．9％）。胸腺正常、胸腺增生以及胸腺瘤在四个组中的比例分别为71．05％、48．68％、35．41％、64．51％;23．68％、17．10％、12．50％、0％;5．27％、34．22％、52．09％、35．49％（Х^2值为32．8,P〈0．005）。胸腺正常主要出现在小于20岁年龄组（71．05％）及大于60岁年龄组（64．51％）,胸腺增生主要发生20岁以下年龄组（23．68％）,并且随着年龄增长,比例逐渐降低;胸腺瘤主要出现在40～59岁年龄组（5z．08％）。结论：MG患者的胸腺病变在不同的年龄组中,发病率有所不同。     

Large infiltrative hepatocellular carcinomas: treatment with percutaneous intraarterial ethanol injection alone or in combination with conventional percutaneous ethanol injection

PURPOSE: To retrospectively evaluate patients' tolerance and the effectiveness of percutaneous intraarterial ethanol injection (PIAEI), alone or combined with conventional percutaneous ethanol injection (PEI), for treatment of advanced hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Neither institutional review board approval nor informed consent was required for this retrospective study; however, all patients had given their consent to be treated with PIAEI. Fourteen men and four women with cirrhosis and HCC who were ineligible for conventional curative treatment (largest tumor diameter, 35-90 mm; mean, 52 mm +/- 16 [standard deviation]) and whose supplying arteries were visible on computed tomographic (CT) and color Doppler ultrasonographic (US) images were treated with US-guided PIAEI-either alone or combined with PEI. Twelve patients had infiltrative tumors, and six had nodular tumors. Four patients had portal venous tumor involvement. Tumor necrosis and recurrence were evaluated with CT, and 1- and 2-year survival rates were evaluated with Kaplan-Meier analysis. RESULTS: In four patients, the main tumor was treated with PIAEI only, and in 14 patients, the main tumor was treated with combined PIAEI and PEI. One patient died of myocardial infarction before CT evaluation. Tumor necrosis was complete in 15 (88%) and incomplete in two (12%) of 17 patients. Results of subsequent surgery performed in three patients confirmed the radiologic findings: complete tumor necrosis in two patients and incomplete necrosis in one patient. Two severe PIAEI-related complications occurred: liver abscess, which resolved, and fatal acute pancreatitis. During the follow-up period (mean, 15 months +/- 6.7), six patients died owing to recurrent HCC, and 10 patients were alive with no detectable tumor after a mean follow-up period of 18 months +/- 11. One- and 2-year survival rates were 76.6% and 44.5%, respectively. CONCLUSION: For patients with advanced HCC who are ineligible for other curative options, PIAEI could be an effective treatment, despite the associated risk of severe complications.     

四维 CT 引导腹腔神经丛阻滞术治疗上腹部顽固性癌痛的临床疗效

目的：评价四维CT引导经皮穿刺行腹腔神经丛阻滞术,对腹腔恶性肿瘤伴有腹膜后淋巴结转移,并侵犯、包裹腹腔神经丛的顽固性癌痛的止痛效果以及安全性。方法48例晚期癌症患者,均有严重的上腹部束带样疼痛、经影像学证实腹膜后淋巴结肿大。应用四维CT引导经皮穿刺对其腹腔神经丛阻滞治疗。结果治疗后24 h,2周,1、2、3个月的有效率分别为100%、96%、94%、90%和83%,治愈率分别为67%、64%、58%、52%和50%。围手术期无严重并发症。结论对恶性肿瘤伴有后腹膜淋巴结转移并侵犯、包裹腹腔神经丛的顽固性癌痛患者,采用四维CT引导腹腔神经丛阻滞术,可取得较好的止痛治疗效果,穿刺过程中实时监控,安全性高,具有较高的临床推广价值。     

Osteoid osteoma: CT-guided percutaneous treatment

Seven patients with presumed osteoid osteoma were treated with percutaneous destruction or drill resection with computed tomographic (CT) guidance. The diagnosis of osteoid osteoma was made on the basis of findings in the clinical history and results at plain radiography, bone scintigraphy, and CT. In four patients, histologic confirmation was obtained. Hospital stay lasted from 1 to 3 days. After 11-38 months of follow-up examinations, all patients were asymptomatic. The authors report this simple procedure as an alternative to the more traditional open surgery technique.