多层螺旋CT门静脉成像对肝硬化患者食管静脉曲张的研究

目的 研究多层螺旋CT门静脉成像(MSCTP)对肝硬化患者食管静脉曲张的检出及分级间关系.方法 对70例肝硬化患者1周内同时行多层螺旋CT与内镜检查,两者进行对照研究.结果 MSCTP与内镜对食管静脉曲张程度的显示具有很好的一致性(Kappa值=0.823),且MSCTP在判断中、重度食管静脉曲张(≥3 mm)的敏感度、特异度及准确度分别为97.78%、88%、94.29%.结论 MSCTP能准确显示食管静脉曲张的范围及程度且患者易接受.     

比较多层螺旋CT门静脉成像与内镜检查诊断肝硬化合并食管胃静脉曲张的优劣

目的 探讨经多层螺旋CT门静脉成像(MSCTP)与消化内镜检查评估肝硬化并食管胃静脉曲张有无、分型、分级的一致性.方法 前瞻性分析临床诊断为肝硬化的患者92例,4周内先后行消化道内镜及腹部MSCTP检查,观察食管、胃有无静脉曲张并进行分型、分级.以内镜结果作为金标准,对MSCTP与内镜判断食管胃静脉曲张的有无、分型、分级行Kappa一致性检验,并计算MSCTP诊断食管胃静脉曲张(EGV)的敏感度、特异度、一致率、Youden指数.结果 内镜诊断食管胃静脉曲张阴性27例,阳性65例;食管胃静脉曲张分型:GOV1型45例、GOV2型19例、IGV1型1例.MSCTP诊断食管胃静脉曲张阴性25例,阳性67例;食管胃静脉曲张分型为:GOV1型46例、GOV2型18例、IGV1型3例.MSCTP发现内镜未诊断的2例IGV1型静脉曲张,其MSCTP表现为胃黏膜下孤立存在的胃静脉曲张.MSCTP与内镜EGV诊断结果一致性较高,Kappa=0.732,P＜0.01;MSCTP诊断EGV的敏感度93.8％,特异度77.8％,一致率89.1％,Youden指数71.6％.MSCTP与内镜EGV的分型及分级结果一致性均较高,Kappa值分别为0.743和0.763,P值均为＜0.01.结论 MSCTP诊断肝硬化合并食管胃静脉曲张的有无、分型及分级,与消化内镜有较高的一致性.对于诊断胃静脉曲张,MSCTP优于内镜.     

64层CT血管成像在下肢静脉曲张检查中的临床应用价值

目的：探讨64层 CT 血管成像在下肢静脉曲张等疾病中的诊断价值和检查意义。方法收集478例双侧下肢静脉造影 CT 扫描,分析检查方法和三维血管成像,了解下肢静脉解剖形态及曲张程度表现。结果478例956条下肢浅静脉血管成像,检出下肢浅静脉曲张704条肢体,其中,两侧下肢浅静脉曲张226例452条肢体;单左侧157例;单右侧95例,静脉曲张合并部分静脉栓塞45例。结论64层 CT 血管成像对诊断下肢静脉曲张及栓塞有较高诊断价值,为下肢静脉曲张等静脉病变手术治疗提供了可靠依据。     

肝硬化门静脉高压多层螺旋CT灌注成像的临床应用研究

目的:探讨多层CT灌注成像在肝硬化门静脉高压中的临床应用价值.材料和方法:肝硬化43例,按有无腹水、上消化道出血门静脉高压并发症分4组.采用彩色灌注图法获得各肝脏灌注参数;30例正常人作对照.结果:对照组、单纯肝硬化组、出血组、腹水组、混合组的灌注参数分别为:肝动脉灌注量(HAP)为24.80±5.84、18.09±6.65、23.44±11.08、20.94±7.23、17.29±3.41 ml·min-1·100ml-1,门静脉灌注量(PVP)为104.91±21.70、91.68±20.14、78.43±28.92、67.26±12.95、54.08±3.88 ml*min-1*100ml-1,总肝灌注量(TLP)为 129.90±25.19、109.76±21.22、101.86±25.11、88.20±13.04、71.37±2.89 ml·min-1·100ml-1,肝动脉灌注指数(HPI,%)为19.13±3.33、16.82±5.92、24.42±14.34、23.96±8.18、24.22±4.65.组间存在显著性差异(P＜0.05);以肝硬化组43例的TLP的平均值97.1 ml·min-1·100ml-1为阈值,TLP对腹水/上消化道出血门静脉高压并发症发生的阳性预测值为88.0%,阴性预测值为83.3%.结论:多层螺旋CT灌注成像可评价肝硬化门静脉高压血流灌注变化.TLP对于预测肝硬化门静脉高压并发症有较高的临床应用价值.     

螺旋 CT 静脉造影成像评价下肢静脉曲张交通静脉显影价值

目的：评估螺旋 CT 静脉造影成像在下肢静脉曲张微创治疗交通静脉评价中的价值。方法对112例(168条患肢)下肢静脉曲张患者行静脉腔内激光闭塞联合泡沫硬化杂交微创治疗,术前检查及术后3个月复查应用256排螺旋 CT 静脉造影成像和静脉顺行造影,回顾性对比分析2种检查方法显示交通静脉的资料。2名放射科医师双盲法分别对图像进行分析,采用5分制评价曲张交通静脉显影情况,Kappa 检验比较诊断结果的一致性;行受试者工作特征(ROC)曲线,计算 CT 下肢静脉造影成像和下肢静脉顺行造影评价交通静脉的敏感度、特异度和准确度。结果术前检查 CT 下肢静脉造影和下肢静脉顺行造影图像质量分级中,1~2分分别占77.38%(260/336)、58.33%(196/336),5分分别占1.78%(6/336)、6.84%(23/336)。2名阅片者 CT 下肢静脉造影成像和下肢静脉顺行造影评分的 Kappa 值分别为0.935和0.821,一致性好;CT 下肢静脉造影诊断评价交通支 ROC 曲线下面积(AUC)分别为0.962、0.948(P =0.019),下肢静脉顺行造影图像的 ROC 曲线 AUC 分别为0.658、0.672(P =0.021),差异均有统计学意义;3个月后评价下肢静脉曲张残存复发交通静脉敏感度、特异度和准确度的平均值分别是 CT 下肢静脉造影成像100%(72/72)、97.72%(258/264)、94.94%(319/336),下肢静脉顺行造影66.67%(48/72)、61.74%(163/264)、61.90%(208/336);2种方法诊断下肢曲张静脉残存或复发的 ROC 曲线分别为0.985、0.963(P =0.013)和0.684、0.587(P =0.026),差异均有统计学意义。结论螺旋 CT 静脉造影成像在下肢静脉曲张交通静脉检出及诊断的准确性方面都优于静脉顺行造影,能够满足临床微创介入手术需要。     

多层螺旋CT阴性法胆道成像的临床应用

目的：分析多层螺旋CT（MSCT）阴性法胆管成像在胆道梗阻病变诊断中的应用价值。方法：收集手术病理证实的各种胆道梗阻疾病患者共35例,分别就MSCT阴性法胆管成像对胆道病变的定位、定性诊断价值进行评价。结果：MSCT阴性法胆管成像的胆道病变定位准确率为100%,肿瘤病变诊断准确率为94.3%,对胆道结石的诊断准确率为82.9%。结论：MSCT阴性法胆管成像对胆道病变的诊断具有较高的临床应用价值。     

多层螺旋CT门静脉成像在食管胃静脉曲张栓塞术前评估中的价值

目的 探讨多层螺旋CT门静脉成像(MSCTP)在食管胃静脉曲张栓塞术前评估中的价值.方法 对50例门静脉高压上消化道出血患者行64层螺旋CT增强扫描,每例病人均采用多平面重组(MPR)、最大密度投影(MIP)和容积显示(VR)3种后处理方法显示门静脉系统血管.对42例明确显示食管胃静脉曲张相关侧枝血管的患者进行了介入栓塞治疗,5例门静脉海绵样变难以分清相关侧枝血管及3例门静脉部分血栓形成不能行介入栓塞治疗的患者做了内镜套扎或硬化治疗.比较42例患者MSCTP和术中直接门静脉造影对食管胃静脉曲张相关侧枝血管显示的差异性.结果 MSCTP显示50例食管胃静脉曲张(100%),胃左静脉38例(76%),胃后或胃短静脉17例(34%),胃肾和/或脾肾分流5例(10%),门静脉血栓形成海绵样变5例(10%),2例门静脉和1例脾静脉血栓阻塞部分管腔.42例2种检查方法对食管胃静脉曲张相关侧枝血管显示的差异性检验(χ2=2.00,P>0.05),表明二者无显著差异.结论 MSCTP能直观显示食管胃静脉曲张及与之相关的侧枝血管.可明确曲张血管的供血血管,明确是否存在门静脉的血栓及栓塞范围,有助于治疗方案的选择和缩短手术治疗的时间.     

肝硬化食管静脉曲张破裂出血89例诱因分析

1979年3月～1994年10月，我们收治肝硬化食管静脉曲张破裂出血89例。现分析其诱发因素。1临床资料1．1一般情况89＠中，男64例，女25例；年龄21～68岁，平均44．7岁。其中肝炎后肝硬化78例，乙醇性肝硬化9例，原因不明2例。1．2诊断方法肝硬化的诊断均由临床、肝功能化验、B超、CT或肝活检确定，经胃镜或食管吞钡检查证实有食管静脉曲张。肝硬化食管静脉曲张破裂出血经胃镜证实39例（43．8％），由典型临床症状诊断50例（56．2％）。首次出血sl例，再次出血38例。1．3诱因89例中，药物所致食管静脉曲张破裂出血23例（25．8％），其中国眼…     

胃左静脉的多层螺旋CT评价对预测食管静脉曲张出血风险的价值

目的 探讨64排螺旋CT门静脉成像(computed tomography portal venography,CTPV)显示胃左静脉对预测食管静脉曲张(esophageal varices,EV)出血风险的临床价值.方法 收集在本院经临床证实的40例肝硬化EV破裂出血的CTPV图像资料,并与40例同期肝硬化EV非出血组及80例正常对照的CTPV图像资料对照,分析胃左静脉直径与肝硬化EV破裂出血的关系.结果 EV出血组均见胃左静脉曲张增粗,伴有胃后、胃短静脉曲张增粗者19例;非出血组32例见胃左静脉曲张增粗,伴有胃后、胃短静脉曲张增粗者11例.肝硬化EV出血组:胃左 静脉直径范围为6.9～ 14.6 mm,平均为(8.67±1.96) mm;肝硬化EV非出血组:胃左静脉直径范围为5.3～12.0 mm,平均为(6.82±2.69) mm;正常对照组:胃左静脉直径范围为2.2～5.8 mm,平均为(4.10±1.86) mm.肝硬化出血组、非出血组、与正常组之间,胃左静脉直径差异有统计学意义(F=92.194,P<0.000 1),两两比较结果显示3组间差异均有统计学意义(P<0.000 1),肝硬化EV出血组胃左静脉直径最大,正常组最小.结论 胃左静脉的MDCT能较准确地预测肝硬化食管静脉曲张出血的风险情况,胃左静脉管径越宽,食管静脉曲张破裂出血危险性就越大.     

多层螺旋CT在急性阑尾炎诊断中的应用价值

目的：探讨多层螺旋 CT 在急性阑尾炎诊断中的应用价值。方法选取30例急性阑尾炎患者作为研究组和30例无任何症状的健康成人作为对照组进行多层螺旋 CT 检查。测量阑尾外径,观察阑尾位置,阑尾腔内液体密度、气体密度,阑尾周围脂肪密度改变及腹膜增厚、腹腔积液等并发表现。结果急性阑尾炎平均阑尾外径为(9.78±2.33)mm,健康成年人平均阑尾外径为(5.05±0.53)mm,二者差异有统计学意义(t=24.85,P <0.01)。阑尾周围组织脂肪密度增高、毛糙25例,占83.33%,CT 值约-40~20 HU;阑尾周围有渗出性改变伴腹膜增厚13例,占43.33%;阑尾管壁增厚、水肿29例,占96.67%;阑尾腔内高密度粪石9例,占30.00%;阑尾炎合并肠梗阻1例(占3.33%);阑尾炎患者并发有腹膜增厚,占80.00%;合并有腹腔积液,占23.33%。结论多层螺旋 CT 全腹部平扫可应用于急性阑尾炎的诊断;当阑尾外径 CT 表现为≥6 mm,阑尾腔积液、腔内粪石、周缘脂肪密度增高、腹膜增厚、腹腔积液等征象,可提示阑尾炎诊断。     

Diagnostic performance of using effervescent powder for detection and grading of esophageal varices by multi-detector computed tomography

Purpose

To investigate the effect of using effervescent powder (EP) on the efficacy of multi-detector computed tomography (MDCT) in detection and grading of esophageal varices in cirrhotic patients by considering endoscopy as the gold standard.

Materials and methods

Ninety-two cirrhotic patients undergoing biphasic liver MDCT followed by upper gastrointestinal endoscopy within 4 weeks of MDCT were prospectively evaluated. The patients were divided into two groups before MDCT. The first group (n = 50) received effervescent powder (EP) before and during MDCT procedure and the second group did not receive (n = 42). The presence, size and grade of the esophageal varices were evaluated. MDCT findings were compared with endoscopic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of MDCT with EP and without EP were calculated and compared. Correlations between the grades of the varices for each group based on MDCT imaging and endoscopic grading were also evaluated.

Results

The sensitivity, specificity, accuracy, PPV, and NPV of MDCT were 100%, 88%, 96%, 94%, and 100%, respectively, in the EP group, whereas they were 76%, 67%, 74%, 89%, and 43%, respectively, in the non-EP group. Correlations between the grades of the esophageal varices on MDCT and endoscopy were significant in both groups (r = 0.94, p < 0.001 for EP group and r = 0.70, p < 0.001 for non-EP group).

Conclusion

During periodic CT scanning of cirrhotic patients, use of EP increases the success rate of MDCT for detection and grading of esophageal varices.     

Abdominal virtual ultrasonographic images reconstructed by multi-detector row helical computed tomography

BACKGROUND: Three-dimensional (3D) images can be generated using thin sections from multi-detector row computed tomography (CT) and computer software, simulating images obtained using conventional ultrasonography (US). This software allows easy diagnosis of abdominal lesions and subsequent treatment of focal liver lesions such as hepatocellular carcinoma (HCC). The present study used newly developed virtual US software for diagnose and treatment of hepatobiliary disease. METHODS: The software was used to create virtual US images in 10 subjects. Radiofrequency ablation (RFA) was performed by virtual US in seven patients with HCC. RESULTS: Slices were easily reconstructed from various angles, and each slice was continuously animated as with conventional US in all subjects. Moreover, when seven patients with HCC were examined using virtual US, HCC nodules were visualized and could be treated with RFA. CONCLUSIONS: Virtual US should prove useful for visualization of HCC nodules that cannot be seen under conventional US. Virtual US is a useful tool for US-guided treatment of HCC.     

多层螺旋CT血管成像对脊髓Adamkiewicz动脉的显示

Adamkiewicz动脉是脊髓胸腰段重要的供血血管,术前对其解剖结构的了解,有助于术前设计周密的手术方案,能有效降低脊髓缺血性损伤及术后截瘫或下肢瘫的发生。以往利用选择性动脉造影来了解脊髓的血液供应,但属于有创检查,且技术要求高。随着现代医学影像的发展,多层螺旋CT血管成像技术凭借其较高的空间分辨率和时间分辨率,可以在注入对比剂后一次扫描即可完成全部数据的采集,再通过强大的后处理功能可以获得Adamldewicz动脉及起源的节段性动脉的清晰影像。它在显示脊髓Adamkiewicz动脉方面的优势日益突出。本文综述多层螺旋CT血管成像对脊髓Adamkiewicz动脉显示的临床应用价值。     

单层与多层螺旋CT所致儿童受检者辐射剂量研究

目的 研究和评价儿童受检者在单层与多层螺旋CT扫描中所受到的辐射剂量。方法 测试21台CT机的头部和体部剂量指数,并结合0～1岁组、5岁组、10岁组儿童和成年人的头部和胸部常规扫描条件,计算CTDI_w、CTDI_vol、DLP值,再由DLP与有效剂量转换系数计算头部和胸部常规扫描所致各年龄组儿童和成年人的有效剂量。 结果 单位mAs的头部CTDI大于体部CTDI;在头部常规扫描中,0～1岁组、5岁组、10岁组儿童受到的有效剂量分别为2.2、1.3、1.1 mSv;在胸部常规扫描中,0～1岁组、5岁组、10岁组儿童受到的有效剂量分别为5.3、3.1、3.4 mSv;每单位mAs所致儿童有效剂量平均比成人高1.8倍;多层CT的儿童头部CTDI_vol、DLP、有效剂量值均大于单层与双层CT,多层与双层CT的儿童胸部CTDI_vol、DLP、有效剂量值均小于单层CT。 结论 与成年人相比,儿童在CT检查中可能受到更大辐射危害,应严格遵循儿童CT检查适应证,并合理选择CT扫描参数,尽可能降低儿童受到的辐射剂量。     

"Downhill" esophageal varices demonstrated by dynamic computed tomography

This is the first case of "downhill" esophageal varices demonstrated by dynamic CT. Dynamic CT may be a noninvasive diagnostic modality for confirmation of "downhill" esophageal varices.     

Gadolinium-enhanced computed tomography angiography in multi-detector row computed tomography: initial observations

Rationale and Objectives. The feasibility of using gadolinium contrast medium for computed tomography angiography (CTA) in multi-detector row computed tomography and the effect of contrast medium dilution was investigated.Materials and Methods. Three pigs were each scanned in multiple sessions with injections of non-dilute and dilute contrast medium at a dose of 0.3 mmol/kg body weight. Non-spiral dynamic scanning at a fixed mid-abdominal aortic level and thoracoabdominal CTA were performed.Results. The magnitude of peak aortic enhancement was not significantly different between dilute and non-dilute contrast medium injections (P = .88), but the former showed earlier enhancement (mean of 2.3 seconds sooner, P < .01) than the latter. CT angiography with gadolinium contrast medium showed much lower enhancement than iodine contrast medium, but small vessels were readily identifiable.Conclusion. Gadolinium contrast medium combined with multi-detector row computed tomography may provide clinically useful CTA. Dilution of contrast medium shortens the enhancement time but has little effect on the magnitude.     

Value of helical computed tomography in the management of upper esophageal foreign bodies

Purpose: To analyze the utility of helical computed tomography (CT) in the diagnosis of suspected upper esophageal foreign bodies.

Material and Methods: A prospective study was performed on 36 patients (26 F, 10 M, mean age 70 years) with a history of foreign body impaction. All had negative findings at indirect laryngoscopy. Radiologic assessment included unenhanced helical CT and a barium contrast study. Patients with positive findings were taken to esophagoscopy. All patients had a posterior clinical surveillance.

Results: Twenty patients had both normal CT and barium study and satisfactory clinical outcome. In 12 patients a foreign body was noted in the cervical esophagus by CT, barium study, and endoscopy. In one patient a fish bone was detected by CT (and not by barium) confirmed with esophagoscopy. Another patient had a fish bone esophageal perforation which was observed only by CT and confirmed at surgery. Two patients with normal barium and endoscopy presented a false-positive CT result.

Conclusion: Barium swallow is currently the first radiologic study, but may involve a risk of aspiration and can impede a subsequent esophagoscopy. Esophagoscopy is an invasive technique with a certain risk of serious complications that can be avoided with a satisfactory radiologic assessment. CT is easy, fast, has 100% sensitivity and is therefore the first choice technique for diagnosing suspected upper esophageal foreign bodies not expected to be visible on plain radiographs.     

Liver imaging with multidetector helical computed tomography

The speed and flexibility of multidetector computed tomography (MDCT) have led to improvements in liver imaging, particularly related to the detection and characterization of focal lesions. This report discusses the different phase of liver enhancement following the bolus administration of iodinated contrast material, and the enhancement pattern of various liver lesions during these phases. We also propose guidelines for designing protocols for MDCT of the liver and discuss the principles of contrast media delivery.     

Improved pelvicalyceal visualization with multidetector computed tomography urography; comparison with helical computed tomography

Our aim was to compare the quality of pelvicalyceal visualization on computed tomography (CT) urography using a small intravenous contrast material dose, hydration, and high-resolution multidetector CT (MDCT) with that of conventional helical CT. The test (MDCT) group (49 consecutive patients, 98 kidneys) was scanned 5 min following an intravenous bolus of 30 ml of iodinated contrast material. The control (helical CT) group (50 consecutive patients, 95 kidneys) was scanned 5 min following injection of 120–150 ml of intravenous contrast material. Enhancement and quality of calyceal detail were measured using a five-scale grading system (1 for no detail, 5 for cupped calyces). Calyceal attenuation was substantial in both groups (more than 220 Hounsfield units, HU) but less in the test group compared with the control group (mean 475 and 920 HU, respectively), p<0.0001. In the test group, the calyceal attenuation was less than 500 HU in the majority of cases (65/98 kidneys), while the opposite was true for the control group, where calyceal attenuation was more than 750 HU in 50/95 kidneys (p<0.001). The quality of calyceal detail was 3.4/5 in the test group compared with 1.8/5 in the control group (p<0.0001). The combination of hydration, low-contrast dose, and the high image resolution achieved with MDCT significantly improves calyceal visualization in CT urography.