Decreased splenic enhancement on CT in traumatized hypotensive patients

Three patients with transient episodes of hypotension following blunt abdominal trauma incurred in motor vehicle accidents were examined by computed tomography within 6 hours of injury. The examinations were done using a contrast material injection technique that ordinarily leads to greater splenic than hepatic attenuation. None of the patients had splenic injury evident on autopsy, surgery, or clinical follow-up study (one case each), nor did they have other characteristic features of splenic infarction. However, in each case the spleen was less enhanced than the liver, leading to an erroneous impression in one patient that the splenic artery had been disrupted. Physiologic studies have shown that splenic perfusion decreases with sympathetic stimulation; this may have been the cause of the diminished enhancement. Decreased splenic enhancement should be interpreted cautiously in traumatized hypotensive patients.     

脾脏肿瘤的多层螺旋CT诊断

脾脏肿瘤包括原发性和继发性，临床上少见，术前定性诊断比较困难。本文收集2003年9月以来9例患者的临床及多层螺旋CT（multislice spiral CT，MSCT）资料，探讨MSCT对脾脏肿瘤的诊断及鉴别诊断。     

明显强化孤立肺结节血流模式的临床价值

目的利用4层螺旋CT动态增强技术定量评价不同性质的明显强化孤立肺结节的血流模式并初步评价血管内皮生长因子(VEGF)表达阳性的孤立性肺腺癌血管生成与血流模式定量CT参数的相关性.方法 78例孤立明显强化肺结节(直径≤4 cm,68例恶性,10例活动性炎性),行多层螺旋CT(MSCT)动态增强(以4 ml/s的流率注入对比剂).记录孤立肺结节增强前后各时相的CT值并计算强化值、灌注值,结节-主动脉强化值比.灌注值等于时间-密度曲线最大斜率除以主动脉强化值.其中30例VEGF表达阳性的肺腺癌患者用免疫组织化学测定微血管密度(MVD)并标定VEGF,评价肺腺癌血流模式定量CT参数(强化值、灌注值、结节-主动脉强化值比及平均通过时间)与MVD的相关性.结果恶性结节强化值(35.79±10.76) HU与活动性炎性结节(39.76±4.59) HU差异无显著意义 (t=1.148 , P=0.255).恶性结节的结节-主动脉强化值比(14.27±4.37)%及灌注值(3.02±0.96)ml-1·min-1·kg-1均低于活动性炎性结节(18.51±2.71)%,(6.34±4.39)ml-1·min-1·kg-1 (t=2.978,P=0.004;t=5.590,P<0.0001).VEGF表达阳性的肺腺癌强化值(33.06±13.57)HU、结节-动脉强化值比(14.25±4.92)%及灌注值(2.97 ±0.56) ml-1·kg-1·min-1与MVD(70.15±20.03)条/视野,均呈正相关性(r=0.781, P<0.0001;r=0.688, P<0.0001;r=0.716, P<0.0001).平均通过时间(14.86±5.84)s与MVD无显著相关性(r=0.260, P=0.200).结论恶性与活动性炎性孤立肺结节血流模式不同,恶性结节通过结节-大动脉强化值比和灌注值可有效区别于活动性炎性结节,有助于两者鉴别诊断.肺腺癌强化值、结节-动脉强化值比及灌注值反映了VEGF表达阳性的肺腺癌的MVD.强化值、结节-动脉强化及灌注值可作为VEGF相关的肺腺癌血管生成的指标.     

Focal liver masses: enhancement patterns on contrast-enhanced images--concordance of US scans with CT scans and MR images

PURPOSE: To assess prospectively the concordance of enhancement patterns of focal liver masses on contrast material-enhanced ultrasonographic (US) scans with patterns on contrast-enhanced computed tomographic (CT) scans or magnetic resonance (MR) images. MATERIALS AND METHODS: This study was approved by the institutional review board; patients gave informed consent. Contrast-enhanced US and contrast-enhanced CT or MR imaging were performed in 135 patients (62 men, 73 women; mean age, 51 years) with 144 confirmed liver masses. Masses included 49 hepatocellular carcinomas, 13 metastases, 30 hemangiomas, 41 lesions of focal nodular hyperplasia, and 11 others. Randomized image sets from each modality were shown independently to three blinded readers, who answered identical questions about enhancement of the lesion and liver in the arterial and portal venous phases and changes with time. Concordance for modalities was calculated from answers of readers and consensus answers between readers, with 95% confidence intervals (CIs). The kappa values were calculated for interreader agreement. RESULTS: Features of arterial phase enhancement showed concordance of more than 76% for modalities. The highest concordance of 92% (132 of 144), with 95% CI of 86% and 95% (kappa>0.84), was for the presence of peripheral pools and centripetal progression. Concordance in the portal venous phase was lower, with agreement for predominant enhancement of the lesion in 61% (86 of 142), with 95% CI of 52% and 68% (kappa>0.83). Portal venous phase washout occurred in 75% (106 of 142), with 95% CI of 67% and 81% (kappa>0.81). The majority of discordances were for malignancies for which only US depicted no sustained enhancement in the portal venous phase. CONCLUSION: US shows high concordance with CT or MR imaging, especially for the arterial phase. Discordance in the portal venous phase may reflect the tendency of CT and MR contrast agents, unlike microbubbles, to diffuse into interstitium.     

64层螺旋CT诊断脾动静脉瘘1例

患者 女,23岁.2007年因胸腹贯通伤并失血性休克于本院行手术治疗,术中单线结扎脾动静脉,术后恢复良好.2009-11因腹痛、腹胀、腹泻以急性胃肠炎收治入院.经抗感染治疗未见好转,并相继出现肠梗阻、食管静脉破裂出血.     

Hyperdense enhancement of pancreatic adenocarcinoma on spiral CT: two case reports.

We are reporting two cases of pancreatic adenocarcinoma that showed dense contrast enhancement on the early phase spiral CT scan and isodensity on the delayed phase scan. Both lesions were located in the head portion of the pancreas, with diameters of 2 cm and 5 cm, respectively. Despite its extremely rare incidence, adenocarcinoma may be included in the differential diagnosis of enhanced pancreatic tumor on early-phase spiral CT scan.     

Normal enhancement of the small bowel: evaluation with spiral CT

PURPOSE: The purpose of this work was to determine normal contrast enhancement of the small bowel with biphasic spiral CT, using water as oral contrast agent. METHOD: Biphasic spiral CT was performed in 50 healthy patients undergoing evaluation as potential renal donors. All patients received 500 ml of water as oral contrast agent and 150 ml of Omnipaque 350 administered by mechanical injector at a rate of 3 ml/s. Dual phase CT of the abdomen was performed in each patient. Acquisition of early phase images began 30 s after the start of the intravenous injection, and portal phase images were obtained 60 s after initiation of the contrast agent injection. Attenuation measurements (in Hounsfield units) were obtained from the wall of the small bowel (duodenum, jejunum, ileum) in both the arterial and the portal phases. RESULTS: During the arterial phase, the mean (95% confidence interval) attenuation of the duodenum, jejunum, and ileum was 120 (+/- 5), 119 (+/- 5), and 118 (+/- 5) HU, respectively. During the portal phase, the average attenuation of the duodenum, jejunum, and ileum was 111 (+/- 4), 111 (+/- 3), and 107 (+/- 3) HU, respectively. There was no statistically significant difference between the attenuation of the duodenum, jejunum, or ileum within either the arterial or the portal venous phases. There was a statistically significant difference in small bowel enhancement between the arterial and portal venous phases. CONCLUSION: There is no important variation in small bowel attenuation during the 30 and 60 s scanning phases. This study serves as a normal reference that may be helpful when spiral CT is used to evaluate ischemic bowel or inflammatory small bowel diseases.     

Congenital anomalies of tracheobronchial branching patterns: spiral CT aspects in adults

Congenital abnormalities of the bronchi have been classically described with chest X-rays, conventional tomography, bronchography, CT and MR imaging. Recently, the capacity of spiral CT to explore a complete volume with no gap and excellent multiplanar reformations has been emphasized. The contribution of this technique to the analysis of congenital anomalies of tracheobronchial branching patterns encountered in adult patients is illustrated. Agenesis, aplasia, and hypoplasia are discussed, followed by bronchial atresia and abnormalities of bronchial divisions. In most cases spiral CT permits a full and correct evaluation of the malformation as well as its associated anomalies. It appears therefore to be the preferable technique for studying such anomalies of the tracheobronchial tree. Moreover, knowledge of CT aspects of the main congenital bronchial abnormalities along with complete visualization of the tracheobronchial tree will probably lead to detection of more incidental anomalies. Received 10 February 1997; Revision received 18 April 1997; Accepted 21 April 1997     

肝脏螺旋CT增强扫描的最佳延时时间

目的 探讨肝脏螺旋CT增强扫描的最佳延时时间。方法 随机选取100例肝脏增强扫描的特例，采用不同的造影剂总量、注射速率和延时时间，观察肝脏的强化程度结果采用3ml／s和4ml／s的注射速率和120ml～l50ml的造影剂总量，肝脏的强化程度最高。注射速率越高，到达强化峰值的时间也越短。结论 肝脏螺旋CT增强扫描的合理的技术方案为采用120ml～150m1的造影剂总量，注射速率3ml／s～4ml／s，动脉期延时20s—26s，门脉期延时70s～80s。     

173例增强检查在螺旋CT扫描中的应用与体会

1 材料与方法。回顾性分析了我院2002年7月至2003年7月完成的173例增强螺旋CT扫描，其中腹部152例、头颅15例、胸部5例、CTA2例(颅底动脉环及髂动脉各1例)，男性146例，女性27例。年龄11岁～83岁．平均57岁。使用非离子造影剂欧乃派克注射液166例，使用离子造影剂安其格那芬注射液7例。CT     

16层螺旋CT增强扫描对肺动脉栓塞的诊断分析

<正> 肺动脉栓塞(plumonary embolism,PE)又称肺栓塞,是指内源性或外源性栓子堵塞肺动脉及其分支引起肺循环和呼吸功能障碍的临床和病理生理综合征。多见于老年人,并发症较多,病死率高达20%～30%,及时准确地诊断和正确地溶栓治疗可明显地改善预后,死亡率可降至8%。螺旋CT增强扫描可为临床提供可靠的诊断依据。本文收集我院最近来诊治的12例经16层螺旋CT增强扫描诊断为肺动脉栓塞病例的影像学资料进行回顾性分析。     

胃癌螺旋CT强化与微血管密度表达关系的研究

目的：探讨探讨术前胃癌螺旋CT强化与CD105标记的血管密度的关系,评价螺旋CT增强扫描对胃癌的临床意义。方法：对70例经病理证实为胃癌患者术前行CT增强扫描,术后用免疫组织化学染色方法检测CD105标记的血管密度,探讨其表达的关系及不同临床特征的意义。结果：螺旋CT分期与TNM临床分期完全符合率为84．28％,不同浸润深度、不同临床分期及有无淋巴结转移的比较中,螺旋CT扫描的强化值与血管密度的表达差异显著,且胃癌中螺旋CT扫描的强化值及血管密度的表达呈正相关。结论：胃癌患者术前行螺旋CT强化具有重要的意义,可能对早期判断患者预后及指导治疗有重要意义。     

Spleen: dynamic enhancement patterns on gradient-echo MR images enhanced with gadopentetate dimeglumine.

To examine the pattern of immediate enhancement with gadopentetate dimeglumine on dynamic magnetic resonance (MR) images of the spleen, this study was divided into two parts: In the first part, the authors retrospectively reviewed the dynamic MR images obtained with a fast low-angle shot (FLASH) sequence in the abdomen immediately after injection of gadopentetate dimeglumine in 137 patients. In the second part, dynamic gadolinium-enhanced FLASH images were prospectively compared with contrast material-enhanced computed tomographic (CT) scans in 17 patients with focal splenic lesions discovered on CT scans. In the first part, 108 patients (79%) had an arciform pattern of contrast enhancement; 22 patients (16%), a uniform pattern of high signal intensity; and seven patients (5%), a uniform pattern of low signal intensity. Most patients had arciform enhancement of the spleen; uniform enhancement occurred in some patients with underlying malignant or inflammatory disease. In the second part, all focal lesions seen on CT scans were seen on dynamic MR images (75 lesions), significantly more than were seen on FLASH images (15 lesions) (P < .001).     

多层螺旋CT血管成像在脾动脉瘤诊断中的应用

目的探讨多层螺旋CT血管成像在脾动脉瘤诊断中的应用。方法收集2011年5月～2012年11月我院腹部CT检查中诊断脾动脉瘤的22例患者的资料。采用多平面重组（MPR）、容积再现（VR）、最大密度投影（MIP）及曲面重建（CPR）等处理技术。观察脾动脉类型、走行、与胰腺的关系,观察动脉瘤的类型、位置、形态、大小、数目、瘤壁有无钙化斑块等指标。结果四种后处理方法均检出全部动脉瘤。脾动脉走行于胰腺上方14例,走行于胰腺后方8例,血管类型属分散型者5例,集中型者17例;动脉瘤均为真性动脉瘤,单发多见;位置以脾动脉干多见,形态多为圆形,直径多小于2cm;瘤壁钙化者检出16例,其中12例合并有非钙化斑块。结论多层螺旋CT血管成像能充分显示脾动脉的走行,诊断脾动脉瘤的存在;多种后处理技术能清楚的显示瘤体的特性及瘤腔内外情况,对临床制定下一步治疗方案有重要价值。     

主动脉远端壁内血肿:CT影像显示灶性强化的临床重要性

目的探讨主动脉远端壁内血肿(IMH)在CT增强时出现病灶强化的发生率、转归及其产生的影响。材料与方法本回顾性研究经机构伦理委员会批准,无需知情同意。