Video/EEG,SPECT和MRI对部分性癫痫定位诊断作用及临床意义探讨

目的：探讨录像脑电图检测（Ｖｉｄｅｏ／ＥＥＣ）,ＳＰＥＣＴ和ＭＲＩ３种方法对部分性癫痫的无创性定位和病因诊断的作用及临床意义。材料与方法：对５２例部分性癫痫患者分别进行Ｖｉｄｅｏ／ＥＥＧ,＾９９ｍＴｃ－ＨＭＰＡＯ－ＳＰＥＣＴ脑血流显像,＾１２３Ｉ－Ｉｏｍａｚｅｎｉｌ ＳＰＥＣＴ脑受体显像和全脑ＭＲＩ检查。根据Ｖｉｄｅｏ／ＥＥＧ记录的癫痫发作类型,ＳＰＥＣＴ显示的ｒＣＢＦ和ＢＺＤ的分布以及ＭＲＩ显示     

帕金森病的神经心理学测验和SPECT对照研究

研究神经心理学测验和脑ＳＰＥＣＴ对帕金森病（ＰＤ）的诊断价值。材料和方法：对３０例正常老人（ＮＡ）和３１例ＰＤ进行神经心理学测验（ＭＭＳＥ,ＦＯＭ,ＤＳＴ,ＲＶＲ,ＢＤ）和ＳＰＥＣＴ检查,比较两组认知功能和脑血流灌注特点。结果：两组间各测验（ＭＭＳＥ,ＦＯＭ,ＤＳＴ,ＲＶＲ,ＢＤ０结果均有显著差异,ＮＡ各测验是分均高于ＰＤ。与ＮＡ相比,ＰＤ双侧项叶、颞叶、基底节、丘脑的放射性计数比值显著降低（Ｐ〈     

肝癌病人门脉海绵变性的血管造影和病理形态学研究

作者对１８０例肝癌病人做了腹腔动脉干和肠系膜上动脉造影，其中９８例造影后做了肿瘤切除术和病理检查。对这些病例分析，发现门静脉阻塞和门脉内无向肝性及离肝性血流，是肝内门脉海绵变性（ＣＴＰＶ）形成的重要因素。同时认为门脉主干癌栓伴有ＣＴＰＶ者预后较好，可作栓塞治疗。文中还对ＣＴＰＶ的形态结构及其形成机制进行了探讨。     

胰源性区域性门静脉高压的多层螺旋CT表现

目的 分析胰源性区域性门静脉高压(pancreatogenic segmental portal hypertension,PSPH)的多层螺旋CT(MSCT)表现和特征.方法 对32例胰源性门静脉高压患者,使用16排多层螺旋CT行上腹部CT平扫、多期相增强扫描,采用多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)等图像后处理技术显示异常的脾静脉及侧枝血管情况.结果 脾静脉均有受压、血栓或受侵表现,孤立性脾静脉阻塞中,食管静脉(EV)、胃短静脉(SGV)、胃冠状静脉(CGV)、胃网膜静脉(GEV)、胃结肠干(GCT)曲张分别占9.37%,67.65%,65.63%,96.88%,28.13%;非孤立性脾静脉阻塞伴有肠系膜上静脉SMV阻塞时,其属支结肠右上静脉(RSCV)、胃结肠干(MCV)、胰十二指肠前上静脉(ASPDV)曲张例数分别为15.63%,18.75%,5.88%.同时伴门静脉海绵样变5例.结论 MSCT及图像后处理系统对PRPH诊断具有莺要价值.     

Alzheimer病与血管性痴呆的SPECT

目的：研究脑ＳＰＥＣＴ在诊断及鉴别Ａｌｚｈｅｉｍｅｒ病（ＡＤ）和血管性痴呆（ＶＤ）方面的作用。材料和方法：分别选择符合《精神障碍诊断和统计手册》第４版（ＤＳＭ—ＩＶ）中ＡＤ或ＶＤ诊断标准的患者各１７例和１２例，进行ＳＰＥＣＴ检查，兼作ＣＴ（或ＭＲＩ），并作神经心理测定及其它相关量表评分。将ＡＤ、ＶＤ和ＳＰＥＣＴ结果，以及ＳＰＥＣＴ和ＣＴ（或ＭＲＩ）的结果进行比较。结果：ＡＤ的ＳＰＥＣＴ以颞、顶叶低灌注为典型表现，ＶＤ以局灶性低灌注为主。在右颞下回和右枕叶，ＡＤ组ＳＰＥＣＴ放射性计数比值显著低于ＶＤ组（Ｐ＜０．０５，Ｐ＜０．０１），而在左顶叶显著高于ＶＤ组（Ｐ＜０．０５）。两组左半球的放射性计数比值普遍低于右半球，但ＶＤ的左右不对称性明显重于ＡＤ，以左顶叶最为突出（Ｐ＜０．０１）。ＭＲＩ结果与ＳＰＥＣＴ有较多的一致性。各量表评分除Ｈａｃｈｉｎｓｋｉ缺血指数外，均无显著差异。结论：ＳＰＥＣＴ在诊断和鉴别ＡＤ与ＶＤ方面有一定实用价值     

进一步开展与提高门静脉系的血管成像技术

门脉系造影成像在上腹部尤其是肝脏疾病的诊疗中占有重要地位。随着外科学的发展，对门静脉系成像的要求也大为提高。门静脉因其解剖结构特点，在ＣＴ、ＭＲ问世前，需借助创伤性检查方法显示其形态。５０年代开始，先后开展了脐静脉门脉造影（ＩＵＶＰ）（开通脐静脉）、...     

螺旋CT门静脉血管造影对肝炎后肝硬化门静脉高压的诊断和评价

目的：探讨螺旋ＣＴ门静脉血管造影（ＳＣＴＰ）及三维重建对肝炎后肝硬化门静脉高压的诊断和临床应用价值。方法：５７例肝炎后肝硬化患者行ＳＣＴＰ及三维重建。三维重建方法包括最大强度投影（ＭＩＰ）,表面阴影成像（ＳＳＤ）和多平面重建（ＭＰＲ）。结果：ＭＩＰ和ＳＳＤ显示５１例门静脉１～２级分支增粗,肝内门静脉２组以下分支细小、扭曲,３５例呈枯枝或残根状。６例仅见门静脉１～２级分支增粗,肝内门静脉２级以下分支     

^123I—IomazenilSPECT脑受体显像对癫痫灶定位的价值

目的探讨１２３ＩＩｏｍａｚｅｎｉｌＳＰＥＣＴ脑受体显像对癫痫灶定位诊断的价值。方法对４０例癫痫病人进行１２３ＩＩｏｍａｚｅｎｉｌＳＰＥＣＴ脑受体显像，并与录像脑电图强化监测（Ｖｉｄｅｏ／ＥＥＧ）、９９ｍＴｃ六甲基丙二胺肟（ＨＭＰＡＯ）ＳＰＥＣＴ脑血流显像和ＭＲＩ检查结果进行对比分析。结果以Ｖｉｄｅｏ／ＥＥＧ癫痫灶检出率９５％（３８／４０）为参照标准，６５８％（２５／３８）癫痫病人脑受体显像异常，表现为局部放射性稀疏，与Ｖｉｄｅｏ／ＥＥＧ定位符合２０例；脑血流显像和ＭＲＩ癫痫灶检出率分别为５５３％（２１／３８）和４７４％（１８／３８），与Ｖｉｄｅｏ／ＥＥＧ定位符合分别为１５例和１６例。１２３ＩＩｏｍａｚｅｎｉｌ脑受体显像联合ＭＲＩ检查，癫痫灶检出率为８４２％（３２／３８）。４例ＭＲＩ、脑血流和受体显像正常患者１８Ｆ脱氧葡萄糖（ＦＤＧ）ＰＥＴ显像全部异常，并均与Ｖｉｄｅｏ／ＥＥＧ定位符合。结论１２３ＩＩｏｍａｚｅｎｉｌＳＰＥＣＴ脑受体显像是癫痫病灶定位的有效方法，与ＭＲＩ配合，能提高病灶检出率。     

门静脉高压病人部分脾栓塞术对门静脉及其分支压力的影响

目的　研究门脉高压,脾功能亢进病人部分脾栓塞（ＰＳＥ） 前后门脉压力改变,以期得到ＰＳＥ对门脉压力改变的影响。方法　采用脾动脉插管及经皮经肝门脉置管在ＰＳＥ前后分别测量门脉主干,脾静脉及肠系膜上静脉压力,通过自身对照ｔ 检验进行统计学研究。结果　ＰＳＥ前门脉主干（ＰＶ）压力为（５１ ．４±１３．７）ｃｍ Ｈ２Ｏ,脾静脉（ＳＶ）为（５５ ．５±２３ ．２）ｃｍ Ｈ２Ｏ,肠系膜上静脉（ＳＭＶ）为（５１．８±１７ ．２）ｃｍ Ｈ２Ｏ,ＰＳＥ后ＰＶ 为（４２．４ ±８．７）ｃｍ Ｈ２Ｏ,ＳＶ 为（４２．３±１１ ．８）ｃｍ Ｈ２Ｏ,ＳＭＶ 为（４３ ．４ ±１３．１）ｃｍＨ２Ｏ,通过自身对照“ｔ”检验,ＰＶ,ＳＶ 为Ｐ＜ ０ ．０５ ,ＳＭＶ 为Ｐ＜ ０ ．００１ 。结论　ＰＳＥ前后门脉主干及其分支压力改变经检验差别有统计学意义。ＰＳＥ术后短期内门脉及其分支压力可明显降低     

螺旋CT胆系造影诊断胆管阻塞

目的用螺旋ＣＴ胆系造影（ＳＣＴＣ）显示胆管狭窄部位和程度，以及扩张胆管的范围。方法阻塞性黄疸患者３７例。用３０％胆影葡胺４０～６０ｍｌ静脉缓注，延迟２５分钟后行螺旋ＣＴ扫描并作三维成像。结果胆管显影率为８１％，３０例显影患者均能显示阻塞部位及扩张胆管，定性诊断正确率为９３％。结论ＳＣＴＣ能显示胆管狭窄部位、程度及胆管扩张范围，安全、简单、可靠。能观察肝分泌功能，估价胆汁流通畅程度，是显示胆系阻塞的有效方法     

多层螺旋CT对胰源性区域性门静脉高压的诊断价值

目的:探讨多层螺旋CT(MSCT)及图像后处理技术对胰源性区域性门静脉高压的诊断及临床指导价值。方法:对胰源性区域性门静脉高压患者18例,使用16排多层螺旋CT机行上腹部CT平扫及增强扫描,采用多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)等图像后处理技术,显示胰源性区域性门静脉高压侧支循环血管。结果:显示胃网膜静脉曲张(84%)、胃短静脉曲张(90%)、胃冠状静脉曲张(78%)、胃结肠干曲张(50%)和食管静脉曲张(17%)。MPR、MIP、VR可以直观地显示各曲张血管的走行及曲张程度。结论:MSCT及图像后处理技术能很好地从不同方位显示胰源性区域性门静脉高压侧支循环血管,具有重要的临床指导价值。     

The gastrocolic trunk and its tributaries: CT evaluation.

Dilatation or occlusion of the gastrocolic trunk (GT) may be a clue to a portal venous or pancreatic pathologic condition. To evaluate the normal and abnormal appearances of the GT and its tributaries at computed tomography (CT), the CT scans, angiograms, and surgical-pathologic records of 21 patients with cancer of the pancreas and 15 patients with chronic pancreatitis were reviewed retrospectively. The CT examinations of 30 patients with metastatic disease of the liver and no known pancreatic disease were studied for comparison. A normal GT (2.6-4.7-mm diameter) was identifiable in 48% of the control group in CT scans obtained with 10-mm-thick sections and in 90% of CT scans obtained with 5-mm-thick sections. The GT was dilated in five patients with isolated splenic vein occlusion and in five patients with occlusion or stenosis of the portal-superior mesenteric vein confluence (P-SMVC) above the level of the GT entry into the superior mesenteric vein. The GT was obliterated in eight patients and was associated with P-SMVC occlusion. Findings at surgery confirmed tumor extension into the root of the transverse mesocolon in three patients with cancer of the pancreas. Abnormal findings at CT, however, do not enable differentiation between benign and malignant pancreatic diseases.     

CT assessment of the inferior peripancreatic veins: clinical significance

OBJECTIVE: The purpose of this study was to evaluate and clarify the clinical significance of CT scans of the inferior peripancreatic veins. MATERIALS AND METHODS: Forty-three patients with suspected pancreatic disease underwent three-phase helical CT (collimation, 5 mm; reconstruction, 2.5 mm; scan delay, 30, 60, and 150 sec). The frequency of visualization on CT of the anterior and posterior inferior pancreaticoduodenal veins, inferior pancreaticoduodenal vein, and first jejunal trunk was assessed and correlated with angiographic and pathologic findings. RESULTS: The frequency of visualization of normal inferior peripancreatic veins in patients (n = 22) with a normal portomesenteric vein was 36% for the anteroinferior pancreaticoduodenal vein, 36% for the posteroinferior pancreaticoduodenal vein, 59% for the inferior pancreaticoduodenal vein, and 100% for the first jejunal trunk. The smaller inferior peripancreatic veins were frequently not visualized when normal. In patients (n = 13) with pancreatic carcinoma involving the portosuperior mesenteric vein, all of the inferior peripancreatic veins were dilated and easily recognizable. When the tumor did not involve the portosuperior mesenteric vein but did involve the anteroinferior pancreaticoduodenal, posteroinferior pancreaticoduodenal, and inferior pancreaticoduodenal veins (n = 8), some of the other peripancreatic veins (first jejunal trunk, anterior and posterior superior pancreaticoduodenal veins, and gastrocolic trunk) were dilated. Dilatation indicated tumor extension to the third portion of the duodenum. In patients (n = 7) with involvement of the inferior pancreaticoduodenal vein, the first jejunal trunk, or both without the involvement of the portosuperior mesenteric vein, dilatation of the other peripancreatic veins (anteroinferior pancreaticoduodenal vein, posteroinferior pancreaticoduodenal vein, anterosuperior pancreaticoduodenal vein, posterosuperior pancreaticoduodenal vein, and gastrocolic trunk) indicated tumor invasion of only the second portion of the extrapancreatic nerve plexus (n = 4) and tumor invasion of both the second portion of the extrapancreatic nerve and the mesenteric root (n = 3). CONCLUSION: Dilatation of peripancreatic veins with nonvisualization of inferior peripancreatic veins suggests tumor invasion of peripancreatic tissue.     

Dual-phase 3D CT angiography during a single breath-hold using 16-MDCT: assessment of vascular anatomy before laparoscopic gastrectomy

OBJECTIVE: In this study, we evaluated the efficacy of dual-phase 3D CT angiography (CTA) during a single breath-hold using 16-MDCT in the assessment of vascular anatomy before laparoscopic gastrectomy. MATERIALS AND METHODS: The study involved 20 consecutive patients (10 men, 10 women; mean age, 59 years) scheduled for laparoscopic gastrectomy for the treatment of early gastric cancer. A dual-phase contrast-enhanced CT scan using 16-MDCT was obtained before laparoscopic gastrectomy. After rapid infusion of a nonionic contrast agent, arterial and venous phase scans were obtained serially with an interval of 15 sec during a single breath-hold of 31 sec. Three-dimensional CTA images in the arterial phase (3D CT arteriography) and venous phase (3D CT venography) were individually reconstructed using the volume-rendering technique, and then the images were fused together. We evaluated the detectability of the celiac trunk, left gastric artery (LGA), right gastric artery (RGA), left gastric coronary vein (LCV), Henle's gastrocolic trunk, right gastroepiploic vein (RGEV), and accessory right colic vein on 3D CTA to compare with surgical findings. RESULTS: In all 20 patients, 3D CT arteriography and venography clearly showed the celiac trunk, LGA, RGA, Henle's gastrocolic trunk, RGEV, and accessory right colic vein, which were correctly identified during surgery. The branching pattern of the celiac trunk was classified as Michels type I in 19 patients and Michels type II in one patient. Imaging showed the RGA originating from the proper hepatic artery (PHA) in nine patients; from the gastroduodenal artery (GDA) in seven patients; and from the left hepatic artery (LHA) in four patients. In 12 patients, the LCV joined the portal vein (PV) and in eight, the splenic vein (SV). In all patients, the accessory right colic vein joined the RGEV, and Henle's gastrocolic trunk proximal to the joining point flowed to the superior mesenteric vein (SMV). In all 20 patients, the fused image simultaneously showed arteries and veins around the stomach, with no mismatch between the arterial and venous phase images. In 10 patients, the LCV joined the PV after running along the dorsal side of the PHA, common hepatic artery (CHA), or splenic artery (SA). In eight patients, the LCV joined the SV after running along the ventral side of the PHA, CHA, or SA. In two patients, the LCV joined the PV after running along the ventral side of the CHA, which correlated with the surgical findings. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct identification of the celiac trunk, LGA, RGA, LCV, Henle's gastrocolic trunk, RGEV, and accessory right colic vein. CONCLUSION: Dual-phase 3D CTA using 16-MDCT clearly revealed individual arteries and veins around the stomach before laparoscopic gastrectomy. The fused image of 3D CT arteriography and venography during a single breath-hold enabled the simultaneous assessment of arteries and veins before laparoscopic gastrectomy.     

多层螺旋CT对门静脉海绵样变的诊断价值

目的:分析门静脉海绵样变(CTPV)的多层螺旋CT(MSCT)表现和特征,探讨MSCT对该病的诊断价值.方法:使用16排MSCT对30例CTPV患者,行上腹部CT平扫、动态增强扫描,采用多平面重组(MPR)、最大密度投影(MIP)、容积再现 (VR)等图像后处理技术显示异常的门静脉及侧枝血管情况.结果:CTPV的MSCT平扫示门静脉结构不清,肝门区可见多发的结节状软组织影.增强扫描示动脉期10例有肝实质灌注异常;门静脉期18例患者门静脉主干和(或)左右分支增粗,内可见充盈缺损,4例门静脉显示不清;8例门静脉主干和(或)左右分支在正常范围内;1例门静脉主干变细.胆管周围静脉丛(100%)、胆囊静脉(60%)及胃左静脉(23.3%)呈点状、簇状扩张.MPR、MIP、VR可直观地显示各曲张血管的走行及曲张程度.结论:MSCT及图像后处理系统对CTPV诊断具有重要价值,门静脉栓塞及其周围纡曲扩张的侧枝静脉为其特征性表现.     

Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT

OBJECTIVE: This study was conducted to evaluate newly introduced criteria for unresectability of pancreatic cancer with thin-section pancreatic-phase helical CT. MATERIALS AND METHODS: Twenty-five patients with adenocarcinoma in the head of the pancreas underwent thin-section pancreatic-phase helical CT. The major peripancreatic vessels were categorized on a scale of 1-4, according to the degree of circumferential involvement by tumor. The maximum diameters of the small peripancreatic veins--gastrocolic trunk, anterosuperior pancreaticoduodenal vein, and posterosuperior pancreaticoduodenal vein--were recorded. Findings on CT were compared with the results of surgery in each patient. RESULTS: Sixteen patients had surgically resectable tumors, and nine patients had surgically unresectable tumors. CT and surgical correlation was available for 98 major peripancreatic vessels; 85 were resectable and 13 were unresectable. Of category 1 vessels, 72 (97%) of 74 were resectable at surgery. Of category 2 vessels, 12 (71%) of 17 were resectable. One (50%) of two category 3 vessels and none (0%) of five category 4 vessels were resectable at surgery. CT showed a dilated gastrocolic trunk in two patients; one of these patients had a surgically resectable tumor, but the other patient had a surgically unresectable tumor. CONCLUSION: In patients with adenocarcinoma in the head of the pancreas, the degree of circumferential vessel involvement by tumor as shown by CT is useful in predicting which patients will have surgically unresectable tumors. A dilated gastrocolic trunk should not be used as an independent sign of surgical unresectability.     

Congenital absence of portal vein with nodular regenerative hyperplasia of the liver

Congenital absence of the portal vein is a very rare anomaly. The intestinal and splenic venous drainage bypasses the liver and drain into the inferior vena cava (IVC). Two cases of such anomaly are described. Both cases were investigated by US coupled with echo-colour Doppler examination, CT and MR imaging, followed by digital subtraction angiography (DSA) and liver biopsy. In the first case the splenic and superior mesenteric vein formed a venous trunk which emptied directly into the IVC; in the second case, the splanchnic blood flowed into a dilated hepatofugal inferior mesenteric vein which connected to the left internal iliac vein. In both cases nodular regenerative hyperplasia of the liver was present, presumably due to an abnormal hepatic cell response to the absent portal flow. The particular contribution of MR imaging to the diagnosis of both vascular abnormalities and liver parenchyma derangement and its advantages over the other diagnostic techniques is emphasized. The clinical and radiological features of 17 previously reported cases are reviewed. Received: 22 September 1998; Revised: 21 January 1999; Accepted: 22 April 1999     

门静脉系统血栓的64层螺旋CT诊断价值

目的 探讨门静脉系统血栓(portal vein thrombosis,PVT)的64层螺旋CT表现特征.资料与方法 15例PVT行64层螺旋CT平扫和双期增强扫描,采用最大密度投影(MIP)、容积再现(VR)及多平面重组(MPR)观察其影像学特征.结果 15例中,血栓发生于门静脉(PV)主干13例,右支6例,左支7例,脾静脉(SV)3例,肠系膜上静脉(SMV)9例,其中血栓同时累及PV主干和SMV 8例,同时累及PV左右支、主干和SMV 4例,累及PV主干和右支6例,累及PV主干和左支6例,累及SV和SMV 2例,PV主干、SV、SMV三岔口处血栓1例.Yerdel分级:Ⅰ级1例,Ⅱ级10例,Ⅲ级3例,Ⅳ级1例;血栓呈高密度10例,等密度2例,低密度3例;血栓为部分偏心性栓塞12例,呈小条状、"柴捆"状;附栓管壁均连续光滑、无外突结节,局部PV管壁呈典型的线样"强化征"或"轨道征";出现食管胃丛及脾丛侧支循环12例,胆管丛及胆囊丛侧支循环4例,无一例出现肝动脉.门静脉瘘.结论 64层螺旋CT能够清晰、立体地显示PVT的部位、累及范围,具有特征性,是PVT重要的检查方法.     

螺旋CT多期扫描在肠系膜上静脉梗塞中的诊断价值

目的 探讨螺旋CT多期扫描在SMV梗塞中的诊断价值. 资料与方法 7例SMV梗塞患者,行CT平扫、门静脉期增强扫描及延迟扫描,分析其CT表现特点,并与超声及手术后病理结果对照. 结果 临床病理证实的SMV主干梗塞患者CT平扫均表现肝脏呈等密度,肠系膜充血水肿.增强扫描显示SMV内圆形充盈缺损,肠管扩张、肠壁增厚、靶征、肠壁强化程度减低等肠缺血表现.门静脉供血减少,门静脉期延迟,肝脏一过性血供不足.延时扫描对比剂在肝脏内分布均匀. 结论 螺旋CT多期扫描在SMV梗塞诊断中具有重要价值.     

腹痛的血管源性病变双源CT分析

目的：通过对血管源性病变导致腹痛的 CT 分析,提高对该类疾病的认识,减少漏诊率。方法回顾性分析69例腹痛血管源性病因的 CT 资料。结果腹痛的血管源性病变中,肠系膜上动脉及静脉闭塞最多见,共30例(43%),而引起闭塞最常见的原因是血栓形成(27%);各种累及腹主动脉的夹层(Ⅰ+Ⅲ型+局限性)15例;腹主动脉和/或髂总动脉多发溃疡9例(13%);B 型壁内血肿6例(8%);单纯肠系膜上动脉夹层5例;其他较少见的有脾动脉血栓闭塞2例,双肾动脉闭塞及单纯脾动脉夹层各1例。所有病例中漏诊7例,主要原因为放射科医生把关注的重点放在腹腔内容易出现腹痛的实性脏器或空腔脏器,而忽略了观察扫描范围内的腹主动脉及其主要分支动脉,缺乏对这一类病变的认识和经验。结论血管源性病因是导致腹痛的一个重要原因,对于临床以腹痛行 CT 检查的患者,在排除常见的肠道及其他腹腔脏器病因后,应想到血管源性病因的可能,并仔细查找腹腔内的动静脉血管以排除可能的病变。