经肺动脉与支气管动脉血管造影的CTA观察原发肺癌的血供

目的用支气管动脉(BA)和肺动脉(PA)造影CTA观察肺癌血供情况。方法前瞻性观察6例支气管肺癌患者,分别行体循环动脉和肺动脉数字减影血管造影(DSA)后,留置BA导管与PA导管行CTBA与CTPA,观察BA与PA对肺癌的血供。结果CTPA上,无体动脉与左心强化的图像上肿瘤未见强化,有体动脉或左心强化的图像上见肿瘤边缘强化,CT强化值为10.0~45.6 Hu。CTBA上肿瘤部分明显强化,CT强化值为150.3~320.7 Hu,可见杂乱无章的肿瘤血管影,3例见纵隔淋巴结强化。结论本组病例观察表明原发性肺癌由BA为主的多发体循环动脉供血,未发现PA参与供血。     

双血供CT灌注用于肺部疾病研究进展

双血供CT灌注(DI-CTP)可同时定量评估肺动脉(PA)和支气管动脉(BA)供血,显示病理状态下二者供血比例变化,提供肺部病灶形态学和血流动力学信息,有助于鉴别良、恶性病变。本文就DI-CTP用于肺部疾病研究进展进行综述。     

256层螺旋CTA在左锁骨下动脉窃血综合征患者术前评估的价值

目的应用256层CTA技术观测左锁骨下动脉解剖特点,评价CTA对锁骨下动脉窃血综合征(SSS)介入治疗术前评估的应用价值。方法回顾性分析60例经临床确诊的SSS患者(疾病组)及500例无SSS受检者(对照组)左锁骨下动脉CTA资料,测量受检者左锁骨下动脉自主动脉弓的起始角度;评价疾病组左锁骨下动脉斑块的特点、管腔狭窄及闭塞情况。结果所有受检者左锁骨下动脉自主动脉弓的起始角度为:71.98°±8.26°,疾病组左锁骨下动脉起始角度71.98°的比例明显高于对照组,差异有统计学意义(P0.05)。疾病组左锁骨下动脉管腔闭塞11例(18.33%),闭塞范围为9~24mm;中度狭窄7例(11.67%),重度狭窄42例(70.00%),狭窄长度8~31mm;偏心性斑块33例,环形斑块16例。以DSA为金标准,CTA诊断左锁骨下动脉狭窄、闭塞的敏感度为96.77%,特异度为100%,诊断符合率为96.97%。结论 256层CTA可准确测量左锁骨下动脉的各项解剖数值;对左SSS术前评估具有重要的应用价值。     

增强CT术前预测骨肿瘤血供程度

目的 观察采用增强CT术前评估骨肿瘤血供程度的可行性。方法 回顾性分析455例骨肿瘤患者,均于栓塞前1个月内接受CT检查,获得肿瘤增强CT值、强化值（肿瘤增强CT值-肿瘤平扫CT值）及与周围肌肉差值（肿瘤增强CT值-周围肌肉增强CT值）;于外科手术前24 h接受血管造影,根据造影评分分为乏血供（≤ 1分）组及富血供（>1分）组,并接受肿瘤局部栓塞。以ROC曲线分析CT值评估肿瘤血供的效能。结果 455例骨肿瘤中,85例乏血供,370例富血供。肿瘤增强CT值、强化值及与周围肌肉差值的AUC分别为0.967、0.973及0.967,增强CT值+强化值、增强CT值+与周围肌肉差值、强化值+与周围肌肉差值的AUC分别为0.977、0.969、0.979,三者联合AUC达0.979。结论 增强CT可于术前评估骨肿瘤血供程度,其中肿瘤强化值评价效能最高。     

双源Flash扫描模式CTA结合迭代重建诊断脑血管病变

目的探讨第二代双源Flash扫描模式CTA结合迭代重建诊断脑血管病变的临床应用价值。方法回顾性分析105例接受双源Flash扫描模式结合迭代重建脑血管CTA的疑诊脑血管病变患者的资料。以3D-DSA为金标准,计算Flash扫描模式CTA诊断脑血管病变的敏感度、特异度、阳性预测值、阴性预测值及准确率。比较3D-DSA与Flash扫描模式CTA诊断脑血管病变的差异,计算双源Flash扫描模式CTA的辐射剂量及对比剂用量。结果 105例中,Flash扫描模式CTA诊断60例共73个脑动脉瘤,其中微小动脉瘤24个;诊断13例脉动静脉畸形(AVM);检出颈内动脉海绵窦瘘5例、静脉畸形2例,脑动脉狭窄9例,烟雾病6例。以3D-DSA为金标准,CTA误诊微小动脉瘤2例,漏诊1例位于大脑中动脉远端区域的AVM。Flash扫描模式CTA诊断脑血管病变的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为98.94%(93/94)、81.82%(9/11)、97.89%(93/95)、90.00%(9/10)和97.14%(102/105),辐射剂量为(231.9±13.2)mGy·cm,对比剂用量为(49.32±2.54)ml。结论脑部Flash扫描模式CTA结合迭代重建可快速、准确诊断脑血管病变,同时辐射剂量低、对比剂用量少。     

CT滚动图像诊断输尿管中、下段结石的价值

目的 探讨CT滚动图像在输尿管中、下段结石诊断中的价值.方法 回顾性分析2009年7月- -2011年12月在本院就诊螺旋CT平扫33例可疑输尿管中、下段结石患者,在CT显示器上通过滚动图像进一步诊断并通过输尿管镜验证.结果 33例患者均通过输尿管镜得到证实.结论 对于可疑输尿管中、下段结石,CT滚动图像对明确诊断具有重要意义.     

支气管动脉CTA对支气管动脉栓塞术的指导作用

目的探讨支气管动脉CTA对支气管动脉栓塞术(BAE)的指导作用。方法回顾性分析48例先后接受支气管动脉CTA及BAE的咯血病例,利用CTA MPR、VR及MIP技术准确、清晰记录支气管动脉分布情况、起源位置及方位、形态改变及非支气管动脉供血情况,并与BAE术中造影结果进行对比。结果 46例咯血患者(除外2例肺栓塞患者)CTA共检出102支支气管动脉,其中57支起源于T5~6椎体水平降主动脉,左侧支气管动脉供血6例,右侧支气管动脉供血9例,双侧支气管动脉共同供血31例;支气管动脉造影(BAG)检出的支气管动脉分布为左侧支气管动脉供血8例,右侧支气管动脉供血13例,双侧支气管动脉共同供血25例,两种方法检出的支气管动脉分布类型差异无统计学意义(P0.05)。CTA检出起源于降主动脉其他水平及其他体循环动脉(异常起源)45支,BAG检出2支。支气管动脉CTA检出20支支气管肋间动脉干,BAG检出4支。CTA检出11例非支气管动脉供血,BAG检出8例。在显示支气管肋间动脉干、非支气管动脉尤其是异常起源的支气管动脉方面,CTA优于BAG。结论支气管动脉CTA准确率高,可以为BAE提供详细的解剖信息,优化治疗方案,提高栓塞的准确率及效率,降低漏栓率。     

胸腺瘤误诊为畸胎瘤1例

患者男．48岁,因贫血入院检查。胸片发现上纵隔占位,遂行胸部CT检查,于前纵隔及中纵隔内各见一不规则软组织样密度影,边缘呈分叶样改变,其内可见多发钙化影,增强后呈中度均匀强化（图1）。术前诊断为“畸胎瘤”。术中所见：前纵隔巨大肿瘤,大小约12cm×10cm×8cm,表面不光滑,肿瘤侵犯心包及两侧纵隔胸膜,与主动脉局部粘连。术后病理：     

小儿纵隔恶性孤立性纤维瘤侵及右肺1例

正患儿男,13岁,咳嗽、咳痰3月余,偶伴发热;既往无特殊病史。查体:右上肺叩诊浊音。实验室检查:白细胞12.20×109/L,血小板503×109/L,中性粒细胞7.09×109/L,单核细胞1.23×109/L,嗜酸性粒细胞0.74×109/L,D-二聚体0.402mg/L,纤维蛋白原5.72 g/L,肿瘤异常糖链蛋白176.821μ。胸部X线片:双肺纹理增多,右中上肺野见团块状高密度影,外缘及下缘尚清,内缘与纵隔重叠,     

Anomalous systemic arterial supply to normal basal segment of the left lower lobe; report of a case

A 28-year-old male was referred to our hospital because of hemoptysis. A chest X-ray revealed an increase of vascular marking in the left lower field and a partial defect in the lateral line of the descending thoracic aorta. An aortogram and pulmonary arteriogram showed a large artery arising from the descending thoracic aorta and supplying the left basal segment, which had no normal pulmonary arteries. A bronchoscopy showed no abnormal findings in the bronchial tree. A clinical diagnosis of systemic arterial supply to the basal segment of the left lower lung was made, and a left lower lobectomy and closure of the anomalous systemic artery by video-assisted thoracic surgery (VATS) were successfully performed. Vascular marking of the visceral pleura of left lower basal segment was observed and the anomalous arterial pressure was 84 mmHg, as high as systemic arterial pressure, during the procedure. The histopathological examination revealed normal alveolar structure, and sclerosis and hypertrophy of pulmonary arteries of the lesion (Heath-Edwards V, which means irreversible vascular changes due to pulmonary hypertension). The patient had an uneventful postoperative course and was discharged on postoperative day 8. The VATS procedure is a more useful and less invasive method for cases of systemic arterial supply to the basal segment of the left lower lung than an open thoracotomy.     

PET/CT显像诊断成人多发骨骼朗格汉斯细胞组织细胞增生症1例

正患者女,37岁,因"右肩部疼痛伴乏力、盗汗1个月"入院,活动后气喘,无发热、寒战;外院CT示双侧第4肋骨及T6椎体右侧附件溶骨性破坏,伴软组织肿块,T5椎体类圆形低密度影。实验室检查:红细胞比容0.345,单核细胞比率0.082,嗜酸性粒细胞0.03×109/L,降钙素原0.112μg/L,谷氨酰基转移酶144U/L。18F-FDG PET/CT:下颌骨、双侧多发肋骨、全身多发椎体、双侧髂骨、左侧髋臼骨及右侧坐骨多发骨质溶骨性破坏,     

右膝关节多灶性Rosai-Dorfman病1例

<正>患者男,37岁,10个月前右膝摔伤,伤后5天左右自觉右膝夜间疼痛剧烈,此后于外院断续接受理疗、针灸等对症处理,疼痛有所缓解,为求进一步诊治来我院就诊。专科查体:右膝关节远端皮温轻度升高,皮肤轻度泛红,无肿胀;右侧股骨远端、胫骨近端及髌骨压痛(+),右膝浮髌试验(+),抽屉试验及侧方应力试验(-)。右膝关节CT:右侧髌骨、股骨远端及胫骨     

Large anomalous systemic arterial supply to basal segments of the left lung

A 29-year-old man with a large anomalous systemic arterial supply to basal segments of the lower lobe was reported here. Pulmonary arteriography showed the absence of blood flow to basal segments. Aortography verified the anomalous artery from the descending thoracic aorta. Lobectomy was performed because the anastomosis between the anomalous and pulmonary arteries was anatomically difficult and segment 6 was small. The resected specimen showed that the anomalous artery had findings of pulmonary hypertension equivalent to grade V in the classification of Heath and Edwards. If the anastomosis between the anomalous and pulmonary arteries is anatomically feasible, pathological examination of open lung biopsy specimen is necessary to determine the operative procedures in this disease and two-staged operation is desirable.