螺旋CT、能谱CT和MRI诊断原发性肝癌的临床价值比较

目的 探讨螺旋CT、能谱CT和MRI诊断原发性肝癌的价值比较。方法 选取47例疑似原发性肝癌患者,采用螺旋CT、能谱CT和MRI诊断,比较不同扫描方法的诊断效能。结果 47例患者经三种扫描方法检查,发现能谱CT诊断的真阳性患者36例（76.59%）,常规CT为30例（63.83%）,MRI为34例（72.34%）,三种方法诊断的差异无统计学意义（P>0.05）;在8例胆管细胞癌患者中,MRI诊断7例,能谱CT和螺旋CT检查均为4例;能谱CT扫描和MRI诊断的灵敏度分别为92.3%和89.2%,均优于常规CT（76.6%,P<0.05）,能谱CT诊断的准确率为72.5%,MRI为69.7%,常规CT为50.0%（P<0.05）;此外,能谱CT扫描曲线下面积（AUC）大于常规CT或MRI（t=7.69,t=9.03,P<0.05）;在小于1 cm的肝癌中,常规CT、能谱CT和MRI扫描的灵敏度分别为53.13%,90.63%和90.63%, MRI扫描和能谱CT均高于常规CT扫描（P<0.05）。结论 能谱CT扫描和MRI在诊断原发性肝癌方面,其灵敏度和准确率均优于螺旋CT扫描,在诊断小肝癌方面也具有明显的优势, MRI在诊断胆管细胞癌方面优于能谱CT或螺旋CT扫描。     

老年糖尿病临床与脑CT,MRI检查对比分析

目的探讨脑ＭＲＩ、ＣＴ在老年糖尿病并发脑血管病早期诊断中的价值。方法本文对５２例老年２型糖尿病患者同时进行脑ＭＲＩ与ＣＴ的对比检查。结果（１）老年糖尿病患者的脑ＭＲＩ阳性检出者为４５例（８６５％）,而脑ＣＴ阳性检出者为２９例（５５８％）（Ｐ＜００１）;（２）糖尿病病程在１０年以内患者中脑ＭＲＩ阳性率（８０８％）明显高于ＣＴ阳性率（３４６％）（Ｐ＜００１）,但当糖尿病病程在１０年和１０年以上患者中脑ＭＲＩ阳性率（９２３％）与ＣＴ阳性率（７６９％）相比（Ｐ＞００５）,无统计学显著差异;（３）糖尿病脑ＭＲＩ阳性组并发高血压和高脂血症者均高于糖尿病ＭＲＩ阴性组（Ｐ＜００５～００１）。结论脑ＭＲＩ是老年糖尿病脑血管病的一种早期敏感的诊断方法。     

MRI与CT在超急性期脑挫裂伤中的应用对比研究

目的对比超急性期脑挫裂伤在CT与MR I中的表现特点,探讨MR I在超急性期脑挫裂伤的应用价值。方法对30例超急性期脑挫裂伤患者进行CT与MR I检查,分析超急性期脑挫裂伤在两者中的表现特点。结果 30例患者中,CT检查可显示12例,漏诊18例;MR I可显示30例,优于CT。结论诊断超急性期脑挫裂伤MR I优于CT,MR I的DW I应作为脑挫裂伤常规扫描方法。     

增强CT扫描与超声造影对肝脏占位性病变的临床诊断价值比较

目的 对比分析增强CT扫描与超声造影对肝脏占位性病变的临床诊断价值。方法 选择2012年3月～2015年5月在我院进行诊治的肝脏占位性病变患者81例,均进行增强CT扫描和超声造影。观察肝脏占位性病变增强CT和超声造影表现特征,记录并比较肝脏良恶性病变患者的超声造影参数,比较增强CT扫描与超声造影对肝脏占位性病变的诊断效能。结果 本组包括肝细胞癌41例,肝硬化再生结节7例,肝脓肿5例,肝腺瘤3例,肝血管瘤18例,肝局灶性结节性增生7例;经过量化分析,41例肝脏恶性病变患者达峰时间[（33.2±5.8） s]、上升时间[（24.1±4.9） s]和平均通过时间[（108.5±21.3） s]均明显低于40例肝脏良性病变患者[分别为（48.6±13.2） s、（38.7±11.5） s 和（156.7±35.6） s,P<0.05],灌注指数（145.3±39.2）明显高于肝脏良性病变患者[（83.6±17.9）,P<0.05];超声造影诊断的敏感度为97.1%,特异度为92.3%,诊断正确率为96.3%,而增强CT扫描则分别为80.3%（P<0.05）、91.2%（P>0.05）和85.2%（P<0.05）。结论 超声造影在诊断肝脏良恶性占位性病变方面能在形态学和数据测量方面提供丰富的反映肝脏占位性病变的影像学信息,且具有较高的诊断灵敏度和诊断正确率。     

肝肿瘤介入后CT,MRI对照研究

目的　比较ＣＴ、ＭＲＩ 对不同介入方法的随访价值　方法　回顾分析１３５０ 例肝肿瘤介入后ＣＴ、ＭＲＩ 资料　结果　１ 、肿瘤直径缩小大于５０ ％ 者仅９－５ ％ ;２ 、除活肿瘤组织和炎症反应可强化外,各种坏死均不强化;３ 、碘油斑ＣＴ 为高密度,ＭＲＩ 为等信号　结论　１ 、坏死范围与肿瘤大小变化同样是评价疗效指标;２ 、首次随访以介入后１ ～３ 月为宜;３ 、碘油栓塞首次随访宜选ＣＴ,了解坏死范围可选ＭＲＩ;４ 、小肿瘤或ＰＥＩ 介入后ＭＲＩ 随访较好;５ 、ＭＲＩ 对凝固性、液化性坏死的定性能力略优于ＣＴ;６ 、鉴别活肿瘤和坏死组织,要求增强扫描     

The role of echocardiography and CT in the diagnosis of cardiac tumors

A young male who presented with atypical chest pain was found to have a primary cardiac tumor. Chest X-ray, electrocardiogram, and echocardiographic findings can be nonspecific. Differential diagnosis and the role of different diagnostic modalities including echocardiogram, computerized tomography and magnetic resonance imaging are discussed.     

原发动脉瘤样骨囊肿的CT和MRI表现与诊断价值

目的探讨原发动脉瘤样骨囊肿的CT和MRI表现与诊断价值。方法分析我院自2011年1月至2013年1月收治的38例原发动脉瘤样骨囊肿患者,均经手术病理证实。38例患者均经CT和MR两种影像学检查方法。比较两种方法的影像学表现。结果 CT、MRI两种影像学检查结果形态上、骨膜反应、关节侵犯比较差异无统计学意义(P0.05);囊腔数目、液-液平面、病理骨折比较差异具有统计学意义(P0.05)。结论 CT和MRI是诊断原发动脉瘤样骨囊肿的有效依据,是区分原发动脉瘤骨囊肿囊腔、液-液平面、病理骨折的重要依据。     

多排螺旋CT肝血流灌注参数诊断原发性肝癌的意义探讨

目的探讨多层螺旋CT（MSCT）灌注参数诊断原发性肝癌的临床价值。方法选择本院肝胆外科收治的60例经病理学检查证实的原发性肝癌患者作为研究对象,另选60例健康人作为对照,使用西门子公司生产的Sensation多排螺旋CT成像系统扫描,对肝癌区组织、癌旁组织和正常肝组织扫描结果经软件处理后获取灌注参数。结果肝癌组织血流量（BF）为（214.7.6±34.7） ml/100 g.min^-1、肝动脉灌注量（AP）为（157.4±33.8） ml/（min.ml^-1）、平均通过时间（MTT）为（19.6±5.1）s、肝动脉供血分数（HAF）为（0.69±0.18）×10^-2,显著高于癌旁组织和健康人肝组织（P<0.05）; 肝癌组织对比剂到达时间（IRF To）为（2.14±1.43）s,显著低于癌旁组织或健康人肝组织（P<0.05）;肝癌组织、癌旁组织和健康肝组织毛细血管通透性（PS）的差异无统计学意义（P>0.05）。结论原发性肝癌患者肝癌组织MSCT灌注参数与癌旁组织或健康肝组织存在显著差异,对临床诊断原发性肝癌具有重要意义。     

CT MRI及CSF免疫学检查在脑型血吸虫病诊断中的价值

目的 探讨脑型血吸虫病的临床特点及诊断方法.方法 回顾性分析42例脑型血吸虫病的CT、 MRI及脑脊液(CSF)免疫学检查资料.结果 通过影像学及免疫学检查确诊40例,1例不能完全排除脑肿瘤通过术后病理检查确诊,1例高度怀疑脑型血吸虫病经吡喹酮诊断治疗证实.结论 CT及MRI对脑型血吸虫病的定位和定性诊断有很大价值.MRI在显示主要病理改变时,其敏感性和准确性均较CT高.CSF免疫学检查对脑型血吸虫病鉴别诊断有重要价值.     

Prevalence of Bicuspid Aortic Valve in Turner Syndrome Patients Receiving Cardiac MRI and CT: A Meta-Analysis

Turner syndrome (TS) is a rare disorder affecting 25–50 in 100000 female newborns. Bicuspid aortic valve (BAV)is assumed to be the most common congenital heart defect (CHD) in TS. In literature, reported BAV prevalence inTS ranges between 14% and 34%. The specific BAV prevalence in TS is still unknown. The aim of this study was togive a more precise estimation of BAV prevalence in TS by conducting a meta-analysis of TS-studies, whichdetected BAV by either cardiac magnetic resonance imaging (MRI) or cardiac computed tomography (CT).We searched PubMed, Cochrane Library, and Web of Science databases to collect observational studies includingthe prevalence of BAV identified by cardiac MRI or cardiac CT in TS patients up to June 4th, 2021. After screeningfor inclusion, data extraction, and quality assessment by two independent reviewers, the meta-analysis was performed with R 4.1.1 software. Results are shown as proportion and weighted mean difference with 95% confi-dence intervals (95% CI). In total, 11 studies involving 1177 patients were included. Pooled data showed thatthe prevalence of BAV in TS patients was 23.7% (95% CI: 21.3% to 26.1%). No high heterogeneity was foundbetween the included studies. The current meta-analysis reveals that BAV can be detected in 23.7% of TS patientsreceiving cardiac MRI or cardiac CT. Therefore, BAV can be considered as the most common CHD in TS. Compared to TTE, cardiac MRI and cardiac CT might represent superior imaging modalities in BAV assessment ofadult TS patients.     

Increased expression of cytokines in liver and serum in patients with extrahepatic diseases

To determine whether the liver plays an immunological role in certain extrahepatic disorders, we investigated the expression of interleukin (IL)-1β, IL-6, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α in 11 patients who had recovered from cholecystolithiasis, 12 patients with gastric cancer, 20 patients with chronic hepatitis, and 6 healthy controls. Cytokine mRNAs in the liver were detected by semiquantitative reverse transcribed-polynerase chain reaction. Serum cytokines and soluble IL-2 receptor (sIL-2R) were investigated by enzyme-linked immunosorbent assays. Increases in TNF-α, IL-6, IL-1β, and IFN-γ mRNAs were found in the livers of patients with extrahepatic diseases. TNF-α and IL-6 peptides were increased in the sera of patients with gastric cancer. TNF-α in the sera and TNF-α mRNA in the liver were correlated in gastric cancer patients. Surprisingly, sIL-2R in the serum of gastric cancer patients was significantly higher than the level in healthy controls. Our findings suggest that the liver produces cytokines in reaction to extrahepatic lesions. Further, the increase in sIL-2R in gastric cancer patients indicates that malignancy may affect the immune network in vivo.     

腔隙性脑梗死CT与MR表现对比研究

目的对比腔隙性脑梗死CT与MRI表现并探讨在腔隙性脑梗死诊断中的价值。方法对180例临床疑似腔隙性脑梗死患者在常规头颅CT、MRI的基础上行FLAIR、DWI和MRA检查,根据影像学结果进行对比分析,选择治疗方案。结果①MRI可以确诊疑似病例患者是负腔隙性脑梗死;②FLAIR可以发现早期脑缺血灶;③DWI可显示常规CT和MRI T1W1、T2W1不能显示的病灶（新鲜病灶）。④MRA显示血管闭塞的部位和狭窄程度。结论通过比较影像学早期诊断腔隙性脑梗死,显示梗死灶与靶血管的关系,早期临床体征可提供切实可行的影像学资料。     

Alpha-fetoprotein and carcinoembryonic antigen in patients with primary liver carcinoma, metastatic liver disease, and alcoholic liver disease

Alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), alkaline phosphatase (ALP) and gamma-glutamyltranspeptidase (GT) were determined in three groups of patients: 21 with primary liver carcinoma (PLC), 106 with metastatic liver disease, and 110 with various degrees of alcoholic liver diseases. AFP was elevated in 12 out of 14 with hepatocellular carcinoma but in none of 7 with cholangiocarcinoma. CEA was elevated in 8 of 14 with hepatocellular carcinoma and in 5 of 7 with cholangiocarcinoma. In metastatic liver disease, 83% had elevated CEA greater than or equal to 5.0 micrograms/l, 50% having CEA levels greater than 20 micrograms/l. AFP was moderately elevated in 26% of the patients, the values being less than 100 micrograms/l in all but one. In patients with alcoholic liver disease, 31% had elevated CEA levels greater than or equal to 5.0 micrograms/l; one of these had an extremely high value of 245 micrograms/l. AFP was moderately elevated to less than 100 micrograms/l in only 9%. CEA is a sensitive indicator of metastases: a value above 20 micrograms/l is almost always associated with malignancy. However, the presence of alcoholic liver diseases must be considered in evaluating patients with increased CEA levels. AFP and CEA seemed to be of value in differentiation between primary and secondary liver carcinoma. ALP and GT are also relatively sensitive indicators of malignant liver disease, but they are more unspecific than AFP and CEA.     

腹部CT检查鉴别诊断恶性肿瘤患者小肝脓肿与肝转移瘤经验分析

目的 探讨在肝外恶性肿瘤患者,使用腹部CT检查鉴别小肝脓肿与肝转移癌.方法 2017年1月～2020年12月我院行肝脏增强CT检查且影像学报告中使用了"肝脓肿"或"肝转移癌"的患者,分析CT特征包括病灶直径、病灶数量、动脉期边缘强化、持续边缘强化和边缘低密度水肿带等.结果 在32例肝脓肿患者和28例肝转移癌患者,腹部C...     

Determination of the integrated CT number of the whole liver in patients with severe hepatitis: as an indicator of the functional reserve of the liver

A study was conducted to estimate the functional reserve of the liver of patients with severe hepatitis by computed tomography (CT), in particular employing the integrated CT number of the whole liver (ICTN). ICTN was calculated by integrating the product of “area” times “mean CT number” of the liver in each CT slice for the entire height of the liver. The following results were obtained:1) In patients with fulminant hepatitis (FH) as well as those with subacute hepatitis (SAH), ICTN was found to be significantly lower as compared to that of patients with acute hepatitis (AH) or non-hepatic diseases. In addition, in FH and SAH patients, ICTN showed a larger degree of decrease when compared with such conventional parameters as either estimated liver volume or mean hepatic CT number. Thus, ICTN seems to more sensitively reflect the changes in functional reserve of the liver. 2) ICTN showed significant positive correlations with prothrombin time and plasma BCAA/AAA ratio, and a significant negative correlation with plasma methionine level. 3) Time course of changes in ICTN correlated well with the clinical features of severe hepatitis. In particular, patients with initial ICTN values above 20 l· HU/m² of body surface area showed significantly higher survival rate than those with initial ICTN below 20. In conclusion, ICTN well indicates the functional reserve of the liver, and is further suggested to be valuable as a parameter to predict the prognosis of patients with severe hepatitis.     

CT与MRI对周围型肺癌的诊断价值比较分析

目的探讨CT与MRI在周围型肺癌诊断中的应用价值。方法随机选取2008年12月份-2014年8月份我院诊治的98例周围型肺癌患者作为研究对象,对比分析所有患者的CT与MRI检查的图像特点以及检出情况。结果对于肿瘤直径5 cm的患者,MRI与CT关于其内部特点以及周围特征的显示情况相近,无显著性差异(P0.05);对于肿瘤直径3-5 cm以及3 cm的患者,CT显示其内部结构以及周围特征的情况显著优于MRI检查,差异具有显著性(P0.05);MRI检出纵隔肺门淋巴结、血管断面,侵犯情况、积液以及胸膜凹陷征的情况显著优于CT检查;CT检出钙化情况显著优于MRI;P均0.05。CT与MRI检查周围型肺癌的检出率,误诊率方面差异无显著性(P0.05)。结论 CT是临床诊断周围型肺癌的重要方法,MRI能够对周围型肺癌的诊断提供更多、更重要的信息,是CT检查的补充手段。     

MRI、CT单独或联合应用在肝细胞癌中的诊断价值

目的探讨MRI、CT单独或联合应用在肝细胞癌中的临床诊断价值。方法经手术或肝活组织检查确诊为肝细胞癌患者49例,CT扫描后1周行MRI扫描,分析CT、MRI单独或联合使用的灵敏度、特异性、准确性以及对不同瘤径大小肝细胞癌的诊断效能。结果 49例肝细胞癌患者共有73个病灶;在小于1cm的肝细胞癌中CT、MRI单独或联合应用的灵敏度分别为46%、70%及94%,CT联合MRI扫描,MRI扫描均高于CT单独扫描且差异有统计学意义(P值分别为0.000、0.019),CT联合MRI扫描高于MRI扫描(P值为0.023)。在1~3 cm肝细胞癌中,CT扫描灵敏度(87.09%)与CT联合MRI扫描(98.39%)差异有统计学意义(P0.05);CT+MRI扫描组在诊断准确率方面高于CT扫描组、MRI扫描组(P值分别为0.015、0.027);CT+MRI扫描组AUC相对于CT扫描组、MRI扫描组差异有统计学意义(P值分别为0.019、0.021)。结论 CT联合MRI扫描在诊断肝细胞癌方面其灵敏度、特异性以及准确性均高于CT、MRI单独扫描。     

Assessment of the viability and treatment response of bone metastases in patients with metastatic castration-resistant prostate cancer using choline PET/CT

This study aimed to evaluate the clinical use of choline-PET/CT for discriminating viable progressive osteoblastic bone metastasis from benign osteoblastic change induced by the treatment effect and evaluating the response of bone metastasis to treatment in metastatic castration-resistant prostate cancer (mCRPC) patients. Thirty patients with mCRPC underwent a total of 56 ¹¹C-choline-PET/CT scans for restaging, because 4 patients received 1 scan and 26 had 2 scans. Using 2 (pre- and post-treatment) ¹¹C-choline-PET/CT examinations per patient, treatment response was assessed according to European Organization for Research and Treatment of Cancer (EORTC) criteria in 20 situations, in which only bony metastases were observed on ¹¹C-choline-PET/CT scans. Viable bone metastases and osteoblastic change induced by the treatment effect were identified in 53 (94.6%) and 29 (51.8%) of 56 ¹¹C-choline-PET/CT scans, respectively. In 27 cases (48.2%), ¹¹C-choline-PET/CT scans could discriminate the 2 entities. The mean SUVmax of the metastatic bony lesions was 5.82 ± 3.21, 5.95 ± 3.96, 6.73 ± 5.04, and 7.91 ± 3.25 for the osteoblastic, osteolytic, mixed, and invisible types, respectively. Of the 20 situations analyzed, CMR, PMR, SMD, and PMD, as determined by the EORTC, were seen in 1, 2, 3, and 14 cases, respectively. Of the 13 patients with increasing PSA trend, all 13 showed PMD. Of the 2 patients with PSA response of <50%, both 2 showed SMD. Of the 5 patients with PSA response of ≥50%, 1 showed CMR, 2 showed PMR, 1 showed SMD, and 1 showed PMD. Choline-PET/CT is very useful to discriminate viable progressive osteoblastic bone metastasis from osteoblastic change, and assess treatment response of bone metastases in mCRPC.     

Assessment of subclinical carotid atherosclerosis in patients with primary osteoarthritis: Correlation with disease severity and insulin resistance

Aim of the workTo assess the carotid artery intima–media thickness (IMT) as an index of subclinical atherosclerosis in patients with primary osteoarthritis (OA) and its correlation to severity and insulin resistance (IR).Patients and methodsThis study included 40 primary OA patients (28 with predominant knee OA and 12 with hip OA) and 15 age and sex matched controls. They were subjected to full medical history, thorough clinical examination and radiological assessment by plain X-rays of knee and hip joints scored according to the Kellgren–Lawrence grading. In patients and control, the IR was calculated by the homeostasis model assessment (HOMA) and carotid IMT measured by ultrasonography.ResultsThere was significant increased carotid IMT in OA patients (0.82 ± 0.12 mm) compared to controls (0.61 ± 0.02 mm) (p < 0.001) with cut-off value of 0.65 mm. There was significant higher HOMA in OA patients (2.55 ± 0.8) compared to controls (1.79 ± 0.44) (p < 0.001). OA patients with IMT > 0.65 mm (n = 34) had longer duration (9 ± 2.56y), higher Kellgren–Lawrence score (2.89 ± 0.45) and higher HOMA (3.8 ± 0.53) compared to those patients with IMT < 0.65 mm (n = 6) (3.41 ± 2.09 y, 2.01 ± 0.26 and 2.23 ± 0.32 respectively). Multi-regression analysis showed that disease duration, Kellgren–Lawrence Grading and HOMA are the best sensitive discriminators for patients having carotid intima >0.65 mm. (F ratio 36.54, p < 0.001).ConclusionOsteoarthritis patients have higher risk of subclinical atherosclerosis independent of traditional risk factors. The severity of OA may contribute to the progression of atherosclerotic disease. Measurement of insulin resistance in OA patients can identify those with higher risk of subclinical atherosclerosis and may help in their follow up and early intervention.