结肠影像学检查方法的进展

结肠是人体内重要器官之一,具有储存、浓缩、排泄粪便和分泌、重吸收水份的功能。炎症、肿瘤、缺血等病理改变可损害这些功能。结肠可通过窥镜进行直接观察和活检,也可通过各种X线检查方法进行间接观察。近十几年来,由于CT、MR等方法的引入,使结肠的影像学检查方法有了较大的改进。本文就结肠影像学检查方法的现状作一综述。一、结肠单纯灌钡造影和双重造影1904年Schule首次做了结肠灌钡检查。1911年     

结肠双对比造影检查的临床意义

结肠的影像学检查方法很多。包括钡剂检查、血管造影检查、CT、B超、MRI及核素检查，还有非影像的内窥镜检查，但实践证明，钡剂检查尤其是气钡双对比造影检查仍是结肠检查最常用最基本最重要的检查方法。根据本人的临床工作体验结合文献资料，对结肠气钡双对比造影检查的原理方法和临床意义作如下总结：     

结肠双对比造影检查前两种肠道准备对比

结肠双对比造影是诊断结畅早期病变一种很有效的检查方法。检查前肠道准备好坏是造影成功与否的关键。本文通过两种肠道准备方法（清洁灌肠注硬下行性清肠法）各100例分析对比，认为下行性清肠法除个别便秘及乙状结肠冗长外，约79％以上可以达到检查要求，与清洁洗肠相比，此法节约检查时间，更重要的是，这种方法使造影剂在粘膜上附着更好，易干显示结肠粘膜做细结构或小微小病变。     

鼻骨骨折的影像学检查方法比较

鼻部（外鼻）凸出于面部中央，易受撞击、磕碰，发生鼻外伤。临床上鼻骨骨折相当多见，并常合并有相邻部位软组织及其他结构的损伤。随着医学科学的迅猛发展，CR、DR等数字成像技术，HRCT及图像后处理技术在临床应用日益普遍，鼻骨骨折检出率明显提高，为临床诊治提供了更多的帮助和参考。笔者回顾性分析经DR及HRCT检查的资料完整的鼻部外伤病例80例，比较不同影像检查方法对鼻骨骨折的诊断价值。     

RSNA2022腹部影像学

2022年RSNA腹部影像学内容丰富,热点问题包括人工智能(AI)及其对肝脏肿瘤、胰腺肿瘤、泌尿生殖系统等的诊断、疗效评估等,为腹部影像学的临床和科研工作提供了更多的思路。     

颈椎病的影像学检查方法

颈椎病即由于颈椎间盘退行性变本身及其继发改变所致的失稳，压迫邻近组织而引起一系列症状和体征。颈椎病是临床常见病多发病其诊断及确诊主要依靠影像学表现及临床症状。颈椎病诊断不仅要求显示出颈椎复杂的骨性结构．还必须能观察骨性椎管内的硬膜囊和脊髓、脊神经、韧带、椎间盘、椎旁软组织。在过去10年中颈椎影像学发展变化较     

脊椎结核影像学检查方法选择探讨

脊椎结核发病率占骨关节结核首位，早期影像学诊断对本病的临床治疗、预后有非常重要的价值，不同病程下选择更为有利的影像检查方法，对了解病变范围、程度从而选择不同的治疗方式显得尤为关键，并且对减少患者受辐射剂量以及合理利用卫生资源有较大帮助。     

头颈部血管的影像学检查方法

如何更好地显示头颈部血管疾病,以达到早发现、早诊断、早治疗的目的,是影像学研究的热点.目前,已有多种影像学检查方法用于头颈部血管的评估,可将其分为有创性和无创性两大类.     

影像学检查的合理选择

医学影像学检查是一种特殊的检查方法,除传统X线检查外,还包括多种现代影像技术,如超声（US）、核素显像、DSA、CT、MRI、ECF、数字X线影像技术、PET-CT等,形成了现代影像学体系,扩大了检查视野,提高了诊断质量。但每种成像方法都有各自的优缺点及适用范围。因此,选择影像学检查应权衡利弊、选优利用。现就各系统影像学检查的合理选择综述如下。     

腹腔镜结肠癌根治术前行腹部CTA和结肠三维成像对手术的指导价值

 目的 研究腹腔镜结肠癌根治术前行腹部螺旋CT血管造影(CT angiography, CTA)和结肠三维成像检查对结肠肿瘤解剖性切除的价值。方法 收集2017-09至2019-02医院80例结肠癌患者资料,按术前检查分为联合成像组和常规CT组,每组40例。比较两组患者基线资料,术中、术后相关指标,分析三维图像所示肿瘤病灶及其供血血管情况。结果 联合成像组患者术中出血量[(137.34±59.68) ml]少于常规CT组[(181.75±53.42) ml](P=0.001);手术耗时[(165.90±47.85) min]短于常规CT组[(192.88±43.16) min](P=0.010);术后腹腔总引流量[(61.03±18.82) ml]少于常规CT组[(73.10±21.16) ml](P=0.009)。腹部CTA联合三维融合图像可直观显示腹腔内各组织器官和结肠肿瘤及其供血血管的全景图像。结论 术前腹部CTA和结肠三维成像检查可明确结肠肿瘤解剖部位及其供血血管,可缩短手术时间、减少术中出血量,具有一定价值,尤其对年轻及手术操作不甚熟练医师可能带来更大帮助。     

磁共振成像检查前护理干预效果观察

磁共振成像技术,是上个世纪80年代初期发展起来的一门新的影像技术,它所提供的信息量远远超过以往其他的医学影像技术,因此越来越受到临床医生的青睐。但由于其设备的特殊性,一些患者在检查中或多或少都有一些恐惧心理[1],因此检查前的护理工作显得尤为重要[2]。本文拟通过行为     

原发性胆囊癌影像学检查新进展

原发性胆囊癌是胆道系统中常见的恶性肿瘤,其起病隐匿,临床无特征性,大多数患者当临床作出诊断时已有肝脏侵犯或远处转移,预后较差,总体5年生存率仅为5.0%～12.0%[1].准确的术前诊断与其疗效密切相关.     

人工耳蜗植入前后影像学检查技术应用进展

人工耳蜗植入是治疗感音神经性耳聋的有效方法,影像学检查对人工耳蜗植入术前的病例选择和术后电极植入的评估具有重要意义。本文综述了人工耳蜗植入前后的影像学检查技术,分别介绍了CT、MRI和数字X线在其评价中的应用研究及临床价值。     

Assessment of acute abdominal pain: utility of a second cross-sectional imaging examination

PURPOSE: To retrospectively determine how often a second cross-sectional imaging examination provides useful additional information or alters management of acute abdominal pain. MATERIALS AND METHODS: The research ethics board approved this study; the informed consent requirement was waived. Authors assessed imaging reports and clinical charts of adult patients who presented to the emergency department and underwent both computed tomography (CT) and ultrasonography (US) of the abdomen within 72 hours. A total of 255 patients fulfilled study criteria. The second examination was categorized as providing additional useful information, providing no additional useful information, or providing contradictory information. It was also noted whether the second examination was recommended because of findings of the first and whether the results of the second altered clinical management. Follow-up was available in 149 patients, and a definitive diagnosis was established. For these patients, it was determined whether either examination favored the correct diagnosis. Fisher exact test, one- and two-sample tests for equality of proportions with continuity correction, and the chi(2) test were used, where appropriate. RESULTS: In 85 patients (33.3%), findings of the second examination agreed with those of the first examination and provided additional information. In 153 patients (60.0%), findings of the second examination agreed with those of the first examination and provided no additional information. In 17 patients (6.7%), findings of the second examination were contradictory to findings of the first examination. The percentage of follow-up CT examinations that provided no additional useful information was significantly lower when recommended by the radiologist (38%) than when recommended by someone else (72%, P < .001). The percentage of follow-up US examinations that provided no additional useful information was significantly lower when recommended by the radiologist (42%) than when recommended by someone else (74%, P = .003). In the 149 patients in whom a final diagnosis was available, both sets of scans were correct in 87 patients (58.4%); only the second set of scans was correct in 43 (28.8%). Overall, findings of the second examination led to a change or could have led to a change in treatment of 23 patients (9.0%). CONCLUSION: A second examination is significantly more likely to be useful when performed because of radiologist recommendation.     

分推腹阴阳法对番泻叶清洁肠道的作用

腹部X线平片检查,都需要做肠道清洁的准备.目前临床上常用的方法大多为口服冲泡番泻叶法.此方法简单易行、费用少、无痛苦,很受患者欢迎.但由于个体差异,对番泻叶的敏感性不同,有的患者有腹痛、腹胀、肠鸣等不良反应或由于排便少、排便时间延迟等因素造成肠道大量积气及残留粪便而影响及时满意的进行摄片.对这部分患者我们采用了中医推拿"分推腹阴阳"法,促使积气积便的清除,收到了较好的效果.     

Computed tomographic air-contrast enema imaging for presurgical examination of colon tumors: assessment with colon phantoms and in patients

Purpose We investigated the mechanism of colon wall deformities in phantoms and assessed the relation between pathological T staging and wall deformity in patients using computed tomography (CT) enema imaging. Materials and Methods We performed multidetector-row CT in mass-containing phantoms with no structural deformities and in 36 patients with colon tumors. In the phantoms, we compared images on double-contrast barium (DCB) and CT enema studies, and we compared wall deformities on CT enema studies and the actual phantom structure. In patients, we compared wall deformities on CT enema studies and T staging. Results Images from CT enema and DCB studies were identical in the phantom, and all profile images showed geometrical basal indentations. In patients, the grade of deformity increased with invasion depth; and the diagnostic accuracy of T staging was 82.5%. Geometrical basal indentation and poor colon expansion were the primary reasons for overestimating T staging on CT enema imaging. Conclusion Although CT enema imaging allows reasonable diagnostic accuracy of T staging, wall deformity is thought to be consistent with tumor infiltration and other factors. We recommend evaluating T staging using not only CT enema imaging but also other techniques, such as virtual endoscopy, axial imaging, and multiplanar reformation imaging.