52例扩张型心肌病的X线、超声及心电图综合研究评价

目的：为了解扩张型心肌病（ＤＣＭ）的临床,Ｘ线,Ｂ超与心电图之间的规律性联系。方法：一分析了５２例被临床证实的ＤＣＭ患。结果：心脏Ｘ线检查;（１）肺淤２血占７０％（３７／５２）;（２）５９．６％心脏扩大呈”普大“或”主动脉”型;（３）心胸比率：０．５３４占２８．８％,０．５７－０．６５占６１％,０．７１有５例,且全部死亡;（４）心搏：正常有１５例,减弱有３７例;（５）２例５０岁以上患行冠状     

眼内异物MRI临床应用研究

目的：通过分析４２例５５枚眼内异物的ＭＲＩ表现，并与ＣＴ和Ｘ线平片比较，探讨了ＭＲＩ对眼内异物的诊断价值。材料与方法：男３３例，女９例，年龄５～４５岁。５５枚眼内异物中非磁性异物５３枚，铁磁性异物２枚。每例均在术前１个月内完成Ｘ线平片、ＣＴ和ＭＲＩ检查。结果：（１）ＭＲＩ对５５枚眼内异物检出率（９４％）和ＣＴ（９１％）相仿（Ｐ＞０．２５），均明显高于Ｘ线平片（４２％）（Ｐ＜０．００５）；（２）ＭＲＩ对眼内异物相关并发症的显示优于ＣＴ，而其对巩膜异物的显示差于ＣＴ；（３）ＳＥ序列Ｔ２ＷＩ和ＰＤＷＩ（质子密度加权成像）是检出眼内异物的优选序列；（４）非磁性异物ＭＲＩ呈信号缺失区，无伪迹产生；而铁磁性异物产生大量伪迹，并可致眼部额外损伤。结论：ＭＲＩ是检出眼内非磁性异物的有效方法，特别适用于Ｘ线平片和ＣＴ不能显示的少数非金属异物。眼内铁磁性异物不适于ＭＲＩ。     

140例急性胸部创伤的X线分析

目的：旨在加强对急性胸部创伤的认识，提高诊断率。方法：本组１４０例，均有较完整临床，Ｘ线资料，对其主要Ｘ线征象从发生机理及病理基础上进行了分析和讨论。结果：本病有９种常见的Ｘ线表现，其发生率是：肺部渗出性改变７０．７％（９９／１４０），肺血肿２．８％（４／１４０），肺囊肿３．６％（４／１４０），肺不张２．１％（３／１４０），血气胸４４．３％（６２／１４０），气胸２０％（２８／１４０），纵隔及皮下气肿３７．８％（５３／１４０），创伤性膈疝２．１％（３／１４０），肋骨骨折８７．９％（１２３／１４０）。结论：所有急性胸部创伤均具有一定的特征性Ｘ线表现，紧密结合临床，有助于提高诊断的准确性。     

胆管囊肿影像学诊断36例

目的：评价Ｘ线、ＣＴ检查在先天性胆管囊肿中的作用。以便为临床选用提供依据。方法：３６例胆管囊肿患和,男１０例,女２６例,年龄３个月～１１岁,肝外胆管囊肿３４ ,肝内胆管囊肿２例,３６例均行Ｂ超和ＣＴ检查,３０例行Ｘ线钡餐检查。结果：Ｂ超正确诊断２７例（７５％）,误诊９例;ＣＴ正确诊断３３例（９１．６％）,误诊３例;３０例Ｘ线钡餐检查。正确诊断２５例（８３．３％）。误诊５例。结论：Ｘ线、Ｂ超和ＣＴ检     

胸部疾病CT诊断的评价

本文通过２６１例Ｘ线与ＣＴ诊断比较，评价胸部ＣＴ在胸部疾病诊断中的价值。结果是（１）弥漫病变ＣＴ诊断正确率为８７．５％，Ｘ线为５８．９％；（２）纵隔肿块ＣＴ诊断正确率为６０．１％，Ｘ线为４８．０％；（３）胸膜肿块ＣＴ诊断正确率为７５．０％，Ｘ线为６６．６％；（４）肺段肺叶阴影ＣＴ诊断正确率为７１．０％，Ｘ线为６８．４％；（５）球块阴影ＣＴ诊断正确率为７３．０％，Ｘ线为７１．０％；（６）斑片阴影ＣＴ诊断正确率为６６．０％，Ｘ线为７２．０％。分析材料表明在Ｘ线检查基础上根据胸部疾病基本影像，在普遍胸部ＣＴ检查上附加高分辨、薄层及增强扫描可提高一些ＣＴ征象发现率，同时可以使胸部疾病ＣＴ诊断水平超过本文报道的水平。     

距骨咀临床X线意义的初步探讨（附12例分析）

距骨咀临床Ｘ线意义的初步探讨（附１２例分析）刘布克徐春福距骨咀属距骨的发育变异［１］，不多见而常被忽视，其临床Ｘ线意义尚未有关报告。我们对７５０例踝关节Ｘ线片观察，仅见１２例（１．６％），并发现其中１０例（８３．３％）有临床症状、体征。本文据所搜集资...     

儿童钙化性椎间盘病68例再评价

目的：对儿童钙化性椎间盘病的Ｘ线表现及其转归作进一步评价。材料与方法，对１９７９年８月～１９９５年１月６８例，８２个钙化性椎间盘突出的颈，胸胸片进行回顾性分析，并对３０例随访，２～９次，１５天～９年，结果，Ｘ线改变包括：（１）椎间盘钙化呈团块状（２４．４％），盘状（１５．９％），碎裂状（２８．０％），上述改变加线状（２５．６％），加半环状（６．０％），（２）髓核脱出或移位（３５．４％），（３）颈椎     

超声显像及X线造影在胃癌诊断中的对照研究

本文对６０例经手术及／或胃镜病理证实的中后期胃癌进行了超声显像与Ｘ线双对比造影的对照研究。结果表明：Ｘ线对中后期胃癌检出的阳性率（９５％）显著高于超声（８１．７％）（Ｐ＜０．０５），诊断正确率（９３．３％）同样显著高于超声（７１．６％）（Ｐ＜０．０５）。对转移病例的检出，超声（８８％）却显著高于Ｘ线（１２％）（Ｐ＜０．０５），超声对胃癌浸润程度的评定亦远较Ｘ线为优。超声显像不应作为诊断胃癌的首选方法。     

食管颈段早期癌的X线与内窥镜对照（附36例分析）

食管瘤的早期发现对预后极重要。而食管颈段［１］癌发病率只占食管癌的１０％以下，早期诊断难，漏诊率较高。作者总结１９８５年～１９９７年经病理证实３６例早期食管颈段癌的Ｘ线征及内镜所见做回顾性对照分析。材料与方法本组３６例男性２５例，女性１１例，年龄３４～７１岁，平均５７．５岁。临床症状为进食有异物或轻微阻感９例，占２５％，有轻微紧缩感１９例，占５３％，进食有疼痛感６例，占１６％，进食有适伴背痛１例，占３％，剑突下烧勺痛１例，占３％，病程２～６个月。所有病例均作双对比造影，采用双重造影领剂，立卧位或…     

婴儿先天性幽门狭窄的X线检查及诊断

目的：探讨小儿先天性幽门狭窄Ｘ线检查方法及其Ｘ线表现的有关病理基础。方法：回顾１６例经手术证实的先天性幽门狭窄的患儿的Ｘ线检查及Ｘ线表现和手术所见。其中有６例有Ｂ超检查结果。结果：明显胃扩张１４例,胃排空延迟１６例。６例Ｂ超结果与手术所见相同。其中３例幽门管呈鸟嘴样梗阻。结论：（１）肩样征提示幽门肌肥厚明显。（２）本病必须与其它疾病鉴别。如先天性胃窦隔膜性狭窄。同时还应排除幽门暂时痉挛造成的假象。（３）Ｘ线与超声结合能为外科手术提供必要的依据。     

Chest radiograph of foreign bodies in the tracheobronchial tree

Chest radiographs in 14 children with foreign bodies in the tracheobronchial trees were evaluated retrospectively. The most common causative materials were nuts, and both main bronchi were most commonly involved. The initial chest radiographs that were used for analysis were obtained one hour to 50 days after aspiration or onset of symptoms. Of the nine cases in which chest radiographs were taken within 7 hours after aspiration, six showed hyperlucency with (three cases) or without overinflation (three cases) in the affected lungs, and the other three showed normal chest radiographs. Two patients had indeterminate diagnoses on chest radiographs at inspiration: one patient underwent chest radiographs at expiration and the other underwent fluoroscopy. Air-trapping was demonstrated in both patients. Of another five cases in which chest radiographs were taken 18 hours after aspiration of a foreign body, three cases showed atelectasis or consolidation and the other two showed hyperlucent lung. From these observations, hyperlucent lung indicates an early stage of the disorder while atelectasis or consolidation indicates a fairly advanced stage. In patients with clinically suspected foreign bodies, we advocate that additional examinations be performed to establish a final diagnosis, even when chest radiographs are normal or indeterminate.     

食管异物及食管损伤X线诊断

目的:探讨食管异物及食管损伤的X线诊断与鉴别。方法:15例食管异物与食管损伤患者采用普通X线透视检查及食管钡餐造影确诊,后经内镜及临床治疗证实。结果:本组病例中不透X线异物4例,其异物的形态特征及位置均表现典型;透X线异物11例,其X线表现为食管腔内不规则的充盈缺损及杯口状阻塞,食管壁损伤者龛影形成,龛影周围黏膜平坦。结论:X线透视钡餐造影不仅对食管异物与食管损伤做出定位、定性诊断,亦能明确食管异物的大小及其与邻近组织结构的关系,据此提出了食管异物损伤与食管癌的鉴别特点,为临床治疗提供重要的参考依据。     

螺旋CT多种成像技术对小儿气道异物的诊断

目的 探讨螺旋CT对小儿气道异物的临床诊断价值。方法 分析18例小儿气道非金属异物患者的螺旋CT表现。结果 薄层横断位像能提示病变所在部位。MPR像直观显示异物大小、密度及气道管壁形态。SSD，RT3D像立体地显示异物与气道的形态及关系。其他技术可验证上述所见。CT显示完全阻塞11例，部分阻塞7例。病变呈软组织或稍高密度的不规则或圆形腔内病变。并可见肺内炎症、肺气肿、肺不张、纵隔移位及双边影、胸壁双边影等间接征象表现。结论 螺旋CT多种技术方法成像显示小儿气道异物直观准确，具有重要的临床应用价值。     

X-ray signs of foreign body aspiration in children

Preoperative chest X-rays were taken in both postanterior and partially lateral views of 94 children with foreign-body aspiration. Additional fluoroscopy was employed in 70 patients. In 7% of the cases, the foreign body was radiopaque; in an equal amount of cases, there were no radiological findings. In the remaining results we observed: emphysema as an indirect radiological sign in two-thirds of the cases; in less than one-third, poststenotic atelectasis; pneumonia in 10%; bronchitis in 9%; pneumothorax in 2%.     

Low-dose MDCT and virtual bronchoscopy in pediatric patients with foreign body aspiration

OBJECTIVE: The purpose of this study was to investigate the potential use of low-tube-current MDCT virtual bronchoscopy for the evaluation of children with suspected foreign body aspiration. SUBJECTS AND METHODS: Low-tube-current MDCT was performed in 23 patients (10 girls, 13 boys) with a mean age of 3.3 years (9 months-13 years) with suspicion of foreign body aspiration. Chest radiographs were obtained before CT was performed. MDCT was performed using 25- to 50-mA tube currents. MDCT virtual bronchoscopy images were obtained. Neither sedation nor IV contrast medium was used during CT scanning. All patients underwent endoscopic evaluation within 24 hr after MDCT was performed. MDCT virtual bronchoscopy findings were retrospectively compared with the results of rigid bronchoscopy. RESULTS: The mean tube current was 35 mA (range, 25-50 mA). Imaging quality was excellent in nine studies (39%), good in 12 studies (52%), and poor in two studies (9%). Motion artifacts were present on several slices in five examinations. In 15 patients, all foreign bodies detected by conventional bronchoscopy were also revealed on MDCT virtual bronchoscopy. The foreign body was in the right main bronchus in six patients, in the bronchus intermedius in one patient, and in the left main bronchus in eight patients. No discordance was found between the two techniques. MDCT revealed hyperaeration of the ipsilateral lung in five patients, atelectasis in five patients, infiltration in three patients, and infiltration and bronchiectasis in two patients; it showed infiltration in four patients and atelectasis in one of eight patients without a foreign body detected. There were no abnormal findings in three patients. CONCLUSION: Evaluation of foreign body aspiration of the airway in children can be accomplished by using a low-tube-current MDCT protocol. It may be useful both in showing the exact location of a foreign body before bronchoscopy and in ruling out a foreign body in patients with a low level of suspicion and normal or nonspecific findings on chest radiography.     

呼吸道异物的X线表现及异物移位机制分析

目的:探讨呼吸道异物和异物移位的X线征像和机制及对临床治疗的意义。方法:回顾性分析103例呼吸道异物患者的病例资料。异物类型:植物类66例、金属类18例、动物类7例、塑料类9例、玻璃类3例。103例均摄X线胸片,同时行透视检查者34例、摄侧位片者67例。结果:22例气管异物中X线显示异物11例,主要为金属和动物类异物;异物形状往往不规则,异物最长径超过患者(患儿)气管内径一半以上18例、异物的一端较锐利位于声门下区(气管开口区域)4例。支气管内的异物类型以植物类为主,异物体积通常较小、形状多为不规则形或近似锥形、圆形等。88例支气管异物术前X线诊断74例。X线诊断异物位于右侧支气管内46例,有37例与术后结果相符;X线诊断异物位于左侧支气管内28例,有23例与术后结果相符。其余不符合者由于异物移位所致的不典型间接征象(对侧或不典型的支气管阻塞性改变)。结论:呼吸道内异物的X线表现多种多样,与异物的性质(如植物类中的花生等)、大小、形状、有无移位有一定联系;细致询问有关病史,了解异物类别,有助于提高X线诊断的准确性。     

CT virtual bronchoscopy in the evaluation of children with suspected foreign body aspiration

OBJECTIVE: Computed tomography (CT) virtual bronchoscopy is a noninvasive technique that provides an internal view of trachea and major bronchi by three-dimensional reconstruction. The aim of this study was to investigate the usefulness of virtual bronchoscopy in the evaluation of suspected foreign body aspiration in children. MATERIALS AND METHODS: Twenty-three children (12 girls, 11 boys) with a mean age of 2.4 years (8 months-14 years) who were admitted to emergency room with a suspicion of foreign body aspiration were included in this study. Chest radiograms, spiral computed tomography scans and virtual bronchoscopy images were obtained. Then, rigid bronchoscopy was performed within 24 h. RESULTS: CT virtual bronchoscopy and conventional bronchoscopy revealed the location of the foreign body in seven patients. It was in the right main bronchus in four patients, in the right lower lobe bronchus in one patient, and in the left main bronchus in two patients. There was no discordance between two modalities. CT examination revealed hyperaeration of the ipsilateral lung in four patients, hyperaeration of the ipsilateral lung and mediastinal shift in one patient and bronchiectatic changes in one patient. CT detected no additional finding in one patient with a foreign body in the right main bronchus. In 10 of 16 patients without foreign body, CT examination demonstrated atelectasis, infiltration, peribronchial thickening, and paratracheal lymphadenpoathy. CONCLUSION: Helical CT scanning with virtual bronchoscopy should be performed in only selected cases with suspected foreign body aspiration. When the chest radiograph is normal and the clinical diagnosis suggests aspirated foreign body, helical CT and virtual bronchoscopy can be considered in order to avoid needless rigid bronchoscopy.     

The interrupted bronchus: a fluoroscopic sign of bronchial foreign body in infants and children.

OBJECTIVE: The objective is to describe the characteristic features of the interrupted bronchus sign and to determine the value of this sign in detection of bronchial foreign bodies. The interrupted bronchus sign refers to disruption of the air column in the main bronchi seen by fluoroscopy. CONCLUSION: The interrupted bronchus sign has a sensitivity of 100% for detection of foreign bodies in the main bronchi. This sign is particularly helpful when chest radiography shows atelectasis or pneumonia. The specificity of this sign for foreign bodies is only 71% because other endobronchial lesions can disrupt the air column. Nevertheless, the interrupted bronchus sign indicates the presence of bronchial occlusion and signifies the need for bronchoscopy. This sign is not sensitive for detection of foreign bodies in lobar or segmental bronchi.     

Tracheobronchial aspiration of foreign bodies: current indications for emergency plain chest radiography

PURPOSE: The purpose of this study was to determine the role of plain chest radiography in the evaluation of patients with suspected foreign-body aspiration. MATERIALS AND METHODS: During a 5-year period, 31 patients (18 men and 13 women; age range 6 months to 85 years) were referred to our observation for clinical suspicion of foreign-body aspiration. Clinically, the patients presented with cough in 27/31 cases (87.1%), decreased breath sounds in 22/31 (71%), choking in 18/31 (58.1%), fever in 7/31 (22.6%) and cyanosis in 5/31 (16.1%). Suspected foreign-body aspiration had occurred 2-72 h before hospitalisation. Within 2 h of hospitalisation, all patients underwent plain chest radiography performed in the upright position (two projections) in 10/31 (32.3%) patients and in the supine decubitus position in the remaining 21 (67.7%) patients. Plain chest radiography was subsequently integrated with multislice computed tomography (MSCT) of the chest in 3/31 (9.7%) patients and with bronchoscopy in 27/31 (87.1%) patients. RESULTS: Plain chest radiography showed the presence of a foreign body in the tracheobronchial tree in 7/31 (22.6%) patients, who subsequently underwent successful bronchoscopy in all cases. Foreign bodies included tooth fragment (three cases), nail (two cases), metallic spiral of a ball-point pen (one case) and an earring (one case). In the remaining 24/31 patients, plain chest radiography was positive in 14 cases, showing atelectasis (seven cases), pneumonia (six cases), pulmonary hyperinflation (one case) and pneumomediastinum (one case). Such findings had been caused by an aspirated foreign body, which was subsequently removed by means of bronchoscopy in all 14 patients. Moreover, three of the remaining ten patients with negative plain chest radiograph were submitted to MSCT of the chest, which required in 1 case tracheobronchial aspiration of a foreign body that was subsequently removed by means of bronchoscopy. Overall, plain chest radiography showed the presence of foreign-body aspiration and/or pleuroparenchymal lesions in 21/31 patients (67.7%); bronchoscopy was positive in 23/27 patients (85.2%), localising the foreign body in the right main bronchus in 16/27 patients (59.3%), left main bronchus in 7/27 patients (25.9%), intermediate bronchus in 2/27 patients (7.4%) and right lower lobe bronchus in 2/27 patients (7.4%). No late complications were observed within 6 months of hospital discharge. CONCLUSIONS: Plain chest radiography remains the initial imaging modality for patients with clinically suspected tracheobronchial aspiration of a foreign body. Nevertheless, in the case of negative chest radiography and a clinical suspicion of foreign-body aspiration, MSCT-possibly integrated with virtual bronchoscopy-should be considered in order to avoid unnecessary bronchoscopy.     

胸部CT扫描与透视在呼吸道非金属异物诊断中的价值对比分析

目的:探讨胸部CT扫描与透视在诊断呼吸道非金属异物中的临床应用价值。方法:将临床纤支镜证实的呼吸道非金属异物54例分为单侧支气管组和非单侧支气管异物组,对比分析两组的CT及胸透检查结果,计算诊断符合率。结果:单侧支气管异物组胸透检查符合率为77%,非单侧支气管异物组胸透检查符合率为0,两组胸透检查总符合率为68.2%;两组的CT检查符合率均为100%。结论:CT对呼吸道非金属异物的诊断明显优于胸透,诊断及时、准确。临床拟诊呼吸道异物时,应首选CT检查。