新型冠状病毒肺炎CT表现动态变化的初步探讨

目的:探讨新型冠状病毒肺炎(简称新冠肺炎)胸部CT表现的动态变化过程。方法:回顾性分析26例新冠肺炎的年龄、性别、临床病史、流行病学病史及胸部CT资料。结果:26例中,普通型19例,其中2例表现为单个磨玻璃结节或双肺多个磨玻璃影,达到出院标准时结节或磨玻璃影未见明显改变;13例病变磨玻璃影多次检查均表现为逐渐吸收;4例磨玻璃影范围先扩大,并新增肺实变或磨玻璃病灶,后期病灶再逐渐吸收变淡。重型或危重型7例,表现为双肺弥漫性磨玻璃影;首次复查3例CT表现为病变轻度吸收,4例病灶较前增多、密度增高;继续复查肺内病灶均表现为少许吸收,且开始向纤维化转归,但达到出院标准时病变仅大部吸收或向纤维化陈旧病灶发展。结论:新冠肺炎的CT表现及其动态变化过程有一定的特征和规律,能对临床治疗效果及预后进行评价,并为研究新冠肺炎的病理机制提供影像依据。     

新型冠状病毒肺炎的初诊CT特征及与流感病毒性肺炎的鉴别诊断

目的:探讨新型冠状病毒肺炎(简称新冠肺炎)的初诊CT特征性表现,以及与流感病毒性肺炎的鉴别诊断。方法:收集临床确诊的8例新冠肺炎及10例流感病毒性肺炎的CT资料,分析2组肺内感染病灶的位置、分布、密度及形态。结果:2组病变分布方式(单肺分布、胸膜下分布、沿中轴支气管血管束分布)、支气管壁增厚及树芽征检出率比较差异均有统计学意义(均P0.05)。结论:当胸部CT出现双肺胸膜下多发磨玻璃影或伴实变、有小叶内间隔增厚呈网格状表现,提示新冠肺炎。出现支气管壁增厚、树芽征、病灶沿中轴支气管血管束分布、伴胸腔积液及淋巴结肿大,新冠肺炎可能性不大。     

新型冠状病毒肺炎的多模态影像表现及临床应用研究

目的 :探讨胸部DR、X线断层融合照片(DCTS)和CT扫描3种检查方法对新型冠状病毒肺炎(简称新冠肺炎)的诊断价值。方法:回顾性分析37例新冠肺炎的胸部DR、DCTS和CT资料,对比3种影像检查方法对新冠肺炎肺内病变的显示能力。结果:对肺内磨玻璃样密度灶的显示,DR(27.0%,10/37)与DCTS(75.0%,21/28)比较,差异有统计学意义(P0.05);DCTS与CT(88.9%,24/27)比较,差异无统计学意义(P 0.05)。结论:在新冠肺炎的显示方面,DR分辨力低,易漏诊;DCTS和CT的密度和空间分辨力明显高于DR,能提高对肺内病变细微结构的显示能力;DCTS与CT对新冠肺炎的诊断效能相近,均可作为新冠肺炎筛查的首选方法。     

肺黏膜相关淋巴组织淋巴瘤的CT诊断

目的 研究肺黏膜相关淋巴组织(MALT)淋巴瘤的CT表现,提高对该病的认识及鉴别诊断能力.方法 回顾性分析经病理证实的12例MALT淋巴瘤的CT表现,影像观察指标为病灶的数量、分布、形态、密度及伴随征象.结果 12例MALT淋巴瘤中共检出肺实变、肺肿块、肺结节、磨玻璃样病灶32个,病灶单发2例,多发10例;多发病例中单肺多发2例,双肺多发8例.肺实变10例共21个病灶,其内均可见支气管充气征,1例2个病灶内见支气管扩张;肺肿块或结节影3例共5个病灶,3个病灶内可见支气管充气征;磨玻璃样改变2例共6个病灶;1例伴纵隔及肺门淋巴结肿大.结论 MALT淋巴瘤CT上常表现为双肺多发、含有支气管充气征的肺实变、肿块、结节样或磨玻璃样改变;上述影像表现及相对缓慢的病变过程提示MALT淋巴瘤的诊断.     

新型冠状病毒肺炎胸部高分辨率CT影像分期与鉴别

目的探讨新型冠状病毒肺炎(COVID-19)胸部高分辨率CT(HRCT)影像分期与鉴别。方法回顾性分析50例临床确诊为COVID-19患者的临床资料及胸部HRCT图像,HRCT图像分析内容包括:病灶分布、范围、形态、密度、实变、磨玻璃影、支气管血管束增厚等。结果 COVID-19胸部HRCT主要表现可分为早期、进展期、重症期、恢复期:1)早期双肺散在、多发斑片状、节段或亚段性磨玻璃密度影(GGO),以肺外周或胸膜下分布为主,可见空气支气管征及血管增粗穿行;2)进展期病灶范围融合增大,累及多个肺段、肺叶呈"反蝶翼"征,可见小叶间隔增厚呈"铺路石"征;少数出现胸膜增厚、胸腔积液、淋巴结肿大或小空洞;3)重症期:双肺弥漫GGO合并实变影,见支气管充气征,可至"白肺";4)恢复期病灶范围缩小,实变灶逐渐消失,部分残留纤维条索影。结论 COVID-19患者胸部HRCT具有特征性表现,其中以双肺外周、胸膜下散在磨玻璃影(GGO)最具特征,可进展至双肺实变或"白肺",治疗后病灶可吸收或残留条索影。     

新型冠状病毒肺炎儿童高分辨率CT表现

目的 探讨儿童新型冠状病毒肺炎(COVID-19)患者高分辨率CT(HRCT)表现。方法 回顾性分析2020年1月25日至2月5日华中科技大学同济医学院附属武汉儿童医院22例经临床及核酸检测确诊为COVID-19患儿的胸部HRCT表现。其中男12例,女10例,年龄2个月~14岁,中位年龄4岁,5岁以下患儿14例。由2名放射科医师共同观察肺部病变分布、形态、密度等特征及有无肺门、纵隔淋巴结肿大及胸膜改变。结果 22例患儿中,3例(3/22)肺部CT正常,19例(19/22)肺部HRCT见病灶浸润,其中单侧肺病变7例,双侧肺病变12例。HRCT表现为:磨玻璃影6例,其中淡磨玻璃影4例、典型铺路石征磨玻璃影2例;4例呈肺实变改变,表现为局限性条索影、斑片状高密度影;6例表现为实变影与磨玻璃影共存,呈斑片状致密影夹杂周围磨玻璃影改变,其中1例呈右侧白肺表现;3例呈类支气管肺炎改变,表现为肺叶内散在点状或斑片状密度不均高密度影。下叶病灶较上叶为重,肺外后带较肺尖部、中央区多见。全部患儿均未见肺门淋巴结增大和胸腔积液,1例见叶间胸膜增厚。结论 儿童COVID-19的HRCT表现多样化,需结合流行病学资料、临床表现及实验室检测综合判断,但肺部CT表现可作为临床早期诊断和防控干预的重要依据。     

肺硬化性血管瘤64层螺旋CT诊断与鉴别

目的:分析肺硬化性血管瘤(PSH)的64层螺旋CT表现,提高对该病的认识及确诊率。方法:收集2008～2010年经手术或CT导引下穿刺病理证实的PSH 10例,其中8例行增强扫描。结果:10例中,呈圆形5例,椭圆形3例,类三角形2例;肿瘤边缘清晰,仅3例病灶可见浅分叶;6例肿瘤密度均匀,4例病灶内部或边缘见点状钙化,3例病灶周边可见"含气裂隙征"。10例均行增强扫描,4例呈斑片样强化,5例肿瘤呈均匀一致性明显强化,1例无明显强化、病灶内部密度均匀;4例肿瘤边缘肺门侧见"贴边血管征",3例肿瘤周围可见磨玻璃样密度。结论:64层螺旋CT层厚薄,图像的空间分辨力和增强扫描的时间分辨力高,可以显示病灶内部的细微钙化及强化特征,确诊率明显提高。     

肺炎型肺癌的CT表现及误诊分析

目的 探讨肺炎型肺癌的CT表现,提高诊断水平,减少误诊.方法 回顾性分析经病理证实的24例肺炎型肺癌的临床及CT资料,观察病灶分布、是否伴有不规则小结节、实变区内有无支气管充气征、不规则小囊腔及病灶周边有无磨玻璃影环绕等.结果 两肺多发分布6例;单发分布18例:上叶5例,中叶3例,下叶10例.所有病灶均为外周分布,伴有小结节11例,实变区内支气管充气征14例,不规则小囊腔7例,周边有磨玻璃影环绕13例.24例中首诊为肺炎23例,肺结核1例.结论 肺炎型肺癌CT表现具有一定特点.对积极抗感染治疗吸收不佳的"肺炎"应警惕肺炎型肺癌的可能,需尽早行活检确诊.     

国医大师刘志明辨证施治重型与危重型新型冠状病毒肺炎的CT动态变化半定量分析

目的 :回顾性分析经国医大师刘志明采用中医药治疗的重型与危重型新型冠状病毒肺炎(简称新冠肺炎)的临床及胸部CT动态变化特征。方法:收集国医大师刘志明诊治的2例重型及4例危重型新冠肺炎的临床和CT资料。重点观察服用中药前与服用中药1周后患者的临床症状及影像表现变化。结果:服用中药1周后患者临床症状明显改善,呼吸机逐步撤除,服中药后3～10 d出院。中药治疗前后CT表现:服中药前患者以磨玻璃影伴混杂密度居多,部分伴明显实变;随病程进展,条索样改变逐渐增多,2例存在胸腔积液;病变分布以右肺中上区多见。中药治疗后1周左右CT示磨玻璃影及实变明显吸收,康复期表现为少许磨玻璃影改变及纤维条索状影。结论:新冠肺炎患者在加服中药治疗后临床症状明显改善,肺部病灶逐步吸收,达到临床治愈。     

甲型H1N1流感合并肺炎的影像表现

目的 探讨甲型H1N1流感合并肺炎的影像表现.方法 分析确诊的甲型H1N1流感合并肺炎患者51例,均摄床旁X线胸片,44例同期行胸部CT检查.按肺内病变程度将所有患者分为轻度、中度、重度3型.结果 轻度患者4例,表现为肺内局限片状阴影;中度33例,肺内片状阴影超过2个肺野,其中双侧病变30例,单侧病变3例;重度14例,肺内广泛分布片状及磨玻璃密度阴影,可以合并间质改变,其中2例合并感染,成人呼吸窘迫综合征(ARDS)6例,并发皮下气肿1例.结论 甲型H1N1流感合并肺炎以片状影及磨玻璃密度阴影为主,可见间质病变,合并感染后影像表现多样,部分患者可进展为ARDS.     

Diagnostic grand rounds: A new teaching concept to train diagnostic reasoning

Introduction

Diagnostic reasoning is a core skill in teaching and learning in undergraduate curricula. Diagnostic grand rounds (DGRs) as a subform of grand rounds are intended to train the students’ skills in the selection of appropriate tests and in the interpretation of test results. The aim of this study was to test DGRs for their ability to improve diagnostic reasoning by using a pre-post-test design.

Methods

During one winter term, all 398 fifth-year students (36.1% male, 63.9% female) solved 23 clinical cases presented in 8 DGRs. In an online questionnaire, a Diagnostic Thinking Inventory (DTI) with 41 items was evaluated for flexibility in thinking and structure of knowledge in memory. Results were correlated with those from a summative multiple-choice knowledge test and of the learning objectives in a logbook.

Results

The students’ DTI scores in the post-test were significantly higher than those reported in the pre-test. DTI scores at either testing time did not correlate with medical knowledge as assessed by a multiple-choice knowledge test. Abilities acquired during clinical clerkships as documented in a logbook could only account for a small proportion of the increase in the flexibility subscale score. This effect still remained significant after accounting for potential confounders.

Conclusion

Establishing DGRs proofed to be an effective way of successfully improving both students’ diagnostic reasoning and the ability to select the appropriate test method in routine clinical practice.     

B型超声辅助X线对肺癌诊断的探讨(附216例分析)

笔者用B型超声显像诊断216例经病理证实的周围型肺癌.病灶最浅在胸膜下,最深距胸膜7cm。初步提出超声诊断肺癌的特征为:(1)强光彗尾征。(2)边界分叶征。(3)满天星征。(4)倒影征。(5)肿块伴有侵犯附近心包大血管或胸膜。(6)纵隔旁肿大的多个淋巴结群内见肺肿块。(7)在肺不张内隐藏有肿块伴有较多胸水或肺门旁肿块伴有同侧肺门淋巴结增大和较多胸水。上述一项征象可提示诊断,2项以上征象可确诊,并讨论了超声诊断的价值和限制。笔者认为超声检查可补充X线检查的不足,能辅助X线对肺癌的诊断。     

Diagnostic image quality of hand-held and wall-mounted X-ray devices in bitewing radiography: a non-inferiority clinical trial

Objectives:The present clinical trial was intended to clarify whether subjective assessments of diagnostic X-ray image quality achieved via hand-held (HH) Nomad Pro 2 (KaVo Kerr, Brea, CA, USA) X-ray device is non-inferior that of the wall-mounted (WM) KaVo Focus (KaVo Dental, Bieberich, Germany).Methods:A prospective, cross-over, and in vivo non-inferiority clinical trial was conducted to compare these two diagnostic modalities. Based on sampling calculations, 205 patients were selected for study, generating 410 paired bitewing radiographs in randomized sequence. The films were assessed independently, engaging three observers blinded to modality for random, side-by-side-comparisons. Diagnostic image quality was rated as follows: no preference, HH preference, or WM preference. Observer judgements were combined accordingly to reach a majority.Results:Collective observer ratings indicated no preference for diagnostic image quality in 63.9% of cases, with WM preference at 16.6% and HH preference at 19.5%. The difference in HH and WM preferences (19.5%–16.6% = 2.9%) was within the expected 95% confidence interval. Majority agreement was reached in 82.7%.Conclusions:Subjectively assessed diagnostic image quality in bitewing radiographs acquired by HH and WM devices did not differ significantly. The hand-held device is thus non-inferior to the WM in this regard. Our data set of paired bitewing radiographs may subsequently aid in future research.     

胰岛素瘤的影像学评价(附28例报告)

目的：探讨多种影像学方法在胰岛素瘤术前定位诊断中的价值。资料与方法：28例经手术病理证实的胰岛素瘤患者于术前做B超和DSA检查，22例行胰腺CT扫描，10例行MRI检查。结果：4种影像学方法对胰岛素瘤术前定位诊断准确率分别为：DSA 82％（23／28），超声57％（16／28），CT 41％（9／22），MRI90％（9／10）。DSA与超声。MRI相结合使本组术前定位诊断准确率达93％（26／28）。结论：MRI和DSA是胰岛素瘤术前定位诊断准确率高而有效的方法。对临床有Whipple三联征患者，应首先选用超声和MRI或螺旋CT检查，特别是MRI或螺旋CT薄层快速动态增强扫描。当上述无创检查方法仍不能明确诊断时，可进一步行胰血管造影，多种影像技术联合应用可以提高本病的诊断准确率。     

肌肉内血管瘤的影像学分析(附11例报告)

目的：探讨肌肉内血管瘤影像学表现与诊断的价值。方法：回顾性总结１１例经手术和病理证实肌肉内血管瘤的Ｂ超、ＣＴ和ＭＲＩ表现。结果：７例Ｂ超检查见肌肉内软组织肿块,２例呈均匀低回声灶,３例呈网状低回声灶,２例呈混合性回声灶;形态规则、边界清楚４例;形态不规则、边界不清楚３例。７例ＣＧ检查见肌肉内肿块影。３例呈等密度,４例呈混合密度,２例可见斑点状钙化;边界清晰者３例,不清晰者４例;增强扫描肿块见明显强     

非潜水性骨梗死影像学诊断

目的 探讨非潜水性骨梗死的影像学表现。方法 7例患中，平片 CT MRI ECT检查、平片 CT、平片 MRI检查各2例；单纯拍平片1例。结果 7例共累及14骨。早期平片、CT可无异常发现，亦可见病变区密度不均或轻度骨膜反应。MRI示病灶中心T1WI呈等骨髓脂肪信号，边缘呈迂曲的低信号带；该带T2WI可分2层。整个坏死区呈地图样改变。ECT显示为中央放射性缺损，边缘放射性浓聚。晚期平片、CT扫描病灶呈类环形、花边状或条状致密影。MRI、ECT此期表现无特征。结论 对早期病例，MRI是最好的检查手段。晚期病例检查应首选平片和CT。     

A microcosting study of diagnostic tests for the detection of coronary artery disease in The Netherlands

Objective

The primary aim of the present study was to calculate the actual costs of four diagnostic tests for the detection of coronary artery disease in the Netherlands using a microcosting methodology. As a secondary objective, the cost effectiveness of eight diagnostic strategies was examined, using microcosting and reimbursement fees subsequently as the cost estimate.

Design

A multicenter, retrospective cost analysis from a hospital perspective.

Setting

The study was conducted in three general hospitals in the Netherlands for 2006.

Interventions

Exercise electrocardiography (exECG), stress echocardiography (sECHO), single-photon emission computed tomography (SPECT) and coronary angiography (CA).

Results

The actual costs of exECG, sECHO, SPECT and CA were €33, 216, 614 and 1300 respectively. For all diagnostic tests, labour and indirect cost components (overheads and capital) together accounted for over 75% of the total costs. Consumables played a relatively important role in SPECT (14%). Hotel and nutrition were only applicable to SPECT and CA. Diagnostic services were solely performed for CA, but their costs were negligible (2%). Using microcosting estimates, exECG-sECHO-SPECT-CA was the most and CA the least cost effective strategy (€397 and 1302 per accurately diagnosed patient). Using reimbursement fees, exECG-sECHO-CA was most and SPECT-CA least cost effective (€147 and 567 per accurately diagnosed patient).

Conclusions

The use of microcosting estimates instead of reimbursement fees led to different conclusions regarding the relative cost effectiveness of alternative strategies.     

代谢综合征的不同诊断标准在北京某集团公司工作人员中的应用比较

目的对北京某集团公司工作人员进行流行病学调查，比较和探讨4种代谢综合征（MS）诊断标准对这一特殊人群诊断的患病率和一致性。方法对2007年3月～2008年3月在我院接受健康体检的3075例（男性2381例，女性694例）北京某集团公司从事管理、科研的脑力工作者，分别采用美国国家胆固醇教育计划成人治疗方案第三次报告（NCEP—ATPⅢ）、美国心脏协会（AHA）对NCEP—ATPⅢ修订的诊断标准（ATPⅢ^＊）、中华医学会糖尿病学分会（CDS）和国际糖尿病联盟（IDF）的MS诊断标准诊断MS，并比较MS的患病率和一致性。结果ATPⅢ标准MS合计患病率为22．57％（男22．89％，女21．46％，P〉0．05）；ATPⅢ^＊标准为34、70％（男33．94％，女37.32％，P〉0．05）；IDF标准为30．70％（男30．32％，女31．99％，P〉0．05）；CDS标准为29．46％（男27．13％，女15．85％，P〈0．001）。ATPⅢ与ATPⅢ^＊、ATPⅢ与CDS、ATPⅢ与IDF、ATPⅢ^＊与CDS、ATPⅢ^＊与IDF和CDS与IDF标准的MS诊断一致率分别为82．02％、81．53％、77.30％、78．05％、92．23％、78．73％。结论调查对象的MS患病率明显偏高，其中男性MS患病率未明显表现为增龄趋势；IDF与ATPⅢ^＊标准的诊断一致性最好；CDS标准中肥胖的判定建议采用腰围指标。     

原发性滑膜骨软骨瘤病的四种影像方法比较研究

目的：比较原发性滑膜骨软骨瘤病(PSO)的X线平片、CT、MR1、超声4种影像方法诊断价值。方法 对照研究手术及病理证实的42例（44个关节）PSO的X线平片、CT、MRI、超声影像资料及病理资料。结果 X线平片：软骨型结节均末显示,显示钙化型结节197枚（28个关节）,骨化型结节96枚（24个关节）,混合型结节5枚（3个关节）;36个关节正确诊断,准确率81.8％ (36/44)。CT检查：软骨型小结节未显示,显示软骨型大结节8枚（5个关节）,钙化型结节255枚（30个关节）,骨化型结节146枚（28个关节）,混合型结节16枚（7个关节）;24个关节VR图像能更直观清晰地显示非软骨型结节的数量、大小、形态及位置;40个关节正确诊断,准确率90.9％（40/44）。MRI:显示软骨型大结节8枚（5个关节）,软骨型小结节70枚（4个关节）,钙化型结节248枚（29个关节）,骨化型结节146枚（28个关节）,混合型结节16枚（7个关节）;在DWI上均呈低信号。增强扫描结节内无强化;43个关节正确诊断,准确率97.7％ (43/44)。超声检查：显示软骨型大结节8枚（5个关节）,软骨型小结节70枚（4个关节）,钙化型结节232枚（30个关节）,骨化型结节142枚（28个关节）,混合型结节16枚（7个关节）;43个关节正确诊断,准确率97.7％( 43/44)。结论 X线平片、CT、MRI及超声4种影像方法诊断PSO各有优缺点,应根据临床需要恰当选择,必要时可联合应用。