胸部钝挫伤致轻度肺出血的CT诊断(附20例报告)

购部钝挫伤致重度肺挫伤出血、创伤性湿肺、血气胸及多发性肋骨骨折等[1～3]，常规X线胸片易显示。但对胸部钝挫伤致轻度肺出血不易显示而忽视漏诊。作者对有胸部钝挫伤史，胸痛、咳嗽伴血痰、胸片示正常者做胸部CT扫描、发现创伤部位相应肺组织内有不同程度的挫伤出血、经及时诊断和治疗无共发症。现报导如下。三方法和结果采用美国GE9000型CT机，从肺尖至肺底轴位横断扫描、层厚层距10mm。20例年龄15～65岁。平均40岁，男12例，女8例，男女之比l．5：l，肺出血右侧肺14例，左侧肺6例，其中单叶15例，两叶5例。发生在肺上叶占10％，中叶…     

家兔肺挫伤早期影像学的变化及其意义

目的探讨单光子发射计算机断层显像(SPECr)、胸部CT以及x线平片对家兔肺挫伤的早期诊断价值。方法建立兔单侧胸部撞击伤动物模型,采用SPECT、胸部CT以及x线平片对兔肺挫伤进行早期诊断,并与病理解剖结果进行对照观察。结果在伤后1、6、24小时,x线诊断肺挫伤的敏感性分别为33．33％(3／9)、55．56％(5／9)、75．00％(6／8),有2只动物未检出肺挫伤病变。在伤后1小时,CT显示双肺均有挫伤100％(2／2),结合动物病理观察,CT与实际伤情非常吻合,而x线低估了肺挫伤的病变范围。结论胸部CT在诊断胸部创伤获得治疗相关信息方面明显优于x线平片。因此,对于严重胸部创伤以及多发伤,急诊检查应采甩CT扫描,以尽快明确诊断。     

纵隔淋巴结肿大CT评价:非增强5mm层厚与增强10mm层厚扫描对比

作者共收集79例非急诊胸部CT检查的病例,女41例、男38例,平均年龄57岁。每例均扫描2次,第一次为5mm层厚平扫,从主动脉弓至右中叶支气管水平连续扫描;第二次为10mm层厚连续动态扫描,从肺尖直至通过肾上腺,用高压注射器注入对比剂100～120ml(1.5～2.0ml/s,50ml,然后用0.8～1.0ml/s,延迟45s)。图像均为标准算法重建,分别用     

64层螺旋CT颈椎采集模式放射剂量的分析

目的 探讨64层螺旋CT 3种颈椎采集模式的放射剂量.方法选用同一水模进行64层螺旋CT检查扫描,扫描范围30 cm,根据采集方式不同,分为3组:分别采用64×0.6 mm(A组)、24×1.2 mm(B组)、20×0.6 mm(C组)采集方式,每组扫描30次.记录每次扫描的平均容积剂量指数、扫描时间和有效球管电流数值,并计算出剂量长度和平均有效剂量.结果 3组平均容积剂量A组>B组>C组;C组平均容积剂量比A组和B组平均容积剂量分别降低21.922%和18.58%.结论 64层螺旋CT 20×0.6 mm采集模式进行颈椎扫描放射剂量最小.     

猪胸部枪弹伤后胸部螺旋CT检查的应用价值探讨

目的：利用64层螺旋CT容积扫描及重建技术探讨猪胸部枪弹伤后胸部影像学表现,结合解剖结果加以分析,为胸部枪弹伤的早期、全面救治提供参考依据。方法：建立猪胸部枪弹伤动物模型10只,致伤后2 h内行胸部64层螺旋CT容积扫描及三维重建,其后解剖。结果：（1）2只（4、10号）弹道出口处粉碎性肋骨骨折,大量出血致失血性休克及右肺功能丧失而死亡。2只（1、9号）CT及解剖出血量有较大差异,提示损伤的右肋间后动脉持续出血可能,符合数小时后解剖发现右侧胸腔积血量明显增加改变。1只（8号）出血量有部分增加,结合CT表现考虑为右肋间后动脉副支损伤导致出血。2只（5、7号）双肺散在渗出性积液、积血,肺组织外观呈暗红色团片影与正常萎缩肺组织相间分布,结合死亡时间,提示5号为急性呼吸衰竭死亡,而7号为继发呼吸衰竭而死亡。（2）肺组织解剖标本测值,弹道区变化不明显,挫伤区及震荡区较CT检查结果明显缩小,考虑为肺组织萎缩后弹道区因血凝块充填,萎缩程度小,而挫伤区及震荡区相反则萎缩程度大。结论：64层螺旋CT不但能清晰显示胸部枪弹伤后血气胸程度,而且能较好地显示枪弹所致肺组织损伤及肋间动脉、胸廓内动脉损伤等易被忽视的致死性损伤,为降低此类患者的死亡率,提高临床救治水平起到重要作用。     

多层螺旋CT扫描层厚、重建间隔和多平面重建图像质量相关性的实验研究

目的探讨Mx80004层螺旋CT机具有实用价值和理想的多平面重建(MPR)技术参数方法用Mx8000CT机对人结肠标本行6.5mm、5.0mm、3.2mm、2.0mm及1.0mm不同层厚扫描,分别进行2.0mm、1.0mm和0.5mm不同间隔重建,在工作站做肠腔纵切面的MPR(包括CPR)成像对各组MPR图像质量进行评分后作统计学对比分析结果在相同间隔重建的MPR图像中,以层厚越薄得分越高在相同层厚的MPR图像中,重建间隔越小,评分相对越高;0.5mm与1.0mm重建间隔间的图像质量相比无明显统计学差异1.0mm层厚的扫描范围太小,CT剂量指数(CTDI)明显高于其它扫描层厚;2.0mm层厚的扫描范围达88mm,且CTDI与剩余层厚者较接近结论Mx80004层螺旋CT机用2.0mm扫描层厚、1.0mm间隔重建,可获取满意质量的MPR图像,并具有实际操作意义     

16层以上螺旋CT对诊断孤立性肺结节的合理应用分析

目的 评价16层以上MSCT对诊断孤立性肺结节(<3 cm)的应用合理性.方法 分析到该院会诊患者的院外胸部CT照片,选择使用16层以上MSCT机型和直径<3 cm孤立性肺结节的150例作为研究对象,记录院外CT片内常规重建层厚、有无靶重建、二维和三维重组应用情况、窗技术应用以及对比剂增强效果等.确定孤立性肺结节的胸部CT正确扫描方法,并与院外胸部CT扫描技术进行对比,评价院外MSCT胸部应用的合理性及正确诊断情况.结果 92例采用16层CT机,54例采用64层CT机,4例为40层CT机.常规重建层厚选择9～10 mm者59例,7～8 mm者12例,5 mm者79例.对病灶局部采用连续薄层(<3 mm)重建46例.9例CT片内仅有重组图像(MPR和VR),没有原始薄层轴面图像.在150例中,由于图像不满意而需重复扫描者53例(35.3%);78例在该院经病理或临床确诊,其中院外诊断错误22例,在该院仅2例诊断错误.结论 16层以上MSCT在孤立性肺结节的应用存在诸多不合理性,直接影响诊断,建议建立国内统一的胸部CT扫描标准.     

CT对确定胸片可疑纵隔出血者是否需行血管造影的价值

钝性减速伤造成胸内大动脉损伤的诊断很困难,为了减少血管造影的阴性率,作者提出了以胸部动态增强CT扫描作为辅助胸片筛选纵隔出血的方法。作者对1287例胸部钝伤病人中的90例胸部仰卧位或立位片纵隔出血征象不肯定、或不能得到技术条件满意的X线片、或临床上有中度或强烈的证据提示有胸部大血管损伤而胸片正常的病人行胸部动态增强CT扫描。在最初18个月手推60%造影剂50ml后在胸廓入口水平开始扫描,扫描时问2s,间隔3s或6s,层厚1 cm,连扫8～10层达隆凸,再追加50ml造影剂,仍以层厚1 cm扫描连     

海量增加的数字化影像资料记录标准的探讨

随着影像医学步入全面数字化时代,图像数量大量增加,使患者携带胶片看病很不方便。以广泛普及的16排螺旋CT为例,扫描一个较小如20cm的范围,1.25mm×16螺旋扫描,所得数据按照1.25mm重建,得到160幅图像,2.5mm重建还有80幅图像。体现多层螺旋CT(multi-slice spiral CT,MSCT)的优势     

多层螺旋CT及重建技术在胸部创伤中的临床应用

目的:讨论多层螺旋CT(MSCT)扫描及重建技术在胸部创伤中的临床应用价值。方法:57例胸部创伤病人行MSCT扫描,重建层厚2.5 mm,间隔1.25 mm,将数据传至专门工作站,对骨性胸廓进行多平面重建(MPR)、薄层最大密度投影(STS-MIP)及容积再现(VR)重建,对横断面图像及重建图像进行回顾性分析。结果:57例胸部创伤患者中,发现肺挫伤44例,肺撕裂伤4例,肺不张及肺萎缩11例,气胸27例,胸腔积液42例,肋骨骨折36例,肋软骨骨折2例,肩胛骨骨折6例,锁骨骨折3例,胸椎骨折1例。MPR图像可清楚显示骨折线的走行及移位,3D重建图像从各个方位显示了骨折的空间改变。结论:多层螺旋CT扫描能够清晰显示肺部损伤情况,胸廓重建图像可以显示骨折的立体空间改变,两者相结合,对临床制定治疗方案具有重要的参考价值。     

成人大脑中央沟在冠状面MRI上的定位

目的：探索大脑中央沟在冠状面MRI上的准确定位。方法：随机选用成年男性头部标本30例、活体健康成年男性6例,以经连合间线中点的垂线为基线,获得4mm层厚的颅脑MR冠状面图像;将头部标本开颅取脑,重要脑回着不同颜色,切制与MR扫描一致的脑断层标本。将脑断层标本与颅脑MRI相对照,统计有关结构的出现率,以确定中央沟在冠状面MRI上的定位。结果：在中央沟首次出现的断面上,背仙是丘脑的出现率左侧为93%、右侧97%,锥体束的出现率左侧为20%、右侧13%;在胼胝体压部后缘断面上,中央沟几近消失,大脑外侧面中央沟出现率两侧均为33%。结论：中央沟首次出现在背侧丘脑显现而锥体束尚未出现的1-2个断面上;在锥体束出现的断面上,外侧沟上方可以3大髓突辨认额上回、中央前回和中央后回,中央前、后回之间为中央沟;至胼胝体压部后缘断面,中央沟大多消失。     

后交通动脉的MRI与生物塑化薄层断面解剖学研究

目的探讨后交通动脉的正常表现及变异.材料和方法以MR成像和生物塑化切片技术完成140例正常人FLASH-3D和TOF-MRA横断位成像及9例标本的生物塑化薄层切片,以塑化切片、源图像及MPR、MIP图像观察后交通动脉的走行、形态及其与动眼神经的关系.结果生物塑化薄片示后交通动脉为节段显示,MRI与之有良好的对应关系,后交通动脉显示率为63.9%,胚胎型后交通动脉显示率8.9%,其中10侧与动眼神经接触,而且胚胎型后交通动脉的存在形式与大脑后动脉的显示有明显的关系.结论MRI不仅能够显示后交通动脉的走行、形态,而且能够明确与神经的关系,是评价后交通动脉的较为准确的检查技术.     

Is forward head posture relevant to autonomic nervous system function and cervical sensorimotor control? Cross sectional study

BackgroundThere is a growing interest concerning the understanding of the sagittal configuration of the cervical spine as a clinical outcome. However, evaluating sensorimotor control and autonomic nervous system for participants with forward head posture (FHP) compared to strictly matched control participants with normal head alignment has not been adequately addressed.MethodsSensorimotor control variables include smooth pursuit neck torsion test(SPNT), Overall stability index (OSI) and left and right rotation repositioning accuracy. Autonomic nervous system function includes amplitude and latency of skin sympathetic response (SSR). We measured these variables in 80 participants with definite forward head posture (Craniovertebral angle less than 50 degrees) and 80 participants with age, gender, and BMI matched normal head alignment (Craniovertebral angle (CVA) more than 50 degrees). Differences in variable measures were examined using the parametric t-test. Pearson correlation was used to evaluate the relationship between FHP, sensorimotor control, and autonomic nervous system function.ResultsThe unpaired t-test analysis showed that there were statistically significant differences between the FHP group and control group for all of the sensorimotor measured variables including SPNT, OSI and left and right rotation repositioning accuracy (P < 0.001). Also, there was a significant difference in neurophysiological findings, including SSR amplitude (P = .005), but there was no significant difference for SSR Latency (P = .7). The CVA significantly correlated with all measured variables (P < 0.001).ConclusionsParticipants with FHP exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal head alignment.     

A systematic review of the reliability of diagnostic ultrasound imaging in measuring tendon size: Is the error clinically acceptable?

BackgroundDiagnostic ultrasound (US) is a commonly used imaging modality for visualising tendon pathology and morphology. In comparison to magnetic resonance imaging (MRI), diagnostic US is perceived to have a higher risk of error when evaluating tendon size.AimTo systematically assess the evidence regarding the Intra rater and Inter rater reliability of diagnostic US measurements of tendon size.Data sourcesEight electronic databases were searched using an agreed set of keywords. Studies which investigated the reliability of tendon size (thickness or cross sectional area) using diagnostic US were eligible.ResultsCombined Inter rater and Intra rater ICC values for tendon thickness ranged from 0.45 to 0.99. Combined Inter rater and Intra rater ICC values for tendon cross-sectional area (CSA) ranged from 0.58 to 0.92. Overall, Intra rater ICC values (0.59–0.99) were marginally higher than Inter rater values (0.45–0.99) across all tendon sites. Percentage co-efficient of variation (CV%) for tendon thickness and CSA ranged from 0 to 35% across all tendons. Percentage standard error of the mean SEM% values for tendon thickness ranged from 3.33% to 7.39%.ConclusionsThe findings of this review suggest diagnostic US measures of tendon size are reliable, both in terms of relative and absolute reliability. However, the findings must be considered in light of the presence of tendon abnormalities in a large percentage of asymptomatic populations.     

Transarticular invasion of bone tumours across the sacroiliac joint

Purpose The purpose of this study was to evaluate the pattern of tumour spread across the SI articulation, correlating with cadaveric anatomic observations, in order to better understand the local spread of tumour and to assist in the assessment of local staging. Material and methods Twenty-four consecutive patients (14 male, 10 female; age range 22–89 years, mean 52 years) with primary bone tumours of the iliac bone or sacrum abutting the SI joint, in whom surgical resection of the SI joint was performed, were studied following institutional ethics approval. In all patients, preoperative magnetic resonance (MR) imaging studies of the pelvis and SI joint were reviewed for imaging evidence of transarticular extension across the SI joint. Gross pathologic and histologic assessment of possible transarticular SI joint tumour extension was performed in all patients. Nine cadaveric pelvic specimens without pelvic neoplastic disease (4 male, 5 female; age range 20–84 years, mean 59 years, median 58 years) were anatomically dissected and the articular anatomy of the SI joint examined macroscopically. Results Twelve of the twenty-four patients demonstrated imaging and histological evidence of transarticular SI joint invasion. Eight tumours infiltrated only the interosseous ligamentous aspect of the SI joint. In the remaining four cases, extensive tumour infiltrated both the cartilaginous and ligamentous aspects of the joint. No case showed tumour involvement isolated to the cartilaginous aspect of the joint. Among the cadaveric specimens studied, degenerative changes were found involving the majority of cases (6/9), with cartilage thinning and fibrillation and antero-superior marginal osteophytes seen involving the cartilaginous portion of the SI joint articulation. Four of the nine specimens demonstrated central ossification bridging the iliac and sacral aspects of the ligamentous (interosseous) SI joint. Conclusion Tumour invasion across the SI articulation favours its interosseous ligamentous portion. Factors influencing transarticular tumour extension and its preferential course across the interosseous component of the articulation have been discussed. It is particularly important to assess the interosseous ligamentous portion of the SI articulation when locally staging primary pelvic bone tumours subjacent to the SI articulation, as this will have a significant impact on planning surgical management.     

贵州省217名水族儿童神经精神发育调查

目的：调查贵州省水族儿童的神经精神发育现状。方法：在贵州省三都水族自治县,随机对6月～84月儿童进行现况调查,采用首都儿研所研制的婴幼儿发育诊断量表进行测查,共调查水族儿童217人,以汉族儿童217人为对照。结果：水族儿童发育商平均值82.82±13.53与汉族儿童发育商平均值84.07±11.98相比差异无统计学意义（P〉0.05）,大运动、精细动作、适应能力、语言、社会行为等各方面发育两民族相比差异也没有统计学意义。性别分析中水族男童和女童对比,发育差异无统计学意义（P〉0.05）。水族男童、女童与汉族男、女童对比发育也没有明显差异（P〉0.05）。发育商分段对比水族儿童发育商低下比例6.91%低于汉族儿童的比例9.22%,水族儿童优秀的比例2.30%高于汉族儿童0.92%,但经卡方检验两民族无明显差异（P〉0.05）。结论：贵州水族儿童神经精神发育与汉族儿童没有明显差异,说明两民族父母的养育观念和养育方法接近。     

Effect of exercise intervention on thigh muscle volume and anatomical cross‐sectional areas—Quantitative assessment using MRI

The objective of this study was to evaluate the location‐specific magnitudes of an exercise intervention on thigh muscle volume and anatomical cross‐sectional area, using MRI. Forty one untrained women participated in strength, endurance, or autogenic training for 12 weeks. Axial MR images of the thigh were acquired before and after the intervention, using a T1‐weighted turbo‐spin‐echo sequence (10 mm sections, 0.78 mm in‐plane resolution). The extensor, flexor, adductor, and sartorius muscles were segmented between the femoral neck and the rectus femoris tendon. Muscle volumes were determined, and anatomical cross‐sectional areas were derived from 3D reconstructions at 10% (proximal‐to‐distal) intervals. With strength training, the volume of the extensors (+3.1%), flexors (+3.5%), and adductors (+3.9%) increased significantly (P < 0.05) between baseline and follow‐up, and with endurance training, the volume of the extensor (+3.7%) and sartorius (+5.1%) increased significantly (P < 0.05). No relevant or statistically significant change was observed with autogenic training. The greatest standardized response means were observed for the anatomical cross‐sectional area in the proximal aspect (10–30%) of the thigh and generally exceeded those for muscle volumes. The study shows that MRI can be used to monitor location‐specific effects of exercise intervention on muscle cross‐sectional areas, with the proximal aspect of the thigh muscles being most responsive. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

高频超声对轻中度腕管综合征注射富血小板血浆疗效的动态评估价值

目的:探讨高频超声动态观察轻中度腕管综合征(CTS)注射富血小板血浆(PRP)疗效的评估价值.方法:选择36例(44腕)轻中度CTS为PRP组注射PRP,同时选择38例(46腕)轻中度CTS作为对照组进行激素治疗,随访1、3、6个月时分别行CTS功能评分及高频超声检查,统计分析轻中度CTS正中神经形态参数与CTS功能评...     

股部断层影像解剖

目的　为股部疾病的影像诊断提供断层解剖学依据。方法　用成年男尸右股部标本 10例 (新鲜尸及用福尔马林液固定尸各 5例 ) ,先做股部横断层之CT及MRI扫描影像 ,冰冻后再切制与其相应的股上、中及下 1/3段横断层解剖标本。结果　观察了各断层的形态结构、毗邻关系和血管、神经等的特征及其变化规律 ,测量了股骨中 1/3及下 1/3处的密质及髓腔 ,并匹配同一尸体相同断层之CT及MRI扫描影像对照 ,讨论了其解剖形态结构与影像诊断及介入放射治疗学的意义。结论　了解股部的详细断层解剖对于该部位临床疾病的CT及MRI诊断具有重要意义     

3D-CISS序列在脑池段动眼神经及其神经血管关系显示中的应用

目的应用3D-C ISS序列和多平面重组(MPR)技术探讨对动眼神经及其与神经血管关系的显示价值。方法在MPR图像上显示动眼神经脑池段的最大长度,并在该MPR图像及其连续图像、3D-TOF序列图像上研究动眼神经与大脑后动脉(PCA)、小脑上动脉(SCA)、基底动脉(BA)及后交通动脉(PCoA)的关系。结果(1)动眼神经在斜横断位、斜矢状位重组图像上以97%的几率全程显示,冠状位重组图像上以100%的几率呈点状显示;3D-TOF序列重组图像上不能清楚显示动眼神经;(2)PCA和SCA是显示率最高的动脉:59.8%(61/102)的动眼神经与PCA接触,61.8%(63/102)动眼神经与SCA接触;(3)将动眼神经走行显示与尸体3D-C ISS MR成像、断层切片标本所显示的动眼神经相对照,三者之间具有良好的对应关系。结论3D-C ISS序列结合MPR技术能够最大程度地显示脑池段动眼神经的走行特点及其与血管的关系。