肝脏局灶性结节增生的CT多期增强研究

目的探讨CT多期增强扫描对肝脏局灶性结节增生的诊断价值。方法采用螺旋CT对12例肝脏局灶性结节增生进行CT平扫及多期增强扫描,增强扫描动脉期25~30 s,静脉期55~60 s,180 s后延迟扫描。结果CT平扫10例呈低密度或稍低密度,其中5例病灶中心可见不规则更低密度影,2例呈等密度。增强扫描动脉期9例明显强化,其中4例强化均匀,5例强化不均匀,其内平扫不规则更低密度影斑痕强化不明显,3例可见供血动脉,2例病灶边缘有斑块状强化,1例强化不明显。静脉期6例呈稍高密度,4例为等密度,2例为高低混合密度影。延迟期12例均低于肝脏密度呈较低密度。结论CT多期增强扫描对肝脏局灶性结节增生的诊断具有特征性,且较准确,对临床治疗具有指导意义。     

肝脏少见原发性恶性肿瘤的CT表现

目的:探讨肝脏少见原发性恶性肿瘤的CT表现特点。方法:回顾性分析经病理证实的8例肝脏少见原发性恶性肿瘤的CT表现并复习相关文献。结果:血管肉瘤3例(巨块结节型2例,弥漫多结节型1例),平扫呈不均匀低密度,2例内部见云絮状稍高密度影;增强扫描动脉期,巨块结节型主灶呈斑片状不均匀强化,弥漫多结节型呈结节状强化,门脉期及延迟期病灶均呈持续向心性强化。恶性纤维组织细胞瘤4例,平扫以等密度为主,夹杂条带状低密度区;3例增强扫描动脉期轻度不均匀强化,门脉期及延迟期强化程度下降,另1例动脉期呈轻度强化,门脉期强化程度增高,延迟期强化度减低。上皮样血管内皮瘤1例,CT平扫呈较均匀低密度影;增强扫描动脉期呈不规则环形强化,门脉期强化程度增高且向中央扩展,延迟期肿瘤均匀强化且程度降低。结论:CT平扫+三期增强扫描并结合临床资料可提高肝脏少见原发性恶性肿瘤的诊断率,确诊仍需依靠病理学检查。     

CT finding of rare primary malignant tumor of the liver

目的:探讨肝脏少见原发性恶性肿瘤的CT表现特点.方法:回顾性分析经病理证实的8例肝脏少见原发性恶性肿瘤的CT表现并复习相关文献.结果:血管肉瘤3例(巨块结节型2例,弥漫多结节型1例),平扫呈不均匀低密度,2例内部见云絮状稍高密度影;增强扫描动脉期,巨块结节型主灶呈斑片状不均匀强化,弥漫多结节型呈结节状强化,门脉期及延迟期病灶均呈持续向心性强化.恶性纤维组织细胞瘤4例,平扫以等密度为主,夹杂条带状低密度区;3例增强扫描动脉期轻度不均匀强化,门脉期及延迟期强化程度下降,另1例动脉期呈轻度强化,门脉期强化程度增高,延迟期强化度减低.上皮样血管内皮瘤1例,CT平扫呈较均匀低密度影;增强扫描动脉期呈不规则环形强化,门脉期强化程度增高且向中央扩展,延迟期肿瘤均匀强化且程度降低.结论:CT平扫+三期增强扫描并结合临床资料可提高肝脏少见原发性恶性肿瘤的诊断率,确诊仍需依靠病理学检查.     

肝腺瘤多排螺旋CT诊断及鉴别诊断

目的 分析肝细胞腺瘤多排螺旋CT表现,提高其诊断准确性.方法 回顾性分析13例经手术或穿刺活检病理证实的肝细胞腺瘤多排螺旋CT表现.结果 9例肝细胞腺瘤平扫呈等或稍低密度影,边缘清楚.增强后9例动脉期明显均匀强化,门脉期及延迟期持续强化,1例无明显强化,始终为相对低密度影,1例呈环状强化.1例病灶较大(171 mm×109 mm),内见片状坏死和出血,增强扫描动脉期实质部分呈轻度强化,囊变坏死及出血无强化,门脉期及延迟期实质部分持续强化,且强化程度高于动脉期.另外1例有乙肝病史,增强扫描动脉期明显不均匀强化,门脉期持续强化,但强化程度有所下降.结论 多排螺旋CT平扫加三期增强扫描对肝腺瘤诊断颇具价值.     

肝局灶性结节增生的CT表现与病理对照分析

目的：总结分析肝脏局灶性结节增生（FNH）的平扫和多期增强扫描的CT表现,探讨其诊断价值。方法：回顾性分析18例（21个病灶）经病理证实的FNH的平扫及三期增强CT表现。结果：CT平扫21个病灶中7个病灶呈均匀低密度,14个呈不均匀低密度。增强扫描动脉期除中央疤痕外,19个病灶有明显均匀强化、1个中等不均匀强化、1个轻度不均匀强化,6个病灶还可见病灶中心或周边增粗、扭曲的动脉影;门脉期和延迟期扫描显示10个病灶呈略高密度,6个病灶呈等密度,5个病灶呈略低密度。平扫显示7个病灶伴有中央星状疤痕者,多期增强CT显示15个病灶有中央疤痕并于平衡期出现延迟强化。结论：CT检查能较全面显示FNH的病理特征和血供特点,FNHCT平扫为低密度,增强扫描以＂快进慢出＂为主要特征。     

肝细胞癌螺旋CT多期扫描边缘强化表现

目的分析肝细胞癌(HCC)螺旋CT多期扫描边缘强化的表现形式。资料与方法回顾性对照分析34例经手术病理证实有包膜的HCC在螺旋CT多期扫描边缘强化的表现特点，着重观察肿瘤包膜、包膜密度、包膜是否完整并与病理切片对照。结果34例中，动脉期未显示明确肿瘤包膜，门脉期和延迟期显示肿瘤包膜呈高密度影18例(52．9％)；动脉期肿瘤包膜呈低密度，门脉期和延迟期显示肿瘤包膜呈高密度9例(26．5％)；三期扫描均显示完整或不完整线状环形高密度影4例(11．8％)；动、门脉期未见显示包膜，延迟期显示包膜呈高密度影2例(5．9％)；三期扫描均未显示明确的肿瘤包膜1例(2．9％)。在多期扫描图像上，I-Ⅱ级高分化HCC包膜以完整环状强化为主；Ⅲ-Ⅳ级低分化HCC包膜以不完整环状强化为主。与病理结果作对照，不完整环状强化判断包膜不完整的符合率为92．9％。结论HCC螺旋CT多期扫描边缘强化的表现形式多样；依据CT边缘强化表现，可预测HCC的分化程度和预后。     

肝脏局灶性结节增生的CT和DSA诊断

 目的 探讨CT和DSA对肝脏局灶性结节增生(focal nodular hyperplasia, FNH)的诊断价值。方法 收集武警四川总队医院2008-06至2016-08经病理证实的5例FNH患者的CT和数字减影血管造影(digital subtraction angiography,DSA)图像,结合文献对其临床、病理和影像表现进行回顾性分析。CT为平扫加多期增强扫描,DSA检查为选择性肝动脉造影。结果 5例均为单发肿块,CT平扫均呈密度不均、边界较清的稍低密度肿块影;增强扫描动脉期病灶均明显强化,其中心为条状或放射状无强化瘢痕影;门脉期病灶呈等密度改变,中心低密度瘢痕影无强化;延迟扫描低密度瘢痕逐渐强化。DSA中病灶表现为富血供占位,供血动脉迂曲、增粗,进入病灶后呈放射状分布显示,染色均匀,境界清楚。结论 FNH的CT多期扫描和DSA表现具有一定的特征性,二者结合对其诊断与鉴别诊断极有价值。     

螺旋CT多时相扫描鉴别诊断肝细胞癌和血管瘤

目的:探讨螺旋CT多时相扫描对肝细胞癌和血管瘤的鉴别诊断。材料和方法:对37例患者(肝癌16例,血管瘤21例)行螺旋CT平扫和增强扫描,分析其表现。结果:37例平扫均发现低密度灶。肝细胞癌在动脉期75%有显著增强,呈高密度,在门静脉期和延迟期则呈低密度;血管瘤54%动脉期有典型增强表现,门静脉期100%有增强,24%全部填充,延迟期91%为高密度或等密度。结论:肝细胞癌和血管瘤在螺旋CT多时相增强扫描中,各有其典型的CT表现,两者鉴别的关键是门静脉期。     

原发性肉瘤样肝细胞癌的CT表现与病理基础

目的探讨原发性肉瘤样肝细胞癌的CT表现。资料与方法回顾性分析7例经手术病理证实的原发性肉瘤样肝细胞癌的CT表现。7例均行CT平扫和动态增强扫描。结果 7例病灶平扫均为低密度,其中6例病灶内见不规则更低密度影。增强扫描动脉期所有病灶均有强化表现,门静脉期显示原动脉期强化区域密度减低,延迟期4例病灶边缘及内部实性区有轻度延迟强化。7例中,单发6例,多发1例。结论原发性肉瘤样肝细胞癌具有肝细胞癌和肉瘤的双重特征,CT有助于提高该病的诊断准确性。     

肝脏局灶性结节增生螺旋CT的诊断研究

目的：探讨CT扫描对肝脏局灶性结节增生的诊断价值。方法：采用螺旋CT对22例肝脏局灶性结节增生进行CT平扫及多期增强扫描，增强扫描动脉期18—20s，静脉期50—60s，120—150s后延迟扫描。结果：CT平扫20例呈低密度或稍低密度其中7例病灶中心可见不规则更低密度影，2例为簿密度。增强扫描动脉期均明显强化，其中10例均匀强化，12例强化不均匀。结论：CT多期增强扫描对肝脏局灶性结节增生的诊断具有特征性，且较准确，对临床治疗具有指导意义。     

Improvement in quality of life in patients with nasopharyngeal carcinoma treated with non-invasive extracorporeal radiofrequency in combination with chemoradiotherapy

Abstract

Purpose: To improve the quality of life (QOL) of patients with nasopharyngeal carcinoma (NPC) after chemoradiotherapy (CRT), it is necessary to find an effective method to reduce the toxic side-effects of CRT.

Materials and methods: Between June 2007 and June 2010, 83 previously untreated patients with NPC were randomized to receive CRT either with or without non-invasive extracorporeal radiofrequency (ERF). All the patients underwent radiation, and weekly chemotherapy of paclitaxel 135–175 mg/m² and cisplatin 60–90 mg/m². In addition, the patients in the treatment group also underwent non-invasive ERF on a radiofrequency machine at 13.56 MHz for 1 hour at 41–43°C. After the completion of treatment, evaluation was carried out to determine the survival rate, disease-free survival time, and QOL. QOL was analyzed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Cancer Module (EORTC QLQ-H&N35) every 6 months during the three-year period.

Results: After completion of the treatments, the 36-month survival rate was 0.730 in the treatment group and 0.535 in the reference group (p = 0.041); the average disease-free survival time was 48 months in the treatment group and only 37.5 months in the reference group (p = 0.048). In the post- treatment questionnaires, several NPC-specific (pain, swallowing, speech, social eating, opening mouth, dry mouth, sticky saliva) QOL domains were better preserved with CRT + ERF compared to CRT at different time-points.

Conclusions: The combination treatment of ERF with CRT can prolong the survival rate and disease-free survival time and improve the QOL for patients with NPC.     

Changes in brain size with treatment in patients with hyper- or hypothyroidism

BACKGROUND AND PURPOSE: Although neuropsychological symptoms and signs are common in thyroid disease, their organic substrate is unknown. We performed brain MR imaging in patients with hyperthyroidism or hypothyroidism before and after treatment and correlated the results with hormonal markers. METHODS. Eight patients with hyperthyroid disease and three with hypothyroid disease underwent imaging within 1-2 days of a thyroid hormone testing. Images were registered, and brain and ventricular sizes were measured by using a semiautomated contour and thresholding technique. Changes in brain and ventricular volume were correlated with serum levels of total thyroxine (T(4)), unbound triiodothyronine (free T(3)), and thyroid-stimulating hormone (TSH) before and after treatment. RESULTS. With treatment, brain size decreased by 6,329-31,183 mm(3) in the hyperthyroid group and increased by 2,599-48,825 mm(3) in the hypothyroid group. Conversely, with treatment, ventricular size increased by 325-6,279 mm(3) in the hyperthyroid group and decreased by 760-2,376 mm(3) in the hypothyroid group. There was a highly significant correlation between reduction in brain size and reduction in T(4), as well as between the increase in ventricular size and reduction in T(4). There was a significant correlation between reduction in ventricular size and reduction in free T(3). There were highly significant correlations between reduced levels of TSH and increase in brain size, as well as between increased levels of TSH and increase in ventricular size. CONCLUSION. In thyroid disease, the size of the brain and ventricles significantly change after treatment, and these changes are correlated with T(4), free T(3), and TSH levels. The mechanism of these changes is uncertain, but it may involve osmolyte regulation, the sodium and water balance, and alterations in cerebral hemodynamics.     

Orbital phlebography in patients with Tolosa-Hunt's syndrome in comparison with normal subjects

Orbital phlebography has been reported to be pathologic in some patients with Tolosa-Hunt's syndrome (recurrent painful ophthalmoplegia). A systematic study of the phlebographic findings in Tolosa-Hunt's syndrome in comparison with a normal material seems not to have been performed. In this investigation, orbital phlebography was performed in 19 patients with Tolosa-Hunt's syndrome and in a reference group of 23 persons without the disease. In 13 of 19 patients (68%) with Tolosa-Hunt's syndrome, the phlebography was pathologic (narrowing or occlusion of particularly the third segment of the superior ophthalmic vein, partial occlusion of the cavernous sinus). Orbital phlebography was normal in all but one of the subjects in the reference group. The medical history of this subject in retrospect revealed symptoms other than painful ophthalmoplegia commonly found in patients with Tolosa-Hunt's syndrome, suggesting that he suffered from a variant of the disease causing the syndrome. In one patient with recurrent painful ophthalmoplegia a biopsy from an eye muscle showed venous vasculitis, probably indicating the basic pathology behind the phlebographic changes in patients with Tolosa-Hunt's syndrome.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Dynamic equinus with hindfoot valgus in children with hemiplegia

In children with hemiplegia, it is important to distinguish between equinus with hindfoot varus (equinovarus) or valgus (equinovalgus). Premature onset of medial gastrocnemius (GM) EMG in individuals with equinus is well documented. Premature onset of Peroneus longus (PL) EMG has been described in neurologically impaired adults with equinovalgus, but not in children. Our aim was to record the onset of PL and GM activity on the hemiplegic side of children with equinovalgus deformity. Fifteen children GMFCS 1 (3.8 yrs ± 2) with hemiplegia had a goniometric assessment of passive ankle range of motion and assessment of ankle function from video and surface EMG recording during gait. The clinical and video observations were used to determine the equinovalgus, as defined by Wren, at initial contact (IC). The premature onset of muscle activity was normalised as a swing (SW) percentage prior to IC of the following stance (ST). A paired T-test compared the onset of muscle activity between PL and GM. The ankle passive dorsiflexion was 13° ± 12° (hemiplegic side) versus 18° ± 10° (non-involved side) (p<0.05). For the non-involved limb, the onset of GM activity was at 14% of the gait cycle (midstance), the onset of PL activity was at 19% (p<0.05). For the hemiplegic limb with equinovalgus, there was a premature onset activity of PL (-24%) and GM(-8%) (p<0.001). On the non involved side, the onset of PL activity occurred, as in adults, after the onset of GM activity, during ST. On the hemiplegic side, there was no triceps surae contracture and the onset of PL activity occurred prior to the onset of GM activity, during terminal SW. This study confirmed the overactivity of PL in hemiplegic children with equinovalgus.     

Metrizamide compared with metrizoate in cardioangiography in high-risk patients with coronary artery disease

In a double-blind, randomized, two-group study of 99 'high-risk' patients mainly with coronary artery disease, the non-ionic contrast medium, Amipaque (metrizamide), was compared with the ionic medium, Isopaque Coronar (meglumine-Na-Ca-metrizoate) in cinecardioangiography. In evaluating the influence of the contrast media on the left ventricular end diastolic pressure (LVEDP), the material was divided into 2 groups, 55 patients with a basal LVEDP of 15 mmHg or less and 44 with an LVEDP above this level. In the former group LVEDP increased significantly after injection of the contrast medium into the left ventricle, but significantly less (p = 0.006) after Amipaque than after Isopaque Coronar. In the patients with a basal LVEDP above 15 mmHg, no significant change occurred in LVEDP after left ventriculography with any of the 2 contrast media. No serious complications occurred.     

Radiochemotherapy in Combination with Regional Hyperthermia in Preirradiated Patients with Recurrent Rectal Cancer

BACKGROUND AND PURPOSE: Encouraging results of phase II studies combining chemotherapy with radiotherapy have been published. In this study, the results of a multimodal salvage therapy including radiochemotherapy (RCT) and regional hyperthermia (RHT) in preirradiated patients with recurrent rectal cancer are reported. PATIENTS AND METHODS: All patients enrolled had received previous pelvic irradiation (median dose 50.4 Gy). The median time interval between prior radiotherapy and the onset of local recurrence was 34 months. The combined treatment consisted of reirradiation with a median dose of 39.6 Gy (30.0-45.0 Gy), delivered in fractions of 1.8 Gy/day. 5-fluorouracil was given as continuous infusion 350 mg/m(2)/day five times weekly, and RHT (BSD-2000 system) was applied twice a week within 1 h after radiotherapy. The primary endpoint was local progression-free survival (LPFS); secondary endpoints were overall survival, symptom control, and toxicity. RESULTS: 24 patients (median age 59 years) with a previously irradiated locally recurrent adenocarcinoma of the rectum were enrolled. The median LPFS was 15 months (95% confidence interval 12-18 months] with a median follow-up of 27 months (16-37 months). The overall 1-year and 3-year survival rates were 87% and 30%, respectively. Pain was the main symptom in 17 patients. Release of pain was achieved in 12/17 patients (70%). No grade 3 or 4 hematologic or skin toxicity occurred. Grade 3 gastrointestinal acute toxicity was observed in 12.5% of the patients. Paratumoral thermometry revealed a homogeneous distribution of temperatures. CONCLUSION: RCT combined with RHT is an efficient salvage therapy showing high efficacy with acceptable toxicity and can be recommended as treatment option for this unfavorable group of preirradiated patients with local recurrence of rectal cancer.