超声内镜、磁共振胰胆管造影、CT对胆道下段 < 4 mm的微小结石的诊断价值对比

目的对比超声内镜（EUS）与磁共振胰胆管造影（MRCP）、CT诊断胆系结石的临床价值。方法回顾我院于2016年1月~2018年12月收治的165例可疑性胆系结石患者临床资料,其中男77例,女88例,年龄54~71岁（47.54±5.23岁）,病程1~8年（4.24±0.58年）。分别采用EUS、MRCP、CT 3种检查方法对患者进行诊断,将诊断结果与手术病理诊断结果对比,分析3种诊断方法的敏感性、特异性、准确性、阳性预测值、阴性预测值以及不同直径结石的检出率。结果在诊断胆系结石方面,EUS与MRCP的敏感性、特异性、准确性、阳性预测值、阴性预测值跟CT检查方式相比,差异有统计学意义（P < 0.05）;EUS在胆系结石诊断方面的敏感性和准确性高于MRCP（P < 0.05）;在 < 4 mm结石中,EUS检出率高于MRCP和CT,而MRCP检出率高于CT（P < 0.05）。结论在胆系结石的诊断中,EUS、MRCP较CT效果更好,EUS较MRCP更具优势,尤其是对胆道下段 < 4 mm的微小结石。      

急性脑梗死临床诊断中MRI、多层螺旋CT与数字减影血管造影的比较

目的探讨MRI、多层螺旋CT（MSCT）与数字减影血管造影（DSA）在急性脑梗死临床诊断中的应用。方法对本院2019年3月~2020年12月100例疑似急性脑梗死患者的临床资料进行回顾性分析,所有患者均接受MRI、MSCT及DSA检查,以DSA结果为金标准,分析MRI、MSCT诊断结果与DSA结果的一致性,计算MRI、MSCT诊断急性脑梗死的准确度、特异性、敏感度、阳性预测值、阴性预测值。结果DSA诊断结果显示,100例疑似急性脑梗死患者中,急性脑梗死患者79例,非急性脑梗死患者21例;MRI诊断结果显示,急性脑梗死患者77例,非急性脑梗死患者23例,与DSA诊断结果一致性分析,Kappa值为0.637;MSCT诊断结果显示,急性脑梗死患者71例,非急性脑梗死患者29例,与DSA诊断结果一致性分析,Kappa值为0.524。MRI对急性脑梗死的诊断准确度、敏感度分别为92.00%、93.67%均高于MSCT的82.00%、83.54%（P < 0.05）。MRI对发病24 h内、发病72 h内检出率分别为89.29%、87.50%,高于MSCT的64.29%、70.83%（P < 0.05）。结论MRI、MSCT对急性脑梗死的诊断结果与DSA具有较好的一致性,但MRI诊断优势更加明显,可为临床尽早拟定治疗方案提供参考。      

输尿管结石螺旋CT与静脉尿路造影检查结果比较

目的比较急性肾绞痛患者螺旋CT和静脉尿路造影检查诊断泌尿系结石的检出率，花费等。材料和方法对50例临床所见急性肾绞痛伴有镜下血尿患者，均行B超、螺旋CT、静脉尿路造影等检查的患者；对所有患者的检查结果进行回顾分析，包括有无结石，结石大小和位置，输尿管扩张以及输尿管梗阻继发症状。结果所有患者中16例无结石，余患者经自行排石，输尿管镜气压弹道碎石或手术均证实有结石。螺旋CT显示了34例结石，静脉尿路造影仅显示22例结石。而结石所致输尿管梗阻螺旋CT和静脉尿路造影有同样的临床意义。结论螺旋CT平扫是急诊诊断输尿管结石准确，安全快捷的方法，明显优于静脉尿路造影检查。可将其作为急诊情况下诊断输尿管结石的首选检查方法之一。     

急性肾绞痛尿常规检查的诊断价值

目的:评估尿常规检查在急性肾绞痛病例中的诊断价值。方法:对96例急性肾绞痛患者即进行尿常规检查,待膀胱充盈后再进行泌尿系B超检查。结果:急性肾绞痛患者血尿出现率达91.7%,B超尿路结石出现率占90.6%,其中输尿管结石达89.6%。结论:急性肾绞痛最常见的病因为尿路结石,尤以输尿管结石多见,尿常规与B超检查的诊断具有高度一致性。     

螺旋CT尿路重建在肾绞痛中的诊断价值

B超及IVU是泌尿系统结石常用的诊断手段。但肾绞痛时B超和尿路平片在诊断输尿管结石时的敏感性下降，不易直接发现输尿管中下段小的结石。短期内行静脉肾盂造影，往往不能观察到患侧肾脏和输尿管显影。     

超声造影与多层螺旋CT在肝透明细胞型癌诊断及手术疗效评估中的应用比较

目的观察超声造影（CEUS）与多层螺旋CT扫描（MSCT）在肝透明细胞型癌（PCCCL）诊断及手术疗效评估的应用效果。方法选取2016年2月~2019年3月本院收治的经手术病理确诊的PCCCL患者100例,另选取同期肝脏局灶性结节增生患者42例,分别行CEUS、MSCT肝脏检查,以手术病理结果为金标准,比较CEUS、MSCT对PCCCL患者不同直径病灶、腹腔积液、后腹膜淋巴结肿大、边缘不清的诊断效果;统计CEUS、MSCT检测的灵敏度、特异度、漏诊率、误诊率;术后1年复诊时采用CEUS、MSCT结果对PCCCL患者的手术疗效（肿瘤复发、转移）进行评价。结果MSCT对直径 < 1 cm的病灶、腹腔积液、后腹膜淋巴结肿大、边缘不清检出情况优于CEUS,差异有统计学意义（P < 0.05）;MSCT对PCCCL的诊断的灵敏度、特异度高于CEUS（P < 0.05）,误诊率、漏诊率低于CEUS（P < 0.05）;MSCT对PCCCL患者术后肿瘤复发、转移的检出率高于CEUS（P < 0.05）。结论CEUS及MSCT对于PCCCL均有一定的诊断价值,但MSCT对于微小病灶及异常影像学表现的诊断效果更好,灵敏度、特异度更高,对手术疗效的评估效果更优。      

多层螺旋CT和直接数字成像系统诊断不同类型肺结核的价值

目的 探讨多层螺旋CT（MSCT）、直接数字成像系统（DDR）诊断活动性肺结核（ATB）、非ATB的价值。 方法 选择2018年2月~2019年10月我院收治的80例肺结核患者,其中ATB 39例、非ATB 41例,均行MSCT和DDR检查。观察ATB、非ATB患者DDR和MSCT征象特征,以病理结果为准,利用受者工作特征曲线分析MSCT、DDR、DDR+MSCT对肺结核诊断价值。 结果 DDR肺结核检出率65.00%,ATB组片状、边缘不清、密度不匀致密阴影检出率高于非ATB组（P < 0.05）。MSCT肺结核检出率76.25%,ATB组MSCT征象以磨玻璃密阴影,结节,树芽征,支气管壁增厚,边缘模糊实变,空洞为主,非ATB组MSCT征象以高密度结节,条索影,肺结构扭曲为主。以病理结果为准,DDR、MSCT、DDR+MSCT诊断ATB的灵敏度为64.10%、84.62%、92.31%,特异度为65.85%、68.29%、87.80%,AUC为0.638、0.752、0.888,DDR+MSCT诊断AUC高于单独DDR、MSCT（P < 0.05）。 结论 MSCT、DDR诊断肺结核均有一定价值,DDR+MSCT可提高对肺结核检出率以及ATB鉴别诊断价值。      

CT平扫和超声检查在急性肾绞痛尿路结石的运用及影响因素分析

目的：对比CT平扫、超声检查在急性肾绞痛尿路结石的诊断价值及其影响因素分析。方法：选取2018年1月—2019年12月郴州市第一人民医院收治的231例肾绞痛患者的临床资料,比较CT平扫、超声检查尿路结石的诊断符合率,以及分析影响其诊断的相关因素,单因素分析采用χ²检验,多因素分析采用二元Logistic回归逐步进入法检验。结果：231例急性肾绞痛疑似泌尿系结石患者中,最终确诊输尿管结石192例。CT诊断肾绞痛尿路结石患者敏感度、特异度和准确性分别为90.10%、92.31%、90.48%,均高于超声诊断的80.73%、74.36%、79.65%,差异有统计学意义(P <0.05)。CT检查肾绞痛尿路结石输尿管上段结石、中段结石、下段结石的准确率分别为94.38%、94.64%、80.85%,均高于超声检查的85.39%、73.21%、61.70%,差异有统计学意义(P <0.05)。单因素分析结果显示：结石大小、输尿管结石部位、肠道气体情况、体质量指数(body mass index,BMI)、膀胱充盈情况均是影响超声检查诊断的影响因素(P <0...     

B超对输尿管结石急性梗阻伴肾周积液的临床分析

目的应用B超观察并探讨输尿管结石急性梗阻致肾周积液的发生机制,以指导临床治疗。方法对输尿管结石急性梗阻伴有肾周积液的患者其放射性绞痛情况、肾及输尿管积水程度、输尿管结石部位及大小、肾周积液程度及部位进行治疗前后对照。结果1.输尿管结石伴有肾周积液患者其放射性绞痛重且持续时间长;2.肾轻至中度积水,3.输尿管近段扩张;输尿管结石大小在(4mm×6mm～22mm×12mm)间;4.肾周积液多位于肾上下极,呈月牙形液暗区或肾上下极呈月牙形暗区而肾周呈线状暗区;5.经抗炎、解痉止痛、ESWL或输尿管镜等综合治疗,症状缓解或治愈,肾周积液暗区2～4d内逐渐消失。结论B超检查能及时发现输尿管结石急性梗阻伴肾周积液情况,对临床治疗有重要指导意义。     

超声心动图和多层螺旋CT在急诊主动脉夹层中的应用价值

目的探讨经胸超声心动图（TTE）和多层螺旋CT（MSCT）在急诊主动脉夹层诊断中的应用价值。方法选取2016年1月~2020年4月在我院治疗的疑似主动脉夹层患者141例,给予TTE和MSCT检查,分析两者诊断价值差异;分析主动脉夹层和非主动脉夹层MSCT征象差异,以及主动脉夹层不同分型MSCT征象差异。结果141例疑似主动脉夹层患者,经手术或CT血管成像确诊112例主动脉夹层患者,29例为非主动脉夹层患者;MSCT诊断主动脉夹层的敏感度、准确性和阴性预测值分别为95.54%、94.33%和83.87%,明显高于TTE诊断（P < 0.05）;MSCT和TTE诊断主动脉夹层的特异性和阳性预测值比较差异无统计学意义（P>0.05）;MSCT征象中,主动脉夹层中钙化内移、主动脉区高密度、线样征和主动脉增宽的比例高于非主动脉夹层（P < 0.05）;主动脉夹层和非主动脉夹层中心包积液、胸腔积液比例差异无统计学意义（P>0.05）;MSCT征象中,A型主动夹层中主动脉区高密度比例高于B型主动脉夹层（P < 0.05）;A型和B型主动脉夹层中钙化内移、线样征、心包积液、胸腔积液和主动脉增宽比例比较差异无统计学意义（P>0.05）。结论相较于TTE,MSCT在急诊主动脉夹层诊断中有较好的应用价值,值得临床使用。      

Can noncontrast helical computed tomography replace intravenous urography for evaluation of patients with acute urinary tract colic?

The objective of this study was to determine whether helical computed tomography (CT) performed without oral or intravenous contrast agents is accurate in the evaluation of patients with suspected acute renal colic. One hundred consecutive patients with suspected renal colic or ureteral colic were referred by our institution's emergency department for unenhanced helical CT scans. We reviewed the original radiographic report for each patient and recorded the size and location of ureteral calculi and other concurrent urinary tract calculi, if any. We also recorded the presence or absence of hydronephrosis, hydroureter, perinephric edema, and periureteral edema. A total of 49 patients had ureteral calculi, 17 patients had only renal calculi, and 34 patients had no stones. Forty-nine patients had ureteral calculi, and 40 (82%) of these 49 patients had associated CT signs including hydroureter and periureteral edema. Calculi were present in the proximal ureter in 11 patients, the midureter in seven patients, and the distal ureter including ureterovesical junction in 31 patients. Calculi were seen elsewhere in the urinary tract and renal pelvis in 44 patients. Other diagnostic tests and stone passage were used to confirm the CT diagnosis of ureteral stones. The sensitivity and specificity of helical CT in evaluating ureteral calculi were 100% and 94%, respectively. Sixteen extraurinary lesions were detected in 34 patients who had no urinary calculi. Most extraurinary lesions (81%) were deemed the cause of acute flank pain. The room time for CT averaged 26 min, compared to 69 min for intravenous urography (IVU). The charge for CT was $600 compared to $400 for IVU in our institution. Unenhanced helical CT was fast and accurate in determining the cause of colic and proved to be highly accurate for emergency situations.     

高场强MRI与多层螺旋CT对膝关节隐匿性骨折的诊断价值

  目的  研究高场强MRI与多层螺旋CT（MSCT）对膝关节隐匿性骨折的检出情况及其诊断价值。  方法  以2019年1月~ 2022年1月我院收治的疑似膝关节隐匿性骨折患者90例为研究对象,所有患者均进行关节镜、高场强MRI及MSCT检查,以关节镜检查结果作为金标准,比较高场强MRI、MSCT对膝关节隐匿性骨折的检查结果与关节镜检出情况、诊断价值及对骨折塌陷程度、水平错位程度显示情况。  结果  90例疑似膝关节隐匿性骨折患者经关节镜检查确诊56例,高场强MRI检出率为92.86%,高于MSCT（78.57%,P < 0.05）。高场强MRI诊断膝关节隐匿性骨折的敏感度、特异性、阳性预测值、阴性预测值、准确度及曲线下面积（92.86%、94.12%、96.30%、88.89%、93.33%、0.935）均高于MSCT（78.57%、67.65%、80.00%、65.71%、74.44%、0.731,P < 0.05）。高场强MRI对骨折塌陷程度、水平错位程度显示率（64.44%、73.33%）均高于MSCT（43.33%、47.78%,P < 0.05）。  结论  与MSCT相比,高场强MRI对膝关节隐匿性骨折的检出率和诊断价值更高,对折塌陷程度、水平错位程度显示情况更好,可为膝关节隐匿性骨折的临床诊断提供可靠信息。      

B超诊断输尿管结石的价值

目的评价B超在输尿管结石中的诊断价值。方法对100例经手术取石、体外震波碎石和综合疗法排石证实为输尿管结石患者进行B超检查诊断分析。结果本组100例输尿管结石患者中,B超诊断正确率为94．00％,无假阳性,漏诊6例,占6．00％。结论B超诊断输尿管结石假阳性率低,可清晰显示x线阴性结石,有较高的临床应用价值和为临床及时准确地提供诊断和治疗依据,是急性。肾绞痛的首选检查方法,特别是在基层医疗单位为首选检查方法。     

Can plain film radiography improve the emergency department detection of clinically important urinary stones?

ObjectivePhysicians frequently use ultrasound to assess hydronephrosis in patients with suspected renal colic, but ultrasound has limited diagnostic sensitivity and rarely clarifies stone size or location. Consequently, up to 80% of emergency department (ED) renal colic patients undergo confirmatory CT imaging. Our goal was to estimate x-ray sensitivity for urinary stones and determine whether x-ray substantially improves stone detection (sensitivity) compared to hydronephrosis assessment alone.MethodsWe reviewed imaging reports from all renal colic patients who underwent x-ray and CT at four EDs. For each patient, we documented stone size, location and hydronephrosis severity on CT and whether stones were identified on x-ray. We considered moderate and severe hydronephrosis (MS-Hydro) as significant positive findings, then calculated the sensitivity (detection rate) of MS-Hydro and x-ray for large stones ≥5 mm and for stones likely to require intervention (all ureteral stones >7 mm and proximal or middle stones >5 mm). We then tested a diagnostic algorithm adding x-ray to hydronephrosis assessment.ResultsAmong 1026 patients with 1527 stones, MS-Hydro sensitivity was 39% for large stones and 60% for interventional stones. X-ray sensitivity was 46% for large stones and 52% for interventional stones. Adding x-ray to hydronephrosis assessment increased sensitivity in all stone categories, specifically from 39% to 68% for large stones (gain = 29%; 95%CI, 23% to 35%) and from 60% to 82% for interventional stones (gain = 22%; 95%CI, 13% to 30%). Because CT and ultrasound show strong agreement for MS-Hydro identification, physicians who depend on ultrasound-based hydronephrosis assessment could achieve similar gains by adding x-ray.ConclusionsAdding x-ray to hydronephrosis assessment substantially improves diagnostic sensitivity, enabling the detection of nearly 70% of large stones and over 80% of interventional stones. This level of sensitivity may be sufficient to reassure physicians about a renal colic diagnosis without CT imaging for many patients.     

输尿管结石的急诊诊断

目的：提高输尿管结石的急诊诊断水平，方法：对310例输尿管结石伴腰得部疼痛患者的急诊诊断方法进行回顾性分析。结果：本组患者定位诊断准确率为92％，定量诊断的准确率是91％，临床症状与体检分析定性诊断的准确率是85．8％，B超检查的定位准确率是72．5％，KUB和IVU检查的定位准确率分别为69．1％和60．3％，CT检查的定性定位准确率是69．6％。，结论：输尿管结石诱发的肾绞痛是泌尿外科急诊的常见多发病，其急诊诊断需要主观症状结合多种辅助检查综合考虑。     

信息-动机-行为技巧模型对输尿管结石气压弹道碎石术患者自护能力及预后的影响

目的 探究信息-动机-行为技巧模型对输尿管结石气压弹道碎石术患者自护能力及预后的影响。方法 选取2017年1月-2018年7月于我院行输尿管结石气压弹道碎石术的98例患者为研究对象,采用随机数字表法将其分为对照组和观察组,各49例。对照组采用常规护理,观察组采用信息-动机-行为技巧模型进行干预。比较2组护理前后的自护能力、并发症发生率、肾绞痛再发率及结石排尽时间。结果 干预后,观察组的自护能力各维度评分均高于对照组(P＜0.001),并发症发生率及肾绞痛再发率均低于对照组(χ²=4.404,P=0.036;χ²=4.438,P=0.035),结石排尽时间短于对照组(Z=-2.125,P=0.034)。结论 信息-动机-行为技巧模型能提高输尿管结石气压弹道碎石术患者自护能力,改善手术预后,值得临床推广应用。     

Sonographic diagnosis of symptomatic ureteral calculi: usefulness of the twinkling artifact

Purpose

Our aim was to analyze the value of ultrasound using the twinkling sign in the diagnosis of ureteral stones in patients with renal colic in the emergency setting.

Materials and methods

Prospective study of 100 patients with suspected renal colic who underwent an US examination, including color Doppler mode. We analyzed sensitivity, specificity, predictive values, and accuracy. We evaluated whether the stone was observed before or after the twinkling artifact, and whether the use of the Doppler color increased the examination time.

Results

US including color Doppler detected 76 of the 84 confirmed lithiasis. The sensitivity and specificity were 90 % and 100 %, respectively. The positive predictive value was 100 % and the negative 67 %. The accuracy was 92 %. A total of 59 calculi (78 %) examined by color Doppler sonography showed the twinkling artifact. Seventy percent of the twinkling-positive calculi showed the artifact before the stone itself was detected. Considering the location of the stones the twinkling sign was seen before the stone in 92 % of lithiasis located in the mid lumbar ureter (p = 0.02). The use of the twinkling artifact showed a trend to facilitate the detection of smaller calculi (<10 mm) (p = 0.08). The average examination time was 5.8 min [±4.3] (without differences between the stones detected before or after the twinkling artifact, p = 0.75).

Conclusion

Doppler US examination shows good sensitivity and specificity for the diagnosis of symptomatic ureteral stones. The twinkling artifact is useful for the early detection of the calculi, especially in the middle tract of the ureter, usually the most difficult place in sonographic diagnosis. It also seems helpful for the detection of smaller stones. The use of color Doppler does not increase the exploration time.