C臂CT在肺小结节胸腔镜切除术前定位中的应用

目的 探讨C臂CT在肺小结节胸腔镜术前定位中的应用价值.方法 回顾性分析2011年1月至2015年12月51例患者51个孤立性肺结节(SPN)于电视胸腔镜肺叶切除(VATS)术前行C臂CT引导下Hook-wire定位技术,并统计该技术的成功率、定位时间、并发症、VATS转开胸手术率,以及SPN平均大小,距脏层胸膜距离、病理学结果.结果 C臂CT引导下Hook-wire定位成功率100％,平均定位时间16 min,无症状气胸发生率7.8％,无症状出血率21.6％,1例(2.0％)发生脱落,SPN平均大小10.7 mm,距脏层平均距离25.3 mm,穿刺距离(皮肤至肺结节的距离)66.7 mm,恶性SPN占60.8％.结论 C臂CT引导下Hook-wire肺小结节定位准确、安全、快速,是一种高效的引导方式,具有临床应用价值.     

Breast skin calcifications: localization with a stereotactic device

Calcifications that lie within the skin of the breast may be mistakenly thought to be intraparenchymal on mammograms if they are projected over breast tissue in two views. A simple, reliable technique was developed to determine calcification location. It uses a commercially available stereotactic localization device and has been used successfully in six patients.     

Rectal stenosis. A rare complication of chronic salpingitis caused by an intrauterine device

The authors describe one case of rectal stenosis complicating chronic salpingitis in a patient carrying an intrauterine device. This observation is peculiar in that the inflammatory fibrous reaction is very intense, spreading all over the pelvis and forming a pseudotumoral mass sheathing the rectum. The clinical signs were mainly digestive, including a rectal syndrome: cramplike pelvic pain before defecation, tenesmus, constipation, abdominal pain and induration of the anterior aspect of the rectum observed during the clinical examination. Radiological examinations (barium enema, ultrasound, CT) show a tissue mass within the pelvis, with considerable thickening of the rectal wall. Ultrasound-guided biopsy in the pelvis yielded only nonspecific inflammatory signs with dominant fibrosis. The diagnosis of rectal stenosis caused by chronic salpingitis complicating the presence of an IUD was made only during surgery.     

Use of a novel percutaneous biopsy localization device: initial musculoskeletal experience

OBJECTIVE: To preliminarily evaluate a new CT-biopsy guidance device, the SeeStar (Radi, Uppsala, Sweden), for use in musculoskeletal applications. DESIGN: The device was evaluated using an imaging phantom and in various simulated clinical biopsy situations. The phantom study was undertaken to optimize the linear metallic artifacts produced by the guidance device. The phantom and guidance device were imaged with CT after altering different imaging parameters, including field of view, filter, focal spot size, kV, mAs, slice thickness and pitch. Clinical biopsy situations were simulated for a superficial biopsy, a deep biopsy and a horizontal biopsy approach. RESULTS: Altering CT parameters had little effect on the subjective appearance of the linear metal artifact, which is used to plan the biopsy approach. Placement of an 18-G needle inside of the biopsy device was subjectively helpful in exaggerating the artifact. Use of this artifact could be helpful in planning biopsy approach for deep lesions or lesions near critical structures. The metal guide on the device adequately supports a standard biopsy needle, making it potentially advantageous for biopsy of superficial lesions and lesions approached from a horizontal orientation. CONCLUSION: Use of this CT-biopsy guidance device is potentially useful for musculoskeletal applications. The linear metal artifact produced by the device can help plan the biopsy approach. The device can also be useful in biopsy situations where the biopsy needle requires external support during imaging.     

A device for immediate determination of focal depths during the localization with a therapy simulator (author's transl)]

Construction and capability of a measuring set-up are described which enables the direct display and storage of distances in a patient's body at arbitrary reference levels during the localization. The arrangement is characterized by a simple mounting immune from disturbances, and it exhibits a high measuring accuracy.     

Intrauterine contraceptive device localization by clinical evaluation and real-time ultrasonography

A total of 43 Intrauterine Contraceptive Device (IUD) wearers were examined clinically and ultrasonically in order to ascertain the intrauterine position of IUDs (copper devices of five different types). The time elapsed from the insertion was 2-26 months. The mean age of the women was 28 years; 95% of them were parous. The intrauterine location of the IUD was assessed clinically by means of threads cut to a standard length. In the ultrasound examination, the distance of the uppermost point of the stem of the device from the fundal wall was measured within an accuracy of 1 mm. The clinical assessment of the IUD location was found to agree surprisingly closely with the results of the ultrasound examination. The clinical assessment deviated significantly from the ultrasonography findings in about 10% of the cases.     

Choledocho-gastric fistula. A rare complication of a cholangiocarcinoma

A case of choledocho-gastric fistula resulting from a cholangio-carcinoma is reported. The final diagnosis was obtained by ERCP, whereas CT, barium examination, and gastroscopy initially did not allow a conclusive diagnosis. The only clinical finding was epigastric pain. Choledocho-gastric fistula is extremely rare.     

A rare localization of osteomyelitis in a child

The authors report a case of osteomyelitis of the anterio-inferior spina iliaca. This original observation actually illustrate the difficulty of the diagnosis of osteomyelitis. They stress the interest of plain radiographs which, if correctly read, would have enabled an early diagnosis, thus avoiding more complex examinations.