彩色多普勒超声在肝脏血管瘤的临床诊断应用

目的：探究彩色多普勒超声诊断肝脏血管瘤的临床价值。方法本文选取了2011年3月~2014年3月我院接受并治疗的60例被确证为肝血管瘤患者为一般资料,随机平均分为实验组和对照组。实验组采用彩色多普勒超声进行诊断,对照组采用CT扫描进行诊断,对病患的临床诊断结果进行分析并最终通过手术治疗证实准确率。结果：实验组采用彩色多普勒诊断在手术中被证实肝脏血管瘤28例,误诊2例,诊断准确率为93.33%。对照组30患者采用CT诊断,通过CT扫描确证肝脏血管瘤病患20例,10例误诊病患被误诊,准确率为66.67%,实验组准确率明显高于对照组。结论：通过临床实验证明采用彩色多普勒超声在检查和诊断肝脏血管瘤具有准确率高、操作简单、创面小等优点,是肝脏血管瘤检查诊断的不二之选,具有临床推广价值。     

肝内周围型胆管细胞癌的CT影像分析

目的回顾分析经病理证实的肝内周围型胆管细胞癌的CT影像表现,以提高术前诊断准确率。方法本组17例病例采用PQ-2000S单排螺旋CT平扫及三期增强扫描。结果CT平扫显示肿块呈不规则形态（13例）或类圆形（4例）,58.8%患者病灶呈低或稍低密度。增强扫描动脉期病灶无明显强化或边缘轻-中度强化,门静脉期及延迟扫描病灶强化逐渐明显,部分病例有逐渐填充趋势;肿块多合并肝内胆管扩张、肝门淋巴结肿大、附近肝叶萎缩等间接征象。结论肝内周围型胆管细胞癌CT扫描有较特征性影像表现,结合AFP等检查可与肝细胞癌和肝血管瘤等肝内其他占位病变相鉴别。     

脑内海绵状血管瘤的CT和MRI诊断

目的探讨脑实质内海绵状血管瘤（CA）的CT、MRI表现及其诊断价值。方法回顾性分析经手术病理证实的CA12例,8例行CT平扫,4例行CT增强扫描,12例均行MR检查,5例行Gd-DTPA增强扫描。结果12例CA共检出14个病灶。CA可发生于脑内任何部位,单发多见（10/12）。海绵状血管瘤CT平扫表现为类圆形高或稍高密度病灶,多数为不均匀,常伴钙化、出血。MRI平扫大部分表现为T1WI呈等信号或稍高信号,T2WI呈高、低混杂信号,11个病灶周围可见低信号环影,大多数病灶周围无水肿带及占位效应。CT和MRI增强后均呈轻度强化或无明显强化。结论CT和MRI检查对CA具有重要的诊断价值,MRI优于CT,是诊断本疾病最佳的影像学方法。     

肝脏超声诊断98例临床分析

目的研究肝脏疾病实施超声诊断的临床效果。方法整合性分析2012年4月～2013年3月我院共收治98例肝脏患者的临床资料,对脂肪肝、肝血管瘤、肝癌、肝囊肿与肝脓肿经超声诊断后得出的图像特征进行详细分析,以合理确诊疾病。结果98例肝脏患者中,48例为脂肪肝,19例为肝血管瘤,14例为肝癌,11例为肝囊肿,6例为肝脓肿。结论充分了解和掌握脂肪肝、肝血管瘤、肝癌、肝囊肿与肝脓肿经超声诊断后得出的图像特征,可有效提高疾病确诊率,值得在临床上推广使用。     

能量多普勒超声可在腹部外伤诊断中替代CT

CT是腹部钝器外伤的最佳检查手段 ,许多情况下患者不能接受 CT扫描 ,寻找 CT的替代检查有很大意义。目的　本研究旨在验证在诊断腹部脏器破裂伤或血肿中 ,能量多普勒超声检查能否成为 CT的替代手段。方法　 15例二维超声检查均正常的腹部外伤患者作为研究对象 ,年龄均在 4～ 43岁 ,采用双盲法。检查了 2 0个脏器 (13例肝、7例脾 ) ,分别做了增强 CT和能量多普勒超声。其中 5例患者应用超声造影剂 ,整个或部分脏器无 CT造影增强或能量多普勒的彩色缺损作为诊断破裂或血肿的指标。结果　两种方法均检查出 5例脏器破裂 ,(2个肝、3个脾 ) ,…     

老年慢性硬膜下血肿30例影像诊断分析

目的探讨老年慢性硬膜下血肿的影像学检查价值。方法搜集30例经手术证实的老年慢性硬膜下血肿影像检查资料进行回顾性分析;全部为男性,年龄53-87岁;30例均行CT平扫,其中行CT增强扫描4例。行MRI平扫6例。结果血肿发生在左侧16例,右侧5倒,双侧9例。双侧中有3例为手术1月后发现对侧出现硬膜下血肿。结论CT平扫在老年慢性硬膜下血肿的诊断中有非常重要的价值,CT增强扫描和MRI检查时本病的鉴别诊断非常有帮助。     

能谱CT联合胸部平扫在肺癌病理分型中的诊断价值分析

目的:探讨能谱CT联合胸部平扫在肺癌病理分型中的诊断价值.方法:回顾性收集 2021 年1 月至 2022 年3 月医院收治的 86 例肺癌患者临床资料,所有患者均进行胸部平扫及能谱CT增强扫描,以穿刺活检结果为金标准,比较胸部平扫与能谱CT增强扫描单独及二者联合诊断在肺癌病理分型中的诊断价值.结果:86 例肺癌患者穿刺活检结果显示,肺腺癌 41例,占 47.67%(41/86),肺鳞状细胞癌 25 例,占 29.07%(25/86),小细胞肺癌 20例,占 23.26%(20/86).胸部平扫、能谱CT增强扫描单独诊断及二者联合诊断在肺癌病理分型的诊断中均有较高诊断准确率,且联合诊断准确率更高,差异有统计学意义(P＜0.05).胸部平扫与穿刺活检结果具有较为理想的一致性(0.4＜Kappa＜0.75).能谱CT增强扫描、胸部平扫联合能谱CT增强扫描与穿刺活检结果具有极好的一致性(Kappa＞0.75).结论:能谱CT与胸部平扫在肺癌病理分型中均有较高的诊断准价值,且联合诊断价值更高.     

胆道手术前CT诊断评价(附87例分析)

目的 将肝外胆道手术87例术前CT诊断与术后病理诊断做对照,显示CT的诊断价值。方法 采用美国GE公司High Speed CT-Ⅰ机型平扫,部分病例做增强扫描,以病理资料做比较。结果 表明CT做为胆道手术前检查方法诊断与病理诊断具有较高的符合率。     

结核性脑膜炎的CT、MRI诊断价值

目的探讨CT、MRI对结核性脑膜炎的诊断价值。方法回顾性分析12例临床确诊的结核性脑膜炎患者的CT、MRI表现。其中CT平扫5例,1例行增强扫描;MRI平扫11例,9例行增强扫描。结果CT平扫表现为脑沟、脑裂、脑池狭窄、闭塞,钙化,脑积水,胼胝体、基底节区腔隙性梗塞,增强后显示鞍上池、侧裂池明显强化。MRI平扫表现为脑沟、脑池狭窄和闭塞,邻近的柔脑膜增厚,增强MRI上,受累的脑膜呈条片状、斑块状、结节状或环状显著强化10例;合并脑积水6例,结核球5例,室管膜炎4例,腔隙性脑梗塞3例,结核性脑脓肿2例,粟粒性脑结核1例;阴性1例。结论MRI能清楚地显示结核性脑膜炎的各种病理改变,可为临床诊断和观察疗效提供可靠依据,优于CT。     

肝异位肾上腺皮质腺瘤1例

患者女性,54岁,2018年2月体检发现右肝占位,无其他不适。实验室检查示甲胎蛋白阴性,乙肝病毒表面抗原阴性。上腹部CT示肝Ⅶ占位,MRI示肝第Ⅵ段富血供结节(图1),均考虑原发性肝癌。肝脏超声报告:肝S6段实性结节,考虑胆管细胞癌或转移癌可能。经充分检查后,行肝脏不规则切除术。     

肝海绵状血管瘤临床特点及病理分析

目的 探讨肝海绵状血管瘤的临床病理特征。方法 收集2014年1月~2017年4月我院存档的25例肝海绵状血管瘤石蜡标本,行HE染色后观察其病理形态,并结合患者病史和影像学资料总结肝海绵状血管瘤的临床病理特征。结果 共25例肝海绵状血管瘤标本,其中女性18例,男性7例;病灶位于左肝叶10例,右肝叶12例,左、右肝叶均有者3例,分布无明显规律;血管瘤单发20例,多发5例;病灶最大径4~10 cm。CT平扫表现为肝实质内圆形、类圆形或不规则形低密度影,边缘尚清楚;动脉期呈结节状强化;门静脉期强化向心性强化;平衡期和延迟期肿瘤持续向心性强化,且强化程度减低。MRI表现为T1WI呈均匀低信号,T2WI呈均匀高信号,病灶边缘清晰。肝海绵状血管瘤表现为质地柔软的肿物,切面无包膜,呈腔隙状;病变与周围肝组织分界清楚,由大量不规则形扩张的血管组成,管腔大小、形状不一。结论 肝海绵状血管瘤临床表现不明显,以女性多见,单发为主;病变主要由大小不等的异常血管腔组成,管腔内衬单层扁平内皮细胞,周围环绕纤维组织。     

肺硬化性血管瘤的CT影像学特点

目的分析肺硬化性血管瘤的CT表现,提高此疾病的影像学诊断能力。方法分析9例经病理证实的PSH的CT表现。结果CT平扫均表现为边界清楚的圆形或椭圆形肿块性病灶,9例病灶中均未见囊变、钙化。1例病灶周边可见"空气新月征"。增强后8例病灶均匀强化,1例不均匀强化;增强后CT值介于78～120Hu之间。结论中年女性CT征象表现为单发、圆形或椭圆形、边界清楚伴有重度均匀强化或空气新月征的肺内肿块时,应考虑到PSH的诊断。     

Initial clinical features of suspected coronavirus disease 2019 in two emergency departments outside of Hubei,China

With an increasing number of Coronavirus Disease 2019 (COVID-19) cases outside of Hubei, emergency departments (EDs) and fever clinics are facing challenges posed by the large number of admissions of patients suspected to have COVID-19. Therefore, it is of crucial importance to study the initial clinical features of patients, to better differentiate between infected and uninfected patients outside Hubei. A total of 116 patients suspected of having COVID-19 who presented to two emergency departments in Anhui for the first time between 24 January 2020 and 20 February 2020 were enrolled in the study. The initial clinical data of these patients, such as epidemiological features, symptoms, laboratory results, and chest computed tomography (CT) findings were collected using a standard case report form on admission. Thirty-two patients were diagnosed with COVID-19; the remaining 84 patients were referred to as negative cases. The median age of the diagnosed patients was 46 years, but only 35 years for negative cases. History of exposure to Wuhan or COVID-19 patients in the previous 2 weeks was observed in 63% of the diagnosed and 44% of negative cases. Median time from illness onset to ED admission was 5 days for all patients, diagnosed patients, and negative cases, respectively. Fever was observed in 27 (84%) and 57 (68%) diagnosed and negative cases, respectively. Nineteen (59%) diagnosed and 24 (29%) negative cases had lymphopenia on admission in ED. A chest CT scan on admission revealed the presence of pneumonia in the majority of the diagnosed patients (30 out of 32, 94%) and in 56 (67%) negative cases. Bilateral involvement and ground-glass opacity (GGO) were present in 91% and 47% of the diagnosed patients. Thirty-two patients were diagnosed with COVID-19; the remaining 84 patients were referred to as negative cases. The median age of the diagnosed patients was 46 years, but only 35 years for negative cases. History of exposure to Wuhan or COVID-19 patients in the previous 2 weeks was observed in 63% of the diagnosed and 44% of negative cases. Median time from illness onset to ED admission was 5 days for all patients, diagnosed patients, and negative cases, respectively. Fever was observed in 27 (84%) and 57 (68%) diagnosed and negative cases, respectively. Nineteen (59%) diagnosed and 24 (29%) negative cases had lymphopenia on admission in ED. A chest CT scan on admission revealed the presence of pneumonia in the majority of the diagnosed patients (30 out of 32, 94%) and in 56 (67%) negative cases. Bilateral involvement and GGO were present in 91% and 47% of the diagnosed patients.     

应用5MHz探头对单侧眼球突出的超声病理诊断研究

目的 探讨用５ＭＨｚ探头超声扫查对单侧眼球突出的诊断价值。方法 分析总结了临床经手术或ＣＴ确诊的单侧眼球突出６８例超声检查结果。结果 与手术及ＣＴ结果比较，超声图像阳性６２例（其中真阳性６０例），诊断准确率８８．２％，其中假瘤１９例，眶囊肿１４例，海绵状血管瘤１２例，转移癌５例，眼型Ｇｒａｖｅｓ病８例，血管畸形５例，海绵窦动静脉瘘２例，泪腺瘤２例，眶脓肿１例，结论 ５ＭＨｚ探头行单侧眼球突出的超声     

延时扫描对肝硬化患者肝脏增强CT检查中动脉期时相的影响

目的 探讨延时扫描对肝硬化患者肝脏增强CT检查中动脉期时相的影响。方法 选取2018年5月~2019年5月我院确诊为肝硬化且疑有门脉高压征象患者200例,按照随机数字表法分为5组,A组延时5 s、B组延时12 s、C组延时14 s、D组延时16 s、E组延时18 s,每组40例。均使用自动追踪触发扫描技术,选取膈顶上2 cm水平的降主动脉为监测点,门静脉期均于动脉期结束后48 s进行扫描,比较五组动脉期图像和门脉期图像评分、动脉期（肝固有动脉、肝实质、门静脉主干）和门静脉期（肝实质）强化CT值。结果 B、C、D、E组动脉期图像和门脉期图像评分高于A组,差异有统计学意义（P＜0.05）;B、C、D、E组动脉期图像和门脉期图像评分比较,差异无统计学意义（P＞0.05）。B、C、D、E组动脉期中肝固有动脉、肝实质、门静脉主干CT值高于A组,差异有统计学意义（P＜0.05）;五组动脉期中肝固有动脉、肝实质、门静脉主干及门静脉期中肝实质CT值比较,差异无统计学意义（P＞0.05）。结论 肝硬化患者腹部增强CT扫描中,利用自动追踪触发扫描技术,触发阈值达到120 HU后,延时12~18 s进行扫描,可获得满意且更利于诊断的动脉期图像。     

Utility of cysticercus fasciolaris antigen in Dot ELISA for the diagnosis of neurocysticercosis

Background: Clinical diagnosis of neurocysticercosis (NC) is established by CT scan and MRI. However, absolute diagnosis is not possible in a fair number of cases, and serological assays are used as adjunct. Besides, CT scan and MR imaging are resource-intensive tests and not practical for screening in endemic areas. Aim: To provide a low-cost, efficient, and reproducible assay for the detection of antibodies against cysticerci. Hence we have attempted to standardize and evaluate the diagnostic utility of the cysticercus fasciolaris antigen in a Dot ELISA assay for diagnosis of NC. Setting and Design: Tertiary hospital-based, case-control series. Materials and Methods: Confirmed cases of NC diagnosed by presence of ring lesions in CT scan or MR imaging with presence of scolex were taken as positive controls (n = 50). Negative controls (n = 50) included subjects with normal CT scan studies (n = 30) and diseased controls with ring lesions in CT scan confirmed to be neurotuberculosis (n = 20). Dot ELISA was standardized and validated with commercially available ELISA (UBI, USA) using sera from the study groups. Statistical Analysis: Chi-square test was used to compare the immunodiagnostic performance of the two tests. P value less than .05 (P < 0.05) was considered significant. Results: The Dot ELISA had a sensitivity of 88% and specificity of 74% with a positive predictive value of 77.19% and negative predictive value of 81.06%. Likelihood ratios for a positive and a negative test were 3.4 and 0.2. The sensitivity and specificity of commercial ELISA were 92% and 84% respectively. Difference between the performances of the two tests was not significant statistically. Conclusions: Dot ELISA has sensitivity and specificity comparable to ELISA for the diagnosis of NC. The test is simpler, not requiring expertise and instrumentation. Further validation of the test as a screening tool is required.     

超声检查在闭合性腹外伤诊断中的价值

目的 探讨超声检查在诊断闭合性腹外伤中的应用价值。方法 回顾性分析2013年1月~2018年1月在我院经超声检查后手术证实或CT证实的106例闭合性腹外伤患者的声像图表现。结果 106例闭合性腹外伤中95例超声探查到腹腔游离液体,均经手术证实为腹腔脏器挫裂,其中脾挫裂65例,包括延迟性脾挫裂12例,占脾挫裂18.46%。7例误诊,其中肝挫裂伤1例,复合挫裂伤3例,小肠挫裂伤3例。超声诊断与手术符合率为92.63%。11例超声未探及游离液体,均经手术或CT证实为腹腔脏器挫伤或血肿。结论 超声检查对腹腔游离液体检出在闭合性腹外伤的诊断中发挥着重要的作用。     

CT平扫诊断颈椎间盘膨出或突出症的局限性（附72例分析）

目的 探讨ＣＴ平扫诊断颈椎间盘膨、突出症的限度。方法 收集７２例做颈椎间盘ＣＴ平扫的病例，根据诊断结果进行分析。结果 ＣＴ平扫诊断颈椎间盘膨、突出症阳性率仅为４．２％（３／７２）。诊断骨质增生４７．２％（３４／７２），阴性占４８．６％（３５／７２）。结论 当ＣＴ平扫异常或诊断与临床表现不相符时，ＣＴＭ能提高正确诊断率。     

The role of the computerized tomography scanner in the cross-transmission of carbapenem-resistant Acinetobacter baumannii between hospitalized patients

ObjectiveTo assess the role of the computerized tomography (CT) scanner in cross-transmission of carbapenem-resistant Acinetobacter baumannii between hospitalized patients undergoing CT scan.MethodsA single-centre retrospective observational analysis of inpatients undergoing CT scans. Patient-unique CT scans were defined as ‘index cases’ (patients undergoing CT scan with carbapenem-resistant Acinetobacter baumannii (CRAB) colonization documented during the previous 60 days), ‘incident cases’ (patients found colonized with CRAB within 14 days following CT scan), and ‘negative cases’ (negative for CRAB before and after CT scan). CRAB acquisition was analysed by time interval between CT scan and CT scan of the prior index-case patient.ResultsAmongst 73 047 CT scans performed over 5 years, 4834 scans were performed within 12 hours of an index case. CRAB acquisition was detected in 20 patients (incident cases), including 16/2725 (5.8/1000 scans) who underwent CT scan within 6 hours of an index-case CT scan and 4/2109 (1.9/1000 scans) who had their CT scan 7–12 hours after the CT scan of an index-case patient (p 0.033, risk ratio 3.1, 95%CI 1.03–9.25). Patient characteristics for the two time periods were similar. While not the only significant predictor of CRAB acquisition (others included age and length of hospital stay prior to the CT scan), the time elapsed from an index case remained a significant predictor for CRAB acquisition on multivariate analysis (OR 0.84, 95%CI 0.74–0.95, p 0.007).ConclusionsPerforming a CT scan within 6 hours of a CT scan performed in a CRAB-positive patient was an independent predictor of CRAB acquisition, approximately tripling the risk. This probably reflects poor infection control practice in the CT suite.