64层螺旋CT冠状动脉成像图像质量控制研究

目的 探讨CT冠状动脉成像图像质量控制的临床应用.方法 102例患者采用64层螺旋CT心电门控冠状动脉成像,男68例,女34例,心率<65次/min为Ⅰ组,65～75次/min为Ⅱ组,>75次/min为Ⅲ组,每位患者的冠状动脉分为12血管段用于图像质量分析.测量冠状动脉各分支图像无伪影显示率和各分支近段和远段对比噪声比.结果 (1)所有患者总体评估结果显示,94.0%冠状动脉血管段显示无伪影.Ⅰ组冠状动脉分支无伪影显示率98.2%,Ⅱ组冠状动脉分支无伪影显 示率95.3%,Ⅲ组冠状动脉分支无伪影显示率85.0%;(2)所有冠状动脉分支平均对比噪声比为14.7±4.1.结论 64层螺旋CT有高质量的冠状动脉图像,心率影响冠状动脉图像,低心率仍是图像质量保证的关键因素.     

房颤患者的64层CTCA:平均心率对图像质量和最佳重建期相的影响

目的:评价房颤患者64层螺旋CT冠状动脉成像中平均心率对最佳图像重建时相和图像质量的影响.方法:58例房颤患者行64层螺旋CT冠状动脉成像,扫描前均未服用美托洛尔.血管图像质量分为好、中等和差.分析平均心率和患者总体图像质量之间的相关性,采用判别分析法计算获得总体图像质量为好和中等的平均心率阈值和最佳重建时相在收缩末期的平均心率阈值.结果:平均心率和患者总体图像质量之间呈负相关(r=-0.43,P=0.001);患者总体图像质量为好和中等的平均心率阈值分别为80次/min和95次/min;最佳重建时相在收缩末期的平均心率阈值为85次/min.结论:控制患者平均心率在一定阈值以下并结合舒张中期蕈建.能保证房颤患者64层螺旋CT冠状动脉成像获得较高的图像质量.     

高心率患者双源CT冠状动脉成像初步研究

目的初步探讨高心率患者无需口服倍他乐克准备的双源CT冠脉成像的扫描技术和图像质量。方法对412例患者行双源CT冠状动脉成像,其中增强扫描平均心率>100次/min的患者共有30例。行平扫和增强扫描。用增强扫描图像行多平面重建(MPR)、最大密度投影(MIP)及容积再现技术(VRT)重建。将图像质量分为3级,按美国AHA冠状动脉分段标准评价冠状动脉各个节段的图像质量。结果30例患者增强扫描平均心率为(115.6±11.8)次/min(101~139次/min),平均屏气时间为(5.7±1.2)s。冠状动脉重建的最佳时相均为收缩期。共评价424个冠状动脉节段,其中图像质量为1级者占93.9%(398/424),图像质量为2级者占5.0%(21/424),图像质量为3级者占1.2%(5/424)。结论在无需口服倍他乐克准备的情况下,双源CT用于高心率患者的冠状动脉成像可获得非常好的冠状动脉各节段图像。     

双源CT前瞻性心电触发序列扫描在房颤患者中的应用研究

目的应用双源CT前瞻性心电触发序列扫描对心房纤颤(atrial fibrillation,AF)患者行冠状动脉成像,并与回顾性心电门控螺旋扫描比较,评估二者的图像质量及放射剂量。方法对40例临床可疑冠心病的AF患者行二代128层双源CT增强扫描。随机分为两组:组1共21例(序列组),使用前瞻性心电触发序列扫描;组2共19例(螺旋组),使用回顾性心电门控螺旋扫描。基于AHA-15段冠状动脉分段法及4级评分法(1分-优秀至4分-差),由两位阅片者独立对所有冠状动脉按节段进行图像质量评价,比较两组患者的图像质量及有效放射剂量。结果序列组平均心率(94±25)次/min,心率波动(69±25)次/min;螺旋组平均心率(86±22)次/min,心率波动(65±22)次/min,组间平均心率(t=1.019,P=0.315)及心率波动(t=0.598,P=0.553)差异无统计学意义。序列组与螺旋组的图像质量优良,评分差异无统计学意义(1.29±0.55 vs 1.25±0.55;Z=-1.290,P=0.197);序列组的有效放射剂量较螺旋组显著降低(4.90±1.62 mSv vs 10.04±3.57 mSv;t=-5.988,P=0.000)。结论 AF患者双源CT冠状动脉成像中,前瞻性心电触发序列扫描与回顾性心电门控螺旋扫描相比,可以提供同样高质量的图像满足诊断需要,同时有效减低放射剂量。     

64层螺旋CT冠状动脉图像质量控制研究:最佳重组时相与心率关系

目的量化评估64层螺旋CT冠状动脉各分支不同重组时相图像质量,探讨冠状动脉CT成像最佳重组时相与心率关系。资料与方法102例患者均采用64层螺旋CT回顾性心电门控冠状动脉成像,男68例,女34例,平均年龄(58.1±9.7)岁,平均心率(66.4±11.5)次/min。心率<65次/min(n=43)为Ⅰ组,65～75次/min(n=34)为Ⅱ组,>75次/min(n=25)为Ⅲ组,每例患者的4支冠状动脉(左主干、左前降支、左回旋支、右冠状动脉)共分为12个节段用于图像质量分析。扫描原始数据以间隔5%在20%～80%时相分别回顾性重组冠状动脉图像,采用横断位、曲面重组、容积再现等方法对图像质量综合评分。结果Ⅰ组60%、65%和70%为最佳时相,Ⅱ组60%、65%时相为最佳时相,Ⅲ组右冠状动脉较优时相为35%、40%,左冠状动脉较优时相为60%、65%。结论心率和重组时相的选择是决定冠状动脉图像质量的重要因素。平均心率≤75次/min,冠状动脉各分支图像质量在心脏运动的舒张中期(60%、65%)最佳;>75次/min时,左右冠状动脉分别进行重组能明显提高冠状动脉的成像质量。     

64层螺旋CT对低龄儿童川崎病冠状动脉成像质量的探讨

目的 探讨64层螺旋CT对随访中低年龄儿童川崎病冠状动脉瘤的冠状动脉成像质量技术,并对图像进行评估分析. 资料与方法 应用64层螺旋CT对12例随访中川崎病冠状动脉瘤的男性儿童(平均年龄5.1岁,随访时间1.1～5.1年)进行回顾性心电门控技术冠状动脉成像,在无屏气状态下进行扫描,扫描时平均心率(74±12)次/min;采用"去条带状伪影"的心脏重组算法进行血管分析处理.由两名影像科医师独立对成像重组时相、每例患者的冠状动脉13个节段进行直径测量和图像质量评估,并观察冠状动脉瘤的数目、位置、形态和大小. 结果 共有114/156个节段能满足图像评价并进行直径测量,符合诊断要求率达到73%;两侧冠状动脉最佳显示相位窗集中在45%和75%～85%两个相位区间.MSCT共观察到30个冠状动脉瘤,其中8个较小或位于中远段的冠状动脉瘤超声心动图未能发现. 结论 在较高心率、无屏气扫描模式下,选择适当的对比剂剂量和流率、准确的扫描时间、合适的重组相位和有效心脏重组算法的64层螺旋CT冠状动脉成像技术,可以成为低年龄川崎病冠状动脉瘤患儿随访和诊断的重要评估方法.     

128层螺旋CT冠状动脉成像的心率变化及其对图像质量的影响

目的 探讨128层螺旋CT冠状动脉成像的心率变化及其对图像质量的影响.方法 对96例临床怀疑或确诊为冠心病的患者行128层螺旋CT冠状动脉造影检查,记录扫描期间的心率变化,根据不同的心率变化分为3组.第一组为心率≤65次/min,第二组心率为76～90次/min,第三组为心率≥90～100次/min.第四组为心率＞100次/min.分别对每组图像质量进行评价,比较不同组间的冠状动脉各节段图像质量差异.结果 第一组的图像质量优良率为97.7％,能够满足诊断率为98.8％,第二组图像质量优良率为97.1％,能够满足诊断率为97.6％,第三组图像质量优良率为93.3％,能够满足诊断率为96.8％.结论 128层螺旋CT冠状动脉成像心率变化幅度小,CTA均可显示清楚,诊断明确,可部分取代CAG.     

心房颤动患者的64层螺旋CT冠状动脉成像的初步临床研究

目的 探讨64层螺旋CT在心房颤动患者冠状动脉CT血管成像(CTA)中的应用价值.方法 分析31例心房颤动患者的冠状动脉CTA图像质量,利用血管分析软件判断血管有无狭窄并测量狭窄率,其中10例患者的冠状动脉CTA结果与冠状动脉造影(CAG)结果进行了对照分析.对于不同心率患者图像质量的比较分析采用多个独立样本(等级资料)的非参数秩和榆验.结果所有患者均采用绝对值时间法重组心脏容积数据.对31例患者中364段血管节段进行成像质量分析:心率为47～69次/min组图像质量为优、良、中和差的血管节段数分别为85、41、5和8个,心率为70～79次/min组分别为63、16、13和15个,心率为80～105次/min组分别为46、25、23和24个,3组间成像质量差异有统计学意义(H=22.08,P＜0.01).10例与CAG进行对照,共分析冠状动脉血管125段,CTA诊断血管狭窄程度≥50%的敏感度为85.0%(17/20),特异度为95.2%(100/105),阳性预测值为77.3%(17/22),阴性预测价值为97.1%(100/103).冠状动脉CTA低估了3段血管的病变,过度评价了5段血管.结论64层螺旋CT对心房颤动患者进行冠状动脉CTA检查具有一定的临床价值.     

心室率、心室率波动及心电编辑对心房颤动患者64层螺旋CT冠状动脉成像质量的影响

目的 探讨不同心室率、心室率波动对心房颤动患者64层螺旋CT冠状动脉成像(CTCA)图像质量的影响程度以及心电编辑对图像质量改善的有效性.方法 50例心房颤动患者行CTCA检查.评价心电编辑前后各节段冠状动脉血管的图像质量(优、中、差).用X~2检验分析不同心室率、心室率波动程度间及心电编辑前后图像质量的差异程度,用Pearson方法分析平均心室率及心室率波动程度与图像质量间的相关性.与冠状动脉造影结果进行比较,计算敏感性、特异性、阳性预测值、阴性预测值.结果 50例心房颤动患者,平均心室率47～153次/min,平均(89±23)次/min;心室率波动程度7.7～36.8次/min,平均(18.2±6.1)次/min.共评价冠状动脉血管节段704段,最终不可用于诊断的冠状动脉血管节段24段(3.4%),6例患者(12.0%)的CTCA图像中部分血管段无法满足诊断需要.平均心室率＞100次/min时图像质量差的冠状动脉节段数(11段)及心室率波动程度＞24次/min时图像质量差的冠状动脉节段数(11段)均明显增加(P＜0.05).冠状动脉各节段总体图像质量、右冠状动脉及远段冠状动脉血管图像质量与平均心室率及心室率波动程度均有显著相关性(r值分别为0.50、0.55、0.53、0.49、0.42和0.44,P值均＜0.05).心电编辑前后图像质量间差异有统计学意义(P=0.013).以患者为单位,与冠状动脉造影对照,诊断冠状动脉狭窄≥50%的敏感性、特异性、阴性预测值、阳性预测值分别为100%(6/6)、93.2%(41/44)、100%(41/41)、66.7%(6/9).结论 应用64层螺旋CT进行心房颤动患者的冠状动脉成像检查,可在一定平均心室率及心室率波动范围内通过心电编辑有效改善图像质量,提高检查成功率.     

64层螺旋CT冠状动脉造影图像质量影响因素分析

目的 分析不同心率下影响64层螺旋CT冠状动脉造影(CTCA)图像质量的因素.方法 对283例临床怀疑或确诊冠心病的患者进行CTCA检查.入选患者按照心率快慢分为5组;按照心率波动幅度分为3组.结果 (1)除心率为66～70次/min组和心率为71～75次/min组间冠状动脉可评估率差异无统计学意义(χ2=1.164,P=0.281)外,其余各组间差异均有统计学意义(P<0.005).(2)在心率≤75次/min时,导致冠状动脉无法评价的原因主要为钙化,在心率＞75次/min时,导致冠状动脉无法评价的原因主要为运动伪影,其次为钙化.(3)不同心率波动组中,当心率波动幅度＞10次/min时,冠状动脉的可评估率明显减低.(4)在心率≤65次/min时,冠状动脉各节段的最佳重建时相主要在75%时相,随着心率的增加冠状动脉各节段的最佳重建时相逐渐趋于45%～50%时相,当心率>80次/min时,冠状动脉各节段的最佳重建时相主要位于50%时相.结论 导致冠状动脉无法评价的原因在心率较低时主要为钙化掩盖血管腔和钙化导致的伪影所致,在心率较高时主要为运动伪影,其次为钙化.     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

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。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。