肝硬化并食管静脉曲张多层螺旋CT门静脉成像的临床应用

目的 研究多层螺旋CT门静脉成像(multi-detector helical computed tomography,MDCTP)评估肝硬化并食管静脉曲张破裂出血(esophageal varices bleeding,EVB)相关危险因素的临床应用价值.方法 肝硬化患者行内镜及64层螺旋CT检查,二者诊断结果 一致者53例,观测MDCTP中食管静脉曲张的最大直径、分级及类型、胃左静脉直径及开口类型、门静脉及脾静脉直径、脾脏指数大小等指标,并根据患者有无食管静脉曲张出血病史进行统计分析.结果 肝硬化并食管静脉曲张破裂出血组与非出血组MDCTP的观察指标中,食管静脉曲张最大直径、分级、胃左静脉直径等指标比较差异有统计学意义(P<0.05),其中出血组与无出血组食管曲张静脉最大直径分别为(6.9±2.2) mm、(4.9±2.2) mm,95%可信区间分别为6.1～7.8 mm、4.0～5.9 mm;胃左静脉直径分别为(6.4±1.3) mm、(5.3±1.2) mm,95%可信区间分别为5.9～6.4 mm、4.7～5.8 mm.食管静脉曲张的类型、胃左静脉的开口类型、门静脉及脾静脉直径、脾脏指数等观察指标比较差异无统计学意义(P>0.05).非条件Logistic回归分析结果 显示对EVB组影响由大到小依次分别为:胃左静脉直径、食管直径;回归系数分别为:0.696、0.401.结论 MDCTP中食管静脉曲张的最大直径及其分级、胃左静脉直径大小与食管静脉曲张破裂出血相关,对预测食管静脉曲张破裂出血有重要意义.     

肝硬化门脉血流动力学改变与食管静脉曲张破裂出血的关系

目的探讨肝硬化门脉血流动力学改变与食管静脉曲张破裂出血之间的关系。方法 96例肝硬化门脉高压症患者为研究对象,为观察组,另选取同期于我院体检的80例健康人为对照组,分别测定其门静脉血管内径、血流量及血流速度,并进行比较。结果观察组患者门静脉内径宽度、血流量明显大于对照组,而血流速度明显慢于对照组,差异有统计学意义(P0.05)。将观察组患者按病情严重程度划分为一般肝硬化、食管中下段胃底静脉曲张、静脉曲张破裂出血三亚组。三亚组间门静脉血管内径、血流量均无明显差异(P0.05)。与一般肝硬化患者相比,食管中下段胃底静脉曲张、静脉曲张破裂患者血流速度明显减慢,差异有统计学意义(P0.05),但静脉曲张破裂出血患者血流速度减慢更加明显,差异有统计学意义(P0.05),提示门静脉血流速度减慢与肝硬化门脉高压症患者食管静脉曲张破裂出血发生有关。结论肝硬化门脉高压症患者门静脉血流速度减慢可明显增加患者食管静脉曲张破裂出血的危险性。     

门脉高压症出血组与未出血组门静脉压力的对照研究

目的：探讨经皮经肝穿刺测量门静脉压力来评估曲张的食管胃底静脉发生出血风险的可行性及判断出血风险的门静脉压力参考值、是否行预防性经颈内静脉肝内门体分流术(TIPSS)的门静脉压力参考值。方法临床确诊的40例乙肝后肝硬化致食管胃底静脉曲张自发性出血患者在行 TIPSS 及经皮经肝食管胃底静脉曲张栓塞术中测量门静脉的压力;对临床确诊的40例乙肝后肝硬化致食管胃底静脉曲张未发生出血的患者在行预防性 TIPSS 及经皮经肝穿刺测量门静脉压力;对2组间的门静脉的压力进行比较。结果肝硬化门脉高压症出血组门静脉压力为(41.97±5.12)cmH 2 O,未出血组压力为(33.44±7.79)cmH 2 O,2组间差异有统计学意义(P <0.001);门静脉压力>37.45 cmH 2 O 可作为行预防性 TIPSS 的参考依据之一。结论通过经皮经肝穿刺测量门静脉的压力,可评估乙肝后肝硬化食管胃底静脉曲张发生出血的风险,通过经皮经肝穿刺门静脉压力测量可作为是否对乙肝后肝硬化食管胃底静脉曲张尚未发生出血的患者行预防性 TIPSS 的参考依据。     

内镜下组织黏合剂栓塞术治疗食管胃底静脉曲张出血的临床研究

目的比较内镜下套扎法及组织黏合剂注射法治疗肝硬化胃底静脉曲张的临床疗效。方法将154例肝硬化食管胃底静脉曲张患者随机分为内镜下套扎组(对照组)及组织黏合剂注射组(观察组),观察两组患者的再次出血发生率、曲张静脉改善有效率及并发症的发生率。结果两组患者手术均成功,均无严重的并发症发生。随访9个月,观察组3、6、9个月内再出血发生率明显低于对照组,而曲张静脉改善的有效率明显高于对照组,差异有统计学意义(P<0.05)。结论内镜下注射组织黏合剂能更加有效的预防再出血的发生,其临床疗效更为确切,可作为治疗食管胃底静脉曲张的首选方法。     

经皮经肝食管胃底静脉栓塞术治疗肝硬化静脉曲张的疗效评价

目的评价经皮经肝食管胃底静脉栓塞术(PTO)在治疗肝硬化静脉曲张的应用价值。方法对56例肝硬化合并食管胃底静脉曲张患者施行PTO治疗,其中35例因急性上消化道出血行急症止血治疗,10例为消化道出血停止后择期栓塞,11例肝硬化伴重度食管静脉曲张行预防性PTO治疗。结果56例患者食管胃底曲张静脉插管、栓塞成功率达100%。35例急性上消化道出血患者,急症栓塞术后均止血成功;11例行预防性PTO治疗病例,术后复查食管静脉曲张7例接近正常,4例静脉曲张程度由重度降为轻度。47例接受2～60个月随访,再出血5例,死亡4例,原因分别为再发消化道出血(1例),肝功能衰竭(1例),合并肝癌(2例)。结论对于肝硬化食管胃底静脉曲张患者,PTD是一种安全、有效的治疗方法,值得推广应用。     

肝血流超声参数联合血清25羟维生素D3在肝硬化患者食管胃底静脉曲张破裂出血中的预测价值

目的 探讨分析肝血流超声参数联合血清25羟维生素D₃[25-(OH) D₃]预测肝硬化患者食管胃底静脉曲张破裂出血的临床价值。方法 选取120例患者作为观察对象,依据其有无发生食管胃底静脉曲张破裂出血分为肝硬化食管胃底静脉曲张破裂出血组(A组,n=74例)和肝硬化组(B组,n=46例),同时,选取同期健康体检者100例作为对照组。三组患者均接受胃镜检查、彩色多普勒超声检查和血清25-(OH) D₃水平检测。比较三组患者门静脉内径(PVD)、门静脉流速(PVV)、肝静脉减振指数(HV-DI)、肝内循环时间(IHCT)以及血清25-(OH) D₃水平,绘制ROC曲线图,比较上述指标评估食管胃底静脉曲张破裂出血(EVH)的价值。结果 A组PVD、HV-DI水平明显高于B组和对照组,差异有统计学意义(P <0.05),PVV、IHCT水平明显低于B组和对照组,差异有统计学意义(P <0.05); A组25-(OH) D₃水平明显低于B组和对照组,差异有统计学意义(P <...     

胃左静脉MSCTA预测肝硬化门静脉高压食管胃底静脉曲张破裂岀血的价值

目的探讨胃左静脉多层螺旋CT血管造影(MSCTA)预测肝硬化门静脉高压食管胃底静脉曲张破裂岀血的临床应用价值。资料与方法应用16层螺旋CT对74例肝硬化门静脉高压症患者和200名正常对照者行上腹部增强扫描,采用多平面重组(MPR)、最大密度投影(MIP)对胃左静脉进行血管重组,观察胃左静脉和食管胃底静脉曲张情况,并测量胃左静脉最大内径进行统计学分析。结果总体肝硬化门静脉高压组胃左静脉最大内径与正常对照组比较明显增宽(P=0.00),肝硬化门静脉高压出血组、未出血组胃左静脉最大内径与正常对照组比较均显著增宽,差异具有统计学意义(P<0.05)。以胃左静脉最大内径7.0 mm为判断岀血的标准,其敏感性、特异性、准确性分别为61.5%、77.1%、71.6%。结论 MSCTA可以清晰显示胃左静脉和食管胃底静脉曲张情况;胃左静脉增宽是肝硬化门静脉高压食管胃底静脉曲张破裂出血的一个危险因素,胃左静脉内径的测量对食管胃底静脉曲张破裂岀血具有一定的预测价值。     

TIPS联合胃冠状静脉栓塞治疗肝硬化门静脉高压伴上消化道出血

目的 对比单纯TIPS和TIPS联合胃冠状静脉栓塞术(GCVE)治疗肝硬化门静脉高压症(PHT)伴上消化道出血(UGH),分析TIPS和GCVE联合应用的必要性、可行性及临床疗效.方法 回顾性分析2010年4月至2012年5月收治的38例PHT伴UGH患者临床资料,其中接受单纯TIPS治疗15例(A组),TIPS联合GCVE治疗23例(B组),观察分析手术前后血液指标、门静脉及脾脏血流动力学、脾脏形态学、消化道静脉曲张程度变化.随访术后并发症发生情况.结果 两组术后门静脉压降低、流速加快、脾静脉淤血指数降低均较术前明显(P＜0.05),B组均优于A组(P＜0.05).术后两组食管胃底静脉曲张(EGV)均明显好转(P＜0.05),B组和A组EGV好转率分别为94.7％、66.6％,急诊止血率分别为100％、75％,再出血率分别为4.3％、28.5％,B组均明显优于A组(P＜0.05).手术前后肝功能指标组内、组间比较,差异均无统计学意义(P＞0.05).两组术后肝性脑病(HE)发生率、支架原发通畅率差异均无统计学意义(P＞0.05).两组再介入通畅率均为100％,支架远端位于门静脉左支者HE发生率显著低于位于右支者(P＜0.05).结论 TIPS联合GCVE治疗肝硬化PHT伴UGH疗效确切,优于单纯TIPS.     

门静脉CTA在门静脉高压门体分流侧支血管显示中的应用

目的 研究多层螺旋CT血管成像(CTA)在门静脉高压患者上腹部分流侧支血管显示中的作用. 资料与方法 对126例门静脉高压患者行门静脉系统及侧支血管的CTA检查. 结果 126例中,CTA提示各类食管静脉曲张108例(85.7%),胃底静脉曲张117例(92.9%),单纯食管静脉曲张8例(6.3%),食管静脉曲张合并胃体部静脉曲张1例(0.8%),食管静脉曲张合并胃底静脉曲张99例(78.6%),单纯胃底静脉曲张18例(14.3%).胃左静脉显示120例(95.2%),附脐静脉显示26例(20.6%),胃网膜静脉显示10例(7.9%).发现脾肾分流道4例(3.2%),胃左肾分流道35例(27.8%). 结论 门静脉CTA可以清晰显示门静脉高压患者食管、胃底静脉曲张及主要侧支血管的走行、分布,为临床治疗方案的选择和疗效的观察评估提供有价值的影像学依据.     

多种无创性模型预测乙型肝炎肝硬化患者食管静脉曲张程度的价值研究

目的 :比较MSCT测得的脾脏体积、天冬氨酸转氨酶(AST)与血小板(PLT)比值指数(APRI)及AST与丙氨酸转氨酶(ALT)比值(AAR)对肝硬化食管静脉曲张及其分级的诊断价值。方法:根据上消化道内镜结果将108例慢性乙型肝炎肝硬化患者分为食管静脉曲张组(47例)和无食管静脉曲张组(61例);2组临床指标比较行t检验或χ~2检验;相关指标(PLT、ALT、脾脏体积、APRI、AAR)与食管静脉曲张分级的关系采用Spearman相关性分析;分析相关指标(PLT、ALT、脾脏体积、APRI、AAR)诊断有无食管静脉曲张及其分级的临界值,并计算ROC的AUC。结果:2组PLT、ALT、脾脏体积、APRI、AAR比较,差异均有统计学意义(均P0.05);ALT、脾脏体积、APRI与食管静脉曲张分级呈正相关(r=0.249、0.703、0.320;均P0.05);PLT、AAR均与食管静脉曲张分级呈负相关(r=-0.389、-0.268;均P0.05);脾脏体积诊断有食管静脉曲张、中度及重度食管静脉曲张ROC曲线的AUC分别为0.886、0.781、0.816(均P0.001)。结论:PLT、ALT、脾脏体积、APRI、AAR与乙型肝炎肝硬化患者并发食管静脉曲张密切相关;与PLT、ALT、APRI、AAR相比,脾脏体积能更好诊断和区分乙型肝炎肝硬化患者的食管静脉曲张及其分级。     

DSA功能性参数的提取与利用

本文介绍了在临床实际中利用功能性参数，对冠状动脉ＤＳＡ心肌血流灌注成像、冠状动脉血流量测定、左心室功能测定、肺动脉高压程度的评价等项目研究结果。重点讨论了提取ＤＳＡ功能性参数的一般方法，认为功能性参数在现代影像诊断学中的作用是对疾病做出程度、定量、动态及功能诊断。     

Head and neck imaging: the role of CT and MRI

High-resolution computed tomography (CT) and magnetic resonance imaging (MRI) have become indispensable tools for the evaluation of conditions involving the head and neck. Complex anatomic structures and regions, such as the orbit, skull base, paranasal sinuses, deep spaces of the neck, larynx, and lymph nodes, require that the radiologist be familiar with the imaging modalities available and their appropriate applications. The purpose of this article is to review the techniques of CT and MRI and the roles they play in clinical practice, including head and neck disorders.     

A monitoring,feedback, and triggering system for reproducible breath-hold MR imaging

A technique is described that provides improved reproducibility of breath-holding for MR image acquisition by monitoring the superior-inferior (S/I) position of the diaphragm. The method incorporates detection of the level of inspiration using an MR signal, rapid display to the patient of diaphragm position to enable breath-hold adjustment, and triggering of image data acquisition once appropriate position is attained. The response time of the system is short, approximately 10 ms. Studies in six volunteers using this method demonstrate a considerable decrease in the S/I range of diaphragm position over 10 consecutive periods of suspended respiration. The mean range is 1.3 mm with the system, while it is 8.3 mm without using it is expected that this method will be of assistance in many abdominal and cardiothoracic studies that use breath-hold techniques.     

Current Status of Optical Imaging for Evaluating Lymph Nodes and Lymphatic System

Optical imaging techniques use visual and near infrared rays. Despite their considerably poor penetration depth, they are widely used due to their safe and intuitive properties and potential for intraoperative usage. Optical imaging techniques have been actively investigated for clinical imaging of lymph nodes and lymphatic system. This article summarizes a variety of optical tracers and techniques used for lymph node and lymphatic imaging, and reviews their clinical applications. Emerging new optical imaging techniques and their potential are also described.     

骨肿瘤的MR灌注和扩散加权成像研究

目的对临床常见的骨肿瘤进行MR灌注成像(PWI)和扩散加权成像(DWI)研究,探讨其在骨肿瘤定性诊断中的价值。方法收集恶性骨肿瘤18例,良性骨肿瘤21例,行MR PWI和MR DWI,应用Functool2软件分析,于灌注像上得到病灶时间-信号曲线(TIC)、首过期(FP)信号递减幅度、TIC最大线性斜率、两次稳态信号差值;于DWI上获得病灶表观扩散系数(ADC)值;采用SPSS13.0统计分析软件,将从良、恶性骨肿瘤两组样本中获得的各种参数用成组设计的两样本均数进行t检验,采用受试者操作特征(ROC)曲线选择良恶性肿瘤鉴别诊断的阈值,计算MR PWI和MR DWI诊断恶性骨肿瘤的敏感度、特异度、和准确度。结果MR PWI显示,17/21的良性骨肿瘤TIC表现为I型(平稳型)及II型(缓降缓升型),恶性骨肿瘤TIC表现为III型和IV型(速降型);良、恶性骨肿瘤之间的FP信号递减幅度、TIC最大线性斜率及两次稳态信号差值在良、恶性骨肿瘤之间的差异均具有显著性统计学意义,其据此诊断恶性骨肿瘤的准确度分别为82.1%、79.5%和87.2%;有4例良性骨肿瘤可根据其MR-PWI作定性判断,结果误诊为恶性肿瘤。MR DWI显示:b=300s/mm2时,良、恶性骨肿瘤的ADC值的差异具有统计学意义;若以ADC1.63×10-3mm2/s为恶性阈值,其诊断恶性骨肿瘤的准确度为79.5%。MR PWI和MR DWI诊断恶性骨肿瘤的准确度分别为89.7%和79.5%。结论MR PWI比MR DWI更有助于鉴别良、恶性骨肿瘤及肿瘤样病变,但恶性骨肿瘤与富血供良性骨肿瘤及肿瘤样病变的灌注参数存在重叠,此时结合MR DWI可以提高诊断准确度。     

Diffusion-weighted and diffusion-tensor imaging of normal and diseased uterus

Owing to technical advances and improvement of the software, diffusion weighted imaging and diffusion tensor imaging (DWI and DTI) greatly improved the diagnostic value of magnetic resonance imaging (MRI) of the pelvic region. These imaging sequences can exhibit important tissue contrast on the basis of random diffusion (Brownian motion) of water molecules in tissues. Quantitative measurements can be done with DWI and DTI by apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values respectively. ADC and FA values may be changed by various physiological and pathological conditions providing additional information to conventional MRI. The quantitative DWI assists significantly in the differentiation of benign and malignant lesions. It can demonstrate the microstructural architecture and celluler density of the normal and diseased uterine zones. On the other hand, DWI and DTI are useful for monitoring the treatment outcome of the uterine lesions. In this review, we discussed advantages of DWI and DTI of the normal and diseased uterus.     

A Velocity k-Space Analysis of Flow Effects in Echo-Planar and Spiral Imaging

A velocity k-space formalism facilitates the analysis of flow effects for imaging sequences involving time-varying gradients such as echo-planar and spiral. For each sequence, the velocity k-space trajectory can be represented by k_v (k)_r; that is, its velocity-frequency (k_r) position as a function of spatial-frequency (k_r) position. In an echo-planar sequence, k_r is discontinuous and asymmetric. However, in a spiral sequence, k_r is smoothly varying, circularly symmetric, and small near the k_r origin. To compare the effects of these trajectory differences, simulated images were generated by computing the k-space values for an in-plane vessel with parabolic flow. Whereas the resulting echo-planar images demonstrate distortions and ghosting that depend on the vessel orientation, the spiral images exhibit minimal artifacts.