自发性蛛网膜下腔出血1 000例的CT诊断

目的对１０００例自发性蛛网膜下腔出血（ＳＡＨ）的ＣＴ表现与血管造影进行回顾性对照,对出血部位和病因进行分析。方法全部病例经ＣＴ与ＤＳＡ检查,观察内容是ＳＡＨ的病因及病变位置。结果１０００例自发性蛛网膜下腔出血的病例中,ＤＳＡ显示有动脉瘤５４７例,血管畸形２８９例,动脉硬化１６１例,其他３例。ＣＴ诊断动脉瘤所致出血４６１例,血管畸形２５９例,动脉硬化１５１例。结论ＣＴ对ＳＡＨ定性、定位有一定意义,对于急诊病人的治疗、手术引流及血管造影的选择具有很大的参考价值。     

自发性肾破裂致肾周和腹膜后出血的CT诊断（附18例报告）

自发性肾破裂致肾周和腹膜后出血的ＣＴ诊断（附１８例报告）宦怡，王禾，荆自芳，郭庆林自发性肾破裂出血少见，一般发生在病理肾，有关其ＣＴ表现文献报告不多。我院自１９８３年以来ＣＴ扫描遇到１８例，其中１０例经手术病理证实，１０例中血肿由肾透明细胞癌引起者４...     

肾血管平滑肌脂肪瘤的DSA特征性表现及介入栓塞治疗

目的：研究肾血管平滑肌脂肪瘤（ＡＭＬ）的ＤＳＡ特征性表现及介入栓塞治疗问题；材料与方法，１５例症状性肾ＡＭＬ，男５例，女１０例，平均年龄４６岁，经Ｂ超和／或ＣＴ诊断正确１０例，误诊５例，全部病例接受ＤＳＡ检查，并用自制的中药白芨粉粒作血管栓塞剂，超选择性动脉栓塞治疗７例，另外８例接受手术治疗；结果１５例均被ＤＳＡ诊断为肾ＡＭＬ。其特征性表现为，动脉期，肿瘤内中小动脉葡萄串联假性动瘤形成（１４例）实     

蛛网膜下腔出血的CT与临床（附94例分析）

本文分析７４例经腰穿证实的自发性蛛网膜下腔出血（ＳＡＨ）及２０例经ＣＴ检查为外伤性ＳＡＨ的ＣＴ和临床表现。着重探讨了自发性ＳＡＨ的病因诊断，笔者认为常见原因是颅内动脉瘤、脑动静脉畸形（ＡＶＭ）、高血压动脉硬化。而动脉瘤、ＡＶＭ最常见，占查出原因的７４％，ＣＴ像上有ＳＡＨ表现的又以动脉瘤最常见，根据ＣＴ像上ＳＡＨ的分布及附近并发的脑内血肿可推断动脉瘤破裂的位置。本文还概括了ＳＡＨ典型的临床表现和常见     

肾血管平滑肌脂肪瘤自发性出血的CT分析

目的:评价螺旋CT检查对肾血管平滑肌脂肪瘤自发性出血的意义,提高对该病的诊断与鉴别诊断的认识.方法:回顾性分析12例肾血管平滑肌脂肪瘤自发性出血患者的CT和病理特征.结果:12例肾血管平滑肌脂肪瘤自发性出血主要CT表现为肾实质内密度不均的肿块内含更低密度影(脂肪),其CT值为-20～-90 Hu.其中肾肿块内出血5例,肾肿块内出血并包膜下出血3例,肾肿块内出血并肾周积血2例,肾肿块内出血并腹腔积血2例.动态增强扫描肾血管及软组织成分明显强化,脂肪成分及出血均不强化.本组12例术前诊断与手术病理诊断结果符合率100%.结论:螺旋CT及多期动态增强扫描对判断肾血管平滑肌脂肪瘤自发性出血具有重要临床价值,有助于术前定位定性诊断.     

自发性肾破裂11例报告

目的：探讨自发行肾破裂的诊断及治疗方法。方法：回顾分析自发性肾破裂１１例并复习文献。结果：本组中肾血管平滑肌脂肪瘤（ＡＭＬ）并出血６例,肾癌１例,原因不明４例。原因不明４例保守治疗成功,余７例均手术治疗。结论：掌握本病临床特点配合ＣＴ检查,可提高诊断率。原因不明者,行肾切除应谨慎。     

肾血管平滑肌脂肪瘤的非典型

分析肾血管平滑肌脂肪瘤的非典型ＣＴ表现，探讨提高非典型ＲＡＬ的ＣＴ诊断水平。材料和方法：回顾分析了２５例经手术，病理证实的ＲＡＬ的非典型ＣＴ表现，并与病理结果对照。结果；２５例ＲＡＬ非典型ＣＴ表现为：（１）较均匀的脂仿密度；（２）较均一的软组织密度；３伴肾静脉，下腔静脉栓塞；４．其它：肿瘤与邻近结果界面不清，出血，合并其它肾病变。     

CT对自发性肾破裂出血病因诊断的价值(附20例报告)

自发性肾破裂出血临床少见 ,多见于病理肾。本文收集经ＣＴ检查发现的自发性肾破裂出血 2 0例 ,对其血肿及病理肾ＣＴ表现作回顾性分析 ,探讨ＣＴ对自发性肾破裂出血病因诊断的价值。报告如下。1　临床资料1 1　一般资料　本组 2 0例中 ,男 7例 ,女 1 3例 ,年龄 2 3～ 70岁 ,平均 3 8岁。主要临床表现 :突发腰腹部疼痛 ,伴或不伴血尿。1 2　ＣＴ检查　本组 2 0例在发病后 1 5ｄ内行首次ＣＴ平扫 ,其中 1 6例加作增强扫描 ,8例复查扫描。层距 0 .5～ 1ｃｍ ,层厚 0 .5～ 1ｃｍ。1 2 1　血肿显示　本组 2 0例 ,ＣＴ能清楚显示血肿分布于不…     

肾血管平滑肌脂肪瘤自发性出血的CT诊断

目的:探讨肾血管平滑肌脂肪瘤(AML)自发性出血的CT征象及诊断价值。方法:搜集经手术病理证实的肾AML并发出血10例,分析其CT表现。结果:全部病例均为多脂肪型,右肾6例,左肾4例,肿瘤直径8.5~25.0 cm,均有不同程度肾实质破坏。其中急性出血8例,肿瘤内出血表现为瘤体内片状或地图样高密度区,肾周血肿显示片带状软组织密度环绕在肿瘤和肾脏周围或脂肪密度混杂在软组织中,肾旁出血表现为血液在腹膜后间隙广泛延伸,慢性腹膜后血肿2例,表现为较大的混杂密度团块增强后包膜中度强化。结论:自发性出血是肾AML常见而严重的并发症,CT是诊断本病最好的影像学检查方法之一,能明确出血部位、范围,估计出血量和肾组织破坏程度,为临床诊断和治疗提供有价值的信息。     

自发性肾破裂CT诊断价值

目的:探讨CT对自发性肾破裂诊断的价值。方法:经手术证实自发性肾破裂6例,对其CT表现作回顾性分析。结果:CT可以确定自发性肾破裂病因、血肿分布及形态以及显示破裂位置。结论:CT扫描简单迅速,对于大多数自发性肾出血能做出病因学诊断,为临床选择治疗方案提供重要依据。     

Colonoscopy with computed tomography with volume reconstruction. The results and a comparison with endoscopy and surgery

PURPOSE: Virtual CT colonoscopy is a novel technique whose diagnostic accuracy and clinical yield are currently investigated. Several studies have shown its capabilities in detecting colon and rectal cancers. We report the results of a preliminary experience with the volume rendering technique and compare CT colonoscopy with endoscopy and surgery. MATERIAL AND METHODS: Our series consisted of 25 patients with colon cancer confirmed at endoscopy and/or surgery. All examinations were carried out with a spiral CT scanner Philips Tomoscan AVE1. Intestinal preparation was adequate in all patients, consisting in gas insufflated immediately before acquisition, after the injection of 100 mL iodinated contrast agent. All examination were performed in prone position using axial 5 mm slices with 5 mm table feed (pitch 1) and 2 mm reconstruction index; 120 kV and 200-250 mA were used. Images were transferred to a workstation (Easy Vision, Philips, release 4.2.1.1) for processing. We acquired multiplanar (MPR) and virtual endoscopic images with volume rendering; the selected threshold was -250 to -600 Hounsfield Units. Virtual endoscopic images could be obtained in 23 of 25 cases. The results of the radiological study were compared with endoscopic and surgical findings in 25 and 17 cases, respectively. RESULTS: Endoscopy and surgery detected 46 lesions: 29 were malignant and 17 benign. Axial CT and MPR alone detected 35 lesions (76%), 29 of them malignant and 6 benign. The 11 benign lesions missed by axial CT ranged 6-8 mm in diameter. There were no false positives. CT colonoscopy alone detected 66 lesions, but 22 of them were false positive due to residual stool in the colon (21 cases) and to residual barium in the colon (1 case). Combining CT colonoscopy and axial and MPR images enabled to correct the false positive diagnoses made by CT colonoscopy alone and to decrease the false negative ratio of axial and MPR images. Forty-one of 44 lesions (93%) were detected. Thirty-seven lesions were found in the 17 surgical patients; 34 of them were correctly identified combining CT colonoscopy and axial and MPR findings, while endoscopy detected only 31 lesions. Thus, CT had 92% sensitivity, versus 83% of fiberoptic endoscopy. CONCLUSION: In this preliminary experience volume rendering CT colonoscopy exhibited high sensitivity in detecting colon cancers, but their correct evaluation and characterization can be obtained if axial and MPR studies are combined. Further investigation and technological developments are necessary to define the yield of this new technique.     

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.     

Quantitative evaluation of muscle perfusion with CEUS and with MR

Functional imaging might increase the role of imaging in muscular diseases, since alterations of muscle morphology alone are not specific for a particular disease. Perfusion, i.e., the blood flow per tissue and time unit including capillary flow, is an important functional parameter. Pathological changes of skeletal muscle perfusion can be found in various clinical conditions, such as degenerative or inflammatory myopathies or peripheral arterial occlusive disease. This article reviews the theoretical basics of functional radiological techniques for assessing skeletal muscle perfusion and focuses on contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) techniques. Also, the applications of microvascular imaging, such as in detection of myositis and for discriminating myositis from other myopathies or evaluating peripheral arterial occlusive disease, are presented, and possible clinical indications are discussed. In conclusion, dedicated MR and CEUS methods are now available that visualize and quantify (patho-)physiologic information about microcirculation within skeletal muscles in vivo and hence establish a useful diagnostic tool for muscular diseases. Invited review article to European Radiology.     

Radiotherapy with and without temozolomide in elderly patients with glioblastoma

Background and purpose

The optimal treatment for elderly patients (age ???70?years) with glioblastoma (GBM) remains controversial. We conducted a retrospective analysis in 43 consecutive elderly patients with glioblastoma who either underwent radiotherapy (RT) or radiotherapy plus concomitant temozolomide (TMZ).

Patients and methods

A total of 43?patients (???70?years of age, median age 75.8?years) with newly diagnosed glioblastoma and a Karnofsky performance status (KPS) ???70 were treated with RT alone (median 60?Gy in 2?Gy single fractions) or RT plus TMZ at a dose of 75?mg/m² per day. The two groups were well-balanced; univariate (log-rank test) and multivariate Cox proportional hazards analysis were used to identify relevant prognostic factors.

Results

The median overall survival (mOS) of the entire patient cohort was 264?days (8.8?months) and the median progression-free survival (PFS) was 192?days (6.4?months). The factors age, sex, previous surgery, KPS, and concomitant use of TMZ had no significant influence on OS/PFS; multivariate analysis was performed to obtain adjusted hazard ratios. TMZ use resulted in a trend toward poorer overall survival when applied concomitantly (314?days compared to 192?days within the TMZ group, p?=?0.106). The subgroup analysis revealed that TMZ use resulted in significantly worse survival rates in patients with KPS70 (p?=?0.027), but for patients with KPS80 this difference was not detectable.

Conclusion

TMZ should only be used carefully in elderly patients with unfavorable KPS. In this patient cohort, radiotherapy alone is a reasonable option. Standard RT plus concomitant TMZ may be an advantageous treatment option for elderly patients with newly diagnosed glioblastoma who present with good prognostic factors.     

Intrahepatic arterioportal fistula and its treatment with detachable balloon and transcatheter embolization with coils and microspheres

BACKGROUND: Although intrahepatic arterioportal fistula (APF) due to acquired or congenital causes are infrequent, they are listed among the causes of portal hypertension. PURPOSE: The aim of this study was to present the results of intrahepatic APF treatment with embolotherapy in six cases. MATERIAL AND METHODS: Transarterial detachable balloon and coil embolization was used on six consecutive cases with traumatic intrahepatic APF from 1989 to 2003. Six-month follow-up angiography was obtained in every case. RESULTS: Successful disconnection of hepatic arterial and portal system was achieved in five cases. At least symptomatic improvement was achieved in one. CONCLUSION: Transcatheter embolization may be the first line of treatment for intrahepatic APF.     

肝癌经肝动脉栓塞术后癌灶化脓性感染的诊断和治疗

报道了７例肝癌经肝动脉栓塞术（ＴＡＥ）后合并感染、脓肿的病例。发生此一严重并发症的机率约为１．４％（７／４９５）。诊断主要依靠临床症状及ＣＴ、Ｂ超影像。在ＣＴ导向下的有效引流和对残癌组织用无水酒精冲洗则是最主要的治疗方法。其转归大概可分为：（１）脓肿痊愈、肿瘤姑息；（２）脓肿痊愈，活癌子灶仍存；（３）死于无法控制的感染。     

艾滋病合并肠管淋巴瘤X线、CT表现与病理

目的：探讨艾滋病合并肠管淋巴瘤的影像学特征表现与病理。方法：回顾性分析3例经活检及尸体解剖病理确诊的艾滋病合并肠管淋巴瘤患者的CT与病理资料。3例均经CT检查,其中2例经上消化道造影,1例钡剂灌肠造影。1例剖腹探查,切除部分增厚肠管组织病理证实,1例尸体解剖病理组织分析证实。结果：2例肠管淋巴瘤发生在空肠,1例发生在降结肠,影像与大体病理均表现为肠管壁不均匀增厚,管腔狭窄,充盈缺损,病理分型均为B细胞淋巴瘤。结论：艾滋病合并肠管B细胞淋巴瘤CT表现与病理符合度高。     

Suicide with moclobemide and perazine

A 51-year-old woman who was diagnosed as suffering from depression was found dead in her flat. The autopsy revealed no morphological changes sufficient to explain death. Toxicological analysis was performed and the drugs moclobemide (49.9 mg/l), perazine (1.27 mg/l) and some metabolites were identified in the blood. A combined drug intoxication resulting in synergistic effects to cardiovascular disorders was proposed as the cause of death. Received: 10 November 1997 / Received in revised form: 29 January 1998     

Three homicides with darts tainted with succinylcholine: autopsy and toxicology

In emergency departments, intoxication with the muscle relaxant succinylcholine (SUX) often leads to a potentially lethal respiratory paralysis or other deleterious side effects. However, homicide cases with SUX poisoning are very rare because the toxic or lethal concentration ranges of SUX have not yet been determined. We described three uncommon homicide cases due to acute poisoning by darts contaminated with SUX. All the victims died quickly (less than 30 min) after being shot by an especially designed dart gun. Succinylmonocholine (SMC), a metabolite of SUX, was used as a marker to detect the latter. HPLC-MS/MS analysis demonstrated the presence of SUX in the droplet residues of the darts and SMC in the blood and urine in all cases. SMC concentrations of 0.45, 14.0, and 17.9 ng/ml were detected in the victims’ blood and 259.0 ng/ml in the urine from the third case. The main pathological changes consisted of hemorrhage of the injured soft tissues, visceral congestion, severe pulmonary edema, and multifocal petechial hemorrhage of the heart and lungs. Taken together, the findings supported a diagnosis of fatal SUX poisoning. Futhermore, our study provided a reference for the lethal concentrations of SUX poisoning.