X线摄影和螺旋CT诊断乳腺良恶性肿瘤的评价

目的：参照X线摄影在乳腺疾病诊断方面的特点．评价用螺旋CT扫描乳腺技术的诊断价值。方法：将外科手术证实的156例乳腺疾病患者分为乳腺癌组和非乳腺癌组．观察X线摄影和螺旋CT扫描对乳腺良恶性疾病诊断的准确性，并比较各自的优缺点。结果：156例有乳腺肿块的患者中．经手术和病理证实乳腺癌65例．乳腺良性疾病91例。65例乳腺癌中有10例乳腺X线摄影检查为阴性．其中4例因腺体致密而不能确诊。这4例中螺旋CT检出2例阳性病变。乳腺X线摄影诊断的敏感性和特异性分别为84．6％和83．5％．螺旋CT扫描为83．1％和76．9％。乳腺X线摄影和螺旋CT扫描的阳性预测值分别为78．6％和72．0％，其阴性预测值为88．4％和86．4％。结论：对于乳腺良恶性肿瘤的检查．首选乳腺X线。必要时CT可作为补充。     

PET-CT在乳腺癌诊断中的应用价值

乳腺癌是当今大多数国家妇女最常见的恶性肿瘤.在过去的数十年中,正电子发射体层显像（PET）的应用极大地提高了乳腺肿瘤的临床诊治率.然而由于PET对肿瘤病灶缺乏准确的解剖定位而使18F-氟代脱氧葡萄糖（18F-FDG）PET临床应用的准确性受到限制.PET-CT的完美结合使对肿瘤的解剖定位和诊断的敏感性及特异性得到了明显的提高.本文着重介绍PET-CT在乳腺癌治疗后再分期、疗效观察、术前分期和放疗计划拟定中的应用价值.     

PET-CT在乳腺癌诊断中的应用价值

乳腺癌是当今大多数国家妇女最常见的恶性肿瘤。在过去的数十年中,正电子发射体层显像(PET)的应用极大地提高了乳腺肿瘤的临床诊治率。然而由于PET对肿瘤病灶缺乏准确的解剖定位而使18F-氟代脱氧葡萄糖(18F-FDG) PET临床应用的准确性受到限制。PET-CT的完美结合使对肿瘤的解剖定位和诊断的敏感性及特异性得到了明显的提高。本文着重介绍PET-CT在乳腺癌治疗后再分期、疗效观察、术前分期和放疗计划拟定中的应用价值。     

钼靶和MSCT在乳腺癌诊断中的应用价值

目的:探讨X线钼靶及其与MSCT联合应用在乳腺癌诊断中的应用价值。方法:回顾性分析72例经手术或穿刺病理证实为乳腺癌患者的钼靶及MSCT的影像资料。结果:钼靶摄片及其与MSCT联合应用对乳腺癌检出的正确率分别为78%和92%。结论:钼靶X线摄影可以作为乳腺疾病的常规和首选检查方法,联合MSCT检查,可以明显提高乳腺癌诊断的正确率。     

Multidetector-row helical CT: analysis of time management and workflow

The purpose of this study was to evaluate time management and workflow for multidetector-row helical CT (MDCT). Time for patient and data handling of at total of 580 patients were evaluated at two different time periods (December 1999, August 2000), each for the following baseline measurements: (a) change of clothes/instruction; (b) patient placement on the CT table/i.v. catheter; (c) CT planning and programming; (d) CT data acquisition; (e) CT data reconstruction; (f) CT data storage/printing. All imaging was performed on a Somatom Volume Zoom (Siemens, Erlangen, Germany). Time measurements summarized for different CT protocols revealed the following: (a) 5:01 min (+/- 2.06 min); (b) 4:36 min (+/- 2.43 min); (c) 4:11 min (+/- 2.55 min); (d) 0:43 min (+/- 0.15 min); (e) 6:59 min (+/- 2.39 min); (f) 09:51 min (+/- 3.51 min). Planning and programming was most time-consuming for CT angiography, whereas chest and abdominal CT needed only 3:26 and 3:30 min, respectively. Reconstruction time was highest for HRCT (9:22 min) and CTA (9:03 min). Data storage/printing was most time-consuming for HRCT (13:02 min), followed by combined neck-chest-abdomen examinations (12:19 min). Comparing the two time periods, during which a software update was performed, a mean time reduction of 4:31 min per patient (15%, p<0.001) was achieved. Whereas CT data acquisition time is no longer a problem with MDCT, patient management, data reconstruction, and data storage are the most time-consuming parts. Well-trained technicians, state-of-the-art workstations, and fast networking are the most important factors to improve workflow.     

CT动态增强扫描对周围型肺癌的诊断评价

目的　探讨动态增强CT对肺癌的诊断价值。方法　选择直径≤ 4cm的孤立性肺结节 42例行动态CT增强研究 ,其中经病理及临床证实的周围型肺癌 3 0例 ,测量其增强前后各时间段扫描的CT值变化 ,绘制时间 -密度曲线 ,分析肺癌的增强特征。结果　孤立性肺结节静注碘剂 10 0ml后 ,所有肺癌均显著强化 ,分 3个类型 :均匀小结节状强化 19例 ,不均匀中心团块状强化 5例和周边不规则强化 6例。结论　动态CT增强扫描对周围型肺癌的诊断及鉴别诊断极具价值     

螺旋CT经动脉门脉造影扫描时间窗的临床研究--造影剂注射速率对螺旋CTAP动态增强的影响

目的　研究造影剂注射速率对螺旋CTAP动态增强的影响 ,寻找适宜的注射速率。方法　 3 2例肝癌患者分成四组。经肠系膜上动脉注入浓度为 2 2 5mg/ml的泛影萄胺 80ml ,注射速率分别为A :3 .0ml/s ;B :2 .5ml/s ;C :2 .0ml/s ;D :1.5ml/s ,选一固定层面作 2 5次单层动态扫描 ,间隔时间 3s。测定每幅图像上肝实质和肿瘤的CT值 ,分别画出时间—密度曲线。分析肝实质和肿瘤动态增强特征。结果　①四组肝实质增强峰值时间 (s)分别为A :3 4.6± 5 .4;B :3 7.2± 4.2 ;C :3 9.1± 3 .8;D :49.7± 5 .1。A、B、C之间无显著性差异 (Ρ >0 .0 5 ) ,A、B、C与D之间有显著性差异 (Ρ <0 .0 1)。②四组肝实质增强峰值 (HU )分别为A :187.5± 13 .1;B :183 .8± 11.2 ;C :178.4± 7.8;D :165 .3± 8.9。A、B、C之间无显著性差异 (Ρ >0 .0 5 ) ,A、B、C与D之间有显著性差异 (Ρ <0 .0 1)。③四组肿瘤均无明显增强。结论　当造影剂用 2 2 5mg/ml的泛影萄胺 80ml时 ,①采用 2 .0～ 3 .0ml/s注射速率优于 1.5ml/s。②在造影剂 2 .0～ 3 .0ml/s注射速率范围内 ,螺旋CTAP增强特征与速率无关。因此选用 2 .0ml/s注射速率为佳     

螺旋CT双期增强扫描在小胰腺癌诊断中的应用

目的　研究螺旋CT胰腺期、门脉期双期增强扫描在小胰腺癌早期诊断和正确分期中的作用。方法　对14例小胰腺癌患者行螺旋CT双期增强扫描,扫描延迟时间分别为30s和65s,对比剂用量100ml,注射速度3ml/s。观察并比较正常胰腺及肿瘤在两期的增强情况。根据CT征象对肿瘤可切除性进行评价,并与手术结果比较。结果　肿瘤-胰腺对比胰腺期和门脉期分别为(47.08±20.39)HU和(28.77±16.23)HU（t=2.533,P<0.01）。14例肿瘤中,术前认为可以切除11例,术中切除9例。结论　螺旋CT双期增强扫描能更清晰地显示小胰腺癌,胰腺期肿瘤-胰腺对比较门脉期更显著,有利于小胰腺癌的早期诊断和可切除性的判断。     

多层螺旋CT三期扫描对正常胰腺和胰周血管增强特性的研究

目的　探讨多层螺旋CT多期增强扫描胰腺实质和胰周血管的强化特点。方法　对 60例正常人群行螺旋CT三期扫描 ,即动脉期 (2 0s)、胰腺期 (3 5～ 42s)、肝脏期 (75～ 80s) ,分别测量各期胰腺及胰周血管的CT值 ,并行统计学分析。结果　胰腺在胰腺期增强峰值高于其它两期 (Ρ <0 .0 1) ,对胰周动脉的增强值胰腺期与动脉期无明显差异 (Ρ >0 .0 5 ) ,但明显高于肝脏期 (Ρ <0 .0 1) ,对胰周静脉的增强值胰腺期与肝脏期无明显差异 (Ρ >0 .0 5 ) ,却明显高于动脉期 (Ρ <0 .0 1)。结论　多层螺旋CT三期扫描尤其胰腺期明显增强胰腺和胰周血管 ,对胰腺疾病的诊断和分期有重要价值。     

胰腺癌螺旋CT动态增强扫描征象的探讨

目的 :对胰腺癌螺旋CT动态增强扫描征象进行探讨。方法 :病理证实胰腺癌 37例 ,胰头癌 2 8例 ,胰体癌 5例 ,胰尾癌 4例。其中男 30例 ,女 7例。给予高分辨率螺旋CT动态增强扫描。结果 :胰腺癌主要征象 :胰腺肿块 ,在动脉期 (胰腺期 )表现为明显的低密度灶 ,胰腺肿块低密度灶与正常胰腺组织密度差有显著差异。其他征象 :胰管和胆管扩张 ;胰周脂肪间隙模糊 ;胰周血管变形和周围淋巴结肿大等。结论 :螺旋CT动态增强扫描对检出胰腺癌是非常有效的方法。     

Evaluation of foramen magnum in gender determination using helical CT scanning

Objective

The present research was undertaken to study the accuracy and reliability of the foramen magnum (FM) and some cranial measurements in gender classification through the use of reconstructed helical CT images.

Methods

88 patients (43 males and 45 females; age range, 20–49 years) were selected for this study. FM sagittal diameter, transverse diameter, area and circumference were measured and data were subjected to discriminant analysis for gender using multiple regression analysis.

Results

FM circumference and area were the best discriminant parameters that could be used to study sexual dimorphism with an overall accuracy of 67% and 69.3%, respectively. By using multivariate analysis, 90.7% of FM dimensions of males and 73.3% of FM dimensions of females were sexed correctly.

Conclusion

It can be concluded that the reconstructed CT image can provide valuable measurements for the FM and could be used for sexing when other methods are inconclusive.     

DCE-MRI和DWI对乳腺腺病和乳腺癌的诊断价值

目的 探讨动态增强磁共振成像(DCE-MRI)和扩散加权成像(DWI)对乳腺腺病和乳腺癌的诊断价值.方法 回顾性分析手术后病理证实的30例乳腺腺病和45例乳腺癌的MRI影像资料,包括病灶的形状、边缘、强化方式、T2WI信号特点、时间-信号强度曲线(TIC)类型、早期强化率(EER)、达峰时间、背景强化程度及病灶的表观扩散系数(ADC)值.结果 在形态学特征中,乳腺癌多表现为边缘不规则,伴或不伴有毛刺,差异有统计学意义(P=0.002);同时多表现为不均匀强化,差异有统计学意义(P=0.009).在动态强化特征上,乳腺癌多表现为TIC流出型,EER多表现为快速流入,达峰时间多在2 min以内,以上差异均有统计学意义(P<0.001).在ADC值上,乳腺癌为(1.03±0.24)×10-3mm2/s,低于乳腺腺病的(1.34±0.30)×10-3mm2/s,差异有统计学意义(P<0.001).乳腺腺病和乳腺癌的形状特点、T2WI信号特点、背景强化程度比较差异无统计学意义(P>0.05).结论 DCE-MRI和DWI联合应用对于鉴别诊断乳腺腺病和乳腺癌具有重要的价值.     

多层螺旋CT增强检查对乳腺病变的诊断价值

目的:探讨多层螺旋CT(MSCT)增强检查对乳腺疾病的鉴别诊断价值。方法:经手术病理证实的84位患者,共检出93例乳腺病变,其中浸润性导管癌57例,粘液癌4例,纤维腺瘤13例,导管内乳头状瘤4例,其他良性病变15例。CT检查先平扫,而后分别于静脉注射对比剂后28s、90s时进行二期增强扫描。对照手术病理结果,分析所有乳腺病变的CT表现。结果:乳腺良、恶性病变的平扫密度之间的差异无统计意义(P>0.05)。乳腺良、恶性病变的形状、边缘及强化形式之间的差异有统计意义(P=1.57×10-4;P=1.75×10-28;P=1.78×10-2)。以25HU为分界点,本组乳腺良、恶性病变动脉期强化程度之间的差别有高度统计意义(P<0.001)。MSCT诊断本组乳腺病变的敏感性为96.7%,特异性为90.6%,阳性预测值为95.2%,阴性预测值为93.5%。MSCT对61例乳腺癌腋窝淋巴结转移的术前检出率为88.8%。结论:多层螺旋CT增强检查在鉴别乳腺良恶性病变方面具有较高的诊断价值。     

胃间质瘤的MSCT征象与其危险度评估的对照分析

目的:探讨胃间质瘤(GIST)的MS CT征象与其危险度评估的关系.方法:回顾性分析21例GIST的临床、影像及病理资料.结果:21例中,极低危险度3例,低危险度9例,中危险度2例,高危险度7例.CT能明确肿瘤部位.极低危险度和低危险度的GIST肿瘤直径＜5 cm,形态规则,腔内生长,密度均匀,强化均匀;中危险度的GIST肿瘤直径＞5 cm,形态规则,密度较均匀;高危险度的GIST病灶直径多＞5 cm,多呈腔内外生长,形态不规则,密度不均匀,坏死区无强化.结论:CT扫描能清楚显示GIST的发生部位、肿块大小、形态、密度及生长方式,对GIST的定位、定性诊断有较高价值.     

3D CT versus axial helical CT versus conventional tomography in the classification of acetabular fractures: a ROC analysis

AIM: To assess the diagnostic power of three-dimensional computed tomography (3D CT), axial helical computed tomography (CT) and conventional tomography in the classification of acetabular fractures by interdisciplinary review. MATERIALS AND METHODS: Receiver operating characteristics (ROCs) were assessed for two radiologists and two surgeons blinded to the presence of acetabular fractures in an animal model (a total of 62 porcine hips, 40 of them with artificial acetabular fractures). Main target parameter was the diagnostic accuracy in the classification of the artificial fractures following Judet et al. RESULTS: ROC analysis for radiologists showed A(z) values of 0.83 for 3D CT, 0.81 for axial helical CT, and 0.78 for conventional tomography; differences between the three techniques were not significant (P = 0.46-0.73). A(z) values for the surgeons were 0.87 for 3D CT, 0.68 for axial helical CT, and 0.60 for conventional tomography; 3D CT was significantly better than axial helical CT (P = 0.01) and conventional tomography (P = 0.001). The differences between axial helical CT and conventional tomography were not significant (P = 0.37). CONCLUSION: Acetabular fractures are best classified by 3D CT, followed by axial helical CT and conventional tomography when assessed by surgeons. 3D CT did not provide any additional significant benefit in the classification performed by radiologists.     

不典型乳腺癌的CT和MRI成像特征分析

目的 分析不典型乳腺癌的不同病理类型在计算机断层扫描(CT)和核磁共振(MRI)影像下的特征,为影像学诊断不典型乳腺癌提供指导.方法 选取经过手术病理确诊的不典型乳腺癌患者60例,收集患者术前2w内进行的CT和MRI检查结果,分析CT和MiRI影像学特征表现与病理结果的相关性,并计算两者对不典型乳腺癌诊断的灵敏度.结果 本组60例中,非浸润性乳腺癌12例,浸润性乳腺癌48例;导管内癌40例,小叶型癌和其他类型癌症各10例.CT共检出肿块48例,钙化灶40个,边缘毛刺征31例,腋窝淋巴结肿大8例,其影像学特征在肿瘤的浸润程度和病理类型上的分布无统计学差异.MRI检查出肿块52例,钙化灶10例,边缘毛刺征51例,腋窝淋巴结肿大10例,其影像学特征在肿瘤浸润程度上的分布无差异,但在不同病理类型上的分布存在统计学差异.CT诊断灵敏度为80.0％,MRI诊断灵敏度为86.7％,二者联合诊断的灵敏度为91.7％.结论 不同病理类型的不典型乳腺癌在MRI影像上的影像特征不同,CT联合MRI诊断不典型乳腺癌灵敏度比单一检查诊断灵敏度高.     

数字化乳腺摄影与普通钼靶摄影在小乳癌诊断中的对比分析

目的：探讨数字化乳腺摄影在小乳癌诊断中的优越性。方法：经手术病理证实的小乳癌57例，采用数字化乳腺摄影及普通钼靶摄影方法。结果：数字化乳腺摄影诊断51例，其敏感性、特异性、准确性分别为89．4％、95．O％、90.9％；普通钼靶摄影术前诊断46例，其敏感性、特异性、准确性分别为80．7％、85．O％、81．8％。结论：在小乳癌诊断中。数字化乳腺摄影在敏感性、特异性、准确性方面均优于普通钼靶摄影。     

CT灌注和X线摄影在乳腺疾病诊断中的价值

目的：探讨CT灌注和X线摄影对乳腺疾病的诊断价值。方法：45例乳腺病变均行X线摄影和CT灌注检查,并与病理结果进行对比分析。结果：X线摄影、CT灌注诊断符合率分别为77.28%和88.89%,综合X线摄影和CT灌注诊断符合率为95.56%,三者之间差异有统计学意义（P〈0.05）。在CT灌注中,乳腺恶性病变的血流量（BF）、血容量（BV）和表面通透性（PS）的均值均明显高于良性病变（P〈0.05）。CT灌注对病变范围、乳腺癌坏死灶的判别优于X线摄影（P〈0.05）。X线摄影对钙化灶的定性诊断优于CT灌注（P〈0.05）。结论：X线摄影和CT灌注具有互补性,两者结合可提高乳腺癌诊断符合率。     

Umbilical metastasis from breast cancer related with tumor marker elevation

We sescribe a 53-year-old woman with tumor marker abnormality caused by an umbilical metastasis from breast cancer. She had undergone breast conservation therapy (BCT) for breast cancer (T2N1M0) 9 years previously. Umbilical metastasis was detected 9 months after tumor marker elevation was first noted. After resection of the umbilical metastasis, tumor marker level decreased immediately and normalized. The patient is alive without other metastasis.     

16层螺旋CT检查输尿管结石的应用价值

 目的 探讨16层螺旋CT在输尿管结石病例中的诊断价值.方法 应用东芝Aquilion 16层螺旋CT对142例临床拟诊输尿管病变病例进行检查分析,采用标准和低剂量扫描两组对比分析,对确诊输尿管结石病例减少造影剂用量行增强扫描.结果 两组扫描方法对输尿管结石诊断准确性无差异,低剂量组辐射剂量仅为标准组的37.12%.增强扫描适当减少造影剂用量,也能满足临床制定治疗方案前评估肾功能的要求.结论 16层螺旋CT对诊断输尿管结石有很高的准确性,适当降低扫描条件不影响结石检出率,适当减少造影剂用量不影响临床评价肾功能,但却减少了辐射剂量和患者费用,在临床中应该得到大力推广.