多层面螺旋CT仿真胆管内窥镜在胆管系统结石的初步临床应用

目的探讨多层面螺旋CT胆道仿真内窥镜（Multi-slicehelicCTvirtualcholangioscopy,MSCTVC)在胆管系统结石诊断中的检查方法和临床应用价值。方法选择38例经B超检查后诊断为胆管系统结石的患者外周静脉滴注50%胆影葡胺20ml行多层面螺旋CT容积扫描,将容积数据薄层重建后传输至工作站,利用Navigator导航软件重建成仿真内窥镜图像,全部病例经B超、CT轴位图像、多层面螺旋CT三维成像（SSD、MIP、Raysum）证实。结果多层面螺旋CT胆道仿真内窥镜可精确显示结石所在部位、结石的形态、大小,与B超、多层面螺旋CT二维（轴、矢、冠状位）图像及三维成像（SSD、MIP、Raysum）具有良好的对应性,尤其对于在轴位CT不能显示的阴性结石通过胆道仿真内窥镜可清晰显示。结论MSCTVC结合CT二维、三维图像对胆管结石的诊断有较高的准确性和临床使用性,提高了胆管系统结石的诊断能力。     

CT仿真内窥镜在喉部的临床应用

目的：探讨CT仿真内窥镜在喉部的应用价值。方法：正常12例，喉癌3例，声带息肉6例，均经手术病理证实，对其进行CT仿真内窥镜重建。结果：CT仿真内窥镜准确显示喉腔，并可多方位多角度观察，与纤维喉镜及手术所见具有良好的对应性。结论：CTVE可作为一种准确而无创性的检查方法，有助于临床医师治疗、手术计划的制定和实施。     

肺部疾病CT仿真支气管内镜的表现及成像技术探讨

目的　观察常见肺部疾患的CT仿真支气管镜征象 ,探讨有关成像技术。方法　选择因肺部疾患接受胸部CT检查的 5 7例患者行螺旋CT薄层扫描 ,将重建后的图像源容积数据传输至同机工作站 ,应用机内图像分析软件选择适当成像方式及阈值模式最终获取仿真支气管内窥镜图像资料。病例均经纤维支气管镜、穿刺活检、手术或临床综合诊断。结果　肺癌 2 3例 ,肺结核 8例 ,肺癌切除术后 6例 ,肺部感染及放射性肺炎 16例 ,支气管扩张症 4例。CTVB显示气管、支气管各种病理征象共 81处 ,与纤支镜对照其敏感性为 82 %。结论　通过仿真支气管内窥镜成像可清晰地显示多种肺部疾患所造成的气管、支气管腔内病理征象 ;合理选择成像阈值 ,优化扫描及重建参数可明显改善图像质量 ,提高其敏感性     

CT仿真内窥镜技术诊断脑血管病变的临床价值

目的探讨CT仿真内窥镜技术诊断脑血管病变的临床价值.材料和方法选择经DSA证实的6例颅内动脉瘤,2例脑血管狭窄性病变,颈内动脉夹层和AVM各1例,行螺旋CT血管造影检查,应用Navigator软件三维重建血管图像模拟内窥镜观察血管腔内结构.结果CT仿真内窥镜能精确显示动脉瘤颈部的解剖关系,帮助了解狭窄处血管的内壁情况和病变程度.结论CT仿真内窥镜是一种无创的血管内腔检查技术,可直观地显示脑血管病变的内腔形态及其三维解剖关系,是DSA和其它三维CT重建方法的重要信息补充.     

EBCT结肠成像技术中二维、三维成像技术的运用

目的：对24例患者进行了结肠充气容积扫描以及图像的二维、三维后处理重建，以探讨二维、三维重建技术的综合运用在结肠疾病诊断中的诊断价值。方法：连续容积扫描后重建得出了24例经结肠镜和／或手术病理证实的结肠CT仿真内窥镜（CTVE）以及多层面重建（MPR）图像，并将此两种图像作对照分析。结果：MPR在检出病灶的同时可显示病灶的密度、二维形态、肠壁受侵程度以及肠外情况作出准确判断。CTVE在对结肠病灶检出率以及对病灶大体形态显示方面优于MPR。结论：CTVE检出病灶后，结合MPR图像对病灶进行多方位观察，将明显提高CT结肠成像技术对结肠病变的诊断能力。     

胆道梗阻病变的多排螺旋CT诊疗价值探讨

目的探讨多排螺旋CT(MSCT)后处理技术对胆道梗阻的诊疗价值。方法回顾性分析经手术病理及随访复诊证实的30例胆道梗阻病例,通过MSCT的多平面重建、曲面重建、最小密度投影等方法显示胆道梗阻的部位、胆管的结构、胆管壁情况及周围组织结构,分析其影像学表现。结果本组显示肝外胆道结石8例,肝门区胆管癌7例,胆总管癌3例,胆囊癌累及胆管1例,胆总管下端及十二指肠乳头区炎症2例,壶腹癌3例,胰头癌6例,MSCT后处理技术对肝外胆道梗阻的定位准确率>90%,定性准确率>95%。结论 MSCT后处理技术对胆道梗阻的定位定性诊断及治疗方案具有重要价值。     

三维CT血管造影在诊断颅内动脉瘤中的应用

目的 研究ＣＴ血管造影诊断颅内动脉瘤的原理、方法及临床价值。方法 选择ＤＳＡ证实为颅内动脉瘤患者５５例,行三维ＣＴ血管造影检查,应用强化螺旋ＣＴ扫描后将容积数据输入工作站,通过调整ＣＴ阈值和应用伪彩色技术,重建颅内血管三维图像,全部病例经手术证实。结果 ５５例患者检出率达９８％;三维ＣＴ血管造影可精确显示动脉瘤颈部的解剖关系,可演示模拟手术并吉进行仿真血管内窥镜检查。结论 三维ＣＴ血管造影是一种相     

多层螺旋CT胆道三维成像在胆管系统结石的诊断价值

螺旋CT在我国已广泛应用,多层螺旋CT也已成为目前应用的趋势。MSCT工作站三维成像功能随着计算机软件、硬件的不断发展也日益丰富和强大起来。用于观察胆道结石的多层螺旋CT三维后处理成像方法主要有最大密度投影(MIP)、表面遮盖法(SSD)和表面透明法(Raysum),曲面重建(CPR)是将弯曲的胆管人为的“拉直”在一个平面上观察的二维成像方法,以及用多层螺旋CT仿真内窥镜(MSCTVE)观察胆管腔内的结石。我们利用MSCT胆道三维成像技术检查了48例临床怀疑胆道系统结石的患者,目的在于探讨MSCT三维成像技术在胆管系统结石中的诊断价值,…     

16层螺旋CT后处理技术在儿童气管、支气管异物的诊断价值

目的：研究16层螺旋CT三维重建及仿真内窥镜技术对儿童气管、支气管异物的诊断价值。方法：使用螺旋CT对22例怀疑儿童气管、支气管异物的病例行胸部CT平扫,图像重建后传送至工作站处理,使用多平面重建（MPR）及仿真内窥镜技术（CTVB）进行分析,全部病例经纤维支气管镜（FOB）或临床证实。结果：22例中,CTVB显示I～III级气管支气管100%,显示第IV级支气管45.5%;MPR显示I～III级气管支气管100%,显示第IV级支气管50.0%;FOB显示I～II级气管支气管100%,显示第III级支气管72.7%。结论：多层螺旋CT三维重建及仿真内窥镜技术能准确显示气管、支气管异物的位置、大小、形态及阻塞程度,是一种准确、安全的无创性诊断方法,给临床诊断、治疗提供直观的影像学资料,具有较高的诊断价值。     

CT仿真内窥镜成像技术临床应用的初步探讨

目的探讨ＣＴ仿真内窥镜成像技术的原理、方法及临床应用价值。材料与方法将螺旋ＣＴ容积扫描数据传输到工作站。通过软件功能调整ＣＴ值阈值和透明度，显示含气器官或主动脉的内腔，赋予人工伪彩色，重建出沿空腔器官中轴行程一致的多幅器官内表面图像。再用电影功能依次回放，获得仿真内窥镜效果。用此方法检查２１例患者及正常人，其中喉部８例，气管支气管３例，结肠５例，主动脉５例。全部病例均经纤维内窥镜或手术病理证实。结果喉、气管支气管及结肠ＣＴ仿真内窥镜获得类似纤维内窥镜显示管腔器官腔壁或腔内病变形态的效果。尚能从梗阻远端观察病变情况。主动脉ＣＴ仿真内窥镜能显示血管内壁、假性动脉瘤的破口、夹层动脉瘤的内膜瓣。结论ＣＴ仿真内窥镜提供了一种无创伤性的诊断方法，可作为纤维内窥镜的补充手段，但其敏感性及特异性有待今后进一步研究提高。     

经皮胆道引流术治疗恶性梗阻性黄疸

目的　回顾性分析恶性梗阻性黄疸的介入性经皮胆道引流治疗方法及其疗效。方法　对4 7例患者采用经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸。先行PTC后探查通过阻塞段 ,如不能越过阻塞段 ,则直接进行外引流 ;如能越过阻塞段 ,则置入内外引流管作内外引流或置入金属支架或塑料内涵管作内引流。结果　内引流组 18例 ,15例置入金属支架 ,共 18枚 ,3例置入塑料内涵管 ,共 4根 ;内外引流组 15例 ,置入 18根内外引流管 ;外引流组 14例 ,置入 17根外引流管。术后 1周总胆红素从术前的 (5 14 .1± 2 0 4 .3) μmol/L降至 (2 38.4± 14 2 .8) μmol/L(P <0 .0 0 1) ,碱性磷酸酶与丙氨酸转氨酶均下降明显 (P均 <0 .0 0 1)。 4例于术后 1个月内死亡。跟踪随访 37例 ,平均随访 5 .3个月 ,8例仍存活。随访期内 18例 (48.6 % )总胆红素降至正常范围。结论　经皮肝穿刺胆道引流术是对恶性梗阻性黄疸的一种安全、有效的姑息性治疗方法 ,可明显缓解黄疸、减轻痛苦、提高生存质量 ,并可改善肝脏功能 ,有限地延长生存时间。     

Malignant biliary obstruction: complications of percutaneous biliary drainage

The medical records of 161 patients who underwent percutaneous biliary drainage (PBD) for malignant biliary obstruction were reviewed with attention to the complications resulting from this mode of drainage. Observed was a higher incidence of complications--particularly of cholangitis--than that generally reported in the literature. Although PBD is an effective method of biliary drainage, it carries a high risk of cholangitis in patients with cancer, who frequently receive myelosuppressive agents that predispose them to infections.     

Silicone biliary stents for percutaneous management of biliary obstruction

Silicone tubes in 2-F increments from 12 to 20 F were developed for long term external-internal drainage of benign and malignant biliary obstructions. Passed coaxially over Teflon catheters and a guidewire, the silicone stents were softer and had larger sideholes than conventional drainage tubes. Once the acute track had matured (two weeks or longer), a silicone stent, 2 F larger than the preceding one, could be placed at each succeeding tube change. We have placed these tubes in 50 patients, 24 of whom had initially placed percutaneous catheters and 26 of whom had surgically placed stents. These tubes remain patent at least as long as conventional catheters and all patients have reported increased comfort using these catheters compared with standard ones.     

Acute cholecystitis, biliary obstruction, and biliary leakage

The use of cholescintigraphy to diagnose acute cholecystitis, biliary obstruction, and biliary leakage dates back to the late 1970s. Today, despite the many advances in imaging instrumentation, radiopharmaceuticals, and methodology over these years, cholescintigraphy still plays an important role in confirming or excluding these diagnoses in acutely ill patients. Acute calculous and acalculous cholecystitis, gallbladder perforation, biliary obstruction, and biliary leakage often present as acute abdominal pain, and must be differentiated from other surgical and nonsurgical etiologies with similar symptoms and presentation. Understanding the pathophysiology of acute hepatobiliary diseases is vital for deciding on the most advantageous imaging work-up and for interpretation of the studies. To optimize the value of cholescintigraphy, up-to-date methology, proper use of appropriate pharmacologic interventions, and recognition of characteristic image findings are critical.     

Metallic biliary endoprostheses

In patients with obstructive jaundice caused by unresectable malignant tumors, biliary endoprostheses insterted percutaneously or endoscopically can provide excellent palliation. Conventional plastic stents are associated with a relatively high rate of occlusion caused by biliary sludge. Migration is another significant problem. Self expandable, metallic stents can be inserted percutaneously via a small transhepatic track but expand to achieve a relatively large internal diameter. This minimizes the problem of occlusion due to encrusted bile and reduces the rate of reintervention. Migration rarely occurs. Metallic stents have also been employed in the management of recurrent benign biliary strictures unsuitable for surgery. In those patients in whom the frequency of radiological intervention is unacceptably high, such endoprostheses can provide a means of preventing restenosis.     

Percutaneous management of biliary leaks: biliary embosclerosis and ablation

Biliary leaks after hepatobiliary surgery are not uncommon. In certain situations minimal invasive percutaneous techniques may result in avoidance or reduction of the extent of surgery. Minimal invasive percutaneous techniques include (1) percutaneous bile collection (biloma) drainage, (2) percutaneous transhepatic biliary drainage, (3) biliary leak site embolization/sclerosis, and (4) leaking biliary segment ablation. There are two clinical applications for biliary ablation. The first is actual bile leak site ablation or embosclerosis to reduce an aperture or ablate a fistula (block a hole). The second is ablating an entire biliary segment to cease bile production and induce hepatic segmental atrophy (cease bile production). This article discusses the techniques used for biliary leak site embosclerosis/ablation (including biliary-cutaneous tract ablation) and biliary segmental ablation.     

Intracorporeal biliary lithotripsy

Most bile duct calculi can be removed with standard percutaneous or endoscopic techniques. Very large stones are the most common cause for failure. Intracorporeal lithotripsy, and EHL in particular, can be used safely in either the biliary tree or gallbladder to fragment these large stones and allow percutaneous removal or passage. Intracorporeal EHL requires direct vision to prevent damage to the bile duct mucosa. Intracorporeal laser lithotripsy may offer some safety advantages, but the laser requires much more expensive equipment than intracorporeal EHL. Additional studies are needed to determine the technique that is better in each circumstance.     

Pediatric biliary interventions

The most common indication for percutaneous biliary evaluation and intervention in children is for the diagnosis and treatment of liver transplant complications, including strictures and bile leaks. Because liver transplants in children are commonly performed using a Roux-en-Y biliary-enteric anastomosis, endoscopic retrograde cholangiopancreatography is not technically possible; therefore, the first-line procedure for evaluation and treatment of biliary obstruction in this population is percutaneous transhepatic cholangiography (PTC). Percutaneous biliary intervention can be challenging in these patients, because ductal dilation may be minimal or altogether absent in pediatric transplant livers even in the setting of severe obstruction. However, with proper technique, including the use of ultrasound guidance, technical success rates for PTC and biliary drainage can be similar to those in adults. Biliary drainage and biliary stenosis management is a long-term commitment that usually takes several months to more than a year and may require multiple repeat cholangioplasties and biliary drainage catheter exchanges. Due to its minimally invasive nature and relatively low morbidity and mortality compared with open surgical alternatives, percutaneous biliary intervention should be considered the first-line treatment option in children with biliary stenosis who have had previous liver transplant, and for those nontransplant patients who cannot be treated endoscopically.