弥漫性肺间质性病变的影像学表现

目的探讨影像学诊断弥漫性肺间质性病变的价值,加深对弥漫性肺间质性病变影像学表现的认识,从而提高弥漫性肺间质性病变的诊断、鉴别诊断水平。方法用DR高千伏摄片及GE 64排螺旋CT对100例弥漫性肺间质性患者进行检查,分析其影像学表现。结果 DR胸片发现弥漫性肺间质性病变为79%,高分辨率CT(HRCT)发现弥漫性肺间质性病变为100%。结论影像学检查特别是HRCT能清晰显示肺组织的细微结构,故可用于弥漫性肺间质性病变的诊断和鉴别诊断,是诊断弥漫性肺间质性病变的重要手段。     

MSCT肺密度测定评价弥漫性结缔组织病的初步探讨

目的 应用多层螺旋CT（MSCT）肺密度测定软件，找出肺密度变化与弥漫性结缔组织病（CTD）之间的相关性，探讨其应用价值。方法对72例临床已确诊为患有CTD的患者，利用MSCT行高分辨扫描（即HRCT），应用附带的Pulmo自动评估软件测定上、中、下肺间的平均CT值及象素的频率分布（即象素指数），并分析它们的变化与结缔组织病所致肺部间质改变的关系。结果 72例患者中42例（R组）HRCT有不同程度的弥漫性肺间质病变表现。同时这些患者的平均肺密度有不同程度的增高，象素分布异常和曲线波峰降低并右移。30例患者HRCT无明显弥漫性肺间质病变的表现，但其中13例（P组）患者的平均肺密度有不同程度的增高和象素分布曲线的异常，17例（N组）患者的平均肺密度和象素分布曲线表现正常。结论 MSCT肺密度测定对早期诊断CTD所致的肺间质改变有一定的应用价值。平均肺密度和象素分布曲线的变化与CTD伴肺间质病变的程度具有相关性。     

椎管内血管性病变的影像学特征分析

目的 探讨椎管内血管性病变的影像学特征和鉴别诊断。方法：66例椎管内血管性病变包括脊髓动静脉畸形(AVM)25例、髓周动静脉瘘(AVF)12例、硬脊膜动静脉瘘(SDAVF)21例、海绵状血管瘤5例和血管母细胞瘤3例，均行磁共振(MR)检查和选择性脊髓动脉造影检查，并行栓塞或手术治疗。结果：MRI对于多数脊髓AVM、髓周AVF和SDAVF多能发现椎管内异常血管。海绵状血管瘤显示为团块状异常信号影和周围环状低信号影，血管母细胞瘤显示为髓内的实质性强化影和异常血管影。数字减影血管造影(DSA)可以显示脊髓AVM、髓周AVF和SDAVF的畸形血管团或瘘口以及供血动脉和引流静脉，海绵状血管瘤一般不显影，血管母细胞瘤的瘤体和供血动脉均可以显影。结论：MRI对病变的定位和分类有重要诊断作用，脊髓选择性血管造影检查是具有确定意义的检查。     

结缔组织病肺间质病变的高分辨率CT特点研究

目的研究结缔组织病肺间质病变的高分辨率电子计算机断层成像(HRCT)特点。方法收集HRCT检查提示存在肺间质病变的住院患者共750例,根据其临床资料,将入选的461例患者分为结缔组织病组(CTD组)、可疑结缔组织病组(sCTD组)和特发性间质性肺炎组(IIP组),比较其HRCT表现。结果 461例患者中CTD组79例(10.53%),sCTD组70例(9.33%),IIP组312例(41.60%)。三组之间HRCT的主要肺间质病变表现差异无统计学意义。结论结缔组织病在肺间质病变中占一定的比例,对HRCT发现的肺间质病变应进行结缔组织病的相关检查以免漏诊、误诊。     

肺隔离症15例临床病理分析

目的：探讨多层螺旋CT（MSCT）和多平面重建（MPR）显示肺隔离症异常血管的价值,分析肺隔离症的临床病理特征并通过复习文献提高对肺隔离症的认识和诊断水平。方法：搜集经手术病理、主动脉造影证实的15例肺隔离症患者,均摄胸部正侧位片,13例行平扫及增强扫描（其中5例行螺旋动态增强CT扫描）,6例行磁共振成像MRI检查,3例行血管造影。结果：胸部平片表现为肺内结节、团块状影9例及囊性病变6例。CT示含气体或液体的囊肿或软组织肿块13例,病变为肺气肿所包裹5例。螺旋CT对异常供血血管显示率93%,高于普通CT检查60%。MRI中4例为软组织结节或肿块,2例为含气囊肿,3例显示出异常的主动脉供血血管。结论：胸部X线平片对肺隔离症的发现及定位有价值,CT（尤其是螺旋CT动态增强扫描）及MRI取代血管造影立体地显示主动脉异常供血血管,且对肺部病变的评价具有优越性,是肺隔离症的最佳影像学检查手段。     

HRCT对肺间质性病变的诊断价值

目的研究肺间质病变的高分辨CT（HRCT）表现及鉴别诊断。方法采用HRCT法对88例临床病理证实的肺间质病变作影像分析。结果HRCT可清晰显示所有病例的肺间质病变征象，常表现为支气管血管束周围间质增厚（27例）；肺小叶改变，其中包括小叶内间质异常（35例）、小叶间隔增厚（36例）；毛玻璃影（38例）；蜂窝征（41例）；胸膜下间质改变（33例）：出现界面影、胸膜下线、网织样变；受牵支气管扩大（28例）。结论HRCT对判断肺间质病变有影像诊断价值。     

颈面部病变的DSA诊断

目的：加深对颈面部病变数字减影血管造影(DSA)表现特点的认识，探讨其诊断价值。方法：回顾性分析320例颈面部病变患者的选择性DSA造影资料，其中包括血管狭窄闭塞性疾病215例和血管肿瘤性病变105例。结果：DSA均能获得明确的诊断。215例血管狭窄闭塞性疾病表现为轻度狭窄者30例，中度狭窄78例，重度狭窄86例，闭塞21例。27例鼻咽部血管纤维瘤，22例颈面部海绵状血管瘤，21例颈动脉体瘤，19例颈面部假性动脉瘤和16例颈面部蔓状血管瘤均能显示其病变的范围、血供情况及特征性DSA表现。结论：DSA是颈面部血管狭窄闭塞性疾病和血管肿瘤性病变诊断的有效手段，有利于估计其预后并制订治疗方案。     

肺间质性疾病DDR和HRCT影像学表现对比分析

目的通过对肺间质性疾病直接数字摄影术(DDR)与高分辨率CT(HRCT)影像学表现的对比分析,评价DDR和HRCT对肺间质性疾病诊断的价值。方法对临床29例为肺间质性疾病患者,进DDR检查,收集我院近年29例经HRCT诊断的肺间质性疾病,且同时做过DDR和HRCT检查,对比各自影像学表现,所有病例都已经病理确证为肺间质性疾病。结果HRCT及DDR对肺间质性疾病的诊断方面都十分敏感,HRCT达100%,DDR约83%,29例经HRCT诊断的肺间质性疾病中,HRCT提示有活动性病变19例,DDR提示有活动性病变8例,两者之间有显著差异。结论DDR图像后处理后可检出大部分(约83%)肺间质性疾病,对肺间质疾病可作为提示性诊断。HRCT对肺间质性疾病的诊断及活动性病变的发现方面明显高于胸部DDR检查,对肺间质疾病的诊断和追踪治疗后效果有重要价值。     

康复期SARS患者HRCT复查的价值

目的 了解经临床确诊为SARS的患者治疗痊愈后其肺内残留改变及HRCT的价值。方法 对22例临床确诊为SARS经治疗后痊愈出院的患者行HRCT扫描复查。结果 首次HRCT扫描显示22例患者中10例肺内有异常改变，包括磨玻璃影、小叶间隔增厚。12例未见异常改变。10例首次复查异常的患者中，有8例8周后进行了第二次复查，HRCT显示病灶较前缩小、数量减少。结论 SARS患者治愈后HRCT扫描可显示肺内残留肺间质异常改变，表现为磨玻璃影及小叶间隔增厚；短时间复查病变较前缩小。HRCT是发现该改变敏感的影像学方法。     

螺旋CT血管造影在肺动脉病变诊断中的应用

目的：探讨螺旋ＣＴ血管造影在少见肺血管病变诊断中的应用价值。材料与方法：对１９９４年４月—９６年１０月间使用ＥｌｓｃｉｎｔＣＴＴｗｉｎ螺旋ＣＴ肺血管造影检出并经手术病理及临床证实的少见肺血管病变２６例进行了分析，所有病例进行了计算机三维立体重建及断面切割。结果：螺旋ＣＴ肺动脉造影检出肺动脉栓塞７例，肺动脉肌纤维发育不良２例，肺段隔离症１例，肺动静脉畸形１例，特发性肺动脉扩张４例，肺动脉狭窄８例，肺动脉缺如２例，肺动脉悬吊１例。结论：螺旋ＣＴ血管造影是肺动脉病变影像诊断方法的一大进步。     

肺动脉闭锁合并室间隔缺损的影像学诊断及评价

目的:评价肺动脉闭锁合并室间隔缺损(PAVSD)的影像学表现及各种检查方法的应用价值。材料与方法:经心血管造影(CAG)和/或手术证实的PAVSD 28例,均行心脏X线平片和超声心动图(UCG)检查,12例行MRI检查。结果:X线平片示肺动脉段直角状凹陷和肺野内局限性肺纹理异常为诊断较特异征象;UCG诊断24例,未能显示中央肺动脉;MRI可显示PAVSD心内结构及中央肺动脉及其发育状况,并可观察到部分粗大侧支血管;经未闭动脉导管造影可显示左、右肺动脉连接处隔膜状狭窄。结论:MRI与X线平片和UCG联合应用,可提高本病无创诊断水平,术前仍需要行CAG检查。     

磁共振成像对肺动静脉畸形诊断价值的研究

目的旨在评价MR在诊断肺动静脉畸形中的作用和价值。方法回顾性分析6例肺动静脉畸形患者的MR表现，并与DSA比较，观察评价成像质量及显示病变血管的能力。结果MR及CE-MRA显示病灶呈瘤样扩张的血管，有一条供血动脉和一条或数条引流静脉与肺门相连。对比增强肺动脉MR成像(CE-MRA)可弥补常规序列的不足，有助于显示病变全貌，图像质量可与肺动脉造影相媲美。结论作为一种无创性评价大血管疾病的方法，在显示肺动静脉畸形方面，MR特别是CE-MRA有可能在一定程度上取代DSA。     

Diagnostic value of gas exchange tests in patients with clinical suspicion of pulmonary embolism

OBJECTIVE: To assess the value of parameters derived from arterial blood gas tests in the diagnosis of pulmonary embolism. METHOD: We measured alveolar-arterial partial pressure of oxygen [P(A-a)O2] gradient, PaO2 and arterial partial pressure of carbon diaxide (PaCO2) in 773 consecutive patients with suspected pulmonary embolism who were enrolled in the Prospective Investigative Study of Acute Pulmonary Embolism. DIAGNOSIS: The study design required pulmonary angiography in all patients with abnormal perfusion scans. RESULTS: Of 773 scans, 270 were classified as normal/near-normal and 503 as abnormal. Pulmonary embolism was diagnosed by pulmonary angiography in 312 of 503 patients with abnormal scans. Of 312 patients with pulmonary embolism, 12, 14 and 35% had normal P(A-a)O2, PaO2 and PaCO2, respectively. Of 191 patients with abnormal scans and negative angiograms, 11, 13 and 55% had normal P(A-a)O2, PaO2 and PaCO2, respectively. The proportions of patients with normal/near-normal scans who had normal P(A-a)O2, PaO2 and PaCO2 were 20, 25 and 37%, respectively. No differences were observed in the mean values of arterial blood gas data between patients with pulmonary embolism and those who had abnormal scans and negative angiograms. Among the 773 patients with suspected pulmonary embolism, 364 (47%) had prior cardiopulmonary disease. Pulmonary embolism was diagnosed in 151 (41%) of 364 patients with prior cardiopulmonary disease, and in 161 (39%) of 409 patients without prior cardiopulmonary disease. Among patients with pulmonary embolism, there was no difference in arterial blood gas data between patients with and those without prior CPD. CONCLUSION: These data indicate that arterial blood gas tests are of limited value in the diagnostic work-up of pulmonary embolism if they are not interpreted in conjunction with clinical and other laboratory tests.     

Vascular anatomy and disorders of the lumbar spine and spinal cord.

The design and interpretation of MR imaging studies of patients with suspected spinal vascular disease are based on a knowledge of arterial and venous anatomy. This article describes the major intradural vessels and their appearance on spin-echo MR images and gadolinium-enhanced MR angiography. Current gadolinium-enhanced MR techniques primarily detect veins, which may be increased in apparent number, size, or tortuosity in the pathological conditions discussed. These characteristics of abnormal veins have yet to be quantified, and differentiation between normal and abnormal is sometimes difficult. Familiarity with the appearance of normal veins on MR angiography facilitates recognition of abnormal vessels and thus the formulation of a more accurate differential diagnosis in the patient with a conus or cauda equina lesion. In the future, gadolinium-enhanced 3D MR angiography may achieve adequate spatial and temporal resolution to differentiate spinal arteries from spinal veins. This differentiation could further simplify the diagnosis of vascular lesions, depending or the complexity of the vascular pattern observed. Also, the combination of MR angiography and diffusion imaging of the cord may finally provide the information needed for characterization by MR imaging of clinically suspected arterial infarction.     

数字减影脑血管造影术对伴发眩晕的后循环缺血患者血管异常病因分析

目的 通过数字减影脑血管造影术(DSA)对伴发眩晕的后循环缺血(PCI)患者的头颈部血管进行检查,分析其血管异常病因,掌握其发病规律.方法 对138例伴发眩晕的PCI患者入院后给予详细的影像学检查,包括MRI、DSA,分析患者血管异常与PCI的因果关系.结果 138例患者,诊断为椎基底动脉系统短暂性缺血发作者89例、椎基底动脉系统脑梗死49例,综合所有的影像学检查结果分析,椎基底动脉血管异常者86例,考虑与PCI病因有关,有12例患者明确有心脏痛心房颤动,考虑与后循环脑梗死病因有关,其余40例患者病因不明确.结论伴发眩晕的PCI患者的血管异常病因为:①椎基底动脉系统血管变异;②椎基底动脉系统血管狭窄或闭塞导致的后循环出现低灌注状态或脑梗死.     

Pulmonary veno-occlusive disease.

Pulmonary veno-occlusive disease has recently been recognized as a distinct pathological entity and a cause of pulmonary arterial hypertension. Twenty previously reported cases and a new patient are here reviewed. The majority presented with breathlessness and in the early stages of the disease, when the abnormal signs were not striking, some patients were wrongly diagnosed as suffering from an anxiety state. The condition usually has an insidious onset but is remorselessly progressive and since no effective treatment is available at present, invariably fatal and the majority of patients have died within two years. The fully developed clinical picture is dominated by symptoms and signs of pulmonary arterial hypertension, similar to those found with other diseases causing a raised pulmonary arterial blood pressure. However, some patients with pulmonary veno-occlusive disease show, in addition, signs of pulmonary venous and capillary hypertension, which can lead to its clinical recognition when associated with a normal left atrial blood pressure. In this condition the pulmonary wedge pressure would appear to be unreliable as a record of the left atrial blood pressure. Pulmonary angiography and lung scanning will differentiate pulmonary veno-occlusive disease from massive thromboembolic pulmonary arterial hypertension but not from primary pulmonary arterial hypertension or micro thromboembolism. Although in some patients it should now be possible to recognise pulmonary veno-occlusive disease in life, there will be others where, even after full investigation, it will still be impossible to differentiate the condition from primary pulmonary arterial hypertension or micro thromboembolism and in these the diagnosis will only be made when the distinctive histological pattern of the disease is demonstrated. In pulmonary veno-occlusive disease there is a widespread occlusion of the pulmonary veins and venules by a loose intimal fibrosis which is often basophilic. Recanalization of the occluded veins is common and in some cases may be very striking. These occlusive lesions in the pulmonary veins lead to an elevation of pulmonary arterial pressure with associated disease of these vessels, and are also responsible for chronic oedema of the elveolar walls with subsequent development of interstitial pulmonary fibrosis. In the present case organised thrombi were present in the pulmonary arteries in addition to the pulmonary venous lesions.     

胸部影像检查在甲型H1N1流感诊治中的应用及规范建议

目的探讨规范的胸部影像检查在甲型H1N1流感患者诊治中的应用价值.方法回顾性分析773例甲型H1N1流感患者的胸部X线、CT及高分辨率CT(HRCT)资料。结果 773例患者均接受胸部X线检查,78例接受CT检查,2例接受HRCT检查。胸部X线表现未见明显异常685例,占88.62%(685/773);双肺纹理增多、增粗、模糊等肺间质改变45例,占5.82%(45/773);肺间质改变伴肺门结构模糊28例,占3.62%(28/773);双肺间质改变合并多发斑片状渗出灶15例,占1.94%(15/773)。5例合并胸膜炎(5/773,0.65%)。结论甲型H1N1流感患者胸部影像学表现具有一定特征性,轻症患者X线检查多无明显异常,胸部X线及CT动态复查是了解病情进展的有效方法。     

Pulmonary Veno-occlusive Disease

Pulmonary veno-occlusive disease has recently been recognizedas a distinct pathological entity and a cause of pulmonary arterialhypertension. Twenty previously reported cases and a new patientare here reviewed. The majority presented with breathlessnessand in the early stages of the disease, when the abnormal signswere not striking, some patients were wrongly diagnosed as sufferingfrom an anxiety state. The condition usually has an insidiousonset but is remorselessly progressive and since no effectivetreatment is available at present, invariably fatal and themajority of patients have died within two years. The fully developedclinical picture is dominated by symptoms and signs of pulmonaryarterial hyptertension, similar to those found with other diseasescausing a raised pulmonary arterial blood pressure. However,some patients with pulmonary veno-occlusive disease show, inaddition, signs of pulmonary venous and capillary hypertension,which can lead to its clinical recognition when associated witha normal left atrial blood pressure. In this condition the pulmonarywedge pressure would appear to be unreliable as a record ofthe left atrial blood pressure. Pulmonary angiography and lungscanning will differentiate pulmonary veno-occlusive diseasefrom massive thromboembolic pulmonary arterial hypertensionbut not from primary pulmonary arterial hypertension or microthromboembolism. Although in some patients it should now bepossible to recognise pulmonary veno-occlusive disease in life,there will be others where, even after full investigation, itwill still be impossible to differentiate the condition fromprimary pulmonary arterial hypertension or micro thromboembolismand in these the diagnosis will only be made when the distinctivehistological pattern of the disease is demonstrated. In pulmonary veno-occlusive disease there is a widespread occlusionof the pulmonary veins and venules by a loose intimal fibrosiswhich is often basophilic. Recanalization of the occluded veinsis common and in some cases may be very striking. These occlusivelesions in the pulmonary veins lead to an elevation of pulmonaryarterial pressure with associated disease of these vessels,and are also responsible for chronic oedema of the alveolarwalls with subsequent development of interstitial pulmonaryfibrosis. In the present case organised thrombi were presentin the pulmonary arteries in addition to the pulmonary venouslesions. The cause of pulmonary veno-occlusive disease is unknown butin several patients a preceding non-specific infection has beennoted. The disease occurs as commonly in the female as in themale and cases have been described in infancy, childhood andup to 48 years.     

门静脉海绵样变的MRI表现

目的探讨门静脉海绵样变(CTPV)的MRI表现,评价MRI诊断CTPV的临床价值及意义.方法分析38例经手术病理或DSA证实的CTPV患者的MRI平扫、动态增强及动态对比增强磁共振血管成像(DCE-MRA)表现.结果CTPV的MRI平扫,所有病例门静脉主干或分支闭塞,周围可见由侧支静脉形成的团块状、网状异常软组织信号影;动态增强MRI,动脉期17例出现肝实质灌注异常,门静脉期全部病例见异常侧支静脉强化;DCE-MRA能直观显示上述改变.结论MRI平扫、动态增强及DCE-MRA检查对CTPV诊断具有重要价值,门静脉闭塞及其周围海绵样侧支静脉扩张为其特征性征象.