儿童脑猪囊尾蚴病42例CT诊断分析

目的探讨脑猪囊尾蚴病患儿的CT影像特点及诊断价值。方法对经免疫学检查和手术病理证实的脑猪囊尾蚴病42例行CT及增强扫描检查,并依CT表现进行分型。结果42例中41例为脑实质型,其中囊泡型12例,脑炎型8例,多发结节和环形强化型18例,多发钙化型3例,脑膜型1例。结论CT检查对儿童脑猪囊尾蚴病的定位、定性及定量诊断具有重要价值,结合临床和免疫学检查可作出正确诊断。     

脑性瘫痪患儿脑白质数量的CT图像及模糊判据分析

目的 利用CT图像,分析脑性瘫痪患儿脑白质数量减少程度,并对脑白质数量减少进行模糊判据分析.方法 选择1 ～3岁临床诊断为脑性瘫痪病例,根据CT检查结果筛选出未见异常、脑白质偏少、脑室旁脑白质软化(PVL)3类病例.将这3类病例,依照年龄每3个月分为一小组,每一小组随机选取6例,共分为24个小组,共144例.利用CT工作站软件测量每例患儿半卵圆层面的脑白质和大脑半球的面积并进行统计分析;根据脑白质面积与大脑半球面积的比值对脑白质减少的性质进行疾病隶属度的模糊判据.结果 1.未见异常组、脑白质偏少组和PVL组患儿脑白质面积数量的中位数依次为2 000 mm2、1 738 mm2和1 387 mm2,未见异常组与脑白质偏少组、PVL组之间的差异均有统计学意义(P ＜0.05,0.01);脑白质偏少组与PVL组间差异无统计学意义(P＞0.05).2.大脑半球面积的中位数分别为5 809 mm2、5 618 mm2和5 370 mm2,3组间的差异均无统计学意义(Pa＞0.05).3.脑白质数量的隶属度图显示脑白质偏少组与PVL组、未见异常组均有交集,但是与PVL组有更多交集;当脑白质与大脑半球的面积比值＜ 0.255时,患儿属于PVL的隶属度≥0.5.结论 影像科诊断医师对脑白质数量的评估较为准确;脑白质偏少可视为轻度PVL.计算半卵圆脑白质与大脑半球的面积比值并由此确认脑白质减少的隶属度对确认病情的严重程度有参考意义.     

小儿颈部包块的X线计算机体层摄影术诊断

目的总结小儿颈部包块的临床及影像诊断经验,分析评价CT在诊断小儿颈部包块中的价值。方法回顾性分析2004年1月-2006年6月本院颈部包块26例的临床、病理诊断资料及CT检测颈部包块起源的位置、密度、边缘情况和与周围结构的关系。结果CT诊断颈部包块发生于颈前区7例、颈外侧区13例、其他部位及不能明确者6例。低密度者8例,等密度、高密度者各2例,混杂密度14例;炎症性包块13例,先天性包块11例;甲状腺炎性包块1例;口咽部纤维、脂肪组织瘤样增生1例。结论CT检查是诊断小儿颈部包块的较佳方法,结合病史及体检有较高的诊断价值。     

计算机断层扫描血管造影对Sturge-Weber综合征的诊断价值

目的 探讨小儿Sturge-Weber综合征的计算机断层扫描血管造影(CTA)和临床表现特点及CTA在临床诊断中的价值.方法 回顾分析本院2006年1月-2008年6月就诊的6例Sturge-Weber综合征患儿CTA和临床资料,均应用16层螺旋CT血管造影,并使用CTA软件进行容积重建(VR)、多平面重建(MPR)、最大密度投影(MIP)等显示脑血管.结果 6例患儿CTA均示患侧脑皮层有不同程度的脑回样或条带状强化,5例患侧大脑萎缩,3例患侧颅板增厚,2例头颅不对称.患侧颅腔狭小,局部脑回肥厚,未见眼脉络膜血管瘤.经VR、MPR、MIP处理后可清晰显示病变的化置、形态及与周围血管和颅骨的关系,6例均示患侧相应脑叶表面软脑膜有不同程度扭曲增粗血管影.临床6例均有与颅内异常CTA表现同侧的面部三叉神经分布区皮肤血管瘤及癫(癎)发作.5例运动发育迟缓,其中轻偏瘫、智力低下、并青光眼各3例.结论 CTA能准确诊断小儿Sturge-Weber综合征,且具有无创、快捷、安全、清晰、准确性高等特点.     

计算机X线断层照像术在支气管异物诊断中的意义

目的探讨计算机X线断层照像术(CT)在儿童支气管异物诊断中的临床意义。方法对21例可疑支气管异物的患儿进行螺旋CT横断面扫描和冠状面重建,采用支气管镜术证实诊断。结果患儿均显示异物的直接征象,CT显示异物位于右肺主支气管12例,右中间支气管1例,右下叶支气管2例,左肺主支气管6例。支气管异物均经支气管镜术取出。结论CT扫描可显示儿童支气管异物,并能精确定位,对病史、体征和常规X线表现不典型的患儿有重要诊断价值。     

CT检查对小儿寰枢椎旋转畸形的诊断价值

目的：探讨ＣＴ扫描诊断小儿寰枢椎旋转畸形的临床价值。方法：对１２例患者颅底和上颈椎进行ＣＴ扫描。结果：通过ＣＴ影像分析，发现病变早期寰枢椎有较固定的旋转关系，枕寰关节与寰枢关节在同一方向运动，枕骨髁与寰椎侧块无分离。病变后期齿状突与寰椎侧块不对称关系及寰椎旋转移位持续存在，枕寰关节在与寰枢关节活动相反方向发生一种新的旋转移位，部分代偿寰枢关节移位。结论：ＣＴ扫描可显示椎管与骨性结构变化的断面图像，能清楚地提供枕寰枢椎横断面的连续图像，作为一种检查手段，明显弥补了Ｘ线片的不足     

Positron Emission Tomography Myocardial Perfusion Imaging in Children with Suspected Coronary Abnormalities

Positron emission tomography (PET) myocardial perfusion imaging has higher spatial resolution than conventional single photon emission computed tomography (SPECT) imaging and allows accurate and reproducible quantification of myocardial blood flow (MBF). In this article, we describe the role of PET myocardial perfusion imaging in clinical decision making in children with suspected coronary abnormalities. We performed a PET myocardial perfusion study using N-13 ammonia in 10 children (median age, 14 years; range, 1–17 years). The indications included exercise-induced chest pain and ST segment changes during exercise testing, coronary artery ectasia, hypertrophic cardiomyopathy with myocardial bridging of the left anterior descending coronary artery, and suspected left coronary stenosis in an infant with William's syndrome. MBF was assessed at baseline and during adenosine hyperemia in all 10 patients and postexercise in 8 patients. Myocardial perfusion was homogeneous at baseline in all 10 patients, during adenosine perfusion in 9 of 10 patients, and postexercise in all 8 patients. Three patients with homogeneous rest and stress perfusion had impaired myocardial flow reserve. The infant with William's syndrome developed a large, reversible perfusion defect in the left coronary territory during adenosine stress and underwent surgical repair. Myocardial flow reserve findings were valuable for clinical decision making in individual patients. We conclude that MBF quantification with N-13 ammonia and PET provides supplemental perfusion information and is helpful in clinical decision making in children with suspected coronary abnormalities.     

Image Quality of Coronary Computed Tomography Angiography with 320-Row Area Detector Computed Tomography in Children with Congenital Heart Disease

The objective of this study was to assess factors affecting image quality of 320-row computed tomography angiography (CTA) of coronary arteries in children with congenital heart disease (CHD). We retrospectively reviewed 28 children up to 3 years of age with CHD who underwent prospective electrocardiography (ECG)-gated 320-row CTA with iterative reconstruction. We assessed image quality of proximal coronary artery segments using a five-point scale. Age, body weight, average heart rate, and heart rate variability were recorded and compared between two groups: patients with good diagnostic image quality in all four coronary artery segments and patients with at least one coronary artery segment with nondiagnostic image quality. Altogether, 96 of 112 segments (85.7 %) had diagnostic-quality images. Patients with nondiagnostic segments were significantly younger (10.0 ± 11.6 months) and had lower body weight (5.9 ± 2.9 kg) (each p < 0.05) than patients with diagnostic image quality of all four segments (20.6 ± 13.8 months and 8.4 ± 2.5 kg, respectively; each p < 0.05). Differences in heart rate and heart rate variability between the two imaging groups were not significant. Receiver operating characteristic analyses for predicting patients with nondiagnostic image quality revealed an optimal body weight cutoff of ≤5.6 kg and an optimal age cutoff of ≤12.5 months. Prospective ECG-gated 320-row CTA with iterative reconstruction provided feasible image quality of coronary arteries in children with CHD. Younger age and lower body weight were factors that led to poorer image quality of coronary arteries.     

非气腹腹腔镜辅助儿童阑尾切除术的探讨

目的 探讨非气腹腹腔镜辅助儿童阑尾切除术(laparoscopic appendectomy,LA)的应用价值.方法 回顾性分析我院近3年来60例儿童阑尾切除术的临床资料.将行非气腹腹腔镜辅助手术的30例患儿与行常规开腹手术(open appendectomy,OA)的30例患儿分成两组,比较两组手术时间、术后肛门排气时间、住院时间以及术后并发症方面的区别.结果 非气腹LA组手术时间、术后肛门排气时间、术后住院时间较OA组明显缩短(P＜0.01).LA组无并发症,OA组出现切口感染3例.结论 非气腹LA较OA创伤小,恢复快,住院时间短,并发症少.     

Application of Computer Programs in the Management of Diabetic Children

Microcomputers have been used in our hospital for the past five years to summarize data from patients and to remind us to carry out routine tests. Recently, we have shown computer data on the screen to patients; this helps us to explain and discuss the monitoring of their condition with them. Unlike some other systems, general data as well as data on self-monitored blood glucose levels are recorded in our computer system. The data consist of five categories: personal profile, treatment, etiological research, indices of control and data for checking complications. The analysis and evaluation of our system are done by the modes of display, statistical calculations, early detection of complications and graphics. The system is compatible with input from a keyboard, optical character readers and interface to a glucose meter with a memory.     

胼胝体发育不全16例CT诊断

目的分析儿童胼胝体发育不全（DCC）的CT特点探讨其CT的诊断价值。方法回顾性分析本院2002年7月～2006年6月收治16例DCC的颅脑平扫CT表现。男9例,女7例;年龄为24d～14岁,平均4.2岁。结果DCC主要表现为球间裂增宽,与第三脑室前部异常靠近或相连16例;侧脑室体部扩大、平行8例;第三脑室扩大、上移3例;双侧脑室前角分离平直,呈倒＂八＂字征4例;并其他畸形6例。结论CT扫描能正确诊断儿童DCC及并颅内发育异常。     

人类辅助生育技术子代生存质量的研究进展

人类辅助生殖技术(ARTs)对子代生存质量影响的研究目前主要集中在围生期结局及短期的跟踪研究。ARTs及其子代监测管理逐步全面和规范化。ARTs可导致较高的早产率、低出生体质量率及新生儿病死率,其原因除与多胎妊娠有关外,还与产妇的不孕因素有关。ARTs子代先天畸形的发生率也较高,但主要与孕妇和精子供体的因素有关。ARTs对子代智力发育有没有不良影响,是否会增加子代患脑性瘫痪的风险尚存争议。冻融胚胎技术及单精子卵细胞浆内显微注射技术对子代的安全性得到大多数学者的认可。     

小儿夜间发作额叶癫的正电子发射扫描与视频脑电图对照研究

目的 探讨小儿夜间发作额叶癫(癎)的正电子发射扫描(PET)与视频脑电图(VEEG)的特征及治疗后VEEG改变.方法 收集2005年6月-2008年6月本院儿科确诊的夜间发作额叶癫(癎)患儿37例(实验组),其他类型的夜间发作的癫(癎)患儿60例(对照组).记录二组患儿性别、发病年龄、发作频率、癫(癎)家族史.实验组予卡马西平或奥卡西平治疗,有过敏者予丙戊酸钠或托吡酯治疗.均行头颅PET检查,治疗前、治疗3个月行VEEG检查,实验组30例及对照组所有患儿行头颅MRI检查.结果实验组患儿PET存在额叶异常者24例(64.9%);实验组17例患儿PET为单侧异常,其中16例患儿VEEG(癎)性放电为单侧.实验组和对照组患儿PET与VEEG完全一致、部分一致、完全不一致的差异无统计学意义(P＞0.05).19例PET正常或轻度异常患儿,VEEG清醒期有(癎)性放电8例,睡眠期放电8例,清醒和睡眠均放电3例;7例PET重度异常患儿,清醒期及睡眠期均有(癎)性放电6例,PET结果与VEEG(癎)性放电时期呈正相关(r=0.461 P＜0.05).治疗后原7例PET正常患儿中5例VEEG为轻度异常;而7例PET重度异常患儿4例VEEG中度异常,3例重度异常,其PET结果与治疗后VEEG的异常程度呈正相关(r=0.410 P＜0.05).结论夜间发作额叶癫(癎)患儿存在额叶异常,其PET检查结果与患儿的VEEG(癎)性放电的时间和部位相符、相关,PET重度异常的患儿治疗后VEEG仍较差.     

传统方法与胸腔镜处理小儿脓胸的比较分析

目的：评价不同治疗方法对小儿脓胸的治疗价值。方法：将9年中43例小儿脓胸分为用传统方法(A组)和电视胸腔镜手术(B组)处理两组,对其术后各种参数进行回顾性分析。结果：两组并发症的发生率和死亡率差异无显著性(P> 0.05),但术后发热时间、抗生素应用时间、胸管留置时间和住院时间B组均短于A组［(2.8±1.7) d vs (5.7±2.1) d, (7.6±2.5) d vs (13.8±4.7) d, (3.8±1.6) d vs (5.8±2.4) d, (10.4±3.0) d vs (17.8±5.6) d］(P<0.01)。结论：电视胸腔镜处理小儿脓胸创伤小,疗效好,疗程短,但应尽早施行。     

计算机辅助手术系统在先天性胆管扩张症诊治中的应用

目的研究计算机辅助手术系统在小儿先天性胆管扩张症诊断与治疗中的应用价值。方法回顾性分析2013年6月至2015年1月青岛大学附属医院收治的25例先天性胆管扩张症患儿的肝脏64排螺旋CT扫描原始数据,采用计算机辅助手术系统(Hisense CAS)进行肝脏及胆道三维重建,根据三维重建结果进行精准的术前诊断和病理形态分析,以及辅助手术规划,确定最佳手术方案。观察术中所见与术前规划的符合程度、术中出血量、并发症等。结果 25例中,囊肿型14例,梭状型11例;合并肝内胆管扩张18例;少见的复杂胆道畸形3例。肝脏及其内部管道系统的三维模型形态逼真、立体感强,清晰地显示胆管的分布走形及其与肝内三套血管系统的空间位置关系。术前手术方案与实际手术方式符合率为88%(22/25)。术中出血量中位数为12 mL,最少出血量为6 mL。术后无一例出现严重并发症或死亡。结论通过计算机辅助手术系统对CT数据进行三维重建,实现了胆道系统的数字化解剖,并能清晰显示胆道及其周围血管系统的空间位置关系,提高先天性胆管扩张症手术的精准性和手术安全性。     

Evaluation of Renal Parenchyma in Children by DMSA Scientigraphy, X-ray Computed Tomography and Intravenous Urography

ABSTRACT. The demonstration of diminished or scarred renal parenchyma in children is often the decisive factor in determining the future management of children with urinary tract malformations. Renal scintigraphy using technetium 99m-labelled dimercaptosuccinic acid (DMSA), computed tomography (CT) and intravenous urography (IU) were used to evaluate the renal parenchyma prior to ureter re-implantation in a series of 13 children. Their ages ranged from 5 months to 3 years 8 months. The indication for operation was ureteric reflux in 8 children and distal ureteric stenosis in 5. CT was performed on a Toshiba TCT-80 scanner. Renal scintigraphy was performed 3 hours after intravenous injection of DMSA. Compared with IU, DMSA imaging gave more information about the renal parenchyma in 6 children, gave equal information in 6 and less in 1. Compared with CT, DMSA imaging gave more information in 2 children, was equally informative in 8 and less so in 3. Accordingly, DMSA imaging was judged to be more sensitive than IU and as sensitive as CT. DMSA imaging can be used both for the initial evaluation and for follow-up assessment of renal parenchymal damage.     

Monitoring of Regional Lung Ventilation Using Electrical Impedance Tomography After Cardiac Surgery in Infants and Children

Electrical impedance tomography (EIT) is a noninvasive method to monitor regional lung ventilation in infants and children without using radiation. The objective of this prospective study was to determine the value of EIT as an additional monitoring tool to assess regional lung ventilation after pediatric cardiac surgery for congenital heart disease in infants and children. EIT monitoring was performed in a prospective study comprising 30 pediatric patients who were mechanically ventilated after cardiac surgery. Data were analyzed off-line with respect to regional lung ventilation in different clinical situations. EIT data were correlated with respirator settings and arterial carbon dioxide (CO₂) partial pressure in the blood. In 29 of 30 patients, regional ventilation of the lung could sufficiently and reliably be monitored by means of EIT. The effects of the transition from mechanical ventilation to spontaneous breathing after extubation on regional lung ventilation were studied. After extubation, a significant decrease of relative impedance changes was evident. In addition, a negative correlation of arterial CO₂ partial pressure and relative impedance changes could be shown. EIT was sufficient to discriminate differences of regional lung ventilation in children and adolescents after cardiac surgery. EIT reliably provided additional information on regional lung ventilation in children after cardiac surgery. Neither chest tubes nor pacemaker wires nor the intensive care unit environment interfered with the application of EIT. EIT therefore may be used as an additional real-time monitoring tool in pediatric cardiac intensive care because it is noninvasive.