超声和X线平片对膝关节囊内骨折的诊断比较及两种方法联合诊断价值研究

目的比较超声和X线平片对膝关节囊内骨折的诊断价值,并研究两种方法联合诊断价值。方法对132例临床疑诊膝关节囊内骨折患者同时进行X线平片检查和超声检查,并以CT（或MRI）检查作为金标准,全部影像检查均在8h内完成。X线平片包括前后位和仰卧水平投照片,制动10min以上摄片。超声检查患者采用仰卧位,探头频率7-12MHz,关节制动时间10min以上。分别统计X线平片和超声显示关节囊内骨折线、积脂血症、以积脂血症作为标准判定关节囊内骨折、以骨折线或积脂血症作为标准判定关节囊内骨折及超声和X线平片联合诊断关节囊内骨折的准确度、敏感度、特异度、阳性预测值、阴性预测值,并进行比较。结果CT（或MRI）显示骨折组104例,其中60例并存关节积脂血症。非骨折组28例。X线平片检查：骨折组87例见骨折线,17例未见骨折线（隐匿性骨折）,48例见积脂血症;非骨折组25例未见骨折线,3例误为骨折（假阳性）。超声检查：骨折组32例见骨折线,72例未见骨折线,其中60例见积脂血症;非骨折组26例未见骨折线,2例误为骨折（假阳性）,均未见积脂血症。在17例隐匿性骨折中,平片和超声分别显示积脂血症8例和13例。平片（和超声）显示骨折线的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为84．8％（43．9％）、83．7％（30．8％）、89．3％（92．9％）、96．7％（94．1％）、59．5％（26．5％）;平片（和超声）显示积脂血症的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为90．9％（100％）、80．0％（100％）、100％（100％）、100％（100％）、85．7％（100％）;以积脂血症作为标准判定关节囊内骨折,x线平片（和超声）的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为57．6％（66．7％）、46．2％（57．7％）、100％（100％）、100％（100％）、33．3％（38．9％）。依据骨折线或积脂血症,X线平片（和超声）诊断膝关节囊内骨折的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为91．4％（74．2％）、91．3％（69．2％）、89．3％（92．9％）、96．9％（97．3％）、73．5％（44．8％）。超声和x线平片联合诊断的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为94．7％、96．2％、89．3％、97．1％、86．2％。结论X线平片和超声检查均低廉、便捷、普及,它们各有优缺点,在膝关节囊内骨折诊断中,单独应用准确率均较低,有漏诊可能。联合应用能提高诊断的准确度、敏感度、阴性预测值。对于部分隐匿性骨折,超声可作为X线平片的有效补充方法。     

肋骨转移瘤多种影像学检查价值及对比分析

目的：探讨影像学检查对肋骨转移瘤的诊断价值并对诊断结果进行对比分析。方法：本组38例进行如下检查：X线平片17例；CR21例；SCT胸部横断扫描并薄层重建7例；薄层横断扫描6例；薄层倾斜扫描7例；MSCT胸部横断扫描并薄层重建、二维多平面重建和三维容积成像、最大密度投影18例。结果：X线平片、CR图像利于定位，其诊断率分别为71．0％、74．3％，诊断的比较差异无显著性（P〉0．05）；SCT、MSCT利于显示病变，其诊断率分别为91．0％、92．6％，CT与前两者间诊断的比较差异有显著性（P〈0．05），说明CT扫描对肋骨转移瘤的诊断优于X线平片和CR图像。薄层CT病变诊断率均达100％，将之确定为诊断标准；2D重建可作为横断图像的补充；3D重建可立体显示骨性胸廓的全貌，利于病变的整体观察及定位。结论：CT扫描及其二维、三维重建对肋骨转移瘤的诊断具有明显的优势，与X线平片或CR图像的联合应用，具有良好的定位、定量及定性诊断作用。     

肺癌骨转移的CT诊断：附36例CT分析

笔者报告36例肺癌骨转移的CT表现,其中29例作X线平片检查。CT表现主要呈溶骨性骨破坏(69.5％),亦可呈成骨性(5.5％)或混合性(25％)骨破坏。CT扫描在发现和估价病变方面较X线平片敏感。如平片骨破坏发现率为75.8％,CT扫描为100％;平片显示软组织肿块发现率为13.7％,CT为61.1％。文中对肺癌骨转移的发病情况、转移途径及CT诊断和鉴别诊断等进行了讨论。     

放射性核素骨显像对乳腺癌的诊断价值

目的：探讨放射性核素骨显像（SPECT）对乳腺癌的诊断价值。方法：116例未经手术、放疗及化疗的乳腺癌Ⅳ期初诊患者，均分别行SPECT核素骨显像、骨X线平片及骨CT检查。所有患者静脉注射^99mTc—MDP3～4h后行放射性核素骨显像检查。结果：116乳腺癌Ⅳ期初诊患者中，SPECT显像阳性：有骨转移的22例，无骨转移的16例。SPECT、X线及CT对病灶诊断的灵敏度分别为84．6％、61．5％和69．2％，SPECT灵敏度明显高于X线平片和CT（P〈0．05）。结论：SPECT对Ⅳ期乳腺癌有无骨转移有重要的诊断价值，在病例筛选中可作为首选检查项目。     

下腰椎小关节退行性病变的X线、CT、MRI影像学比较

目的探讨X线、CT和MRI对下腰椎小关节退行性病变的诊断价值及局限性。方法收集41例明确有下腰椎小关节退行性病变的X线、CT和MRI影像学资料,包括腰椎正、侧、斜位及过伸、过屈位片,L3～S1段椎小关节CT横断位及MRI横断、冠状、矢状位扫描图像。结果X线平片对腰椎小关节的显示仅限于对关节面骨质及关节间隙宽窄度改变的观察。CT对椎小关节突骨质、关节面平整度及关节面下骨质、关节间隙、关节囊钙化等改变的显示明显优于X线平片及MRI（均P〈0．05）。MRI在显示关节面软骨、关节囊肿胀、滑膜囊肿及滑膜囊疝等方面明显优于X线平片和CT（均P〈0．05）。结论X线平片、CT、MRI三种影像学检查方法在显示椎小关节退行性病变方面各有优缺点,综合应用和合理选择影像学检查方法可为临床正确诊断和治疗腰椎小关节病变提供可靠依据。     

成人股骨头缺血坏死的X线体层摄影与CT诊断比较

目的：探讨成人股骨头缺血坏死的X线体层摄影与CT诊断比较价值。方法：54例患者均行X线体层摄影与CT扫描。结果：X线体层摄影征象I期12例,Ⅱ期8例,Ⅲ期18例,Ⅳ期16例;CT征象I期3例,Ⅱ期15例,Ⅲ期19例,Ⅳ期17例。结论：CT在诊断早期股骨头缺血坏死及早期分期中明显优于X线体层摄影。     

胫骨髁间隆突撕脱骨折的影像学研究

搜集因膝关节外伤就诊、X线片及CT资料完善者17例,比较分析胫骨髁间隆突撕脱的X线平片及CT表现。结果17例中髁间隆突撕脱骨折15例,X线平片确诊11例,假阴性4例,假阳性2例;CT确诊14例,假阴性1例。两种技术的诊断结果在统计学上无显著性差异,但CT扫描的灵敏度(93.3%)明显高于X线平片检查。     

骨转移瘤的X线征像分析（附93例报告）

目的：通过对93例骨转移瘤X线征像的分析,旨在提高对骨转移瘤的临床及影像表现的再认识。方法：93例中,原发性肿瘤主要为肺癌（32例）,占34．4％,胃癌（8例）,占8．6％,乳腺癌、鼻咽癌各7例,分别占7．5％,原发灶不明11例占11．8％。结果：溶骨型骨转移瘤81例,成骨型骨转移瘤5例,混合型骨转移瘤7例,囊状型骨转移瘤2例。结论：骨转移瘤以40～60岁男性多见,转移部位以脊柱、骨盆及肋骨多见,转移类型以溶骨型为多见。X线对骨转移瘤的诊断具有十分重要的临床价值。     

CT与X线平片对强直性脊柱炎的诊断价值

目的：探讨CT与X线平片对强直性脊柱炎的诊断价值。方法：回顾分析84例强直性脊柱炎患者的X线表现，其中46例行骶髂关节，髋关节CT扫描，18例行腰椎CT扫描。结果：病变主要累及双侧骶髂关节84例（100％），其次为脊柱（74．8％）和双髋关节（37．9％），其他周围关节炎仅6例。结论：强直性脊柱炎的X线表现有一定的特性性，对临床疑强直性脊柱炎患者X线检查十分必要，CT对病变的显示更清晰，对于X线平片可疑的病变，CT常可排除或肯定诊断，但不能取代X线平片检查。X线平片仍是诊断本病首选和基本的方法。     

隐匿性骨折的CT、MRI分析

目的探讨CT、MRI对隐匿性骨折的诊断价值。方法63例急性外伤患者均行X线摄片检查，对X线摄片有怀疑、临床体征明显或随访仍有怀疑、或软组织肿胀明显的病例做CT和（或）MRI检查，共检出隐匿性骨折51例。结果所选病例外伤X线平片均未显示明显骨折线，隐匿性骨折阳性率达81．0％（51／63）。27例行CT检查，其中22例做CT三维重建，均清楚显示骨折线；20例行MRI检查，显示骨挫伤12例、骨折8例；4例骨折同时行CT和MRI检查。结论骨创伤性病变影像诊断中，CT、MRI对X线平片不易发现或临床体征、症状不能除外的骨折，是有效的检查手段。     

Options for reducing patient radiation dose with cardiovascular computed tomography

Computed Tomography (CT) scanner manufacturers and users are aggressively pursuing radiation exposure reduction strategies for cardiovascular imaging. Strategies include the design of scanner hardware to prevent X-rays not contributing data to image formation from reaching the patient, user manipulation of scan parameters to decrease the number and/or energy of the X-ray photons interacting with the patient, and hardware and software improvements to increase efficiency of data detection and utilization. This paper provides an overview of CT technology with an emphasis on dose related features and scan parameters and describes in detail the options currently available for reducing radiation exposure with cardiovascular CT.     

Options for reducing patient radiation dose with cardiovascular computed tomography

Computed Tomography (CT) scanner manufacturers and users are aggressively pursuing radiation exposure reduction strategies for cardiovascular imaging. Strategies include the design of scanner hardware to prevent X-rays not contributing data to image formation from reaching the patient, user manipulation of scan parameters to decrease the number and/or energy of the X-ray photons interacting with the patient, and hardware and software improvements to increase efficiency of data detection and utilization. This paper provides an overview of CT technology with an emphasis on dose related features and scan parameters and describes in detail the options currently available for reducing radiation exposure with cardiovascular CT.     

18F-前列腺特异性膜抗原-1007 PET/CT显像、11C-胆碱PET/CT显像及单光子发射计算机断层成像术骨显像对前列腺癌骨转移的诊断价值比较

目的探讨¹⁸F-前列腺特异性膜抗原(PSMA)-1007标记的正电子发射体层显像融合计算机体层显像技术(PET/CT)显像、11C-胆碱(11C-CHO)PET/CT显像及单光子发射计算机断层成像术(SPECT)骨显像在前列腺癌骨转移诊断上的差异。方法回顾性分析2018年9月至2020年7月北部战区总医院核医学科收治的43例男性前列腺癌患者的临床资料,年龄(77.47±11.87)岁,年龄范围为55~89岁。所有患者行¹⁸F-PSMA-1007 PET/CT显像、11C-CHO PET/CT显像及SPECT骨显像检查。分别统计¹⁸F-PSMA-1007 PET/CT显像、11C-CHO PET/CT及SPECT骨显像诊断骨转移的阳性例数和阴性例数,计算三种方法各自的灵敏度、特异度、准确性、阳性预测值、阴性预测值,绘制受试者工作特征(ROC)曲线,计算并比较各自曲线下面积(AUC),评价三种检查方法对前列腺癌骨转移的诊断效能。结果 43例前列腺癌患者中,27例患者出现骨转移。¹⁸F-PSMA-1007 PET/CT显像示26例患者发生骨转移,漏诊1例;11C-CHO PET/CT显像示24例患者发生骨转移,误诊1例,漏诊4例;SPECT骨显像示23例患者发生骨转移,误诊3例,漏诊7例,三者诊断前列腺癌骨转移的灵敏度、特异度、准确性分别为96.3%(26/27)、100%(16/16)、97.7%(42/43);85.2%(23/27)、93.8%(15/16)、88.4%(38/43);74.1%(20/27)、81.3%(13/16)、76.7%(33/43)。¹⁸F-PSMA-1007 PET/CT显像、11C-CHO PET/CT和SPECT骨显像ROC曲线的AUC和95%CI分别为0.981(0.885~1.000)、0.913(0.763~0.967)、0.777(0.624~0.889)。三种检查的AUC曲线下面积进行两两比较,差异均有统计学意义(P<0.05)。采用Wilcoxon秩和检验对27例患者三种方法检出的骨转移灶的数量进行两两比较发现,¹⁸F-PSMA-1007 PET/CT显像与SPECT骨显像比较,差异有统计学意义(Z=-2.484,P=0.013),¹⁸F-PSMA-1007 PET/CT显像与11C-CHO PET/CT显像比较,差异无统计学意义(Z=-0.160,P=0.873);11C-CHO PET/CT显像与SPECT骨显像比较,差异有统计学意义(Z=-2.085,P=0.037)。结论 PET/CT显像较SPECT骨显像能发现更多的骨转移灶。¹⁸F-PSMA-1007 PET/CT显像对前列腺癌骨转移诊断的灵敏度、特异度及准确性高于其他两种检查方式。在低前列腺特异性抗原(PSA)的情况下,能够精确地对前列腺癌骨转移做出诊断。     

ED utilization of computed tomography in a poisoned population

The objective of this prospective, analytic study was to identify predictors and describe the demographic and clinical correlates of head computed tomography (CT) evaluation in patients with poisoning or drug overdose and altered mental status. Forty-three patients that were evaluated by head CT and 109 that were not evaluated by head CT were entered into the study at a poison control center. None of the 43 scanned patients had any acute findings on head CT. A logistic regression model yielded 4 predictors that were statistically associated with the ordering of a head CT scan: Glasgow Coma Scale (GCS) < or = 8 (odds ratio [OR]: 2.3; 95% confidence interval [CI] 1.03-5.7); age > or = 41 years (OR 5.3; 95% CI 2.2-13); use of drugs or abuse by history (OR 2.8; 95% CI 1.04-7.6); and witnessed seizure activity (OR 4.8; 95% CI 1.3-17.9). We also tested 2 additional models to identify predictors of hospital admission, 1 with and 1 without CT scan included as a covariate. In the first model, only GCS 相似文献   

CT及X线钡餐造影在中晚期胃癌诊断中的对照研究

目的 对中晚期胃癌进行CT与X线钡餐造影的对照研究。方法 分析48例经手术及／或胃镜病理证实的中晚期胃癌的CT与X线钡餐造影的表现。结果 CT及X线钡餐造影在中晚期胃癌病灶的检出率上无显差别，CT在检出转移灶及判断邻近器官的受侵的程度上明显优于X线钡餐造影。但有对CT在检出转移灶及判断邻近器官的受侵程度上也可出现假阳性（误诊）与假阴性（漏诊）。X线钡餐造影在观察病变空间位置、胃壁柔软度方面则优于CT。结论 在中晚期胃癌的诊断上，X线钡餐造影仍不失为一种首选的常规检查方法。CT检查则可用来作佐证，以相互补充证实。     

Study of the sensitivity and specificity of computerized tomography in the detection of calcified gallstones which appear radiolucent by conventional roentgenography

Radiolucent gallstones frequently contain significant calcium deposits. Their detection is important in the evaluation of patients for medical gallstone dissolution treatment. The sensitivity and specificity of computerized tomography (CT) in detecting calcium was studied in 20 patients with radiolucent and in 3 with radiopaque gallstones. Although the sensitivity of the CT scan was somewhat higher than that of conventional radiography — 46% versus 23%, respectively, for a calcium content of at least 4% — the CT scan was negative in 4 out of 6 patients in whom the percentage of calcium in the gallstones ranged between 10 and 100. The CT scan was specific: there were no false positive results. The results of the CT scan were not related to the amount or type of calcium salt present. The study shows that the presently used CT scan of the gallbladder is not sensitive enough to select gallstone patients for medical dissolution treatment.     

Ambulatory follow-up of aortic dissection: comparison between computed tomography and biplane transesophageal echocardiography

Aim of the study was to assess the relative usefulness of transesophageal echocardiography (TEE) and X-ray computed tomography (CT) in the follow-up of patients who survived an aortic dissection. Materials and Methods. We evaluated 44 patients (age = 57±12 years) with treated aortic dissection: 14 had a De Bakey type I, 20 a type II and 1 patient a type III dissection treated surgically; 1 patient had a type I, 1 a type II and 7 a type III dissection treated medically. All entered an outpatient follow-up program with serial evaluations at 1, 6 and 12 months after initial diagnosis by dual noninvasive imaging protocol. A contrast-enhanced CT scan and a TEE with biplane probe were performed on the same day and in random order. Results. A total of 252 evaluations with both CT and TEE were considered. A completely normal study was found in 45 TEE and 48 CT evaluations. The following abnormal findings could be documented by one or both techniques: thrombus in the false lumen (TEE: n=48; CT: n=45 evaluations); intimal flap (TEE and CT: n=68); aortic dilatation (TEE and CT: n=15); pericardial effusion (TEE and CT: n=3); aortic pseudoaneurysm (TEE: n=2; CT: n=3); isthmic coarctation (TEE and CT: n=1). Regarding the presence or absence of these abnormalities, which are within the diagnostic domain of both imaging techniques, the results were fully concordant in 245 studies, and discordant in 7, with an overall agreement of 97%. In addition, some abnormal findings could be detected by TEE only: aortic insufficiency (n=36); intimal tear (n=25); spontaneous echocontrast effect in the false lumen (n=39 evaluations). Other abnormal findings could be detected by CT only: a pleural effusion in 4, a truncus anonymous dissection in 1, a pseudoaneurysm due to suture dehiscence of the distal anastomosis of the ascending aorta in 1 evaluation (which yielded ambiguous results by TEE, with turbulent flow departing from the graft). Conclusion. Both CT and TEE are atraumatic, safe and accurate techniques for serial follow-up imaging of patients treated for aortic dissection. Information provided by CT is largely redundant, rather than additive, to that provided by TEE. The latter should be probably preferred for shorter imaging time, accuracy and convenience, although CT might still play a role in selected cases of ambiguous TEE results.     

腰椎椎体后缘离断症的影像诊断(附19例分析)

目的　探讨腰椎椎体后缘离断症的影像诊断价值。方法　回顾性分析 19例经手术证实的腰椎椎体后缘离断症病例的影像表现。结果　 19例X线平片显示腰椎椎体后缘离断症 11例 (5 6% ) ,行椎管造影 15例 ,显示腰椎椎体后缘离断症 11例 (73 % ) ,19例CT平扫显示 18例 (95 % )。结论　X线平片是检查腰椎椎体后缘离断症的基本方法 ,CT平扫是检查诊断腰椎椎体后缘离断症的最有效手段 ,结合CTM能更准确地显示椎管的狭窄程度     

Lung computed tomography during a lung recruitment maneuver in patients with acute lung injury

OBJECTIVE: To assess the acute effect of a lung recruitment maneuver (LRM) on lung morphology in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). PATIENTS: Ten patients with ALI/ARDS on mechanical ventilation. DESIGN: Prospective clinical study. SETTING: Computed tomography (CT) scan facility in a teaching hospital. INTERVENTIONS: An LRM performed by stepwise increases in positive end-expiratory pressure (PEEP) of up to 30-40 cm H(2)O. Lung basal CT sections were taken at end-expiration (patients 1 to 5), and at end-expiration and end-inspiration (patients 6 to 10). Arterial blood gases and static compliance (C(st)) were measured before, during and after the LRM. MEASUREMENTS AND MAIN RESULTS: Poorly aerated and non-aerated tissue at PEEP 10 cm H(2)O accounted for 60.0+/-29.1% of lung parenchyma, while only 1.1+/-1.8% was hyperinflated. Increasing PEEP to 20 and 30 cm H(2)O, compared to PEEP 10 cm H(2)O, decreased poorly aerated and non-aerated tissue by 16.2+/-28.0% and 33.4+/-13.8%, respectively ( p<0.05). This was associated with an increase in PaO(2) and a decrease in total static compliance. Inspiration increased alveolar recruitment at all PEEP levels. Hyperinflated tissue increased up to 2.9+/-4.0% with PEEP 30 cm H(2)O, and to a lesser degree with inspiration. No barotrauma or severe hypotension occurred. CONCLUSIONS: Lung recruitment maneuvers improve oxygenation by expanding collapsed alveoli without inducing too much hyperinflation in ALI/ARDS patients. An LRM during the CT scan gives morphologic and functional information that could be useful in setting ventilatory parameters.     

Clinical guidelines, computed tomography scan, and negative appendectomies: a case series

INTRODUCTION: Prior studies suggest that preoperative abdominal computed tomography (CT) scan can contribute to a low negative appendectomy rate. Our study objective was to evaluate cases of negative appendectomies for clinical criteria and CT use. METHODS: Retrospective 1-year study of all negative appendectomies at a community hospital. Data included clinical evidence for appendicitis as well as CT results if performed. RESULTS: Of 122 cases reviewed, 8 (6.6%) were negative appendectomies. Six were younger than 20 years. Four had a preoperative CT scan. Overall, 106 (87%) of 122 cases received preoperative CT and had a negative appendectomy rate of 3.8%. Sixteen cases did not have preoperative CT and had a negative appendectomy rate of 25% (odds ratio, 8.5; 95% confidence interval, 1.9-38.5; Fisher exact test P = .01). CONCLUSION: Patients who had a CT scan for suspected appendicitis had a lower rate of negative appendectomies than those who had no CT. Most of the negative appendectomies occurred in patients younger than 20 years.