多层螺旋CT动脉造影对骨盆骨折动脉损伤的诊断价值

目的探讨多层螺旋CT动脉成像对骨盆骨折动脉损伤的诊断价值.方法对25例骨盆骨折患者行多层螺旋CT动脉造影（MSCTA）检查,将图像在工作站上用容积重建（VR）、最大密度投影（MIP）及多平面图像重建（MPR）进行后处理,分析骨折周围的血管走行和损伤情况.结果扫描图像双侧髂总动脉,双侧髂内髂外动脉及其分支均显示清晰,轴位及多种方法重建后见32处骨折周围血肿内中小动脉旁造影剂漏出影,1例髂内动脉截断影,均经手术证实.结论多层螺旋CT血管造影能较好显示骨盆骨折后骨盆血管的损伤情况,对骨折造成的动脉损伤具有很高的诊断价值;缺点是费用较高.     

多层螺旋CT脑血管成像的临床应用

目的：探讨多层螺旋CT脑血管成像的方法与临床应用价值。方法：对18例病人用西门子Sensation4四层螺旋CT机按照CT脑血管成像参数进行扫描，然后将所获图像数据导入CT3D工作站，利用后处理软件——MPR、MIP、SSD、VRT、CTVE进行成像，由两位放射科医生和两位内科医生对图像进行分析。结果：18例中，正常8例，脑动脉瘤1例，血管狭窄3例，动静脉畸形2例，脑肿瘤4例。几种后处理软件——MPR、MIP、SSD、VRT都能清楚地显示脑血管，尤其以MIP效果最好；CTVE的优势在于显示血管腔内情况。结论：多层螺旋CT脑血管成像具有安全、无创、准确的优点，可部分替代DSA。     

64排螺旋CT评估冠状动脉支架置入术效果的价值

目的：研究64排螺旋CT冠状动脉成像评价冠状动脉支架通畅性的价值。方法：对70例冠状动脉支架植入术后9～12个月患者行64排螺旋CT冠脉成像（共106个支架）,观察支架及其支架血管的通畅性。采用5分制计分法评价支架的轴位多平面重建图像,同时测量支架内管腔直径。计算支架内管腔直径与支架近端的管腔直径比值。结果：图像平均质量达到优良水平。支架通畅85个（80．2％）,支架内狭窄3个,闭塞1个,支架前后血管狭窄18个。平均支架内腔直径比率为（78．3±12．6）％。结论：64排螺旋CT可作为冠状动脉支架置入术后随访观察和了解冠心病进展情况的重要手段。     

多排螺旋CT气管、支气管仿真影像学的临床应用

多排螺旋CT（MSCT）仿真内窥镜成像（CTVB）是利用计算机功能,将螺旋CT容积扫描所获得的图像数据进行后处理,然后重建出空腔器官内表面的立体图像,酷似纤维内镜所见：此项技术在结肠、大血管等器官的临床应用方面取得了较人的进展,在气管、支气管方面也有一定研究。常规胸部CT扫描显示的足横断面图像,对支气管腔的观察缺乏连续性,较难辨认垂直走向的支气管。CT仿真支气管内窥镜是一种气道3D成像新技术,其方法是用薄层螺旋CT扫描数据重建成模拟气道影像,CTVB能连续观察管腔内表面,将观察点置于气管、支气管内,任意在管腔内探查和漫游,并能深入到较大的哑段支气管内,能观察到酷似支气管镜所见的影像。所示图像直观而牛动,可进入5～7级支气管,町通过重度狭窄对远端支气管进行观察,这种非侵入性的成像技术成为评价气道病变的新方法。[第一段]     

动脉硬化症的多排CT仿真血管镜诊断

目的探讨多排CT应用仿真血管镜技术对动脉硬化的诊断价值.方法 35例临床诊断为动脉硬化症病人及40名正常人行多排螺旋CT扫描,将所有的CI图像进行低对比薄层重建,然后将重建图像导入CT 3D工作站,用软件CT仿真内镜、多平面成像、最大密度投影、容积成像技术进行图像后处理,并就正常血管及病变血管在CT仿真血管镜中的改变进行分析和记录.结果对入选的35例病人和40名健康志愿者进行了CT仿真血管镜成像,35例临床诊断为动脉硬化症的病人中,血管壁钙化32例共102处病变,血管内壁不规则及增厚30例,血管狭窄29例,动脉硬化斑块19例66处病变;40例正常人的血管仿真血管镜图像表现为血管壁光滑,管腔无狭窄;12例冠心病病人同时行血管造影术检查,其结果与CT仿真血管镜成像检查相似 .结论用多排螺旋CT仿真血管镜诊断动脉硬化症具有一定的临床价值.     

64层螺旋CT三维血管成像在主动脉夹层诊断中的价值

目的 探讨64层螺旋CT三维血管成像在主动脉夹层诊断中的价值.方法 对34例主动脉夹层(AD)患者行64层螺旋CT薄层扫描,在工作站采用最大密度投影 (MIP)、多平面重建 (MPR)及容积再现(VRT)技术对轴位图像进行三维重建.结果 34例AD中显示真假腔34例,内膜片27例,壁内血肿7例;27例典型夹层三维成像均显示明确破口,主动脉弓部破口以矢状位显示最佳,降主动脉破口以轴位及冠状显示最佳,VRT显示病变全程较清晰,但对破口及内膜片的显示不如MIP、MPR及轴位.结论 64层螺旋CT三维血管成像能全面清晰显示AD解剖病理改变,尤其是对破口的显示,是AD的重要诊断手段.     

上颌骨骨折的多层螺旋CT诊断

目的 研究多层螺旋CT对上颌骨骨折的应用价值.方法 对32例上颌骨骨折患者进行多层螺旋CT扫描和重建.结果 本组上颌骨骨折以复合型较多见.CT横断图像对3例LeFort I型骨折显示欠佳,5例深部细小骨折在三维图像上未能明确显示,CT二维图像通过软组织窗能清晰显示骨折周围软组织改变.结论 上颌骨骨折的多层螺旋CT诊断在常规横断位图像的基础上加以二维多平面(MPR)及三维容积成像(VR)等二维、三维重建,能提供立体、直观的图像,明确诊断.     

前瞻性心电触发轴位扫描技术在64层螺旋CT中的应用

目的探讨在64层螺旋CT冠状动脉成像中采用前瞻性心电触发轴位扫描技术的图像质量和辐射剂量。方法选择采用前瞻性心电触发轴位扫描技术进行64层螺旋CT冠状动脉成像的患者160例作为前瞻组。将相同扫描参数输入回顾性心电门控螺旋扫描程序,获得扫描剂量数据作为回顾组。由2名放射科医师分别进行图像重建和图像质量评价。冠状动脉图像质量分级采用4级评分法。结果 2名放射科医师在图像重建和图像质量评价方面均有良好的一致性。160例患者除8例图像有严重血管错层伪影、2例冠状动脉严重钙化,共显示1449个冠状动脉节段。1～3分以上的1431个节段(98.76%)具有较好的图像质量,可以满足临床诊断要求。前瞻组与回顾组的平均有效剂量差异有统计学意义[(3.17±1.17)mSv vs (22.09±6.72)mSv,P0.01]。结论在64层螺旋CT冠状动脉成像中采用前瞻性心电触发轴位扫描技术可在保证图像质量的同时显著降低辐射剂量。     

多层螺旋CT及图像后处理技术在胫骨平台骨折中的应用

分析23例胫骨平台骨折的X线片。CT横断位、多平面重建（MPR）及三维容积再现（3DVR）图像，并与手术所见对照。发现多层螺旋CT扫描及图像后处理能为胫骨平台骨折的诊断和治疗提供有价值的信息，有助于临床选择最佳治疗方案。     

神经根型颈椎病患者椎间孔狭窄的特点及原因

目的 探讨神经根型颈椎病患者椎间孔狭窄的特点和原因.方法 对存在颈神经根压迫症状和颈椎间孔狭窄的101例患者的颈椎多层螺旋CT扫描图像进行多层面重建,分析颈椎间孔病变的特点及原因.结果 101例患者C3～ C7节段共832个椎间孔中有263个狭窄,其中C5～C6节段狭窄105个（39.9％）,单节段狭窄者53例（52.5％）,3个节段和4个节段狭窄者共16例（其中发生在50 ～ 59岁和60 ～ 69岁年龄组者14例）.颈椎间孔狭窄的原因分别为钩椎关节骨质增生197个,椎间盘突出75个（中央型突出12个、后外侧型突出63个）,关节突增生错位63个,椎间隙狭窄51个,后纵韧带骨化1个.结论 颈椎间孔狭窄以C5～ C6节段最常见,且以单节段为主,3个节段和4个节段的椎间孔狭窄主要发生在50 ～ 59岁和60 ～ 69岁年龄组.导致椎间孔狭窄的原因以钩椎关节骨质增生为主,其次为椎间盘突出（以后外侧型突出为主）和关节突增生错位等,由两种以上原因引起的椎间孔狭窄主要发生在50 ～ 59岁和60 ～ 69岁年龄组.     

Surgical results and complications in elderly patients with benign lesions of the spinal canal.

OBJECTIVE: To describe the long-term outcome and complications of spinal surgery in a population of elderly patients. DESIGN: Retrospective chart review and clinical follow-up. SETTING: A 700-bed tertiary care midwestern hospital. PATIENTS: Patients 70 years of age or older who underwent elective surgical procedures for the treatment of benign lesions of the spinal canal. MAIN OUTCOME MEASURES: Data obtained from chart review included age, sex, nature and duration of neurological symptoms, activities of daily living (ADL), associated illnesses, length of hospitalization, type of surgery, and complications attributable to surgery. Outcome measurements included changes in neurological symptoms and ADL and a standardized scale obtained from consecutive outpatient visits, telephone interviews, or written responses. RESULTS: Seventy-eight patients with lumbar canal stenosis or soft disc herniations underwent laminectomies, foraminotomies or discectomies. Eleven patients underwent cervical laminectomies for multilevel spondylitic myelopathy. Limb and spine pain were the most common neurological symptoms in patients with lumbar lesions; diminished ADLs were present in eight patients with cervical myelopathies. Six patients died of unrelated causes, and 78 were followed for an average of 27.1 months. Twenty-three (85.2%) of 27 patients with lumbar disc herniations reported improvements or resolution of limb pain while 35 (81.4%) of 43 patients with lumbar canal stenosis reported fair or good results. Five of eight patients with multilevel cervical spondylosis reported improvements of myelopathic symptoms. Twenty-six (28.6%) complications were attributable to 91 surgical procedures including five severe complications and one fatality. Patients with three or more associated illnesses demonstrated a significantly higher incidence of postoperative complications. CONCLUSIONS: Elderly patients with benign lesions of the spinal canal may achieve significant reduction in limb pain and increases in ADL following appropriate surgery, with a tolerable rate of severe complications. The preoperative physical condition of the elderly patient served as an indicator for operative morbidity.     

Clinical Case Report of Expansive Laminoplasty for Cervical Myelopathy Due to Both Disc Herniation and Developmental Cervical Spinal Canal Stenosis in Older Adolescents

Reports on adolescent patients with cervical myelopathy who underwent anterior cervical discectomy and fusion are scarce. However, to our knowledge, no cases of expansive laminoplasty for cervical myelopathy associated with progressive neurological deficit after a series of conservative treatment, caused by both disc herniation and developmental cervical spinal canal stenosis, have been reported.From January 2006 to July 2012, we retrospectively studied 3 patients in late adolescence presenting with cervical myelopathy who underwent expansive unilateral open-door laminoplasty at our hospital. The outcomes after the surgery were evaluated according to the Japanese Orthopedic Association scores.Symptoms presented by these patients were due to both disc herniation and developmental cervical spinal canal stenosis. No major complications occurred after the surgical procedures. The median follow-up time was 66 months (range 36–112 months). The Japanese Orthopedic Association scores after surgery showed a significant increase. Long-term outcomes after surgery were satisfactory according to the evaluation criteria for the Japanese Orthopedic Association scores. However, the ranges of motion of the cervical spine decreased, especially the ranges of motion on flexion after surgery showed a significant decrease.Expansive laminoplasty is helpful for older adolescent patients with cervical myelopathy due to both disc herniation and developmental cervical spinal canal stenosis, presenting with progressive neurological deficit after long conservative treatment.     

Lumbar and cervical stenosis. Frequency of the association,role of the ankylosing hyperostosis

Summary The authors report a study of 47 patients admitted for cervical myelopathy (N=17) or symptomatic lumbar spinal stenosis (N=30). Nine patients had clinical evidence of coexisting cervical myelopathy and lumbar spinal stenosis. Ten out of the 17 patients having cervical myelopathy had lumbar spinal stenosis as evidenced by saggital tomography and/or computerized tomography. Nine out of the 30 patients admitted for symptomatic lumbar spinal stenosis had coexisting cervical canal stenosis as evidenced by sagittal tomography. Thirteen out of these 19 patients with both cervical and lumbar canal stenosis had also ankylosing spinal hyperostosis.     

Radiographic and clinical evaluation of single-level lateral interbody fusion in patients with severe stenosis analyzed using cluster analysis

This study was a retrospective review of patients treated in a single institution. We performed a cluster analysis of the degree of preoperative stenosis to investigate the effect of indirect neural decompression in single-level lateral lumbar interbody fusion (LLIF). Surgery is generally indicated for patients with severe stenosis. On the other hand, severe lumbar spinal stenosis is a relative contraindication to LLIF and is excluded in most studies. If LLIF, which is less invasive to treatment, can be applied to severe stenosis patients, it may help treatment. Cluster analysis classified 80 patients into 3 groups based on preoperative central canal area (CCA), preoperative canal diameter (CD), and preoperative Schizas grade: group 1 with severe stenosis (n = 43); group 2 with moderate stenosis (n = 27); and group 3 with mild stenosis (n = 10). Preoperative and immediately postoperative CCA and CD in magnetic resonance imaging were compared between groups. Disc angle (DA) and anterior, posterior, and average disc heights (AvDH) (anterior disc height, posterior disc height, average disc height AvDH) were measured using standing lateral plain radiographs. For clinical analysis, a numeric rating scale was used to evaluate clinical outcomes. DA, anterior disc height, posterior disc height, and AvDH increased significantly after the operation in all groups, but the average changes in these factors did not differ. Mean midsagittal CD and axial CCA on MRI magnetic resonance imaging increased significantly in all groups, but as with DA and DH, the changes in axial CCA and midsagittal CD did not differ between groups. The numeric rating scale score did not differ between groups at any time. The cluster analysis results suggested that postoperative changes in indirect neural decompression for severe stenosis after LLIF similar for moderate and mild stenosis and that pain did not differ according to the severity of stenosis after surgery.     

经皮椎间孔镜在治疗中老年腰椎间盘突出症中的应用

目的评价应用经皮椎间孔镜(PTED)治疗中老年腰椎间盘突出症的临床效果和价值。方法前瞻性研究分析2016年3月至2018年9月空军特色医学中心骨科采用PTED切除突出椎间盘髓核减压治疗的50～72岁腰椎间盘突出症患者,共50例,并以同期常规开放椎板开窗或半椎板切除减压突出椎间盘髓核切除手术的50～71岁患者50例为对照组。比较2组患者术中出血量、手术时间、术后住院时间。以术后1 d、1个月、3个月疼痛视觉模拟评分(VAS)和术后3个月Oswestry功能障碍指数(ODI),及术后6个月改良MacNab标准评定手术疗效。手术前及术后3～6个月行MRI检查,观察手术前后椎管及椎间盘突出的变化。使用STATA 12.0统计软件进行统计分析。结果 2组患者年龄、术前VAS和ODI评分差异无统计学意义(P0.05),术后VAS和ODI评分较术前均显著下降(P0.01);PTED组术后1 d、1个月的VAS评分显著低于对照组(P0.01)。术后3个月,2组VAS和ODI评分差异无统计学意义(P0.05);术后6个月,2组改良MacNab标准评定功能差异无统计学意义(P0.05);PTED组术中出血量、术后住院时间显著少于对照组(P0.01);2组手术时间无统计学差异(P0.05)。MRI检查结果显示,与术前比较,2组术后3～6个月椎间盘突出均消失或明显减小,椎管通畅、面积明显增大。结论 PTED技术治疗中老年腰椎间盘突出症,中期疗效与单纯开放手术相当,但PTED早期疗效好、损伤小、恢复快、并发症少。     

Comparison of intravascular ultrasound to contrast-enhanced 64-slice computed tomography to assess the significance of angiographically ambiguous coronary narrowings

The efficacy of contrast-enhanced multislice computed tomography (MSCT) for assessment of ambiguous lesions is unknown. We compared both quantitative coronary angiography (QCA) and MSCT to the gold standard for a significant stenosis-minimum luminal area (MLA) by intravascular ultrasound (IVUS)-in 51 patients (64 +/- 10 years old, 19 men) with 69 angiographically ambiguous, nonleft main lesions. The MSCT was performed 17 +/- 18 days before IVUS analysis. Overall diameter stenosis by QCAwas 51.0 +/- 9.8%; 39 of 51 patients (76%) eventually underwent revascularization (38 by percutaneous coronary intervention and 1 by coronary artery bypass graft). By univariate analysis, minimum luminal diameter, MLA, lumen visibility by MSCT, and minimum luminal diameter by QCA were significant predictors of MLA by IVUS 相似文献   

老年肺结核的影像学表现

老年肺结核患者由于病程长、免疫机能降低、并发疾病多等特点,除导致肺实质的病变外,还会引起肺间质、肺血管的病变。其肺部病灶具有多发性、多形性、不典型性的表现。随着影像学技术的发展,对异常征象及时、准确的判读可以给老年肺结核临床诊断提供有力依据。     

MRI morphometric characterisation of the paediatric cervical spine and spinal cord in children with MPS IVA (Morquio-Brailsford syndrome)

Nearly all children with MPS IVA develop skeletal deformities affecting the spine. At the atlanto-axial spine, odontoid hypoplasia occurs. GAG deposition around the dens, leads to peri-odontoid infiltration. Transverse/alar ligament incompetence causes instability. Atlanto-axial instability is associated with cord compression and myelopathy, leading to major morbidity and mortality. Intervention is often required. Does the presence of widened bullet shaped vertebra in platyspondily encroach on the spinal canal and cause spinal stenosis in MPS IVA? So far, there have been no standardised morphometric measurements of the paediatric MPS IVA cervical spine to evaluate whether there is pre-existing spinal stenosis predisposing to compressive myelopathy or whether this is purely an acquired process secondary to instability and compression. This study provides the first radiological quantitative analysis of the cervical spine and spinal cord in a series of affected children. MRI morphometry indicates that the MPS IVA spine is narrower at C1–2 level giving an inverted funnel shape. There is no evidence of a reduction in the Torg ratio (canal-body ratio) in the cervical spine. The spinal canal does not exceed 11 mm at any level, significantly smaller than normal historical cohorts (14 mm). The sagittal diameter and axial surface area of both spinal canal and cord are reduced. C1–2 level cord compression was evident in the canal-cord ratio but the Torg ratio was not predictive of cord compression. In MPS IVA the reduction in the space available for the cord (SAC) is multifactorial rather than due to congenital spinal stenosis.     

Role of curved planar reformations using multidetector spiral CT in diagnosis of pancreatic and peripancreatic diseases

AIM: To investigate the role of curved planar reformations using multidetector spiral CT (MSCT) in diagnosis of pancreatic and peripancreatic diseases. METHODS: From October 2001 to September 2003, 47 consecutive patients with pancreatic or peripancreatic diseases, which were confirmed by operation, endoscopic retrograde cholangiopancreatography and clinical follow-up, were enrolled in this study. CT scanning was performed at a MSCT with four rows of detector. A set of images with an effective thickness of 1.0-2.0 mm and a gap of 0.5-1.0 mm (50% overlap) were acquired in all patients for post-processing. Curved planar reformations were carried out by drawing a curved line on transverse source images, coronal or sagittal multiplanar reformations according to certain anatomic structures (such as cholangiopancreatic ducts or peripancreatic vessels) and the position of lesion. RESULTS: With thin collimation, MSCT could acquire high-quality curved planar reformations to display the profile of the whole pancreas, to trace the cholangiopancreatic ducts and peripancreatic vessels, and to show the relationship of lesions with pancreas and peripancreatic anatomic structures in one curved plane, which facilitates diagnosis and rapid communication of diagnostic information with referring physicians. CONCLUSION: MSCT with thin collimation could be used to create high-quality curved planar reformations in evaluating pancreatic and peripancreatic diseases with pertinent anatomic information and relative pathologic signs to facilitate the diagnosis and enhance communication with the referring physician. Curved planar reformations can serve as supplements for transverse images in diagnosis and management of pancreatic and peripancreatic diseases.     

多层螺旋CT门静脉血管成像在胰源性门脉高压症诊断中的应用

目的 研究多层螺旋CT门静脉血管成像在胰源性门静脉高压患者诊断中的应用.方法 应用16排多层螺旋CT门静脉血管成像,对47例临床怀疑胰腺体尾部病变的患者的门静脉系统形态改变与126例肝源性门脉高压患者和47例正常对照组进行形态学对比观察,并测量胃冠状静脉、门静脉、脾静脉、肠系膜上静脉内径、门静脉期肝实质和门静脉主干CT值,对比肝脏、脾脏体积.结果 在47例胰腺体尾部病变中发现有脾静脉狭窄、闭塞者38例,其中胰腺肿瘤患者27例(71.1%),急慢性胰腺炎患者11例(28.9%).38例胰源性门脉高压患者中,发现食管静脉曲张5例(13.2%),胃底静脉曲张25例(65.8%),胃体静脉曲张22例(57.9%),胃短-胃后静脉显示26例(68.4%),胃冠状静脉显示26例(68.4%),发现胃网膜静脉曲张24例(63.2%),肠系膜静脉曲张1例.脾静脉闭塞14例(36.8%),脾静脉狭窄23例(63.2%).结论 胰源性门脉高压在影像学上表现为脾静脉栓塞,脾脏增大,脾门处大量曲张静脉,胃后-胃短静脉及胃网膜静脉增粗迂曲,胃底和胃体静脉曲张,较少合并食管静脉曲张,肝脏形态大小亦无异常.多层螺旋CT门静脉血管成像检查可为胰源性门脉高压患者提供血管形态、病因诊断等多方面有价值信息,为临床诊断和治疗提供客观的影像学依据.