肾上腺占位病变的多层螺旋CT诊断及鉴别诊断

目的 探讨多层螺旋CT对肾上腺占位病变的诊断及鉴别诊断价值.方法 回顾性分析经手术病理证实的53例肾上腺占位病变的多层螺旋CT表现特征,所有病例均行多层螺旋CT平扫及增强扫描.结果 本组53例共有64个病灶:皮质腺瘤15例21个病灶,嗜铬细胞瘤18例21个病灶,皮质腺癌6例6个病灶,转移瘤4例6个病灶,神经母细胞瘤5例5个病灶,淋巴瘤1例1个病灶,肾上腺囊肿2例2个病灶,节细胞神经瘤2例2个病灶.结论 大多数肾上腺占位病变的表现具有一定特征,多层螺旋CT对肾上腺占位病变的诊断及鉴别诊断有重要价值,结合临床及生化检查可显著提高诊断的准确率.     

肾上腺转移瘤的CT诊断及鉴别诊断

目的:分析肾上腺转移瘤的CT特征,探讨CT检查对肾上腺转移瘤的诊断与鉴别诊断价值;方法:回顾性分析本院2013年2月~2016年11月经过病理证实的42例肾上腺转移瘤患者的临床及CT资料,总结其临床及CT特征。结果:42例患者中肺转移16例,消化道(胃4例,肠道3例,食管1例);胰腺7例,肝2例,肾1例,其它来源不明8例;病灶位于双侧9例,单侧33例(左侧25例,右侧8例);病灶直径0.5cm~5.4cm,边界规则或不规则,增强扫描轻~中度强化。结论:CT平扫+增强是发现、诊断肾上腺转移肿瘤的可靠方法,可结合患者临床资料及CT特征及测量病变平扫及强化后的CT值进一步作出诊断与鉴别诊断。     

多排螺旋CT对肝脏占位性病变的诊断与鉴别

多排螺旋CT不仅具有普通螺旋CT的特征，而且可快速、准确地对病变行多方位、多平面及三维重建观察，更易发现病变的特征，利于鉴别诊断。现将笔者利用多排螺旋CT诊断肝脏占位性病变的经验报告如下。     

多层螺旋CT在诊断肾脏小肿瘤中的临床价值

目的探讨多层螺旋CT在诊断肾脏小肿瘤中的临床价值。方法回顾分析23例经病理证实的肾脏小肿瘤在平扫、皮质期、实质期及肾盂期的螺旋CT薄层扫描和冷冻切片的诊断结果。结果共收治肾实性占位23例，经手术及病理证实肾癌17例，肾错构瘤2例，肾囊肿伴淋巴细胞浸润2例，肾血管平滑肌脂肪瘤2例。结论肾脏小肿瘤的偶发率和良性率较高，常规CT鉴别其良恶性有一定难度，螺旋CT薄层扫描和冷冻切片检查有助于正确诊断。     

螺旋CT双期增强扫描在腮腺常见肿瘤中的诊断价值

目的 探讨螺旋CT双期增强扫描在腮腺常见肿瘤中的诊断价值.方法 回顾性分析21例经手术病理证实的腮腺占位性病变的CT平扫和双期增强扫描图像,对病灶的位置、形态,数目,大小,特别是强化方式进行分析.结果 21例病灶中共发现病灶23个,多形性腺瘤13个,增强表现为渐进性强化;4个腺淋巴瘤表现为＂快进快出＂,1个腺淋巴瘤表现为渐进性强化;恶性肿瘤5个表现为早期快速强化,峰值在延迟期.结论 螺旋CT双期增强扫描可以为腮腺常见肿瘤的鉴别诊断提供较多依据.     

螺旋CT双期增强扫描在腮腺常见肿瘤中的诊断价值

目的 探讨螺旋CT双期增强扫描在腮腺常见肿瘤中的诊断价值.方法 回顾性分析21例经手术病理证实的腮腺占位性病变的CT平扫和双期增强扫描图像,对病灶的位置、形态,数目,大小,特别是强化方式进行分析.结果 21例病灶中共发现病灶23个,多形性腺瘤13个,增强表现为渐进性强化;4个腺淋巴瘤表现为"快进快出",1个腺淋巴瘤表现为渐进性强化;恶性肿瘤5个表现为早期快速强化,峰值在延迟期.结论 螺旋CT双期增强扫描可以为腮腺常见肿瘤的鉴别诊断提供较多依据.     

多层螺旋CT后处理技术在肾上腺肿瘤及肿瘤样病变中的应用价值

目的：探讨多层螺旋CT（MSCT）在肾上腺肿瘤及肿瘤样病变中的诊断价值及其临床意义。方法：收集经临床保守治疗或手术病理证实的肾上腺肿瘤及肿瘤样病变24例,进行多层螺旋CT检查及三维重建,后处理技术包括薄层重建、多平面重组（MPR）、容积重组（VR）及最大密度投影（MIP）,并进行回顾性分析。结果：24例肾上腺占位病变中,肾上腺增生7例,腺瘤6例,髓样脂肪瘤2例,肾上腺囊肿3例,嗜铬细胞瘤1例,肾上腺转移癌5例。肾上腺良性病变直径多小于3 cm,边界清晰。三维重建图像能清晰显示肾上腺肿瘤及肿瘤样病变的细微结构并能比较准确地对肾上腺肿瘤及肿瘤样病变作出诊断。结论：多层螺旋CT图像质量好,对肾上腺肿瘤及肿瘤样病变的综合判断能力较强,具有较好的应用价值。     

螺旋CT对原发性肝癌的诊断价值

目的探讨螺旋CT对原发性肝癌的诊断价值。方法回顾性分析58例经临床及病理证实的原发性肝癌患者的螺旋CT双期扫描表现。结果58例共发现病灶89个。其中肝左叶35个．肝右叶64个。肿瘤大小0．5-17．9cm,平均4．2cm。平扫发现病灶53个,27个表现为低密度,密度均匀者19个,7个不均匀密度病灶中可见到更低密度的坏死区或脂肪变性。肝动脉期扫描发现病灶82个,高密度均匀性强化75个,不均匀性强化6个,有1个无明显强化仍为低密度。门静脉期扫描发现病灶73个,均转化为稍高密度或等低密度影。结论螺旋CT能充分反映肝癌的血供特点,可为原发性肝癌的诊断提供更多可靠的信息及病变特征。     

95例甲状腺结节性病变的CT诊断分析

目的 分析甲状腺结节性病变CT影像特点及诊断与鉴别诊断价值。方法 分析95例甲状腺结节性病变的CT表现，其中结节性甲状腺肿57例，甲状腺腺瘤16例，甲状腺癌22例，均经临床手术及病理证实。结果 正常甲状腺体平均CT值为114HU，病变区CT值测量平均分别为：甲状腺肿为53HU、甲状腺腺瘤为47HU、甲状腺癌为59HU。病变区CT平扫均呈低密度，明显低于正常甲状腺体密度，表现为单个或多个囊性、实性或囊实性并存的低密度结节，病灶内可有斑点状钙化，实性结节增强扫描可有不同程度强化。良性结节多境界清楚，恶性结节多边缘模糊，可伴有颈部周围淋巴结肿大、颈静脉癌栓形成。结论 甲状腺结节性病变CT定位诊断可靠，可达100％，CT定性诊断为70％～80％，有较高的诊断价值，少数单发结节CT鉴别诊断困难。     

女性盆腔囊性病变的多层螺旋CT鉴别诊断价值

目的:探讨女性盆腔囊性病变中多层螺旋CT鉴别诊断的价值。方法:选取2013年2月~2014年2月间该院收治的盆腔囊性病变女性72例,行多层螺旋CT平扫、增强扫描和多平面重建,分析CT图像特征和诊断结果。结果:共发现96个囊性病灶,直径大小为18~211 mm,其中良性78个,恶性18个。72例中卵巢囊肿17例,病灶20个;卵巢囊性畸胎瘤13例,病灶15个;卵巢囊腺瘤11例,病灶13个;卵巢囊腺癌5例,病灶9个;卵巢内膜异位囊肿12例,病灶17个;盆腔囊性感染性包块7例,病灶7个;其他7例,病灶15个。CT检查定位准确率为93.75%,定性准确率为78.12%。结论:针对各种盆腔囊性病变的多层螺旋CT扫描图像均具有较为明确的特征性表现,其对女性盆腔囊性病变肿块的定位和定性诊断具有较高的价值。     

From diagnosis to social diagnosis

In the past two decades, research on the sociology of diagnosis has attained considerable influence within medical sociology. Analyzing the process and factors that contribute to making a diagnosis amidst uncertainty and contestation, as well as the diagnostic encounter itself, are topics rich for sociological investigation. This paper provides a reformulation of the sociology of diagnosis by proposing the concept of 'social diagnosis' which helps us recognize the interplay between larger social structures and individual or community illness manifestations. By outlining a conceptual frame, exploring how social scientists, medical professionals and laypeople contribute to social diagnosis, and providing a case study of how the North American Mohawk Akwesasne reservation dealt with rising obesity prevalence to further illustrate the social diagnosis idea, we embark on developing a cohesive and updated framework for a sociology of diagnosis. This approach is useful not just for sociological research, but has direct implications for the fields of medicine and public health. Approaching diagnosis from this integrated perspective potentially provides a broader context for practitioners and researchers to understand extra-medical factors, which in turn has consequences for patient care and health outcomes.     

胆囊炎症性疾病的影像学诊断与鉴别诊断

胆囊炎症性疾病比较常见 ,随着新设备新技术的不断出现 ,其影像诊断水平发展较快。在选择内科、外科或介入性疗法前多需采用合理有效的影像学检查以保证诊断的准确性。1　各种影像学检查方法的现状X线平片与体层摄影以及静脉法胆系造影虽已失去当年检查此类疾病的主导作用 ,但在某些情况下仍可用作参考。口服法胆囊造影因显影效果欠佳已很少采用。超声 (US)、CT、MRI、磁共振胆胰管成像 (MR CP)、ERCP/PTC是目前常用的影像学检查方法 ,但仍都有其局限性 ,如 :US易受肠道气体影的干扰 ,普通CT横断面检查往往限制胆胰管树全貌的显示…     

宫角妊娠的超声诊断及鉴别诊断

目的探讨宫角妊娠的超声诊断及鉴别诊断要点。方法回顾性分析浙江省温岭市中医院2005年10月至2013年4月的56例门诊拟诊为宫角妊娠的病历资料。结果其中10例妊娠44天内的早期宫角妊娠2周内转为宫内妊娠;其余46例均经手术治疗和病理检查,其中38例为宫角妊娠（右侧20例,左侧18例）,6例为间质部妊娠,1例为滋养细胞性疾病,1例为纵膈子宫一侧妊娠。宫角妊娠总的诊断准确率为67．86％,其中经腹部和经阴道超声诊断准确率分别为44．44％和63．16％,两种方法联合诊断准确率94．74％,联合组诊断准确率明显高于经腹部及阴超组（χ2值分别为11．19和5．70,P值分别为0．001和0．017）。结论①对于停经天数较短的早期诊断的宫角妊娠应密切观察,部分可以转为宫内妊娠;②超声是诊断宫角妊娠的有效方法,阴超与腹部超声两种检查方法联合应用能够大大提高诊断的准确率。     

Evidence-based diagnosis

Making an accurate diagnosis is essential to ensure that a patient receives appropriate treatment and correct information regarding their prognosis. Characteristics of diagnostic tests are quantified in test accuracy studies, but many such studies have methodological flaws. The HSRC evidence-based diagnosis programme has focused on methods for systematic reviews of test accuracy studies, and the wider context in which tests are ordered and interpreted. We carried out a range of projects relating to literature searching, quality assessment, meta-analysis, presentation of results, and interactions between doctors and patients during the diagnostic process. We have shown that systematic reviews of test accuracy studies should search a range of databases and that current diagnostic filters do not have sufficient accuracy to be used in test accuracy reviews. Summary quality scores should not be used in test accuracy reviews; the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Reviews (QUADAS) tool for assessing test accuracy studies is acceptable for quality assessment. We have shown that the hierarchical summary receiver operating characteristic (HSROC) and bivariate models for meta-analysis of test accuracy are statistically equivalent in many circumstances, and have developed an add-on module for the statistical software package Stata that enables these statistically rigorous models to be fitted by those without expert statistical knowledge. Three areas that would benefit from further research are literature searching, synthesis of results from individual patient data and presentation of results.     

Distant diagnosis

Effective communications are essential for any operation and for management of health-related problems. Telemedicine has altered profoundly the manner in which primary care physicians can interact with hospitals and specialists. As dedicated medical ICT systems evolve, medical care will be delivered to patients in remote locations in a more efficient and cost-effective way. Companies invariably have a vision that healthcare decisions benefiting patient care should be made anytime and anywhere in a model that facilitates care at the point of need. The development of telemedicine programs is inevitable as business globalization expands to more challenging cultural and geographic areas.