胆囊腺肌增生症的X线诊断 (附14例报告)

本文探讨胆囊腺肌增生症的Ｘ线诊断与鉴别诊断。材料与方法：１４例胆囊腺肌增生症的患者均经胆囊造影和Ｂ超检查，１２例经手术，病理证实。结果；根据病理改变和Ｘ线表现可分为３型：（１）弥漫型；（２）节段段：（３）局限型或基底型。     

不同部位放大像与普通X线平片对照分析(附210例分析)

目的：探讨放大像与普通Ｘ线平片对同一部位骨质病变的诊断效果。材料与方法：对２１０例（男１２０例、女９０例）既有Ｘ线平片又有放大像的病例所摄照片进行分析、对比。结果：放大像发现病变的阳性率为７２％；Ｘ线平片发现病变的阳性率为５９％。结论：当临床高度怀疑有骨质病变，常规Ｘ线平片表现为正常或怀疑异常时，应摄放大像以减少漏诊。     

不同部位放大像与普通X线平片对照分析

目的．探讨放大像与普通Ｘ线平片对同一部位骨南病变的诊断效果。材料与方法：对２１０便（男１２０例、女９０例）既有Ｘ线平片又有放大像的病例所摄照片进行分析、对比。结果：放大像发现病变的阳性率为７２％；Ｘ线平片发现病变的阳性率为５９％。结论：当临床高度怀疑有骨质病变，常规Ｘ线平片表现为正常或怀疑异常时，应摄放大像以减少漏诊。     

左房粘液瘤X线诊断探讨

左房粘液瘤常误诊为风湿性二尖瓣病变。为探讨左房粘液瘤的Ｘ线特征，作者分析了１０例手术病理证实的左房粘液瘤Ｘ线平片表现，并与同期手术病理证实的１３例风湿性二尖瓣狭窄的Ｘ线平片表现进行对照研究。结果表明左房粘液瘤具有下列Ｘ线相对特征：①一般无左心耳增大或仅轻微增大，不出现重度左心耳增大表现，②左房体部多为轻至中度增大，一般不见心底部双重影及右心缘双弧影；③一般不出现肺间隔线和肺间质纤维增生。若瘤体嵌入二尖瓣环引起血流突发阻塞时则可见左房增大轻微与重度肺瘀血之不相称表现。④一般心胸比值不大于０．６０。本文还结合文献对左房粘液瘤时左室增大的机理及Ｘ线平片对左房粘液瘤的诊断价值等进行了讨论。     

神经纤维瘤病的眶面部影像学表现：附11例报告

目的：探讨神经纤维瘤病在眶面部的ＣＴ表现。材料和方法：总结分析了１１例经手术病理证实的神经纤维瘤病在眶面部的Ｘ线平片和ＣＴ表现。结果：本病的典型Ｘ线表现是眶骨骨质缺损和眼眶扩大，并可形成空眶征和立卵形扩大。ＣＴ表现为：（１）丛状神经纤维瘤病（６例），表现为周界不清楚、形状不规则的软组织影，颞肌和眼睑肌及眼直肌增粗变形；（２）眶骨发育不全（８例）；（３）眼眶内肿瘤（５例）；（４）眼积水（２例）。一个患者可有上述一种甚至四种表现。结论：ＣＴ能直接全面地显示神经纤维瘤病在眶面部的表现及眼眶与颅脑的交通，并能明确病变的范围和程度，为手术和临床治疗提供指导性意见。     

空肠憩室的X线表现（附42例报告）

回顾性分析了４２例空肠憩室的Ｘ线表现，其中单发者１５例，多发者２７例。平片表现假性肠梗阻征和局限性固定气囊影。笔者将４２例空肠憩室根据其Ｘ线表现特征分为四型：即Ⅰ型（孤立型），Ⅱ型（弥散、均称型），Ⅲ型（憩室伴肠转位不全型），Ⅳ型（等异型）。并着重讨论平片检查对空肠憩室的诊断价值以及Ｘ线分型的临床意义。     

双腔右心室的临床及影像学分析

本文报告了经手术证实的双腔右心室２５例。其特征为：１、症状多出现在２岁以后；２、胸部平片示肺血偏少，右室增大；４０％的病例右室流出道有局限性凹陷带；３、右心造影显示右室流出道呈环形狭窄，将右室分成两个腔。多数可显示室间隔缺损；４、超声心动图可探及右室流出道狭窄环及异常肌束和室间隔缺损。     

肺腺棘细胞癌的 X 线分析

目的：探讨肺腺棘细胞癌的Ｘ线表现并与肺鳞癌、肺腺癌进行比较。方法：报告的５０例患者均经手术及病理证实，全部有胸部正侧位平片，男４３例，女７例，年龄３５～６８岁（平均５５．７岁）。结果：作者根据Ｘ线表现将其分为二型：（１）周围型（包括肺段型）３７例，肿块直径多大于３ｃｍ（７９．４％）。（２）中心型１３例，其中１例为气管肿瘤，以肺门肿块及肺不张为主要表现。结论：肺腺棘细胞癌以周围型多见，其Ｘ线表现介于周围型肺鳞癌和肺腺癌之间的一些特点。     

脊柱转移瘤的CT诊断：附41例分析

笔者报告４１例脊柱转移瘤的ＣＴ表现。原发灶以肺癌、乳腺癌和肝癌较多见。ＣＴ表现主要呈溶骨性（６８．３％），亦可呈成骨性（１４．６％）或混合性（１７．１％）。本组４１例中２０例作平片Ｘ线检查。ＣＴ扫描在发现和估价病变方面较平片Ｘ线检查为敏感，如ｘ线平片发现骨破坏仅为５５％，ＣＴ扫描为１００％；Ｘ线平片显示椎管受累为１４％，ＣＴ扫描为６５％。对脊柱转移瘤的ＣＴ表现、ＣＴ诊断和鉴别诊断价值等进行了讨论。     

眼内异物MRI临床应用研究

目的：通过分析４２例５５枚眼内异物的ＭＲＩ表现，并与ＣＴ和Ｘ线平片比较，探讨了ＭＲＩ对眼内异物的诊断价值。材料与方法：男３３例，女９例，年龄５～４５岁。５５枚眼内异物中非磁性异物５３枚，铁磁性异物２枚。每例均在术前１个月内完成Ｘ线平片、ＣＴ和ＭＲＩ检查。结果：（１）ＭＲＩ对５５枚眼内异物检出率（９４％）和ＣＴ（９１％）相仿（Ｐ＞０．２５），均明显高于Ｘ线平片（４２％）（Ｐ＜０．００５）；（２）ＭＲＩ对眼内异物相关并发症的显示优于ＣＴ，而其对巩膜异物的显示差于ＣＴ；（３）ＳＥ序列Ｔ２ＷＩ和ＰＤＷＩ（质子密度加权成像）是检出眼内异物的优选序列；（４）非磁性异物ＭＲＩ呈信号缺失区，无伪迹产生；而铁磁性异物产生大量伪迹，并可致眼部额外损伤。结论：ＭＲＩ是检出眼内非磁性异物的有效方法，特别适用于Ｘ线平片和ＣＴ不能显示的少数非金属异物。眼内铁磁性异物不适于ＭＲＩ。     

右室异常肌束的心血管造影诊断（附21例分析）

目的：探讨右室异常肌束的心血管造影征象，并讨论其诊断与鉴别诊断。材料与方法：回顾性分析１９８５年至１９９４年经手术证实的有完整造影资料的２１个病例的右心室造影征象。结果：右室异常肌束行右心室造影显示基本造影征象为：横跨右心室腔的充盈缺损、狭窄口、喷射征、漏斗部弧形膨出或囊袋状突出等。结论：右心室造影对右室异常肌束的诊断及评估肌束的位置、走向和粗细均很有价值，提出了与法乐氏四联症的鉴别诊断要点，认为根据造影表现两者容易鉴别。     

完全型心内膜垫缺损的MRI诊断

目的 评价ＭＲＩ对完全型心内膜垫缺损的诊断价值和限度。方法 对８例（男５例,女３例）患者行自旋回波（ＳＥ）和电影ＭＲＩ诊断。诊断由Ｘ线平片,超声心动图,Ｘ线右心导管加心血管造影以及ＭＲＩ等多种影像学技术作出,其中４例行手术治疗。结果 ＭＲＩ显示心脏各个房室腔扩大,多数以右心房室扩大为著,伴有右心室壁增厚心内膜垫结构消失,４个心腔呈“十”字形直接相通,形成膜部空间隔缺损和Ｉ孔型空间隔缺损,二,三尖瓣     

单侧肺动脉异常起源于主动脉的影像学诊断

目的 评价单侧肺动脉异常起源于主动脉的影像学诊断。方法 回顾性分析了９例单侧肺动脉异常起地主动脉患者的临床表现、Ｘ线征象、诊断方法和手术治疗资料,所有病人均做了Ｘ线平片、彩色多普勒超声心动图及心血管造影检查。结果 ９例Ｘ线平片均有肺血增多,心脏增大。多普勒超声心动图检查６例漏诊,３例术前确诊。９例心血管造影均清楚显示该症的解剖畸形。结论心血管造影是诊断单侧肺动脉异常起源于主动脉最可靠的手段。     

Right-to-left shunts with right ventricular hypertrophy: Pathologic aspects

When a right-to-left shunt occurs on the basis of congenital cardiac disease, a major dividing point in differential diagnosis is whether or not right ventricular hypertrophy is present. When right ventricular hypertrophy is present, the shunt may occur either at the ventricular or atrial level. When the shunt occurs at the ventricular level, cases may be subdivided according to the vascular connections with the right ventricle into the following groups: (1) connection of the ascending aorta and of the pulmonary trunk with the right ventricle, (2) connection of the ascending aorta alone with the right ventricle, and (3) connection of the pulmonary trunk and of the descending aorta (through a PDA) with the right ventricle.

When a transatrial right-to-left shunt occurs, it is on the basis either of

1. (1) right ventricular hypertrophy incident to pulmonary stenosis or atresia or

2. (2) total anomalous connection of the pulmonary veins.

     

双腔右心室75例临床诊断及分析

回顾性总结75例经临床检查并经手术证实有双腔右心室患者的临床资料,通过临床体征、X线胸片、心电图、超声心动图、右心导管检查和右室造影表现特点,总结诊断和鉴别诊断经验。结果显示,术前诊断有双腔右心室57例（76％）,其中单纯双腔右心室9例,合并其它心内畸形48例（64％）,同手术结果比较,术前有18例（24％）未诊断出双腔右心室,导管尖端进肺动脉记录肺动脉至右室流入道压力曲线和仔细分析右室造影征象是提高术前诊断率的关键。     

Roentgenology of tetralogy of Fallot

If the patient is cyanotic and has EKG evidence of right ventricular hypertrophy, tetralogy can be suggested from the plain chest film. The characteristic plain film findings are a slightly enlarged heart with an elevated apex, a prominent aorta, an inconspicuous pulmonary artery and decreased pulmonary vascularity. Helpful associated findings are a right aortic arch and disproportionate decrease in left pulmonary vascularity. If the heart is large, an additional anomaly, especially atrial defect, should be suspected.

Angiography is often needed to distinguish tetralogy from pseudotruncus, truncus, transposition, single ventricle and double outlet right ventricle. Angiography is vital for alerting the surgeon to the anatomy of the obstruction.

Obstruction to right ventricular outflow may be demonstrated at any one or combination of five levels: the infundibulum, pulmonary valve, valve ring, main pulmonary artery or left pulmonary artery.     

Anomalous unilateral single pulmonary vein: two cases mimicking arteriovenous malformations and a review of the literature

Total anomalous pulmonary venous drainage is a rare congenital anomaly. It usually involves a pulmonary to systemic venous shunt and most cases have a septal defect in order to survive. Anomalous pulmonary venous drainage with pulmonary venous shunting is an extremely rare and entirely benign entity. We present two such cases, in which there was atresia of the left superior pulmonary vein and drainage via a tortuous collateral vein to the left inferior pulmonary vein. This collateral was mistaken on plain film and CT for a pulmonary arteriovenous malformation. Awareness of this anomalous unilateral single pulmonary vein and its radiological appearances may help in avoiding unnecessary pulmonary angiography.     

Horseshoe lung: clinical, pathologic, and radiologic features and a new plain film finding

Horseshoe lung is a rare congenital malformation in which an isthmus of pulmonary parenchyma extends from the right lung base across the midline behind the pericardium and fuses with the base of the left lung. Six cases are presented and eight previously published case reports are reviewed. Eleven of these 14 cases occur in conjunction with scimitar syndrome, the complex of anomalies including hypoplasia of the right lung, anomalous right pulmonary venous return, and anomalous arterial supply to the right lung. Differentiation of scimitar syndrome from horseshoe lung can be made on the plain chest film, if, in addition to the typical radiographic findings of scimitar syndrome, there is evidence of a fine linear density in the medial aspect of the left base representing the lateral extent of the pulmonary isthmus. Recognition of horseshoe lung is important because children present in the first few years of life with significant respiratory symptoms, whereas the scimitar syndrome alone is usually discovered fortuitously after the first decade of life.     

Angiocardiography of obstructing muscular bands of the right ventricle.

Two types of obstructing anomalous muscle bundle are described on the basis of right ventricular angiocardiographic analysis in 28 patients. In the low type the anomalous muscle bundle is located in the midsinus of the right ventricle; in the high type it lies at the subinfundibular level. Ocassionally, both forms of obstruction exist in the same individual. A ventricular septal defect was present in 24 of the 28 patients (85%). Serial catheterizations at a mean interval of 6.6 years demonstrated progession of the obstruction in eight of 15 patients. Differentiation of anomalous muscle bundle from tetralogy of Fallot is facilitated by clear angiographic delineation of the anomalous muscle and the position of the parietal band in most cases, but may not be possible when both anomalies occur together.     

二尖瓣闭锁的MRI诊断

目的 分析二尖瓣闭锁（MA）的病理改变和MRI表现,方法 回顾分析5例经手术证实MA的MRI表现,并与心血管造影（CAG）比较,结果 显示了3型MA的病理改变：双心室左侧房室瓣无孔1例,右室型单心室左侧房室无连接3例,以及左室型单心室左侧房室瓣无孔1例,主要合并畸形有：房间隔膨出瘤1例,全肺静脉异位引流心上型1例,左肺动脉缺如1例及肺动脉狭窄4例,5例行右室和（或）右房造影,除1例外均难以显示MA解剖结构,结论 MRI在MA的诊断中有一定的临床应用价值。