隐源性机化性肺炎的CT表现及糖皮质激素治疗后改变

目的探讨隐源性机化性肺炎(COP)的CT表现及糖皮质激素治疗后改变。方法回顾性分析我院COP患者29例,其中21例患者给予糖皮质激素治疗并随诊,随访时间1～38个月。结果 23例(79.3%)为多发病灶,病灶位于双肺20例,单肺3例,其中14例为多发实变,3例为多发磨玻璃样变,6例为实变及磨玻璃样病灶并存;6例(20.7%)为单发病灶,其中4例为片状肺实变,1例为实性结节,1例为片状部分实性密度影;16例(55.2%)伴有条索样改变。9例(31.0%)COP患者可见"反晕征"表现。11例(37.9%)COP患者伴有轻度支气管扩张。糖皮质激素治疗21例,治疗后病灶大部分吸收14例,完全吸收2例;3例在治疗过程中出现游走性。结论 COP最常见的表现是肺实变影和磨玻璃样变影,肺实变多表现为沿支气管血管束和胸膜下分布,磨玻璃样变分布不具有特异性。CT上出现"反晕征"对诊断COP有一定提示作用。糖皮质激素对部分COP患者有较好的疗效。     

甲型H1N1流感的胸部CT表现

目的 探讨甲型H1N1流感的胸部CT表现.资料与方法 30例甲型H1N1流感患者行胸部螺旋CT扫描41(例/次),并对CT图像作回顾性分析.结果 30例中病变位于双侧肺野28例(93.3%),单侧2例(6.7%).分布于肺野中央14例(46.7%,其中支气管周围分布11例),胸膜下11例(36.7%),弥漫分布5例(16.7%).累及中肺野24例(80%),下肺野30例(100%).病变表现为磨玻璃样密度影12例(40%),磨玻璃样密度影+实变影11例(36.7%),实变影2例(6.7%);实变影中9例(56.3%)有支气管气相.发生合并症(并发症)者6例,其中肺部继发感染4例,气胸2例.甲型H1N1流感较具特征性的肺部CT表现为:(1)病灶分布呈多发性、双侧性,以中、下肺野多见.(2)斑片状磨玻璃样密度影,部分伴有实变影,常伴有支气管气相,以胸膜下或支气管树周围分布为主.结论 CT对于甲型H1N1流感肺部病变的检出、病变范围及治疗后随访具有重要价值,并能及时发现出现的合并症.     

百草枯中毒肺损伤的CT表现与临床意义

目的 探讨百草枯中毒患者肺损伤的CT表现及临床价值。方法 回顾性分析6例百草枯中毒患者肺损伤的CT影像学资料,根据中毒时问分早期(1~2 d)、中期(3~14d)、晚期(>14d)3个阶段。对中毒患者进行CT表现与临床表现的对比。结果 6例百草枯中毒患者中3例死亡,2例肺纤维化,1例痊愈。早期CT表现:3例无异常,2例磨玻璃样变,1例肺纹理增多、模糊;中期CT表现:6例磨玻璃样变、马赛克征,6例肺实变,4例胸膜下线,4例出现伴行支气管扩张,2例少量胸腔积液;晚期CT表现:4例肺实变及纤维化,3例磨玻璃样变、马赛克征,1例胸腔积液,1例纵隔气肿。结论 百草枯中毒的临床表现与CT表现基本相符,具有相对分期特征,有助于临床对病情的及时评估,从而指导临床治疗。     

SARS的胸部CT表现

目的 探讨SARS的胸部CT表现。方法 搜集6例临床确诊为SARS的患者共9次胸部CT扫描(复查3例)资料，采用标准肺窗、纵隔窗、宽窗宽条件分别摄片。分析胸部CT影像。结果 6例中双肺多叶、多段实变灶5例，无明显肺叶、肺段或特定体位分布趋势；双肺病变均为大片肺实变与多发小实变灶并存；大片肺实变表现为一侧或双侧2～4片沿支气管树分布的肺段实变；内有明显的空气支气管征；相邻肺段实变融合或在叶间裂处相邻的肺叶实变扩展，于影像接触部位融合，形成更大片实变影，未观察到病变越过叶间裂蔓延至邻近肺叶的现象；肺内小病灶均为双肺多发，呈类圆形或棉球状，沿肺纹理分布最多见；大片肺实变可呈均匀致密实变、磨玻璃样变、蜂窝状实变，小病灶与大片实变灶一致，磨玻璃样变可出现在初诊和吸收期病例；胸膜反应性增厚常见，胸腔积液罕见；无纵隔、肺门淋巴结肿大。结论 CT改变提示：SARS在病程发展阶段，病变有经支气管肺泡系播散的特点。     

隐原性机化性肺炎的CT征象分析

目的：提高对隐原性机化性肺炎（cOP）影像表现的认识。方法：回顾性分析23例经肺活检病理证实为COP患者的影像表现。结果：23例患者中CT表现为多发性斑片状含气实变影15例，主要分布在胸膜下区和双肺下叶。14例伴有磨玻璃影及小支气管扩张，还有条索状影。6例有病灶游走的表现。21例对肾上腺皮质激素治疗有显著疗效。结论：隐原性机化性肺炎的诊断需结合临床表现、影像、病理等检查结果综合分析，对CT表现的认识非常重要。     

新型冠状病毒肺炎的初诊CT特征及与流感病毒性肺炎的鉴别诊断

目的:探讨新型冠状病毒肺炎(简称新冠肺炎)的初诊CT特征性表现,以及与流感病毒性肺炎的鉴别诊断。方法:收集临床确诊的8例新冠肺炎及10例流感病毒性肺炎的CT资料,分析2组肺内感染病灶的位置、分布、密度及形态。结果:2组病变分布方式(单肺分布、胸膜下分布、沿中轴支气管血管束分布)、支气管壁增厚及树芽征检出率比较差异均有统计学意义(均P0.05)。结论:当胸部CT出现双肺胸膜下多发磨玻璃影或伴实变、有小叶内间隔增厚呈网格状表现,提示新冠肺炎。出现支气管壁增厚、树芽征、病灶沿中轴支气管血管束分布、伴胸腔积液及淋巴结肿大,新冠肺炎可能性不大。     

胸部结节病的多排螺旋CT表现

目的探讨胸部结节病(sarcoidosis)的多排螺旋CT表现,旨在提高对该病的认识及诊断水平。方法回顾性分析经病理或临床随访证实的36例胸部结节病患者的CT和临床资料。结果 36例结节病患者中,仅肺门及纵隔淋巴结肿大者6例,肺门及纵隔淋巴结肿大并肺内浸润者25例,仅见肺内浸润无淋巴结肿大者5例;肺内表现:肺内小结节沿支气管血管束及胸膜下分布者19例,小叶间隔不规则增厚者16例,实变影17例,"磨玻璃影"3例,蜂窝变10例。淋巴结表现:双肺门、上纵隔右下气管旁、气管隆突下分布多见,平扫CT值均匀,增强扫描呈中度以上明显强化。结论双侧肺门淋巴结对称性肿大和/或纵隔淋巴结肿大,以及沿支气管血管束分布的不规则结节影是肺部结节病特征性影像学表现,多平面重组(MPR)图像对该病的诊断有较高的价值。     

6例重症甲型H1N1流感的肺部CT影像分析

目的:探讨重症甲型H1N1流感患者的肺部CT影像表现。材料和方法:回顾性分析6例经临床综合确诊的重症甲型H1N1流感患者的临床和CT资料,男4例,女2例,年龄25～61岁,平均39.83±12.41岁,所有患者均于住院期间行2～4次胸部64层螺旋CT扫描。结果:所有患者肺部阴影均较明显,发展迅速,表现为两肺多叶弥漫性渗出,病灶位于中下叶并呈外周分布居多。异常胸部CT表现包括:多发斑片状磨玻璃阴影6例,单发小圆形磨玻璃阴影4例,小结节状高密度影4例,大结节状高密度3例,磨玻璃密度影内出现结节或索条影1例,不规则肺实变3例,部分肺不张2例,细支气管扩张2例,少量胸腔积液3例,胸膜增厚2例,纵隔淋巴结肿大3例。当病变逐渐吸收后主要表现为两肺残留索条状或斑片状阴影。结论:发展迅速,双肺受累,弥漫分布,大片磨玻璃阴影伴有实变、结节,多累及两肺中下叶呈外周分布是诊断重症甲型H1N1流感的相对特征性表现。     

肺黏膜相关淋巴瘤的CT表现(附10例报告及文献复习)

目的 探讨原发性肺黏膜相关淋巴瘤的CT表现.方法 对10例病理证实的肺黏膜相关原发淋巴瘤的CT特征及病理进行分析讨论.结果 10例在CT上存在不同范围的肺实变,在所有实变的病灶中见空气支气管征,并且部分病灶中可见有支气管扩张症及肺大泡,磨玻璃样改变或间质网格状改变分布在实变的边缘部位.病灶均无坏死,空洞及钙化存在.无胸膜增厚及胸腔积液,无肺门及纵隔淋巴结肿大.结论 肺黏膜相关原发淋巴瘤的CT表现只有肺和(或)支气管受侵而无淋巴结的肿大;此表现有助于本病的诊断.     

肺部结节病CT特征及误诊分析

目的分析肺部结节病多排螺旋CT的特征性影像学表现。资料与方法回顾性分析经病理证实的42例肺部结节病患者的多排螺旋CT影像资料,总结其特征性CT表现。结果 42例结节病首诊误诊11例(26.19%)。影像学表现:肺门纵隔淋巴结增大28例,仅肺门淋巴结增大12例,仅纵隔淋巴结增大1例,肺门纵隔均无淋巴结增大1例;肺内结节沿支气管血管束及胸膜下分布为主38例;肺内不规则大片状实变区1例;小叶间隔不规则结节样增厚8例;支气管牵拉性扩张3例;肺内纤维索条影13例;胸膜下蜂窝影6例;双肺磨玻璃密度影16例;肺内结节病合并双侧乳腺受累1例;上颌窦受累1例;鼻部皮下结节1例。结论肺部结节病的CT表现有一定特征性,最重要的影像学征象是肺内沿淋巴道分布的小结节以及肺门纵隔淋巴结增大,部分不典型结节病影像学诊断困难,应积极进行穿刺活检。     

Pathologic subgroups of nonspecific interstitial pneumonia: differential diagnosis from other idiopathic interstitial pneumonias on high-resolution computed tomography

OBJECTIVE: To determine whether the subtypes of nonspecific interstitial pneumonia (NSIP) could be differentiated from other idiopathic interstitial pneumonias (IIPs) on the basis of findings on high-resolution computed tomography (CT). METHODS: Two observers evaluated the high-resolution CT findings in 90 patients with IIPs. The patients included 36 with NSIP, 11 with usual interstitial pneumonia (UIP), 8 with cryptogenic organizing pneumonia (COP), 10 with acute interstitial pneumonia (AIP), 14 with desquamative interstitial pneumonia (DIP) or respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and 11 with lymphoid interstitial pneumonia (LIP). The NSIP cases were subdivided into group 1 NSIP (n = 6), group 2 NSIP (n = 15), and group 3 NSIP (n = 15). RESULTS: Observers made a correct diagnosis with a high level of confidence in 65% of NSIP cases, 91% of UIP cases, 44% of COP cases, 40% of AIP cases, 32% of DIP or RB-ILD cases, and 82% of LIP cases. Group 1 NSIP was misdiagnosed as AIP, DIP or RB-ILD, and LIP in 8.3% of patients, respectively. Group 2 NSIP was misdiagnosed as COP in 10% of patients, LIP in 6.7%, AIP in 3.3%, and DIP or RB-ILD in 3.3%. Group 3 NSIP was misdiagnosed as UIP in 6.7% of patients, COP in 6.7%, and DIP or RB-ILD in 3.3%. CONCLUSIONS: In most patients, NSIP can be distinguished from other IIPs based on the findings on high-resolution CT. Only a small percentage of patients with predominantly fibrotic NSIP (group 3 NSIP) show overlap with the high-resolution CT findings of UIP.     

火药燃烧致群体一氧化碳中毒的影像学表现及分析

目的：探讨火药燃烧致急性一氧化碳中毒肺、脑损伤的影像学表现．以提高诊断水平。方法：对37例一氧化碳中毒患者行胸部X线、头颅MRI检杏，并分析其影像学表现特点。结果：①急性肺损伤8例，表现为肺纹理增强、肺门浓密和肺部大片状阴影；②脑部损伤6例，表现为对称性海马、苍白球信号异常。结论：肺、脑是急性一氧化碳中毒极易受损的器官，肺损伤以肺水肿改变为主，脑损伤以海马、苍白球水肿、缺血、坏死改变为主。     

Colloid-oncotic pressure in patients with diffuse suppurative peritonitis

35 patients with various phases of generalized purulent peritonitis were tested. The goals of this study were to define the colloid-oncotic pressure (COP) and the contents of its main ingredient--albumin, determine the significance of the COP studies for the diagnosis of edema of lungs in cases of purulent peritonitis, and the influence of fluid management and parenteral nutrition upon the COP index. The studies have shown a clear dependency of COP and albumin ratio upon the phase of peritonitis. The authors come to a conclusion that the definition of COP dynamics is one of the most reliable criteria that makes it possible to chart a correct program of fluid management and reduce the number of postinfusional complications.     

Idiopathic interstitial pneumonias: prevalence of mediastinal lymph node enlargement in 206 patients

OBJECTIVE: The purposes of our study were to determine the prevalence of mediastinal lymphadenopathy in idiopathic interstitial pneumonias, correlate their presence with high-resolution CT (HRCT) findings, and assess the potential value of mediastinal lymphadenopathy in the differential diagnosis of idiopathic interstitial pneumonias. MATERIALS AND METHODS: The study included 206 consecutive patients from three medical centers with pathologically proven idiopathic pulmonary fibrosis (n = 136), non-specific interstitial pneumonia (NSIP) (n = 47), cryptogenic organizing pneumonia (COP) (n = 16), respiratory bronchiolitis-interstitial lung disease (RB-ILD) (n = 5), and desquamative interstitial pneumonia (DIP) (n = 2). HRCT scans were retrospectively reviewed for the presence of mediastinal lymphadenopathy (short-axis diameter, >or= 10 mm), predominant parenchymal pattern, and extent of disease. RESULTS: Mediastinal lymphadenopathy was seen in 139 (67%) of 206 patients, including 90 (66%) of 136 with idiopathic pulmonary fibrosis, 38 (81%) of 47 with NSIP, six (38%) of 16 with COP, and five (71%) of seven with RB-ILD or DIP. The presence of enlarged nodes was less common in COP than in the other idiopathic interstitial pneumonias (p = 0.04). No significant difference was found in the prevalence of lymphadenopathy in patients with predominant ground-glass opacity (53%) or predominant reticulation (40%). The extent of parenchymal abnormalities was 25-50% in 74 patients (53%), 50-75% in 30 (22%), < 25% in 22 (16%), and > 75% in 13 (9%). A positive correlation between the extent of disease and presence of lymphadenopathy was seen in patients with NSIP (p = 0.01). CONCLUSION: Mediastinal lymphadenopathy is a common feature in idiopathic interstitial pneumonias, being slightly less common in COP than in the other idiopathic interstitial pneumonias. The presence of lymphadenopathy therefore has limited value in the differential diagnosis. In patients with idiopathic pulmonary fibrosis, the presence of lymph node enlargement did not correlate to any specific HRCT pattern or to the extent of disease.     

骨盆骨巨细胞瘤影像特征分析

目的:分析骨盆骨巨细胞瘤X线平片、CT及MRI征象,探讨其影像特征及鉴别诊断要点。方法:分析总结经手术及病理证实的29例(包括7例复发)骨盆骨巨细胞瘤患者的X线平片、CT、MRI表现。结果:①X线平片表现:囊状骨质破坏15例,单纯溶骨性破坏8例,"多房性"骨质破坏6例。②CT表现:18例呈囊样膨胀性骨质破坏,11例呈单纯溶骨性破坏,未见骨膨胀扩张征象;增强扫描肿瘤实质部分均出现轻度至中度的强化。③MRI表现:6例MRT1WI上均呈等信号、低信号,T2WI上呈低信号、等信号、高混杂信号。结论:骨盆巨细胞瘤的影学表现为膨胀性溶骨破坏,与长骨巨细胞瘤比较除膨胀更为显著外,余无明显差异;骨盆骨巨细胞瘤诊断需综合运用X线平片、CT及MRI并与临床表现相结合,且能够提高骨盆骨巨细胞瘤诊断及鉴别诊断的准确性。     

绞窄性肠梗阻的螺旋CT增强扫描征象分析

目的:分析螺旋CT增强扫描图像上绞窄性肠梗阻的征象,提高对绞窄性肠梗阻术前诊断的准确性.方法:64例手术证实的绞窄性肠梗阻病例纳入研究,男43例,女21例,年龄23～72岁,平均42岁.采用单排螺旋CT进行全腹部扫描,对比剂以2～3ml/s速度注射,注射后60s扫描,层厚10mm.参照术中所见,回顾性分析上述CT资料,包括:①间接征象:肠腔扩张积液,肠壁增厚及肠壁密度改变(靶征),肠系膜脂肪水肿及渗出(缆绳征),肠系膜血管增粗并肠系膜扭曲(漩涡征),肠壁间、肠系膜间及门静脉积气,腹水;②直接征象:肠系膜上动脉或上静脉充盈缺损.结果:正确诊断54例,正确率82.8％.CT显示肠腔扩张积液47例(73％),其中6例积液呈高密度提示肠腔内积血(9.3％);肠壁水肿增厚19例(29.6％),其中11例增强后肠壁密度不匀,呈“靶征”(17％),8例肌壁未见强化(12.5％);肠系膜脂肪水肿及渗出(缆绳征)43例(67％),肠系膜血管增粗并肠系膜扭曲呈“漩涡”状9例(14％),肠壁间积气、肠系膜积气各1例,门静脉积气2例,腹水31例(48.4％).肠系膜上动脉或上静脉充盈缺损3例.结论:绞窄性肠梗阻CT表现有一定特征,可做出提示性诊断.     

肺栓塞的螺旋CT诊断(附15例分析)

目的:探讨螺旋CT对肺栓塞的诊断价值。方法:回顾性分析15例肺栓塞患者CT平扫及增强扫描表现。结果:15例平扫显示片状实变影、磨玻璃影、楔型影、“马赛克”征等。增强扫描中央型肺栓塞12例,周围型肺栓塞3例;中央肺动脉扩张10例;右心室增大7例;支气管动脉显示15例,其中扩张6例;支气管静脉显示并扩张1例;根据肺动脉内栓子形态分4类。结论:CT对肺动脉栓塞具有较高的诊断价值。     

原因不明胃肠道出血的DSA

目的：进一步提高消化道出血的诊断率，探讨ＤＳＡ的应用价值。材料和方法：对３０例原因不明胃肠道出血病例行选择性腹腔动脉和肠系膜上、下动脉造影。在常规ＰＵＣＫ快速摄片后，再行ＤＳＡ，比较两种方法所见。结果：３０例中２４例发现病理血管，检出病变，检出率为８０％。其中肿瘤６例（胃肠平滑肌瘤或肉瘤５例，腺瘤１例），血管病变１１例（ＡＶＭ６例，小肠毛细血管扩张症４症，胃底静脉曲张１例）；炎症性病变６例（麦克尔憩室２例，胆道出血１例，胃溃疡或糜烂３例）和十二指肠粘膜异位１例。ＤＳＡ较常规血管造影片显示病变更清楚，血管结构更仔细。２例小肠毛细血管扩张症在常规血管造影片上仅见小血管密集，紊乱，而ＤＳＡ则能清楚显示病变肠段较正常肠段染色异常增浓，因此术前得以确诊。本组资料显示ＤＳＡ对于提高胃肠道出血的病变检出率和诊断正确率很有价值。１例小肠毛细血管扩张症出血第一次检查阴性。一周后采用山莨菪碱药物血管造影，ＰＵＣＫ及ＤＳＡ见造影剂外溢及肠管异常染色而得到诊断。结论：胃肠道出血的血管造影检查结合应用ＤＳＡ，可进一步提高病变检出率和诊断正确率。     

儿童神经母细胞瘤的CT表现

目的:描述儿童神经母细胞瘤的CT表现,以提高对本病的认识。方法:回顾性分析13例经病理证实的神经母细胞瘤的CT表现,研究肿瘤的CT特征。结果:13例中,原发在头部1例,颈部1例,纵隔3例,腹部6例(源于肾上腺4例,源于腹膜后交感神经链2例),盆腔2例。肿瘤形态,其中不规则形2例,圆或椭圆形11例。8例显示钙化,钙化呈散在或弥漫分布斑点样钙化6例,索条状1例,不规则形钙化1例。共10例进行CT增强,增强后均匀强化1例,不均匀强化9例。与血管、气管关系,包绕周围血管4例,推移血管2例,推移气管1例。结论:神经母细胞的CT表现有一定特征,可有助于临床诊断。     

囊性肾癌的CT诊断和鉴别诊断

目的:探讨囊性肾癌的CT表现特点,旨在提高诊断及鉴别诊断水平。方法:回顾性分析14例经手术病理证实的囊性肾癌CT影像学表现特点。结果:囊性肾癌14例中,单囊8例、多囊6例。囊壁增厚或厚薄不均11例,囊壁菲薄均匀3例。其中伴壁结节及分隔各4例、伴壁结节与分隔同时存在2例,分隔厚薄不均5例、纤细均匀1例。平扫肿瘤呈囊实性混杂密度12例、呈较均匀囊样低密度2例;囊液密度较高、隐约见碎屑、絮状物或明显出血9例,囊液均匀如水5例;肿瘤实性部分钙化3例。增强后肿瘤实性部分呈明显快进快退型强化11例,部分呈快进快退型强化合并部分中度进行性延迟强化1例,轻度强化2例。肾门或后腹膜淋巴结转移4例。结论:CT检查对囊性肾癌的诊断和鉴别诊断具有一定的临床实用价值。