64排螺旋CT冠脉成像效果与影响因素研究

目的 探讨64排螺旋CT冠脉成像中影响图像质量的各种因素及其影响程度以及评估冠脉狭窄的效果.方法 通过838例临床疑似冠心病患者的6_4排螺旋CT冠脉成像,并以其中218例在1周内进行的常规冠状动脉造影为标准,分析64排螺旋CT冠脉成像在评估冠脉狭窄的灵敏度、准确率、阳性预测值和阴性预测值.结果 心率、心率变化幅度、延迟时间设定、β受体阻滞剂、呼吸频率、屏气合作与否、造影剂注射总量与速度、图像重建时相、冠状动脉钙化、扫描参数、患者年龄性别、机器软硬件性能等是影响64排螺旋CT成像质量的因素.64排螺旋CT冠脉成像评估冠脉狭窄的准确率为95.9%,阳性与阴性预测值分别为92.3%、90.0%.结论 得到了影响64排螺旋CT冠脉成像的各种因素,分析了减少和消除这些因素影响的方法.在评估冠脉狭窄方面,64排螺旋CT冠脉成像基本能满足临床要求. Abstract： Objective To study the various factors that influence image quality of 64-slice spiral CT coronary artery imaging, their impact extent and the assessment effect of coronary artery stonnsis. Methods Through examination of 838 clinical coronary heart disease suspect patients, by 64-slice spiral CT coronary artery imaging, in which, 218 patients were also examined by conventional coronary angiagraphy in a week, we took the conventional coronary angiography as the standard, analyzed the 64-slice spiral CT coronary artery imaging in the assessment of coronary artery stenosis by sensitivity, accuracy, positive predictive value and negative predictive value. Results The factors which affect the image quality of 64-slice spiral CT coronary artery imaging include heart rate, heart rate change range, delay time setting, β-blocker, respiratory rate, breath-holding or not, total amount of contrast medium and the speed of injection, image reconstruction phase, coronary artery calcification, the scan parameters, age and sex of patients, machine     

Right internal iliac vein joining the left common iliac vein: case report demonstrated by CT angiography

An unusual variation of the iliac veins was detected by computed tomography (CT) angiography in a 35-year-old man. In coronal CT reconstructions, it was shown that the right internal iliac vein of this patient crossed to the left side and drained to the left common iliac vein. This variation is important in retroperitoneal, laparoscopic and orthopedic surgery. We present the CT findings and discuss the embryological origin of this unusual congenital anomaly.

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Electronic Supplementary Material The french version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at .

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Veine iliaque interne droite tributaire de la veine iliaque commune gauche. Un cas découvert par angio-scanner

Résumé Une variation inhabituelle des veines iliaques a été découverte par tomodensitométrie chez un malade de 35 ans. Les reconstructions coronales ont montré que la veine iliaque interne droite du patient croisait la ligne médiane vers la gauche pour se drainer dans la veine iliaque commune gauche. Cette variation est importante à connaître en chirurgie rétro-péritonéale, laparoscopique et orthopédique. Nous présentons les documents obtenus par tomodensitométrie et discutons l'origine embryologique de cette anomalie congénitale rare.

     

双源CT诊断先天性冠状动脉畸形的研究

目的探讨双源CT(DSCT)对先天性冠状动脉畸形(CCA)的诊断价值及临床意义。方法对我院DSCT冠状动脉成像资料进行回顾性统计,对其中冠状动脉畸形病例进行统计分析,探讨临床应用价值。结果 1824例冠状动脉成像中检出CCA共43例(2.36%),其中冠状动脉起源异常24例(1.32%),冠状动脉走行异常18例,均为心肌桥,占CCA总数的41.9%,占总例数的0.99%。冠状动脉起源异常中右冠状动脉起源于左冠状窦9例,左冠状动脉起源于右冠状窦仅1例。结论 DSCT能够准确地显示冠状动脉畸形,特别是对心肌桥的敏感性高于其他检查方法,对临床诊断和预后评估有重要的应用价值,特别适用于门诊冠脉疾病的"一站式"检查。     

Anatomical variations of pulmonary venous drainage in Thai people: multidetector CT study

Objective:

To evaluate the patterns of pulmonary venous drainage into the left atrium and to determine the frequency of each variant of pulmonary venous anatomy.

Materials and methods:

After institutional review board approval (No. 09JUL011148), 300 studies of thoracic multidetector computed tomography were retrospectively reviewed for the anatomical features of the pulmonary vein and its drainage pattern into the left atrium. The percentage of each pattern was calculated.

Results:

The anatomy of pulmonary venous drainage in 300 patients (150 male and 150 female, mean age 60.16 years) showed some variation. In the right pulmonary vein, the most common drainage pattern was two ostia (90.33%), followed by three to five ostia (6.33%) and a single ostium (3.33%). There were one or two separate middle lobe vein ostia in groups of more than two openings. On the left side, there were two patterns; a single venous ostium (59%) was much more common than two ostia (41%). In both right and left pulmonary veins, there were five cases (2 male, 3 female) that had a single pulmonary venous ostium, bilaterally. However, there were only 17 cases (5.67%), out of 300 enrolled in this study, that had bilateral pulmonary venous ostial variations.

Conclusion:

A classification system to succinctly describe pulmonary venous drainage patterns was developed. In left-sided drainage, a single left pulmonary ostium was the most common variation. The right-sided venous drainage varied more in both number and pattern than those of the left side; nevertheless, bilateral pulmonary venous ostial variation was not frequently found.     

Synchrotron‐Based Micro‐CT Imaging of the Human Lung Acinus

Structural data about the human lung fine structure are mainly based on stereological methods applied to serial sections. As these methods utilize 2D images, which are often not contiguous, they suffer from inaccuracies which are overcome by analysis of 3D micro‐CT images of the never‐sectioned specimen. The purpose of our study was to generate a complete data set of the intact three‐dimensional architecture of the human acinus using high‐resolution synchrotron‐based micro‐CT (synMCT). A human lung was inflation‐fixed by formaldehyde ventilation and then scanned in a 64‐slice CT over its apex to base extent. Lung samples (8‐mm diameter, 10‐mm height, N = 12) were punched out, stained with osmium tetroxide, and scanned using synMCT at (4 μm)³ voxel size. The lung functional unit (acinus, N = 8) was segmented from the 3D tomographic image using an automated tree‐analysis software program. Morphometric data of the lung were analyzed by ANOVA. Intra‐acinar airways branching occurred over 11 generations. The mean acinar volume was 131.3 ± 29.2 mm³ (range, 92.5–171.3 mm³) and the mean acinar surface was calculated with 1012 ± 26 cm². The airway internal diameter (starting from the bronchiolus terminalis) decreases distally from 0.66 ± 0.04 mm to 0.34 ± 0.06 mm (P < 0.001) and remains constant after the seventh generation (P < 0.5). The length of each generation ranges between 0.52 and 0.93 mm and did not show significant differences between the second and eleventh generation. The branching angle between daughter branches varies between 113‐degree and 134‐degree without significant differences between the generations (P < 0.3). This study demonstrates the feasibility of quantitating the 3D structure of the human acinus at the spatial resolution readily achievable using synMCT. Anat Rec 293:1607–1614, 2010. © 2010 Wiley‐Liss, Inc.     

Computed tomography imaging of early coronary artery lesions in stable individuals with multiple cardiovascular risk factors

OBJECTIVES:To investigate the prevalence, extent, severity, and features of coronary artery lesions in stable patients with multiple cardiovascular risk factors.METHODS:Seventy-seven patients with more than 3 cardiovascular risk factors were suspected of having coronary artery disease. Patients with high-risk factors and 39 controls with no risk factors were enrolled in the study. The related risk factors included hypertension, impaired glucose tolerance, dyslipidemia, smoking history, and overweight. The characteristics of coronary lesions were identified and evaluated by 64-slice coronary computed tomography angiography.RESULTS:The incidence of coronary atherosclerosis was higher in the high-risk group than in the no-risk group. The involved branches of the coronary artery, the diffusivity of the lesion, the degree of stenosis, and the nature of the plaques were significantly more severe in the high-risk group compared with the no-risk group (all p < 0.05).CONCLUSION:Among stable individuals with high-risk factors, early coronary artery lesions are common and severe. Computed tomography has promising value for the early screening of coronary lesions.     

心理干预对64层螺旋CT冠状动脉成像的效果观察

目的 探讨心理干预对64层螺旋CT冠状动脉成像的效果.方法 样本为我科室2009年9月-2010年9月期间进行CT冠状动脉造影检查的100例患者,随机分为干预组和对照组.对照组检查前给予一般指导和口服美托洛尔,干预组在检查前给予系统的心理干预和口服美托洛尔,比较两组检查者心率控制速度、呼吸配合训练时间和检查过程心率波动...     

SPECT/CT融合显像在分化型甲状腺癌转移灶诊断中的应用价值分析

目的 探讨SPECT/CT 131I显像在诊断分化型甲状腺癌转移灶中,以及在131I放射治疗后复发和转移中的应用价值,为临床诊断和治疗甲状腺癌提供依据.方法 选择2013年5月至2016年5月我院住院治疗经病理证实的分化型甲状腺癌住院患者90例,分别实施131I-WBS,131I-SPECT/CT显像诊断,观察显像诊断结果以及Tg水平.结果 131 I-WBS共诊断出125个复发和转移病灶,其中113个经病理检查证实,其诊断灵敏度和准确度分别为85.03％,78.62％:131I-SPECT/CT共诊断出134个复发和转移病灶,其中128个经病理检查证实,其诊断灵敏度和准确度分别为91.16％,87.58％;说明131I-SPECT诊断的灵敏度要优于131 I-WBS显像,两组数据比较差异有统计学意义(P＜0.05);此外131I-WBS显像、131I-SPECT/CT显像阳性的Tg水平与阴性患者比较明显升高,且差异有统计学意义(P＜0.05).结论 SPECT/CT显像在诊断分化型甲状腺癌转移灶方面具有重要价值,值得临床广泛的应用.     

SPECT/CT脑血流灌注显像的临床应用进展

SPECT/CT脑血流灌注显像是SPECT(单光子发射计算机断层显像)技术和CT(计算机断层扫描技术)同机融合的一种检查方法,能够将解剖显像与功能显像完美的结合在一起,提高定位准确率的同时还可以对疾病进行多角度的分析,兼具了SPECT灵敏度高和CT特异性、分辨率高的优点,因此,对很多疾病如脑梗、TIA、癫痫等缺血性病变的病灶定位、治疗指导和预后评估以及正常脑功能的研究有着独特的优势.本文结合国内外资料对SPECT/CT脑血流灌注显像的原理、技术和临床应用的进展进行综述.     

儿童与成人支原体肺炎CT表现及临床意义

目的：分析儿童与成人支原体肺炎的CT影像表现特点,指导临床对支原体肺炎的早期诊断。方法：回顾性分析36例经血清学证实的支原体肺炎患者的CT影像资料,根据支原体肺炎患者的年龄分为儿童组（20例）和成人组（16例）,对其CT影像表现进行对比分析。结果：儿童组的病变部位主要位于右肺下叶11例（55％）、右肺中叶6例（30％）和左肺上叶5例（25％）,成人组的病变部位主要位于右肺下叶8例（50％）、左肺下叶5例（31％）和右肺中叶4例（25％）,两组间病变位于左肺舌叶、左肺下叶的发生率差异有统计学意义（P〈0．05）。入院时,儿童组的CT影像表现以大片状实变影为主15例（75％）,成人组CT影像表现以磨玻璃样变12例（75％）和小斑片状实变影8例（50％）为主,两组间CT影像表现差异有统计学意义（P〈0．05）。结论：儿童与成人支原体肺炎的病变部位和CT影像表现具有一定的特征性,对支原体肺炎的早期诊断有重要的指导意义。     

An anatomical study of the human cardiac veins with special reference to the drainage of the great cardiac vein

Many case reports in which the main aim was to clarify the development of the superior vena cava (SVC) with persistent SVC have so far been published. However, there have only been a few systematic studies of the cardiac veins. Therefore, we macroscopically investigated the cardiac veins using 337 human adult hearts to obtain a detailed understanding of the morphology of the heart.

From our study, we obtained the following results.

1. The frequency of persistent left SVC including one case of bilateral SVC was observed to be higher 7 cases (2.1%) than in previous reports.

2. We observed a second case in which the great cardiac vein drained directly into the right SVC (the first case being reported by Bergman et al. 1988).

3. Variations in the drainage of the great cardiac vein (GV) were observed from the right SVC to the left SVC, while the middle cardiac vein (MV) showed less variations of the drainage and course.

4. The drainage boundary between the GV and MV was classified into 3 types: MV-dominant type in 123 cases (36.5%), intermediate type in 182 cases (54.0%), and GV-dominant type in 32 cases (9.5%).

From our results, we speculated that the MV did not generate any variations due to its short course before draining into the right atrium, while the GV had many variations due to its long course before draining into the right atrium. From the few GV-dominant types, the halfway boundary between the anterior (GV) and posterior (MV) route for drainage into the right atrium could be considered to be the anterior side rather than the Apex cordis.     

99Tcm-MIBI SPECT/CT同机融合显像对脑肿瘤的诊断价值

目的 与单纯SPECT显像或单纯CT显像进行对比研究,探讨99Tcm-MIBI SPECT/CT同机融合显像对脑肿瘤良恶性判断的临床应用价值.方法 对45例临床疑似脑肿瘤的患者行99Tcm-MIBI SPECT显像,CT显像及99Tcm-MIBI SPECT/CT同机融合显像.以术后病理结果为准,分别计算出以上三种方法对脑肿瘤定性诊断的灵敏度、特异性、准确性,通过统计学方法将融合显像结果分别与单一显像结果进行对比分析.结果 SPECT/CT融合显像与单纯SPECT显像相比,灵敏度（x2 =4.383,P＜0.05）、特异性（x2=3.949,P＜0.05）、准确性（x2=8.073,P＜0.01）均明显提高,差异有统计学意义.SPECT/CT融合显像与单纯CT显像相比,灵敏度（x2=5.543,P＜0.05）、特异性（x2=5.100,P＜0.05）、准确性（x2=10.497,P＜0.01）均明显提高,差异有统计学意义.结论 99Tcm-MIBI SPECT/CT同机融合显像对脑肿瘤的诊断较单一显像具有更高的诊断价值.     

Descriptive anatomy of the dominant septal perforators using Dual Source coronary CT angiography

Although clinical outcomes for septal ablation in treating left ventricular outflow tract obstructions are generally favorable, a variety of complications have been reported including a high incidence of right bundle branch block. These complications may be attributed to anatomic variability of the dominant septal perforator. We used Dual Source CT Coronary Angiography (DS‐CTA) to determine the location of the termination point of the dominant septal perforator as well as the distance of the termination point from the mitral annulus in patients undergoing DS‐CTA. One‐hundred‐fourteen DS‐CTA scans were retrospectively reviewed by two observers by consensus. The left ventricle was divided into anterior wall, anterioseptum, and inferioseptum. For each segment, the myocardium was divided into three layers (1) right ventricular side, (2) mid portion, and (3) left ventricular side. The zone of termination of the dominant septal perforator was identified as well as the distance of the termination point from the mitral annulus. The dominant septal perforator terminated in the right ventricular side of the anterioseptum in 86 of the 118 visualized terminations (73%) and in the left ventricular anterior wall in 6 visualized terminations (5%). On average, the dominant septal perforator terminated 26.3 ± 8.6 mm from the mitral annulus. In the majority of cases, the dominant septal perforator terminates in the right ventricular side of anterioseptum. In addition, there is great variability in the distribution of the termination point of the dominant septal perforator from the mitral annulus. Clin. Anat. 23:70–78, 2010. © 2009 Wiley‐Liss, Inc.     

The utility of multi-detector row spiral CT for detection of coronary artery stenoses

Contrast-enhanced multi-detector row spiral computed tomography (MDCT) was introduced as a promising noninvasive method for vascular imaging. This study examined the accuracy of this technique for detecting significant coronary artery stenoses. Both MDCT(Sensation 16, Siemens, Germany, 12x0.75 mm collimation and 0.42 sec rotation speed, 120 kV, 500 effective mA, and 2.7 mm/rotation table-feed) and invasive coronary angiography (CAG) were performed on 61 patients (mean age 59.2+/-10, 44 men) who were suspected of having coronary artery disease. All patients were treated with atenolol (25-50 mg) prior to imaging and the heart rate was maintained below 65 beats per minutes during image acquisition. The images were reconstructed in the diastole around TI-400 ms with a 0.5 mm increment and a 1.0 mm thickness. All coronary arteries with a diameter of 2.0 mm or more were assessed for the presence of a stenosis (>50% luminal narrowing). Two independent radiologists who were unaware of the results of the invasive CAG evaluated the MDCT data, and the results were compared with those from the invasive CAG (interval 1-27, mean 11 days). An evaluation of the CT coronary angiogram (CTCA) was possible in 58 of the 61 patients (95%). Image acquisition of the major coronary arteries including the left main trunk was available in 229 out of 244 arteries. Invasive CAG showed that 35 out of 58 patients had significant coronary artery stenoses by. patient analysis of those who could be evaluated showed that CT coronary angiography correctly classified 30 out of 35 patients as having at least 1 coronary stenosis (sensitivity 85.7%, specificity 91.3%, positive predictive value 93.8%, negative predictive value 80.8%). By analyzing each coronary artery, CAG found 62 stenotic coronary arteries in the 229 coronary arteries that could be evaluated. MDCT correctly detected 50 out of 62 stenotic coronary arteries and an absence of stenosis was correctly identified in 156 out of 167 normal coronary arteries (sensitivity 80.6%, specificity 93.4%, positive predictive value 81.9%, negative predictive value 92.8%). The non-invasive technique of MDCT for examining the coronary artery appears to be a useful method for detecting coronary artery stenoses with a high accuracy particularly with the proximal portion and large arteries.     

多排螺旋CT对胃肠道内可疑异位胰腺病灶的影像学诊断

目的:探讨多层螺旋CT诊断胃肠道内异位胰腺的价值及对误诊病变进行分析。方法:对18例术前64排螺旋CT诊断为异位胰腺并获得病理结果的病例进行分组回顾分析。结果:收集到18例患者共19处病灶。诊断正确组有10例患者11处病灶,其中7处位于胃黏膜,3处位于十二指肠,1处位于回肠。以上病灶中5处可见“中央脐凹征”。诊断错误组有8例患者共8处病灶,3处位于胃黏膜或粘膜下,4处位于十二指肠内,1处位于食管下段内,病理结果提示8处病灶中3处为炎性病灶,2处为肿瘤病灶（胃肠间质瘤及神经内分泌肿瘤）,1处为胃底腺异位,1处为胃粘膜脱垂,1处为Peutz-Jeghers息肉;其中胃底腺异位及间质瘤的影像表现上均有类似“中央脐凹征”表现。结论:通过64排多层螺旋CT扫描并收集到的病例中:（1）诊断正确组中大多数病灶位于胃及十二指肠;（2）诊断错误组中部分病灶表现为类似“中央脐凹征”,可能是导致误诊的原因之一;（3）误诊病例中炎性病变占比较大,认为胃肠道炎性病变需作为异位胰腺的鉴别诊断之一。     

Vascular engineering of the vertebral venous drainage system

The recent distribution infra-cranial distribution of malignant cerebral neoplasms has prompted a search for possible routes to explain such spread. The intimate connections of the intracerebral veins with the vertebral venous system, the close proximity of cerebral neoplasms to the ventricular system, and the postural hemodynamics of a largely valveless drainage system have all added another dimension to the vertebral venous circulation described by Batson. This flow pattern ascended from the sacrum to the skull. An inferior “reverse” flow is now proposed by which neoplastic cells may extend into the cervical and mediastinal lymph nodes, breast, liver, or lung.     

心脏保存后冠脉流量减少机制的实验研究

目的: 探讨离体心脏低温较长时间保存后冠脉流量减少的发生机制。方法: 离体大鼠心脏在不同的保存液中0℃8h保存后再灌注,应用作用于血管内皮及平滑肌的药物,观察冠脉流量(CF)、冠脉血管阻力(CVR)及再灌注前、后的水肿程度。结果: 心脏0℃8h保存-再灌注后,各实验组CF均降低(P<0.01),CVR升高(P<0.01)。应用作用于血管内皮的药物(5-HT)后,山东医科大学心脏保存液-1号(SDMC-1)组,Collin's组:CF降低;CVR升高。而Stanford组CF无变化,CVR升高;SDMC-2组CF显著增加(P<0.01),CVR降低(P<0.05)。而应用作用于血管平滑肌的药物(腺苷)后,4组CF均增加,CVR均降低(P<0.01)。保存末4组的水肿程度基本相同,再灌注后,Collin's组水肿加重,Stanford组水肿显著加重,SDMC-1、2组无变化。结论: 冠脉血管内皮结构或功能的损伤是引起CF降低的主要原因。     

The anatomy of the coronary sinus and its tributaries

The coronary sinus and its tributaries were studied by anatomical dissection in 37 adult human cadaveric hearts, which had been fixed in formalin solution. An anastomosis of approximately 1.0mm in calibre was observed between the anterior and posterior interventricular veins in 19% of specimens. Myocardial bridges were detected above the anterior interventricular vein or its tributaries in 8% of specimens. The great cardiac vein formed the base of the arteriovenous trigone of Brocq and Mouchet with the bifurcating branches of the left coronary artery in 89% of specimens and formed an angle accompanying these arterial branches in 11%. In the trigone the anterior interventricular and great cardiac veins were superficial to the arteries in 73% of specimens. The left marginal vein was present in 97% of specimens, emptying into the great cardiac vein in 81% of cases and into the coronary sinus in the remaining 19%. The small cardiac vein was present in 54% of specimens. In the coronary sulcus the great cardiac vein was adjacent to the circumflex branch of the left coronary artery in 76% of specimens and to the right coronary artery in 5% in 19% there was no relationship with either artery. The coronary sinus maintained a relationship with the right coronary artery in 46% of specimens and with the left coronary artery in 32% in 22% it had no relationship with these vessels.     

16层CT脑血管容积成像的临床应用

目的：研究分析16层螺旋CT脑血管容积成像的临床应用及价值。方法本次研究中共入选研究对象104例,入选研究的时间为2012年6月~2014年6月,均为疑似脑血管性疾病并在本院接受治疗的患者,所有患者均给予16层螺旋CT容积成像检查,同时与数字减影脑血管造影检查结果或者手术病理结果进行对照。结果104例患者中,66例检查确诊为脑动脉瘤,脑血管畸形患者16例,烟雾病2例。结论采用16层螺旋CT进行脑血管性病变的检查和诊断效果显著,值得临床广泛关注和推广。