多层螺旋CT对胫骨平台骨折Schatzker分型的诊断价值

目的探讨多层螺旋CT(MSCT)多平面重组技术(MPR)和容积再现技术(VR)对胫骨平台骨折Schatzker分型的诊断价值。方法 36例胫骨平台骨折患者行MSCT容积扫描,薄层图像进行图像后处理并进行诊断分型,并与临床手术结果分型对照。结果 36例中,SchatzkerⅠ型6例(17%),Ⅱ型12例(33%),Ⅲ型7例(19%),Ⅳ型5例(14%),Ⅴ型4例(11%),Ⅵ型2例(6%)。CT横断轴位分型诊断准确率为78%(28/36),MPR技术分型诊断准确率为100%(36/36),VR技术分型诊断准确率为64%(23/36)。结论 MSCT后处理重组技术能对胫骨平台骨折进行准确Schatzker分型,MPR技术准确率最高,值得临床推广应用。     

应用64排螺旋CT低剂量对跟骨骨折检查的价值分析

目的探讨64排螺旋CT低剂量扫描对跟骨骨折检查的价值。方法收集2013年1月~2014年6月,我院就诊的跟骨骨折患者76例,随机分为常规剂量组、低剂量组、低mA及低kV组,各19例。四组均采用64排螺旋扫描与重建,比较四组的有效剂量、辐射剂量以及图像质量。结果常规剂量组、低mA组以及低kV组的有效剂量均显著高于低剂量组(P<0.05);各组的图像质量比较差异无统计学意义(P>0.05)。结论 64排螺旋CT低剂量检查跟骨骨折具有检查剂量低、图像质量好等优点,值得推广应用。     

多层螺旋CT三维重建技术在颌面部骨折中的应用

目的探讨螺旋CT三维成像技术对颌面部骨折的应用价值。方法选择32例颌面部骨折病人,均以多层螺旋CT于颌面部骨折部位行薄层连续扫描,运用三维表面重建处理软件,重建颌面部骨折的三维影像,获得最佳图像照片,并进行分析。结果螺旋CT三维重建成像可清晰地显示颌面部骨折的部位、骨折线及碎骨片的移位等,并指导临床手术。结论螺旋CT的三维成像技术,在影像显示上有独特的优势,可直观地了解颌面部骨折在三维立体空间的实际大小、形态位置及周围结构的解剖关系,对颌面部骨折术前制定手术方案和术前、术后对比均有重要的指导作用。     

多层螺旋CT对椎间盘病变检查方法的改进

腰椎间盘病变的好发部位多在腰3/4、腰4/5、腰5骶1,所以CT扫描的一般做法是先扫描定位图,然后按照椎间隙的方向和椎间隙的宽度进行定位,常规是每个椎间盘进行3～5层扫描,分别定位在椎间隙的上缘层面、中间层面和下缘层面。而经过这样的检查,最后只能得到9～15幅图像,此种检查提     

多层螺旋CT对急性机械性肠梗阻的诊断价值

目的探讨16层螺旋CT对急性机械性肠梗阻的诊断价值。方法回顾性分析我院2011年1月²013年10月收治142例经手术证实为机械性肠梗阻的病例资料,分别计算腹部立卧位X线片(X线CR)和16层螺旋CT对肠梗阻定性、定位、程度及病因的诊断符合率(准确率),并行率的统计学比较。结果腹部X线CR对肠梗阻定性诊断、梗阻原因诊断、梗阻部位诊断、梗阻程度诊断符合率均显著小于16层螺旋CT(P<0.05);患者舒适度、图像清晰度均显著小于16层螺旋CT(P<0.05),而操作难度却显著高于16层螺旋CT(P<0.01)。结论 16层螺旋CT对肠梗阻的定性、定位、程度、病因等方面有较高的诊断率,值得在临床上推广使用。     

急性胸腹部创伤并骨折的螺旋CT应用价值

目的探讨多层螺旋CT对急诊胸腹部创伤并骨折的应用价值。方法回顾分析45例急诊胸腹部创伤且无肺损伤、气胸或液气胸、皮下气肿及腹部脏器损伤患者的CT影像表现。结果 CT显示31例有骨折(占68.89%)。其中肋骨骨折17例(隐匿性骨折11例),胸椎椎体骨折2例,腰椎椎体骨折5例,腰椎横突骨折7例;复合性骨折2例。结论多层螺旋CT薄层横断面结合二维、三维重建技术能够明显提高急诊胸腹部创伤并骨折的诊断准确率,为临床治疗方案及法医伤情鉴定提供重要参考价值。     

多层螺旋CT 血管造影表现对主动脉夹层患者 院内生存状况的影响

目的 探究多层螺旋CT 血管造影（CTA）对主动脉夹层患者院内生存状况的影响。方法 回 顾性分析2013 年1 月—2017 年12 月兴义市人民医院收治的63 例主动脉夹层患者的临床资料,患者均经多 层螺旋CTA 检查。8 例患者经介入手术治疗,55 例患者接受内科保守治疗,其中17 例患者住院期间死亡作 为死亡组,其余患者作为存活组。采用单因素和Logistic 多因素分析主动脉夹层患者多层螺旋CTA 影像学表 现与院内死亡的关系。结果 死亡组累分支血管数≥ 3、有胸腔积液、有心包积液、Stnford 分型为A 型、假 腔撕裂范围≥ 3 段发生率及平均总管腔增大均高于存活组（P <0.05）。受累分支血管数≥ 3[Ol ^ R=1.737,（95 CI ：2.397,4.184）,P =0.024] 和假腔撕裂范围≥ 3 段[Ol ^ R=3.522,（95 CI ：2.025,3.987）,P =0.019] 为主动脉 夹层患者院内死亡的危险因素。结论 多层螺旋CTA 能够显示主动脉夹层患者真假腔、内膜破口及血栓等 情况,具有较好的诊断价值和治疗参考价值,受累分支血管数≥ 3 和假腔撕裂范围≥ 3 段为主动脉夹层患者 院内死亡的相关因素,应加强对该类患者的监测,及时采取有效措施以改善院内生存状况。     

多层螺旋CT成像技术在筛骨纸样板骨折中的临床应用价值

探讨多层螺旋CT成像技术对筛骨纸样板骨折的应用价值。对97例筛骨纸样板骨折病例行多层螺旋CT容积扫描后,进行轴位高分辨率重建、冠状位多平面重组及薄层最大密度投影、容积再现等后处理,并与原始图像比较。线性骨折42例,骨折线呈线样、无明显移位等;凹陷性骨折48例,纸样板内移凹陷、皱褶成角等;非凹陷性骨折7例,纸样板断裂、外移但仍保持弧形外凸形态;“双边征”12例;合并内直肌肿胀等39例,眶内积气、筛窦积液66例,球后出血15例。多层螺旋CT及后重建技术能精确显示纸样板骨折的直接、间接征象,并可进行分型,是诊断纸样板骨折的有效方法。     

螺旋CT在胸腰椎爆裂性骨折诊断中的临床价值分析

目的探讨螺旋CT在胸腰椎爆裂性骨折诊断中的临床价值。方法选取我院2016年5月至2018年6月收治的68例胸腰椎爆裂性骨折患者,均行X线片及多层螺旋CT检查,对比不同检查方式对患者椎体骨折个数、椎管分度及附件骨折处数的诊断情况。结果多层螺旋CT平扫诊断患者椎体骨折个数、椎管分度及附件骨折处数的准确率较X线片高,差异有统计学意义(P<0.05);多层螺旋CT轴位平扫及多平面重建(MPR)诊断患者椎体骨折个数、椎管分度及附件骨折处数的准确率较容积再现(VRT)高,差异有统计学意义(P<0.05);MPR患者椎体骨折个数、椎管分度及附件骨折处数的准确率较轴位高,差异有统计学意义(P<0.05)。结论螺旋CT在胸腰椎爆裂性骨折诊断中具有较高的临床价值,其可有效诊断椎体骨折个数、椎管分度及附件骨折情况,尤其是后处理技术MPR,准确度更高。     

螺旋CT后处理技术对眶壁骨折法医学鉴定的价值

目的探讨64层螺旋CT后处理技术在眼眶骨折法医学鉴定中的临床价值。方法回顾性分析150例眼眶骨折的64层螺旋CT薄层高分辨率轴位图像与后处理图像,对图像进行诊断及分类。结果眶上壁骨折13处,下壁骨折66处,内侧壁骨折142处,外侧壁骨折9处,经CT轴位图像检查明确诊断157处,经图像后处理技术检查明确诊断230处。结论 64层螺旋CT薄层扫描及后处理技术可以准确诊断眼眶骨折,在法医学鉴定中具有重要的应用价值。     

64排螺旋CT冠状动脉成像对左冠状动脉主干病变的诊断价值

目的 比较64排螺旋CT(MSCT)冠状动脉造影(MSCTA)检查与经导管冠状动脉造影(CAG)和血管内超声(IVUS)检查在诊断左冠状动脉主干(LMCA)病变方面的应用价值,探讨MSCTA在LMCA病变诊断中的作用.方法 2007年11月-2009年2月在复旦大学附属中山医院心内科临床诊断为冠状动脉性心脏病的住院患者中入选91例,男53例,女38例,平均年龄为(64.8±9.2)岁,均行64排MSCTA、CAG和IVUS检查.以1VUS检查为金标准,比较MSCTA与CAG诊断LMCA病变的敏感度、特异度、阳性预测值、阴性预测值和可靠性.比较MSCTA与IVUS对LMCA病变定量评价的能力.结果 以IVUS检查为金标准,CAG诊断LMCA病变的敏感度为25.0%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为26.0%,Kappa值为0.122(P<0.05);MSCTA诊断LMCA病变的敏感度为93.1%,特异度为84.2%,阳性预测值为95.7%,阴性预测值为76.2%,Kappa值为0.744(P<0.001).MSCTA与IVUS检查测量LMCA病变最小管腔面积(MLA)、外弹力膜面积(EEM-CSA)和斑块负荷的Pearson相关系数(r)分别为0.815、0.740和0.736(P<0.01).结论 以IVUS检查为金标准,MSCTA检查诊断LMCA病变的敏感度和阴性预测值高于CAG检查,MSCTA检查对LMCA病变的定量评价与IVUS检查的相关性良好,能作为LMCA病变的筛查手段.     

计算机体层摄影对髌骨隐匿性骨折的诊断评价

目的探讨髌骨隐匿性骨折的影像学诊断方法的诊断效果。方法对50例X线正侧位片阴性或可疑阳性的疑诊髌骨隐匿性骨折患者加拍X线轴位片和计算机体层摄影（CT）,观察两种影像学检查的诊断结果并作比较。结果各型髌骨隐匿性骨折CT的骨折检出率均高于X线轴位平片,总体阳性率X线轴位平片为12.0%,计算机体层摄影为90.0%,两者比较差异有统计学意义（P〈0.05）。CT诊断隐匿性骨折特异度达100%。结论 X线平片在髌骨骨折中应优先考虑选用,但CT检查清晰、快捷、准确,有利于临床决策,在各类髌骨隐匿性骨折中可权衡使用CT检查作为X线平片的有益补充。     

Sixty-four-multi-detector computed tomography diagnosis of coronary artery anomalies in 66 patients

Background The abnormalities of coronary arteries, though rare and sometimes benign, may first present clinically as myocardial infarction or sudden death. Multi-detector computed tomography （MDCT） is a non-invasive test that is highly suitable for detecting these anomalies. The study aimed to review the 64-MDCT appearance of the coronary artery anomalies in 66 patients and to discuss the clinical importance of these anomalies.Methods In 6014 consecutive patients examined over 12 months by 64-MDCT for the study of coronary artery disease, 66 were diagnosed for coronary artery anomalies. All patients were symptomatic for one or more of the following diseases： chest pain, dyspnoea, palpitations, arrhythmia and myocardial infarction. Nine patients had undergone a coronary angiography. All the CT images were evaluated by two radiologists and one cardiologist. The right coronary artery （RCA） and the conus branch arising separately, myocardial bridging and duplication of arteries were not analysed in our study.Results The incidence of coronary artery anomalies found in our study group was 1.097%. In the selected patients, seven different types of coronary anomalies were found by 64-MDCT examination. The high takeoff, origin of the coronary artery from the opposite or noncoronary sinus with an anomalous course, and coronary artery fistula were the three common forms of anomalies （n=16, 18 and 16, respectively）. Compared with the results of the coronary angiography, the number of the drainage sites of two coronary artery fistula was less in MDCT images （3 small sites in total）. In all cases, coronary artery computed tomography angiography （CTA） technique was able to recognize the origin of the coronary artery, its three-dimensional course and its spatial relationship with the adjacent structures. Conventional coronary angiography in two cases, however, was unable to provide sufficient information for correct and complete diagnosis.Conclusions In conclusion, the study showed that 64-MDCT, especially the volume rendering technique （VRT）, may be useful for the assessment of complex variations, even if the conventional angiography may not be sufficient. It may be considered as the first-choice imaging modality when an anomalous coronary artery is suspected.     

术前新辅助化疗对宫颈癌手术患者病理符合率及切缘阳性率的影响

目的 探讨术前新辅助化疗对宫颈癌手术患者的应用效果.方法 回顾性分析2018年3月至2019年8月本院收治的180例宫颈癌患者的临床资料,根据治疗方法的不同分为对照组(单纯手术治疗)与观察组(术前新辅助化疗+手术治疗),各90例.比较两组术中出血量、手术时间、手术前后病理符合率、切缘阳性率及术后病理特征.结果 观察组术中出血量少于对照组,手术时间短于对照组,差异有统计学意义(P<0.05);两组手术前后病理符合率、切缘阳性率比较差异无统计学意义;观察组术后宫颈深层间质浸润率、淋巴结转移率、脉管浸润率、宫旁转移率、颈管累及率均低于对照组,差异有统计学意义(P<0.05).结论 采用术前新辅助化疗治疗宫颈癌手术患者,可减少术中出血量,缩短手术时间,且对手术前后病理符合率、切缘阳性率无影响,同时能减少淋巴结转移,改善患者在术后病理特征.     

Quantitative and qualitative assessment of non-obstructive left main coronary artery plaques using 64-multislice computed tomography compared with intravascular ultrasound

Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with intravascular ultrasound （IVUS） as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.Methods A total of 91 patients （53 men, 38 women, mean age （64.78±9.19） years） were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values （PPV and NPV） of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index （K） for the agreement between MSCTA and IVUS was calculated. Minimal lumen area （MLA）, external elastic membrane cross-sectional area （EEM-CSA） and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index （K=0.744, P〈0.001） indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 （P 〈0.01）. The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively （both P 〈0.01）. The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were （52.52±15.71） HU, （108.32±43.44） HU and （604.16±377.67） HU （P〈0.001）. Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4%. Conclusions Sixty-four section MSCTA is an effective diagnostic tool for the detection of LMCA plaques with higher sensitivity and specificity. The correlation of quantitative and qualitative analysis between MSCTA and IVUS was excellent. The CT value of plaques can help the diagnosis of plaque composition.     

机器学习结合CT影像组学预测2型糖尿病患者椎体脆性骨折

目的：探讨机器学习结合CT影像组学特征构建模型预测2型糖尿病（type 2 diabetes mellitus,T2DM）患者椎体脆性骨折的准确性。方法：回顾性收集140例（新发椎体脆性骨折的T2DM患者70例,对照组70例）患者CT图像和临床资料。另收集18例（椎体脆性骨折的T2DM患者16例,对照组2例）患者的前次CT图像和临床资料作为外部验证集。应用单因素分析、Pearson相关分析、最小冗余度最大相关度算法、二元logistic回归分析和最小绝对值收缩和选择算子模型筛选出最佳特征。基于支持向量机、多层感知器、极端梯度提升（eXtreme Gradient Boosting,XGBoost）构建预测模型。应用受试者工作特征曲线下面积（area under the curve,AUC）对模型效能进行评估。结果：从每例患者的CT图像中提取了1 037个影像组学特征,然后精简为14个影像组学特征。17个临床特征中性别、年龄、体质指数是预测结果的独立因素。其中XGBoost分类器表现最好,训练集中XGBoost模型的AUC分别为1.000、0.929、1.000;测试集中分别为0.954...     

74例占位性突眼患者的CT诊断

目的　评价分析CT对突眼的诊断价值 ,提高诊断准确率。方法　采用东芝 30 0S全身CT机 ,对 74例患者进行眼眶轴位、冠位平扫及强化CT扫描。结果　 74例突眼患者CT明确诊断肌锥内病变 33例 ,肌锥外病变 1 3例 ,眼球肿瘤 8例 ,眶外病变 9例。结论　CT能确切地了解突眼患者病变形态大小及毗邻关系 ,明确病变定位定性诊断 ,具有重要临床指导意义。     

Can computed tomography identify patients with anaemia?

Thirty-three in-patients attended for non-contrast enhanced computed tomography (CT) of chest and/or abdomen within a six-week period (11 M, 21 F) . All had measurement of their full blood profile within the previous 72 hours. Patients with a blood dyscrasia or known history of active bleeding were excluded. All patients were imaged using a Siemens Somatom Plus S scanner. The scanning parameters were standardised at 210 mA, 120 kV, 10 mm slice thickness, pitch of 1. Following image review, circular regions of interest (ROI) were defined within the lumina of the aorta and inferior vena cava (IVC) at the level of the superior mesenteric artery origin. The mean attenuation value was calculated using on-board computer software, and recorded. The mean patient age was 59.6 years (range 18-85 years). A non-parametric correlation analysis was performed and a linear regression plot obtained. A significant correlation was demonstrated between haemoglobin measurement and the aortic and IVC attenuation value. The correlation was stronger (r = 0.64) for the aortic attenuation value than for the IVC attenuation values (r = 0.57). In addition, if anaemia is defined as less than 14g/I for a male and less than 12g/I for a female, then, in our study group, no male with an aortic attenuation value greater than 50HU and no female with an aortic attenuation greater than 45 HU was found to be anaemic. The results demonstrate a significant correlation between patients' haemoglobin measurement and the derived aortic attenuation value. We do not propose this as a method of accurately measuring the patient's haemoglobin; however, we feel that it may be possible for a radiologist at non-contrast enhanced CT examination to note the probable presence of anaemia.