涎腺介入治疗术

涎腺管堵塞是涎腺最常见的疾病,主要是腺管结石、狭窄或两者共同造成,影像学对判断梗阻的原因、程度及造成的结果能作出明确诊断,而影像引导下的微创介入治疗是涎腺管堵塞的重要方法。本文综述了涎腺微创介入的现状。     

体模在涎腺造影术剂量测量中的应用

体模型是仿照真人大小和形状,选用与人体各器官和组织等效材料制作而成,可以用于放射诊疗和事故性意外照射时的剂量估算。本文应用SMN—I型非均匀人体模型模拟病人接受涎腺造影检查,并对局部器官吸收剂量作一分析。     

平板数字旋转右室造影在法洛四联症中的临床应用

目的：与常规右室造影比较,探讨平板数字旋转右室造影在法洛四联症（TOF）中的临床应用价值。方法：对39例法洛四联症患者行平板数字旋转右室造影,详细记录从右前斜（RAO）35。到左前斜（LAO）70。各种主要畸形及解剖所见,包括右室流出道、肺动脉主干、左肺动脉起始部、右肺动脉起始部、室间隔缺损、主动脉骑跨度、冠状动脉开口及走行、动脉导管未闭（PDA）、侧支血管及其他畸形等;选取同一患者,在TOF常规造影体位RAO30。头位及I。AO60。头位观察造影所见,并进行对照分析。结果：右室流出道、肺动脉主干、左肺动脉起始部、右肺动脉起始部、室间隔缺损、主动脉骑跨度、冠状动脉开口及走行、PDA、侧支血管及其他畸形等在旋转造影中除左肺动脉起始部良好显示率为97％,其余均为100％;而在RAO30。头位、LAO60。头位,良好显示率分别为87％、82％、77％、87％、82％、82％、72％、O％;旋转造影与常规造影在肺动脉主干、左肺动脉起始部、室间隔缺损、主动脉骑跨、冠状动脉开口及走向显示上的差异有统计学意义（P〈0．05）。结论：旋转造影较常规造影能提供更丰富的影像学信息,可从任意角度观察心腔、血管的情况,为临床治疗提供更多有益的资料。     

数字断层融合摄影在肺转移结节诊断和随访中的价值

目的探讨胸部数字断层融合(DTS)检查对恶性肿瘤肺转移结节的诊断和随访价值。资料与方法对257例恶性肿瘤患者进行胸部DTS检查和数字X线摄影(DR)检查,以多层螺旋CT作为参照,比较DTS和DR对肺转移结节的检出情况,评估DTS对肺转移结节的诊断效能。结果 257例患者中,34例发生肺转移,共确认187个转移结节。DR检出16例共计65个结节,DTS检出31例共计164个结节。DR和DTS对恶性肿瘤肺转移的诊断敏感性、特异性、阳性预测值、阴性预测值分别为47.1%、87.9%、37.2%、91.6%和91.2%、99.6%、96.9%、98.7%。DTS对直径<5mm和5～10mm的肺转移结节的检出率明显高于DR(P<0.01)。结论 DTS较DR对肺转移结节具有更高的敏感性,可用于转移性肺癌的诊断和随访。     

涎腺肌上皮瘤的CT表现

目的分析涎腺肌上皮瘤(myoepithelioma,ME)的CT表现,以提高对该病的认识。资料与方法回顾性分析12例经病理证实的涎腺ME的CT表现并复习相关文献。所有病例均行CT平扫,其中9例行增强扫描。结果 12例肿瘤中发生于大涎腺9例(其中腮腺6例,颌下腺3例),小涎腺3例(鼻腔、硬腭、咽旁间隙各1例)。8例肿块边界清楚,4例肿块边界不清,其中1例发生于硬腭伴有骨质吸收破坏。平扫肿块多呈中等软组织密度,9例密度不均,3例密度均匀。增强扫描不均匀强化7例,肿块内可见结节样强化,囊变区不强化,均匀强化1例,1例位于硬腭病灶强化不明显。结论涎腺ME的CT表现具有一定特点,能为临床诊断和选择手术方式提供帮助。     

下颌骨数字化曲面体层X线摄影技术及其临床应用

目的 :研究下颌骨数字化曲面体层X线摄影技术及其临床应用。材料和方法 :采用德国西门子公司的sirona5 9685 73D3 2 0 0型ORTHOPHOSPLUSDS系统 ,对 10 0例患者进行下颌骨数字化曲面体层X线摄影。结果 :与传统胶片曲面体层摄影技术比较 ,下颌骨数字化曲面体层X线摄影技术曝光量减少了 5 0 %～ 60 % ,影像质量 :甲级 86例 ,乙级 10例 ,丙级 4例。结论 :下颌骨数字化曲面体层X线摄影技术具有普通胶片曲面体层摄影技术所不具备的优越性 ,是临床及科研的一种新检查手段。     

涎腺区肿块的CT诊断

目的：探讨涎腺区病变的ＣＴ诊断价值。方法：回顾性总结经手术病理证实的３４例涎腺区肿块的临床与ＣＴ资料，对其ＣＴ表现进行了分析。结果：３４例中有２６例术前ＣＴ准确诊断，诊断符合率７３．５％，腮腺区２４例，颌下腺区１０例。良性肿块的ＣＴ表现：结节状（１３例），分叶状（５例），不规则形（３例）。大多数肿块边缘光滑，边界清晰，密度均匀。病理对照：有完整包膜１８例，无完整包膜３例。恶性肿块ＣＴ表现呈不规则形（１３例），边缘毛糙，与周围正常组织分界不清。病理对照：肿块多数无包膜（１１例）。结论：涎腺ＣＴ扫描的最大优势在于定位准确，能明确病变的范围及其与周围组织的关系，同时可根据肿块的形态及密度较好地鉴别其性质。     

曲面体层摄影受检者的X线辐射剂量研究

目的：测量颌骨牙列曲面体层摄影人体不同组织器官的X线吸收剂量,并计算当量剂量、有效剂量以及涎腺有效剂量。方法：使用仿真成年人体模测量颌骨牙列曲面体层摄影时腮腺、颌下腺、舌下腺、下颌骨表面、眼晶体、垂体、受照区皮肤、颈椎红骨髓、甲状腺、乳腺、卵巢以及睾丸等器官组织的X线吸收剂量,计算各器官组织的X线当量剂量、有效剂量以及涎腺有效剂量。结果：X线吸收剂量0μGy~730.50μGy,当量剂量0μSv~730.50μSv,有效剂量36.28μSv,涎腺有效剂量47.78μSv。结论：颌骨牙列曲面体层摄影受检者X线吸收剂量、当量剂量、有效剂量均较小,对眼晶体、甲状腺、性腺等敏感器官组织有较高安全性,从放射防护角度,使用曲面体层摄影观察上下颌牙列、牙槽骨的形态是合理的。     

CR在静脉肾盂造影中的应用价值

目的：探讨计算机X线成像（computed radiography，CR）在静脉肾盂造影中的应用。方法：随机抽取2002年11月-2005年11月200例使用AGFA ADC SOLO系统行静脉肾盂造影者影像资料，分析图像的显示情况。结果：200例患者中，共85例原始图像显示欠佳。其中78例因曝光条件不恰当引起图像显示不理想。经CR处理后得到明显改善，另7例因病理改变所致。经CR处理后无明显改善。结论：CR系统能较好的显示泌尿系统病变，对诊断很有价值。     

直接数字X线摄影在尘肺病诊断中的应用价值

目的 探讨直接数字X线摄影(DR)在尘肺病诊断中的应用价值.方法 对随机抽取的298例接尘对象分批组织同期分别摄高仟伏和DR胸片,先由6名具有尘肺病诊断资质的医师随机均分甲、乙两组分别进行诊断,然后甲、乙两组合并阅片,使分组诊断不一致的结果得到统一.对DR和高仟伏两种胸片统一后诊断的胸片质量、小阴影的形态和大小、总体密集度、小阴影分布肺区数、尘肺分期等结果进行分析比较.结果 DR胸片质量等级集中在优片(97.99％),高仟伏胸片集中在良片(93.63％);DR胸片和高仟伏胸片小阴影的形态和大小、小阴影总体密集度、尘肺分期经一致性检验Kappa值分别为0.642、0.406、0.436,符合率分别为88.26％(263/298)、67.79％(202/298)、65.77％(196/298);小阴影分布肺区数在下肺区DR胸片明显多于高仟伏胸片.结论 DR胸片质量明显优于高仟伏胸片,可用于尘肺病的诊断.     

DR胸部X线摄影技术在临床的应用

目的评价直接数字X线摄影系统在胸部疾病诊断与筛查中的实用意义。方法自2005年9月以来,应用西门子FX直接数字X线摄影系统对我院门诊、急诊、住院患者及来院体检者进行了胸部检查。DR影像经激光打印机打印后,以数字化形式传入我院PACS供实时共享。DR影像显示病变的能力与常规X线平片进行了比较。结果自2005年9月应用西门子FX直接数字X线摄影系统以来,基本满足了我院门诊、急诊、住院患者胸部疾病诊断和来院体检者胸部疾病筛查的实际需要。与常规X线平片比较,DR影像能更清晰、准确地显示病灶。结论DR是诊断和筛查胸部疾病的重要影像技术,尤其与PACS联合应用是医院数字化管理的重要标志。     

腮腺造影对诊断干燥综合征的价值

目的 研究腮腺造影诊断干燥综合征（Sjogren’s syndrome，SS）的价值。方法 以2002年SS国际分类（诊断）标准为对照，对SS的腮腺造影诊断标准进行诊断试验。入选病例共202例，其中SS患者149例，慢性腮腺炎14例，良性腮腺肥大2例，正常者37例。结果 SS患者以末梢导管病变发生率最高（80．20％，239／298侧），主导管病变表现为边缘毛糙（28．19％，84／298侧）或管腔扩张，但边缘不毛糙（13．09％，39／298侧），也可以表现为前2种病变的混合形式，但较少见（2．68％，8／298侧）。分支导管病变与主导管类似，但不同的是观察效果受末梢导管病变的广泛程度影响。SS累及腮腺的0～Ⅴ期病变均有发生，同一患者两侧腮腺病变分期不同的病例占25．98％（33／127例）。非SS患者中，慢性腮腺炎也可表现为末梢导管扩张（7／28侧）、分支导管扩张（10／28侧）、主导管扩张（11／28侧），但导管无边缘毛糙征象。其他非SS病例无导管病变征象。诊断试验结果中，分支导管或主导管边缘毛糙的诊断特异度为100％，末梢导管扩张的敏感度及Youden’s指数最高。结论 （1）在以腮腺导管病变诊断SS时，末梢导管扩张是理想的筛选诊断标准，而分支导管和主导管边缘毛糙则是对SS的确诊标准。（2）腮腺造影诊断SS的价值可受导管病变表现形式及是否为双侧腮腺同时造影等因素的影响。     

Radiation dose reduction in direct digital panoramic radiography

Objectives

(a) To measure the absorbed radiation doses at 16 anatomical sites of a Rando phantom and (b) to calculate the effective doses including and excluding the salivary gland doses in panoramic radiography using a conventional and a digital panoramic device.

Study design

Thermoluminescent dosimeters (TLD-100) were placed at 16 sites in a Rando phantom, using a conventional, Planmeca Promax and a digital, Planmeca PM2002CC Proline 2000 (Planmeca Oy, 00880 Helsinki, Finland) panoramic device for panoramic radiography. During conventional radiography the selected exposure settings were 66 kVp, 6 mA and 16 s, while during digital radiography two combinations were selected 60 kVp, 4 mA, 18 s and 66 kVp, 8 mA, 18 s with and without image processing function. The dosimeters were annealed in a PTW-TLDO Harshaw oven. TLD energy response was studied using RQN beam narrow series at GAEC's Secondary Standard Calibration Laboratory. The reader used was a Harshaw, 4500. Effective dose was estimated according to ICRP₆₀ report (E_ICRP60). An additional estimation of the effective dose was accomplished including the doses of the salivary glands (E_SAL). A Wilcoxon signed ranks test was used for statistical analysis.

Results

The effective dose, according to ICRP report (E_ICRP60) in conventional panoramic radiography was 17 μSv and E_SAL was 26 μSv. The respective values in digital panoramic radiography were E_ICRP60 = 23 μSv and E_SAL = 38 μSv; while using the lowest possible radiographic settings E_ICRP60 was 8 μSv and E_SAL was 12 μSv.

Conclusions

The effective dose reduction in digital panoramic radiography can be achieved, if the lowest possible radiographic settings are used.     

Dose-image optimisation in digital radiology with a direct digital detector: an example applied to pelvic examinations

In diagnostic radiology increasing attention has been focused on dose reduction while maintaining a clinically good image quality. With the use of digital detectors balancing dose vs image quality is done differently than in film-screen radiography, since dose and image brightness are uncoupled in digital imaging. In this study a new direct digital detector (flat-panel detector) was used in a dose-image optimisation of a simulated pelvic examination. X-ray images were taken with a direct digital detector (DDD), of the pelvic of a phantom using varying tube current (varying stochastic noise). The entrance surface dose was measured for each image. These images were scored by two radiologists according to EU guidelines. A dose comparison was made with an older PCR system (storage phosphor plates). With decreasing tube current the noise in the images increased and the image with the lowest dose and still acceptable image quality was identified. The results showed that the entrance surface dose using the DDD decreased from 1.4 mGy (PCR value) to 0.48 mGy (DDD standard settings). Through the optimisation the dose could be further decreased to 0.24 mGy while still maintaining an acceptable image quality. A substantial dose reduction was obtained with this new direct digital detector. This simple but efficient optimisation approach is easily applicable to other examinations and both DDD and storage phosphor plate detectors.     

MR涎管造影临床研究及应用

目的 评价MR涎管造影的各种序列技术和临床应用。方法 依次采用短时反转恢复序列(STIR)、重T2加权快速自旋回波序列(重T2WIFSE)、单次激发快速自旋回波序列(SSFSE)，厚层扫描，快速采集，于服用维生素C(VitC)前后分别扫描。检查了30例，其中13例为志愿者，17例为可疑涎管异常者。结果 3种序列均能显示正常腮腺和颌下腺主导管。13例志愿者STIR序列均能清晰显示涎管1级和2级分支，2例能显示管径约为0．8mm的末梢分支；重T2WIFSE序列可清晰显示13例志愿者1级分支、10例2级分支；SSFSE序列可显示10例涎管1级分支、6例2级分支。STIR序列能清晰显示患者主导管和涎管1、2级分支；重T2WIFSE序列清晰显示患者12例涎管1级、8例2级分支；SSFSE序列清晰显示患者10例1级分支、4例2级分支。17例可疑异常者，腺体炎症7例，急性炎症主导管稍增粗，末梢导管呈点、球状扩张；颌下腺癌1例，导管受压移位，呈截断状改变；良性肿瘤7例，涎管受压移位，无中断；干燥综合征及涎腺病各1例，涎管未见明显异常。16例患者含服VitC0．2g后5min重复扫描，涎管显示较前增粗。结论 MR涎管造影能清晰显示腮腺和颌下腺导管系统，其中STIR序列能清晰显示导管2级分支，是1种显示涎管的非侵袭性方法，含服VitC后可使唾液分泌增多，从而使涎管显示率增加，具有较高的临床实用价值。     

DR静脉尿路造影诊断输尿管阴性结石的价值

目的：探讨DR静脉尿路造影诊断输尿管阴性结石的价值。方法：利用DR设备行静脉尿路造影检查180例，男123例，女57例，年龄8－75岁，平均41岁。造影中动态透视观察，DR点片，2例造影后又行CT检查。所有病例均经手术或CT扫描证实。结果：利用DR检查，发现输尿管阴性结石42例，占180例输尿管结石23．33％，超过以往文献报道的约10％。输尿管阴性结石X线表现分为五型：①输尿管某段突然狭窄型18例；②充盈缺损型13例；③输尿管间嵴增宽伴全程输尿管不同程度扩张型6例；④一侧肾盂肾盏不显影型4例；⑤结石染色型1例。结论：DR在造影中可做动态观察，利用DR行IVU检查可以更容易发现输尿管阴性结石，为临床治疗提供依据。     

Optimisation of radiographic acquisition parameters for direct digital radiography: A systematic review

IntroductionThe objective of this systematic review was to uncover and synthesise all available literature regarding appropriate acquisition parameters for direct digital radiography. It sought to either confirm current practices as optimal, or to uncover practices that may produce more optimised results.MethodsA comprehensive search of published and unpublished literature was undertaken to find studies that evaluated how adjustment of different acquisition parameters affected subjective image quality and patient radiation dose. Eight hundred and fifty-eight studies were retrieved for title and abstract screening. Eighty-nine studies were retrieved for full-text screening, and 23 were included for review and methodological quality screening.ResultsNarrative synthesis of the 23 included studies revealed limited evidence to guide any potential change or acceptance of currently accepted best practice. Meta-analysis was unable to be performed for any of the included studies due to high levels of methodological heterogeneity. A key finding of this review was that the goals of optimisation research varied greatly across the included studies.ConclusionSignificant methodological heterogeneity in the included studies limited the number of clinically relevant findings that would give evidence to an acceptance of, or suggest changes to, currently accepted best practice. Improving consistency in approach across future works of technique optimisation will ensure future systematic reviews will be able to provide strong evidence and meta-analysis will be able to be performed.Implications for clinical practiceThis review highlights that in the literature, studies of optimisation of radiographic acquisition parameters have varying goals. This methodological heterogeneity limits the applicability of systematic reviews and precludes the use of meta-analysis. The authors recommend that a framework for optimisation research be produced as a priority to help improve homogeneity in future research.     

Optimizing digital radiography of children

Pediatric projection imaging differs from imaging of the adult patient. Children are smaller, more radiosensitive, and less compliant than their adult counterparts. Their characteristics affect the way projection imaging is practiced and how dose is optimized.Computed radiography (CR) and digital radiography (DR) have been embraced by pediatric practitioners in order to reduce dose and improve image quality. Unfortunately, dose optimization with CR and DR has been hampered by a lack of definition of appropriate exposure levels, a lack of standardization in exposure factor feedback, and a lack of understanding of the fundamentals of CR and DR technology. The potential for over-exposure exists with both CR and DR. Both the Society for Pediatric Radiology and the American Association of Physicists in Medicine recognize the promise and shortcomings of CR and DR technology and have taken steps to join with manufacturers in improving the practice of CR and DR imaging. Although the risks inherent in pediatric projection imaging with CR and DR are low, efforts to reduce dose are worthwhile, so long as diagnostic quality is maintained. Long-standing recommendations for limiting radiation dose in pediatric projection imaging are still applicable to CR and DR.     

骨盆数字化X射线摄影曝光剂量的优化研究

目的研究直接数字化X射线摄影照射剂量与成像质量的关系，确定骨盆X射线摄影的最佳摄影条件。方法以对比度一细节体模CDRAD2．0在不同照射剂量下所获取的影像的图像质量因子IQF，进行ANOVA及SNK统计学分析，确定最佳照射条件。应用X射线摄影模拟人拍摄骨盆X射线影像，按照欧共体（CEC）图像质量标准验证最佳摄影条件与常规摄影条件下照射剂量与成像质量的差别。结果不同照射剂量条件下，对比度一细节体模影像质量因子IQF有显著性差别（P=0．0001），照射剂量大于0．61mGy时，不同剂量组间IQF差异无统计学意义。对以最佳照射条件和常规照射条件所拍摄的X射线摄影模拟人影像按照CEC标准评判，两者影像质量的差异无统计学意义。结论直接数字化X射线摄影时通过增大照射剂量可以提高影像质量，但是当曝光剂量达到足够大时，再增大曝光剂量并不能显著改善图像质量，影像质量与曝光剂量间存在一个优化剂量。标准体模骨盆X射线摄影的优化剂量为0．61mGy。