超声对新生儿颅内囊性病变的诊断价值

目的探讨新生儿颅内各种囊性病变的颅脑超声检查诊断思路。方法回顾2008年1月-2011年7月在我院颅脑超声检查发现的321例新生儿颅内囊性病变的病例,并结合CT和MRI检查结果。结果在321例超声发现的颅内囊性病变病例中,251例为室管膜下囊肿(占78.2%),45例为颅内正常位置腔室的异常扩张(占14.0%)。超声对于部分类型的颅内囊性病变,尤其是大脑实质内的囊性病变鉴别诊断较困难。结论新生儿颅内囊性病变种类较多,部分疾病超声表现相似,而治疗及预后有较大差异。超声检查时对发现的颅内囊性病灶,需多切面、多窗位扫查明确其位置,动态观察,从而判断病灶来源和性质,不断提高鉴别诊断的能力。     

质子磁共振波谱分析在颅内病变诊断中的应用

目的:探讨氢质子磁共振波谱(MRS)检查技术在颅内占位性病变诊断中的临床应用价值.方法:对40例经立体定向活检确诊的颅内占位性病变病例行常规MRI检查,同时行MRS检查,并计算病变区Cho/Cr,NAA/Cr,Cho/NAA值,分别依据单纯常规MRI和MRI结合MRS作出术前诊断,最后再与病理结果比较.结果:不同的疾病有不同的波谱特征;与病理诊断比较,常规MRI诊断正确率为37.5% (15/40),而MRI结合MRS诊断正确率为80%(32/40),二者相比差异有统计学意义(P＜0.05).结论:MRS可提供组织生化和代谢方面的信息,可以提供比常规MRI之外更多的信息,对颅内占位性病变的诊断提供帮助.     

HFUS、LFUS 联合检查对腹部占位性病变确诊率的影响

目的:分析高频超声(High frequency ultrasound,HFUS)、低频超声(Low frequency ultrasound,LFUS)联合检查对腹部占位性病变确诊率的影响.方法:选取2019年2月至2021年2月我院收治的97例腹部占位性病变患者,均行HFUS、LFUS检查,以病理检查为金标准,统计HFUS、LFUS单独及联合检查结果,对比其诊断效能及病变类型及确诊率.结果:与HFUS、LFUS单独检查相比,HFUS+LFUS检查诊断腹部占位性病变准确度(96.91％)、灵敏度(100.00％)、阴性预测值(100.00％)较高,漏诊率(0)较低,病变类型确诊率较高(P<0.05).结论:HFUS、LFUS联合检查腹部占位性病变,有利于提高确诊率,为临床诊断疾病类型、制定治疗方案提供信息支持,有临床推广价值.     

经食管与经胸超声心动图在心房及瓣膜占位病变诊断中的应用价值分析

目的分析经食管与经胸超声心动图在心房及瓣膜占位病变诊断中的应用价值。方法选取心房及瓣膜占位性病变患者44例,均行经食管超声心动图检查(TEE)及经胸超声心动图检查(TTE)。观察超声心动图显示的占位性病变形态、大小、内部结构、病理性质提示。结果 TEE检查对心房及瓣膜占位病变的内部结构、病理性质提示检查结果要优于TTE检查,差异具有统计学意义(P 0. 05); TEE与TTE检查占位病变大小测量结果比较,差异无统计学意义(P 0. 05)。结论心房及瓣膜占位病变诊断中行经食管超声心动图较经胸超声心动图可获得更佳的影像学信息,两者结合可做出明确诊断。     

肝脏占位性病变的CT诊断

目的 探讨肝脏占位性病变的CT影像学特点,提高诊断的准确率.方法 回顾性分析50例经手术证实的肝脏占位性病变,比较病灶的大小、数目、密度、边缘、及强化方式,总结肝脏占位性病变的诊断要点.结果 CT对于肝脏占位性病变有重要的参考价值,不同病变的CT强化方式各具特点结论CT扫描对于肝脏占位性病变的诊断具有重要的临床意义,结合病史及实验室检查,可以提高诊断的准确率.     

超声造影鉴别肝脏局灶性病变良恶性的临床价值

目的探讨超声造影对肝脏局灶性病变良恶性的鉴别能力.方法2004年7月至2005年9月间于深圳市人民医院进行超声造影的肝脏局灶性占位病变72例.所有患者均进行了增强CT或增强MRI检查,47例经病理证实及随访观察.结果72例肝脏局灶性病变,恶性病灶23例,包括肝细胞性肝癌17例、胆管细胞性肝癌2例、转移性肝癌4例;良性病灶49例,包括血管瘤18例、局灶性结节增生9例、局部脂肪缺失17例、肝脓肿3例、肝硬化增生结节3例、炎性假瘤1例、肝囊肿1例.肝脏恶性病灶和良性病灶的超声造影方式明显不同.结论超声造影对鉴别肝脏占位病变良恶性具有较大的价值,但对于一些不典型的病例仍需进一步检查.     

超声造影技术在肝病中的应用

文章论述了超声造影(CEUS)技术在肝病中的应用,包括诊断肝脏局灶性病变(FLL)、指导消融治疗肝肿瘤、指导肝脏移植和监测术后并发症。临床试验表明,CEUS对FLL诊断的结果与增强CT或者增强MRI的诊断结果基本一致,但是CEUS更加安全准确。CEUS用于指导肝脏恶性肿瘤的消融治疗时,对病灶边界的显示较传统灰阶超声更加明确,能更准确地显示病灶的浸润范围及大小,对病灶的清除更加彻底。CEUS可用于检测肝癌术后残留组织,以及指导残留组织的切除。CEUS已被用于移植肝脏血流灌注的评价及术后血管并发症的监测。CEUS技术在肝脏各种病变的定性及定量诊断、肝癌的手术切除、肝脏移植、并发症监测等方面已经取得重大进展。     

超声弹性成像与彩色多普勒超声在乳腺占位性病变诊断中的对比分析

目的：分析与研究超声弹性成像与彩色多普勒超声在乳腺占位性病变诊断中的应用价值。方法对我院2012年3月~2013年10月收治的120例乳腺占位性病变患者共148个病灶的超声弹性成像与彩色多普勒超声表现进行回顾性分析,148个病灶均经手术病例结果证实。将超声弹性成像、彩色多普勒超声结果与病理结果进行对比。结果超声弹性成像在乳腺占位性病变诊断中的准确性、特异性、敏感性明显优于彩色多普勒超声,差异具有统计学意义(P<0.05)。结论乳腺站位性病变良恶性诊断中,超声弹性成像的准确率明显高于多普勒超声成像,其误诊率明显低于多普勒超声成像。     

多层螺旋CT对乳腺占位性病变中的应用价值

目的 探讨多层螺旋CT在乳腺占位性病变显示方面的优势及诊断价值.方法 对38例临床或钼靶检查怀疑有乳腺占位的患者进行了6层螺旋CT扫描,应用多平面重组(MPR)和最大密度投影(MIP)等技术行后处理,观察乳腺病变本身表现,并与穿刺及手术结果相对比.结果 经病理证实乳腺癌32例、乳腺腺瘤4例,小叶增生2例.轴位及MPR图像能清楚显示乳腺结构,对于病灶定位准确,定性资料(大小、形态、边缘、密度以及邻近组织改变情况)详细,同时可清楚显示肺部、纵隔及腋窝等情况.结论 多层螺旋CT能够敏感的显示并诊断乳腺占位性病变,与其他检查方法相结合,有助于乳腺病变的正确诊断,指导临床治疗.     

超声弹性成像对肝脏局灶性病变良恶性的鉴别诊断作用

目的探讨超声弹性成像对肝脏局灶性病变良恶性的鉴别诊断作用。方法选取肝脏局灶病变患者50例,均接受常规超声和超声弹性成像检查,并以手术病理学检查为金标准,分析比较两种超声检查对肝脏局灶良恶性评价效果。结果手术病理诊断50例肝脏局灶性病变患者检出良性病灶16例,诊断为恶性病灶34例。在肝脏局灶性病变良恶性的鉴别诊断中,超声弹性成像的灵敏度、准确度及阴性预测值均显著高于常规超声检查(P0.05)。结论超声弹性成像鉴别诊断肝脏局灶性病变良恶性更为有效,值得推广。     

99Tcm-MIBI SPECT/CT同机融合显像对颅内占位病变的临床应用价值

近年来,随着SPECT/CT融合显像的发展,^99Tc^m-MIBI作为一种应用广泛的亲肿瘤显像剂在颅内占位病变的应用价值变得越来越高.本文介绍了^99Tc^m-MIBI的显像机制,阐述了^99Tc^m-MIBI SPECT/CT同机融合显像对颅内占位病变的临床应用价值,并与多模态影像技术进行了分析与比较.     

Osteoma of the frontal sinus complicated by intracranial mucocele

We present a rare case of intracranial mucocele associated with frontal sinus osteoma in a patient suffering from generalized convulsion. The intracranial mucocele occurs as a complication of obstruction of sinus drainage caused by osteoma, but it is often diagnosed preoperatively as an intracranial or intracerebral cyst because of the rarity of these combined lesions in neurosurgical practice. However, once the mucocele extends intracranially, several other complications, including infections and/or a convulsion, can occur, indicating the necessity for surgical treatment. Moreover, the differentiation of the mucocele from the intracranial endodermal cyst predominantly depends upon its continuity with the intracranial osteoma portion or the sinus. Thus, knowledge of this rare lesion is important for accurate diagnosis and clinical management.     

The clinical significance of elevated CSF and plasma histamine in cerebral aneurysm surgery utilizing cardiopulmonary bypass with total circulatory arrest

Recently there has been a renewed interest in the neurosurgical treatment of large cerebral aneurysms and AV malformations utilising cardiopulmonary bypass (CPB) and total circulatory arrest (TCA). However, the differing tolerance limits of coagulation and bleeding, pH control and fluid constraint are difficult to reconcile. Although clinical assessment, electro encephalogram (EEG) and intracranial pressure-monitoring assist in identification of cerebral damage, CPB and TCA inflict their own penalties with resultant uncertainty in post-operative neurological evaluation, and producing difficulties in interpretation and management. Additionally, an unanswered question is, to what extent the known cardiac and cerebral effects of circulating histamine might influence the post-circulatory arrest recovery in these patients, and whether this would further compromise the neurological result. We report our experience of 9 such cases who underwent this procedure, and were able to achieve a satisfactory neurological result in 7 patients with differing lesions. During the operation both CSF (from the open cranium) and blood (from the right internal jugular vein) were sampled at intervals for subsequent plasma histamine estimation. Despite markedly elevated histamine levels during CPB and TCA, this was not associated with an unfavourable neurological outcome. These early findings have given us encouragement to the useful role of CPB and TCA in these complex neurosurgical presentations, and raise interesting questions about the clinical importance of histamine-evoked cerebral ischaemia that has been demonstrated in experimental models.     

计算机模拟建模及应用：微波消融治疗心房颤动的温度场

背景：心房颤动是临床上最为常见的持续性心律失常,微波消融是治疗房颤的一种新技术,在国内外临床应用时间短,经验不足。 目的：对国内外微波消融治疗心房颤动温度场的研究现状及新进展作一综述。 方法：应用计算机检索CNKI、EI、SCI数据库中关于微波消融温度场的文章,在标题和摘要中以“消融,心房颤动,微波,温度场”或“ablation,atrial fibrillation,microwave, thermal field”为检索词进行检索。 结果与结论：微波导管消融术对引起心律失常的关键部位(即靶点)进行精细标测,使靶点及邻近的心肌组织发生凝固性坏死,以破坏心动过速的病灶及折返途径,从而消除心律失常。在尽量减少对正常组织伤害的同时,保证消融切割线的连续性,对于房颤消融至关重要。实现温度场的计算机模拟能够全面反映温度场的分布规律,医护人员可以在热疗手术进行之前对治疗过程有比较直观的认识,提出比较详细的手术规划,并且可以在术中根据部分参数修正模拟结果和加热的时间与强度,达到理想的治疗效果。     

Brain ultrasound rehearsal before surgery: A pilot cadaver study

It has been shown that brain ultrasonography (US) is an efficient tool for improving three‐dimensional (3D) spatial orientation during neurosurgical interventions. However, it necessitates specific training as it is highly operator‐dependent. To date, neurosurgeons have relied solely on intraoperative practice to improve their mastery of brain US; this has obvious limitations. Herein, we consider whether a study of brain US on human cadavers could enable a training platform for neurosurgeons and residents to be developed. Standard two‐dimensional (2D) brain US was performed on two human cadavers (one fresh‐frozen and one Thiel‐prepared) through left frontoparietal, left frontal, right temporal, and left parietal craniotomies. US workflow and image quality were assessed in both preparations. It was possible to assess US in both cadaver preparations; however, the specimen prepared with Thiel‐fixation performed better, with superior image quality and specimen usability at room temperature. US images were obtainable through all surgical corridors with the main intracranial anatomical landmarks easily identifiable. US of cadaveric brains is feasible and delivers good quality results. This technique could allow neurosurgeons to develop the expertise required for a successful clinical application preoperatively. Clin. Anat. 30:1017–1023, 2017. © 2017 Wiley Periodicals, Inc.     

CT和有限元数字化骨盆模型构建的研究和临床应用

背景：螺旋CT三维重建能够直观、完整的再现骨盆结构,为骨盆病变的治疗提供精确可靠的依据。 目的：评价CT和有限元数字化骨盆模型构建的研究和临床应用。 方法：检索Pubmed数据库、维普数据库,以“骨盆,CT,有限元,模型构建”为中文关键词;以“pelvis;CT;finite element modeling”为英文关键词,采用计算机检索2006-01/2011-11相关文章。纳入与骨盆模型构建及应用相关的文章;排除重复研究或Meta分析类文章。以26篇文献为重点讨论CT和有限元模型构建在骨盆中的研究和应用。 结果与结论：CT和有限元模型在骨盆病变中具有重要应用价值,骨盆有限元模型的构建为临床医师提供可靠的手术模型,为手术设计合理方案。有限元模型和CT三维模型合理应用,为骨盆病变的手术提供更多可靠的影像信息,临床医师可根据模型进行手术方案设计,模拟手术流程,显著降低了手术风险。     

颅内动静脉畸形14例手术治疗分析

目的：探讨颅内动静脉畸形（AVM）外科治疗的临床疗效。方法：采用开颅手术切除畸形血管团方法治疗颅内AVM14例。结果：14例中治愈13例，术后死亡1例。存活13例，11例获随访1月-10年，术后未出现新的神经功能障碍，术后未见癫痫再发作，头痛症状消失或明显减轻。结论：颅内动静脉畸形急性出血期以手术治疗为主，未出血者或病情允许的情况下，外科手术联合介入治疗疗效更佳。     

Neuropsychological changes following the neurosurgical treatment of normal pressure hydrocephalus

Extracranial shunting of cerebrospinal fluid is a well-known neurosurgical procedure for the treatment of normal pressure hydrocephalus. Research indicating reasonable success using this technique has been based primarily on subjective and global neurosurgical opinion. Given that the treatment carries morbidity risks, and that decisions to shunt are related to increasing adaptive functioning, attention must be paid to adequate measurement of surgical outcome. As part of a larger study, we report pre and postsurgical neuropsychological, neuroradiological, and clinical data on hydrocephalic patients, as well as presurgical intracranial pressure data. Prior to shunting, increase in ventricular dilatation and cerebral atrophy were associated with decreased cognitive functioning, gait disturbance, and bladder dysfunction. Following shunting, there were significant improvements in neuropsychological functioning in terms of attention, concentration, verbal and nonverbal memory, language and communication skills, and constructional skills, as well as clinical improvement in gait and bladder functioning. Improvement was related to presurgical dilatation of the temporal horns of the lateral ventricles and mental status, particularly memory functions.     

超声引导下经皮肺自动穿刺活检的临床应用

目的通过超声引导下经皮肺自动穿刺活检对肺及胸膜肿块作出病理诊断,为早期诊断肺及胸膜肿块提供可靠依据方法对３０例经Ｘ线及ＣＴ诊断为肺部外周型肿块或怀疑结核或炎症但临床高度怀疑癌变或胸膜病变,需进一步明确诊断者,在超块引导下经皮用自动穿刺活检针进行穿刺活检及病理检查．结果全部获得病理学诊断．其中良性病变１１例（占３６７％）,恶性病变１９例（占６３．３％）结论对于胸膜病变及贴近胸壁的肺占位病变,经皮肺自动穿刺活检是一种良好方法．     

多层螺旋CT三维重建技术在创伤性骨折中的应用

背景：螺旋CT三维重建技术尤其在解剖结构复杂、重叠较多的骨关节骨折中具有非常重要的应用价值,能够显著提高诊断率,减少漏诊率,为临床提供更多的诊断信息。 目的：探讨了螺旋CT三维及多平面重建的应用原理及不同部位骨折中的临床应用。 方法：应用计算机检索万方数据库、维普数据库和PubMed数据库中1999-01/2011-09关于多层螺旋CT三维重建技术在骨科领域应用的文章。选择文章内容与骨折及螺旋CT重建相关,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到157篇文献,根据纳入标准选择30篇文章进行探讨。 结果与结论：螺旋CT扫描后三维或多平面重建技术在骨折创伤检查中显示出重要的价值,它能很直观地显示骨折关节的损伤情况,有助于骨折正确分型,为骨科医师进行合适的治疗方案选择提供依据。随着多排螺旋CT的快速发展,三维CT重建技术更快捷、简单、实用,图像更加清晰,目前在计算机图像处理技术的基础上发展出了计算机辅助外科手术系统,与三维图像重建的有机结合可使临床医生能够更好的进行手术计划制定评估预后或治疗后随访,有较好的应用价值及前景。 关键词：螺旋CT;骨折;三维重建;评估;计算机辅助 doi:10.3969/j.issn.1673-8225.2012.09.038