脊髓造影与CTM联合应用诊断腰椎间盘突出症46例报告

本文报告手术证实的４６例腰椎间盘突出症术前经正位，侧位的中立，过伸，过屈位脊髓造影符合率为８７％，ＣＴＭ的符合率为９７．７％，而两者联合应用则诊断准确率可提高到１００％。     

228例不孕症子宫-输卵管碘油造影与宫-腹腔镜联合通畅试验检查诊断符合率分析

目的探讨不孕症患者子宫-输卵管造影（hysterosalpingography,HSG）诊断与宫-腹腔镜诊断的符合率。方法对228例不孕症HSG检查为输卵管梗阻、输卵管积水、盆腔粘连者再进行宫-腹腔镜联合通畅试验检查。结果HSG诊断输卵管梗阻与宫-腹腔镜检查的符合率为58.7%（64/109）,诊断伞端积水的符合率为90.8%（109/120）,诊断盆腔粘连的符合率为78.5%（153/195）。结论宫-腹腔镜联合通畅试验检查准确率高于HSG检查。     

ERCP在梗阻性黄疸诊治中的价值

目的：评价经内镜逆行胰胆管造影（ERCP）对梗阻性黄疸的诊治价值。方法：75例病因不确切梗阻性黄疸患者均行ERCP检查,并与MRCP对比分析ERCP诊治结果。结果：ERCP对梗阻性黄疸病因诊断符合率84.0%（63/75）,明显高于MRCP诊断符合率53.3%（40/75）,差异有统计学意义（P〈0.05）。ERCP、MRCP对胆系结石所致梗阻性黄疸诊断符合率分别为92.1%（35/38）、78.9%（30/38）,差异无统计学意义（P〉0.05）。对胆系结石以外的病因所致梗阻性黄疸,ERCP诊断符合率为80.0%（28/35）,明显高于MRCP28.6%（10/35）,差异有统计学意义（P〈0.01）。10例胆总管结石患者在ERCP下取石成功。结论：在明确梗阻性黄疸病因方面的作用,目前MRCP尚不能取代ERCP。ERCP对于部分梗阻性黄疸患者具有一定治疗作用。     

经直肠超声造影和磁共振成像诊断前列腺癌的临床价值比较

目的:探讨经直肠超声造影(CEUS)和磁共振成像(MRI)诊断前列腺癌(PCa)有关问题,评价二者的诊断价值。方法:选取有完整相关临床资料的患者48例,对患者行前列腺超声造影及MRI检查,并与病理检查结果进行比较。结果:48例患者经病理检查证实为PCa 30例。经直肠CEUS诊断符合率为77.08%,敏感性为80.00%,与MRI的符合率(79.16%)、敏感性(76.67%)比较,差异无统计学意义(P>0.05),但其特异性(72.22%)低于MRI的特异性(83.33%),差异有统计学意义(P<0.05)。二者联合诊断的符合率为89.58%,敏感性为90.00%,特异性为88.89%,与单独一种诊断比较,差异均有统计学意义(P<0.05)。结论:经直肠CEUS及MRI对PCa的诊断各有优势,经直肠CEUS联合MRI可提高PCa的检出率。     

脊髓造影、CT及CTM对腰椎间盘突出症的诊断评价（附62例报告）

本文分析比较了脊髓造影、CT及CTM的诊断效果。本组62例中单纯造影19例,手术后符合率为89％,单纯CT扫描16例,手术符合率为94％,同时作了CT扫描和脊髓造影27例,手术符合率为93％。认为对不典型病例或脊髓造影出现多处压迹难以确定时,应采用CT扫描检查,造影后CT扫描效果更好。     

经阴道超声输卵管显影与腹腔镜检查的对照研究

目的 :通过与腹腔镜检查的比较 ,评价经阴道超声输卵管显影对输卵管病变的诊断价值。　方法 :对 5 2例原发性或继发性不孕症病人的 10 4根输卵管在生理盐水和空气的介导下进行经阴道超声输卵管显影的检查 ,继之作腹腔镜检查并以美蓝作输卵管通色素试验 ,二者的结果作kappa分析。　 结果 :对输卵管伞端形态异常 ,2种方法的诊断符合率为 82 .7% ,超声输卵管显影的灵敏度和特异度分别为 77.4 %和 87.2 % ;对输卵管周围粘连 ,符合率为 80 .8%。灵敏度和特异度分别为 79.4 %和 83 .0 % ;对输卵管通畅性的诊断 ,3项指标分别为 87.5 % ,87.7%和 87.0 %。超声输卵管显影对输卵管病变的诊断价值与腹腔镜检查无显著性差异。　结论 :经阴道超声输卵管造影是一种可靠实用的检查方法 ,可作为不孕症初步诊断中首选方法。     

经直肠超声造影与经直肠常规超声诊断前列腺癌的比较研究

目的:比较经直肠超声造影与经直肠常规超声诊断前列腺癌的各自优势。方法:选择前列腺癌患者213例,年龄54~83岁,平均71岁。检测PSA为4.12~150.00μg/L,平均22.53μg/L。先行经直肠常规超声检查,再行经直肠前列腺超声造影检查,绘制时间强度曲线(TIC曲线),分别判读常规超声和超声造影结果。随后行12针前列腺系统穿刺活检。结果:213例患者中,常规超声诊断前列腺癌123例,超声造影诊断前列腺癌113例,穿刺活检病理确诊前列腺癌99例。常规超声与病理检查的诊断符合率为53.52%,超声造影与病理检查的诊断符合率为80.28%。两种诊断方法敏感度、特异度、假阳性率、假阴性率、漏诊率、病理检查符合率差异均有统计学意义(P0.05)。结论:经直肠超声造影可灵敏显示前列腺血流分布情况,对前列腺癌的诊断有较高的准确性,值得推广使用。     

常规超声与超声造影诊断盆腔结核对比分析

目的对比研究常规超声与CEUS对盆腔结核的诊断价值。方法回顾性对比分析42例临床病理诊断的盆腔结核患者的常规超声与CEUS与图像。结果常规超声诊断符合率42.86%(18/42),误诊率57.14%(24/42),CEUS诊断符合率66.67%(28/42),误诊率为33.33%(14/42),应用CEUS诊断盆腔结核的符合率高于常规超声(χ2=4.806,P=0.028)。常规超声显示15例表现为输卵管增大呈腊肠样改变,27例表现为以实性为主的混合回声病灶;病灶最大径(45.31±15.30)mm,CEUS显示15例表现为输卵管不均匀高增强,27例表现为以囊性为主的混合回声病灶,病灶中有多处较大的造影剂缺损区;病灶最大径(47.31±17.30)mm,与常规超声测得的病灶最大径差异无统计学意义(Z=0.289,P=0.773)。病灶实性部分造影剂上升时间平均为(10.24±2.55)s,子宫肌层增强时间为(14.52±3.11)s,差异有统计学意义(Z=3.990,P0.001);病灶造影剂从峰值降至一半时间为(50.53±25.71)s,子宫肌层造影剂从峰值降至一半时间为(49.28±15.64)s,二者差异无统计学意义(Z=0.131,P=0.896)。结论 CEUS诊断盆腔结核的准确率高于常规超声。CEUS能客观的反映盆腔结核的血流灌注,提高盆腔结核的早期诊断率。     

超声造影技术对子宫内膜癌肌层浸润深度诊断价值的探讨

目的探讨超声造影技术对子宫内膜癌肌层浸润深度的诊断价值。方法对我院自2005年6月至2007年12月期间经诊刮确诊为子宫内膜癌患者,行超声造影检查,选择手术病理分期为I期的30例患者为研究对象,进行回顾性分析。将术前超声造影检查及术中肉眼观察的内膜癌肌层浸润情况,与术后的病理诊断相比较。结果30例患者中,病理检查诊断为Ⅰa期5例,Ⅰb期19例,Ⅰc期6例。术前超声造影检查的总符合率为66.7%(20/30)。经一致性检验,Kappa=0.435,提示超声造影检查与病理结果之间存在中等程度的一致性。术中肉眼观察的总符合率为56.7%(17/30),经一致性检验,Kappa=0.287,提示两者一致性属一般。术前超声造影检查判断肌层浸润的敏感性、特异性、准确率、阳性预测值和阴性预测值分别为84.0%、2/5、76.7%、87.5%和2/6;术中肉眼观察分别为76.0%、3/5、73.3%、90.5%、3/9。术前超声造影判断深肌层浸润的敏感性、特异性、准确率、阳性预测值和阴性预测值分别为5/6、87.5%、86.7%、5/8和95.5%;术中肉眼观察分别为4/6、87.7%、83.3%、4/7、91.3%。结论术前应用超声造影辅助诊断内膜癌的肌层浸润深度有一定意义,优于术中肉眼观察,但对于合并子宫肌腺症及病灶较大的患者易误诊,需扩大样本量及积累操作经验进一步评价其意义。     

子宫输卵管造影及腹腔镜检查在输卵管性不孕的诊断价值研究

目的:探讨子宫输卵管造影(HSG)与腹腔镜检查在诊断输卵管性不孕症中的临床价值。方法:回顾性分析不孕症患者100例,先后接受HSG和腹腔镜检查,分析比较其检查结果。结果:HSG宫腔异常检测率为11.0%(11/100),腹腔镜检出率35.0%(35/100),两者比较差异有高度统计学意义(P<0.01)。HSG通畅符合率为60.0%,诊断特异性为38.5%(5/13),灵敏度为65.0%(52/80);腹腔镜检查通畅符合率为80.0%,诊断特异性为16.1%(5/31),灵敏度为86.7%(52/60),两者比较差异均有统计学意义(P<0.05)。HSG盆腔病变检出率为24.0%,腹腔镜检出率81.0%,两者比较差异有高度统计学意义(P<0.01)。结论:腹腔镜检查可直视下直接寻找导致不孕的原因,准确性高,有利于宫腹腔内病变的治疗,术后妊娠率高,是目前不孕症诊治的最佳方法之一,值得临床上推广。     

骶部硬膜外囊肿的临床影像学表现与外科治疗(18例报告及文献综述)

[目的]结合文献探讨骶部硬膜外囊肿（SEC）的临床表现、影像学特点与外科治疗，以便提高对该病的临床诊断和治疗水平。[方法]本组18例，其中腰骶部钝痛17例（95％）、下肢放射性疼痛和间歇性跛行16例（90％）、神经功能损害14例（77％）、盆腔或下腹部无痛渐进性肿块并压迫临近器官2例（11％）。18例均行腰骶部及骨盆X线片检查，其中17例行CT扫描、11例行MRI检查、7例行脊髓造影、4例行CTM扫描。[结果]本病临床误诊率为78％，X线诊断率17％，CT诊断率72％；MRI检查、脊髓造影、CTM扫描诊断率100％。18例均手术切除，病理报告为硬膜外囊肿，椎管内型、积液型、单发囊肿为多数；随访15～32个月，平均24个月，未发现症状加重和复发病例。[结论]骶部硬膜外囊肿临床与影像学具有特征性表现；微创术和腹腔镜、脊髓或椎管镜摘除骶椎管内囊肿的临床应用疗效有待于定论；显微外科技术的应用提高了SEC全切除率，手术是治疗和防止本病复发的最主要和最可靠方法。     

腰骶神经根管非骨性段狭窄的动态影像学与临床研究

对临床具腰腿痛并脊髓造影显示单或双侧腰骶神经根影中断者，做了椎管斜位伸屈造影（３５例）和动态ＣＴＭ扫描（１３例），观察了根影动态变化。其中１７例术中加用伸屈腰椎拱桥探查了椎管前外侧角与神经根间关系。上述研究结果结合临床症状、体征发现：Ｌ５、Ｓ１神经根受椎管非骨性段挤压机会显著高于Ｌ４神经根。分析认为：常遇的腰骶神经根中断多发生在非骨性段的椎管前外侧角，椎间盘与黄韧带退变是神经根受压的主要病理因素，症状可随体位变动减轻或加重。斜位椎管造影和动态ＣＴＭ对判断不同狭窄节段与指导手术有重要参考价值。     

Usefulness of MRI in the preoperative diagnosis of cervical disk herniation

Summary We investigated the preoperative diagnostic value of MRI, myelography, and CT myelography (CTM) in a retrospective analysis of 17 patients (15 men and two women) who were surgically treated for cervical disk herniation. Their ages ranged from 29 to 63 years, with a mean of 49 years. Anterior interbody fusion using iliac bone grafts was performed following microscopic diskectomy in all patients. MRI, myelography, and CTM were performed in 13 patients, while four patients were operated on after MRI alone. Neurological improvement was observed in all 17 patients after the surgery. MRI proved useful for determining the level of symptomatic cervical disk herniation. Surgery can be carried out on the basis of MRI findings alone when there is disk herniation at a single level which corresponds with the patient's symptoms and signs.     

动态脊髓造影诊断腰椎间盘突出症

目的：探讨动态脊髓造影对于腰椎间盘突出症的诊断价值。方法：对186例腰椎间盘突出症患者进行脊髓造影，动态观察，拍摄不同体位的X线片。186例均经CT检查，110例经CTM检查，106例经手术治疗。结果：186例中213个椎间隙诊断为腰椎间盘突出，96个椎间隙诊断为腰椎间盘膨出，动念脊髓造影检查结果与手术诊断符合率为93．62％，CT检查结果与手术诊断符合率为86．74％，CTM检查结果与手术诊断符合率为96．88％。结论：动态脊髓造影检查克服了传统脊髓造影、CT、MRI检查静态观察的缺陷，降低了假阳性率和假阴性率，对L5／S1间盘突出诊断效果更为明显，并可鉴别诊断腰椎问盘突出和膨出。     

Morphometry of the cervical spinal cord and its relation to pathology in cases with compression myelopathy

The purpose of this study was to determine whether or not computerized tomography myelography (CTM) gave an actual size and shape of the cervical spinal cord, and whether such dimensions reflected pathology of the spinal cord in cases suffering from compression myelopathy. Spinal cord transverse area and compression ratio (sagittal diameter divided by transverse diameter) were measured as indicators of spinal cord morphology. As a basis for this study, we first performed CTM of cadaveric cervical columns and compared the actual dimensions of the spinal cord of the cadaveric specimens with the CTM image. Second, the correlations between these dimensions and pathology of the affected spinal cord were investigated. The results showed that CTM provided a precise image of the actual cross-section of the spinal cord. In 12 cadaveric specimens of cervical myelopathy examined, the transverse area and compression ratio were in good correlation with the severity of observed pathological changes.     

Value of computed tomographic myelography in neurofibromatosis

Computed tomographic myelography (CTM) is the procedure of choice in patients exhibiting spinal manifestations of neurofibromatosis. Due to the lack of specificity of several of the more important plain spine radiographic findings in this disease, CTM may be necessary to distinguish between surgical and nonsurgical entities. CTM will determine the size, shape, and intraspinal extension of posterior mediastinal neural tumors and separate them from the more common thoracic meningoceles. CTM will likewise elucidate the causes of posterior vertebral body scalloping, distinguishing between dural ectasia and neural tumor. CTM will also frequently demonstrate additional asymptomatic lesions at other levels.     

Myelography using water-soluble contrast media as an outpatient procedure.

Established practice as reported in the literature is that all patients undergoing myelography with water-soluble contrast media are admitted to hospital for observation after the procedure. However, I believe that if the examination is expertly performed and with due consideration to the factors influencing the effects of contrast media used in myelography, it can be done as an outpatient procedure in most cases.     

Diagnosis of lumbar arachnoiditis by magnetic resonance imaging

Twenty-four cases of lumbar arachnoiditis were evaluated by magnetic resonance (MR) imaging. The morphologic changes of arachnoiditis by MR were compared in 20 cases with CT myelography (CTM) and plain film myelography (PFM). An abnormal configuration of nerve roots was seen by MR. Three anatomic groups were identified. Group 1 showed conglomerations of adherent nerve roots residing centrally within the thecal sac. Group 2 demonstrated nerve roots adherent peripherally to the meninges, giving rise to an "empty sac" appearance. Group 3 showed a soft tissue mass replacing the subarachnoid space. Magnetic resonance imaging resulted in accurate diagnosis, and had excellent correlation with CT myelography and plain film myelographic findings in the diagnosis of lumbar arachnoiditis.     

经胸腔侧前方入路治疗胸椎间盘突出症

本文报告经胸腔侧前方入路切除椎间盘治疗胸椎间盘突出症９例。均为中央型和旁中央型，经过脊髓造影、ＣＴＭ或ＭＲＩ检查确诊。随访１～４年，平均２年１０个月。根据Ｏｔａｎｉ分级方法标准，结果为优３例，良５例，一般１例，优良率达８９％，获得较满意效果。采用ＣＴＭ或ＭＲＩ诊断胸椎间盘突出有较高价值。该手术方法直接、充分地显露硬膜囊和神经结构，切除突出的椎间盘和刮除骨赘，减压较安全有效，同时对脊柱的稳定性和脊髓的血供影响较小。作者认为经胸腔侧前方入路进行椎间盘切除减压是治疗胸椎间盘突出症的一种安全有效的方法。