长期血液透析患者腰椎骨密度定量CT的检测及意义

目的　研究长期维持性血液透析患者骨密度的变化 ,探讨腰椎QCT -BMD检测的应用价值。方法　 5 0例长期血液透析患者按不同透析年限分组 ,应用QCT技术分别检测其 2～ 4腰椎椎体松质骨BMD ,并与年龄、性别相匹配的正常人腰椎BMD进行比较分析。结果　 5 0例血液透析患者有 45例 (90 .0 % )骨密度降低 (T值 <-1.0 ) ,其中 2 0例 (4 0 .0 % )T值 <-2 .5 ,明显低于相应年龄性别正常对照组 ,并随透析时间延长患者BMD进一步降低。结论　长期血液透析患者骨矿含量明显降低且与透析时间呈正相关 ,QCT -BMD检测敏感性和准确性高 ,对肾性骨病的早期诊断具有较大的应用价值。     

电子束CT在主动脉瘤诊断中的临床应用

目的　评价电子束CT(electronbeamcomputedtomography ,EBCT)血管造影及三维重建在主动脉瘤诊断中的临床应用价值。方法　收集经EBCT诊断的主动脉瘤 3 2例 ,男 2 4例 ,女 8例 ,其中 9例与手术结果作了对照。胸主动脉扫描采用单层步进容积增强扫描序列 (SVS ) ,心电门控采像 ;腹主动脉扫描采用单层连续容积增强扫描序列 (CVS ) ,无心电门控。所得图像进行后处理三维重建 ,主要采用多层面重组法 (MPR )、最大密度投影法 (MIP )、表面阴影显示法 (SSD )、容积再现法 (VR )进行处理。结果　 3 2例主动脉瘤中 ,真性主动脉瘤 8例 ,假性动脉瘤 5例 ,夹层动脉瘤 19例。其中 9例动脉瘤接受手术治疗 ,手术证实EBCT诊断符合率为 10 0 %。结论　EBCT血管造影可获得高分辨率的大血管解剖影像 ,三维重建图像能直观地显示主动脉瘤病变的范围、大小形态及夹层动脉瘤内膜撕裂口 ,对诊断具有优良价值 ,并能指导手术。在主动脉瘤的诊断上 ,可取代常规血管造影。     

64层螺旋CT诊断复杂先天性心脏病的临床价值

目的 探讨64层螺旋CT(64SCT)对比增强及后处理技术对复杂先天性心脏病(CCHD)的诊断价值.方法 39例CCHD手术前均行经胸心脏二维超声(TTE)检查和648CT对比增强扫描检查,其中CT扫描时有8例采用心电门控技术.手术后按心内畸形、心脏大血管连接部畸形及大血管部分畸形分别统计CT及TTE 2种检查方法及有否使用心电门控技术的诊断正确率,并使用SPSS13.0版软件包对结果行χ~2检验.结果 手术证实畸形共102处,其中心脏部分畸形47处,CT和TTE的诊断准确率分别为85.1%和95.7%,2种检查的诊断正确性差异无显著性意义(χ~2=2.68,P>0.05);心脏大血管连接部分及大血管部分畸形共计55处,CT和TTE的诊断准确率分别为98.2%和78.2%,64SCT诊断正确率明显高于TTE(χ~2=14.64,P<0.01).未使用和使用心电门控在定性诊断准确性差异上无显著意义(χ~2=1.84,P>0.05),但采用心电门控技术CT扫描图像更清晰.结论 64CT对CCHD的检查具有较高的诊断价值.扫描时是否采用心电门控技术对CCHD的定性诊断无明显统计学差别.     

电子束CT在急性肺动脉栓塞治疗中的应用价值

目的　探讨电子束CT(EBCT)在急性肺动脉栓塞 (PE)溶栓治疗中的应用价值。方法　 2 0 0 2 -0 5～ 2 0 0 3 -0 4经EBCT确诊的 9例急性PE ,8例行静脉溶栓及抗凝治疗。所有病例溶栓后 1～ 2周内行EBCT第 1次复查 ,5例更换药物治疗后EBCT第 2次复查。结果　 3例急性PE溶栓后第 1次EBCT复查示血栓完全或基本消失 ,5例效果不明显而更改治疗方案行第 2次静脉溶栓 ,EBCT 2次复查 2例血栓基本消失 ,另 3例则有明显好转。结论　EBCT不仅是诊断PE的重要检查方法 ,对溶栓后疗效的评价也有重要的指导意义 ,可作为治疗后随访的常规检查方     

正常成人颅骨多层螺旋CT三维重建表现

目的：探讨正常成人颅骨多层螺旋CT（multi-slice computed tomography,MSCT）三维重建表现。材料和方法：收集2009年5月7月于我科行容积CT数字减影血管造影检查者颅脑资料130例,头颅数据行容积再现（volume render,VR）、最大密度投影（maxi mumintensity projections,MIP）三维重建,观察颅骨解剖;蛛网膜颗粒压迹、血管压迹的表现;颅缝整体形态及闭合情况。结果：本组共检出蛛网膜颗粒压迹27例（20.77%,27/130例）,血管压迹51例（39.23%,51/130例）。颅缝整体形态分3型：普通型（86.15%,112/130例）;②囟门骨型（5.38%,7/130例）;③骨内颅缝型（8.46%,11/130例）。每条颅缝闭合形态分5型：Ⅰ型,完全闭合型（3.0%,16/531条）;Ⅱ型,嵌合型（78.3%,416/531条）;Ⅲ型,缝间骨型（7.0%,37/531条）;Ⅳ型,未完全闭合型（3.6%,19/531条）,颅缝平均宽度1.41mm&#177;0.70mm;Ⅴ型,混合型（8.1%,43/531条）。结论：MSCT三维重建技术显示颅骨解剖结构清晰,VR更好地显示颅骨三维解剖,MIP显示颅缝闭合情况、蛛网膜颗粒压迹、血管压迹更清晰和敏感,颅缝整体形态分3型,闭合状态分5型。     

Feasibility of Automated Quantification of Regional Disease Patterns Depicted on High-Resolution Computed Tomography in Patients with Various Diffuse Lung Diseases

Objective

This study was designed to develop an automated system for quantification of various regional disease patterns of diffuse lung diseases as depicted on high-resolution computed tomography (HRCT) and to compare the performance of the automated system with human readers.

Materials and Methods

A total of 600 circular regions-of-interest (ROIs), 10 pixels in diameter, were utilized. The 600 ROIs comprised 100 ROIs that represented six typical regional patterns (normal, ground-glass opacity, reticular opacity, honeycombing, emphysema, and consolidation). The ROIs were used to train the automated classification system based on the use of a Support Vector Machine classifier and 37 features of texture and shape. The performance of the classification system was tested with a 5-fold cross-validation method. An automated quantification system was developed with a moving ROI in the lung area, which helped classify each pixel into six categories. A total of 92 HRCT images obtained from patients with different diseases were used to validate the quantification system. Two radiologists independently classified lung areas of the same CT images into six patterns using the manual drawing function of dedicated software. Agreement between the automated system and the readers and between the two individual readers was assessed.

Results

The overall accuracy of the system to classify each disease pattern based on the typical ROIs was 89%. When the quantification results were examined, the average agreement between the system and each radiologist was 52% and 49%, respectively. The agreement between the two radiologists was 67%.

Conclusion

An automated quantification system for various regional patterns of diffuse interstitial lung diseases can be used for objective and reproducible assessment of disease severity.     

Identification of Local Recurrence and Radiofibrosis by Computed Tomography Perfusion on Nasopharyngeal Carcinoma After Radiotherapy

Purpose

The aim of this study was to investigate the role of perfusion computed tomography (CT) for identification of local recurrence (LR) and radiofibrosis (RF) in patients with nasopharyngeal carcinoma after radiotherapy.

Methods

Forty-eight prospective patients were recruited for this study. NPC diagnosis was confirmed by pathologic biopsy examination. Immunohistochemistry staining was used on biopsy specimens, and microvessel density was calculated by microscopy. Perfusion CT was performed on both the LR group (n = 31) and the RF group (n = 17) after intravenous injection of contrast medium. Time-density curve, blood flow, blood volume, and mean transit time, as well as permeability surface area product, were analyzed as perfusion CT parameters. The microvessel density was compared between both the LR and RF groups.

Results

There is a significant difference between the LR and RF groups in microvessel density, the time density curve, blood flow blood volume, mean transit time, and the permeability surface area product (P < .01).

Conclusions

The results demonstrate that perfusion CT is a reliable and accurate method to identify LR and RF after radiotherapy in patients with nasopharyngeal carcinoma.     

The Journal of Cardiovascular Computed Tomography year in review - 2018

Since the introduction of ≥64 detector row coronary computed tomography angiography (CCTA) as a noninvasive imaging modality, various clinical trials have established its diagnostic performance and prognostic significance when compared to other anatomic and functional tests for coronary artery disease (CAD). CCTA has been increasingly utilized for a wide range of clinical scenarios, driven by both advances in technology as well as data showing improvement in outcomes. Accumulating evidence has continually refined and supported the central role of CCTA within clinical care, and this year has witnessed continued evolution of the application of CCTA within healthcare and translational research. The purpose of the present review is to summarize the year of the Journal of Cardiovascular Computed Tomography (JCCT), highlighting the evidence base supporting the appropriate application of cardiac computed tomography across numerous clinical domains.     

螺旋CT及重组技术对小肠Crohn病的诊断价值

目的：探讨小肠Crohn病的CT表现。方法：回顾性分析经病理证实的8例Crohn病的CT扫描及后处理图像,分析病变肠管的数量、部位、肠壁的厚度和增强后病变肠壁的强化及并发症（蜂窝组织炎、炎性肿块、脓肿和瘘管）。结果：CT及后处理图像均能显示小肠Crohn病的病变肠段,敏感度为100%,8例共显示27段炎症肠壁。小肠Crohn病的CT表现：增强后所有病变肠段肠壁均有强化,25个病变肠段（92%）肠壁增厚,病变累及第6组小肠（回肠远段）8例,累及第5组（回肠中段）、第4组（回肠近段）、第3组（空肠远段）和第2组小肠（空肠近段）者分别7例、3例、2例和2例,累及回盲部3例,广泛累及结肠2例,8例均同时累及2组及2组以上小肠并呈节段性分布。肠系膜血管改变5例（62%）,肠管周围蜂窝织炎3例,炎性肿块2例,腹腔脓肿形成1例,未见瘘管形成。结论：螺旋CT及后处理技术是诊断小肠Crohn病的一种敏感的检查方法,并可判断病变的活动性,对指导临床治疗具有重要意义。     

Assessment of the Right Ventricular Function and Mass Using Cardiac Multi-Detector Computed Tomography in Patients with Chronic Obstructive Pulmonary Disease

Objective

We wanted to assess the relationship between measurements of the right ventricular (RV) function and mass, with using cardiac multi-detector computed tomography (MDCT) and the severity of chronic obstructive pulmonary disease (COPD) as determined by the pulmonary function test (PFT).

Materials and Methods

Measurements of PFT and cardiac MDCT were obtained in 33 COPD patients. Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, the patients were divided into three groups according to the severity of the disease: stage I (mild, n = 4), stage II (moderate, n = 15) and stage III (severe, n = 14). The RV function and the wall mass were obtained by cardiac MDCT. The results were compared among the groups using the Student-Newman-Keuls method. Pearson''s correlation was used to evaluate the relationship between the right ventricular ejection fraction (RVEF) and the wall mass results with the PFT results. P-values less than 0.05 were considered statistically significant.

Results

The RVEF and mass were 47±3% and 41±2 g in stage I, 46±6% and 46±5 g in stage II, and 35±5% and 55±6 g in stage III, respectively. The RVEF was significantly lower in stage III than in stage I and II (p < 0.01). The RV mass was significantly different among the three stages, according to the disease severity of COPD (p < 0.05). The correlation was excellent between the MDCT results and forced expiratory volume in 1 sec (r = 0.797 for RVEF and r = -0.769 for RV mass) and forced expiratory volume in 1 sec to the forced vital capacity (r = 0.745 for RVEF and r = -0.718 for RV mass).

Conclusion

Our study shows that the mean RV wall mass as measured by cardiac MDCT correlates well with the COPD disease severity as determined by PFT.     

糖尿病和非糖尿病患者冠状动脉粥样硬化病变的比较研究

目的:比较在冠状动脉CT检查中所显示的糖尿病和非糖尿病患者冠状动脉粥样硬化病变的情况.方法:96名糖尿病患者(平均年龄:64±10岁;男性:52例)和202名非糖尿病患者(年龄:61±13岁;男性:120例),应用冠状动脉CT检查有无冠状动脉病变及病变程度.同时利用钙化积分来评估冠状动脉钙化情况.结果:与非糖尿病患者相比,糖尿病患者冠状动脉有较多部位动脉粥样硬化病变(4.1±4.2 vs 2.1±3.0;P<0.000 1);冠状动脉钙化积分>400的比例较高(P<0.001);阻塞性冠状动脉病变比例较高(37% vs 18%;P<0.000 1),而正常的冠状动脉的比例较低(20% vs 42%;P<0.000 1).结论:糖尿病患者的冠状动脉粥样硬化负荷较高.