贲门区正面观诊断早期贲门癌

本文报道29例病理证实的早期贲门癌,着重讨论胃双对比造影贲门区正面观对诊断早期贲门癌的重要作用。详细叙述了贲门区正面观的显示方法,对其正常X 线表现及早期癌肿征象进行了分析。强调摄片体位与透视下动态观察钡剂流动是正确应用该方法的关键。认为贲门区正面观以双对比像显示率高,正常形态恒定,局部结构表现异常清晰,极易发现微小病变。将其作为胃双对比造影常规摄片体位可明显提高贲门早期癌肿的诊断水平。     

胃双对比造影贲门区正面像对早期贲门癌的诊断价值

早期贲门癌诊断是胃肠X线检查难点之一,尤其是癌肿尚未侵入食道下端,临床无吞咽困难症状时,胃肠检查极易漏诊。本文通过200例正常人与11例早期贲门癌的对比观察,着重分析胃双对比造影贲门区正面像的正常形态及早癌X线征象。同时介绍显示贲门区正面像的检查方法、注意事项及有关鉴别诊断问题。认为贲门区正面像显示该区结构清晰,容易发现异常X线征象,对早期贲门癌诊断极为有益,尤其当癌肿未侵入食道下端时,显示病变往往优于其它投照体位。     

食管胃结合部肿瘤的气钡双对比造影检查

食管胃结合部（贲门）是指以贲门人口为圆心,2．5cm为直径的范围,包括食管下端的前庭部和贲门及胃小弯近贲门处和紧邻贲门的胃底部。该部位病变容易遗漏,不管是胃镜还是X线检查都有一定的困难。本文收集资料完整并经手术病理证实的32例食管胃结合部肿瘤的气钡双对比造影图像,探讨食管胃结合部肿瘤气钡双对比造影的检查方法,提高该部位肿瘤的清晰显示率。     

胃底贲门部病变的CT诊断

目的探讨胃底贲门部病变的CT征象及其诊断价值.方法对64例胃底贲门部病变的检查方法及征象进行分析.结果(1)胃充水检查方法能清楚显示胃粘膜征象,是一种简单、有效的方法;(2)对贲门癌CT主要对其胃外浸润和分期的确定有重要意义;(3)胃底静脉曲张可分为假瘤型、结节型及壁厚型;(4)胃平滑肌瘤CT表现以粘膜面连续性线样强化征为其特征性表现.结论CT作为胃肠道的一种检查手段,对胃底贲门部病变有其特殊的诊断价值.     

贲门区的检查技术与贲门癌的特殊X线表现

发生在胃底贲门区的癌，由于其所处的解剖部位特殊，有着和胃其它部位发生的癌不同的特点，常需采用一些特别的检查方法以发现其特有的X线表现。贲门区局部解剖复杂，粘膜排列不规律，又缺乏蠕动，并高居于肋弓下，单对比手法触诊或者加压技术常难以施行。双对比造影对贲门癌的检查比胃其它部位癌的检查更为必要。     

贲门胃底癌多层螺旋CT双对比剂充盈增强扫描三维重建

目的 探讨胃双对比剂充盈MSCT增强扫描三维重建对贲门胃底癌应用价值.方法 60例经胃镜及手术证实的贲门胃底癌患者,水对比剂充盈行MSCT平扫、增强双期扫描;碘对比剂充盈行延迟扫描及二维多平面、曲面重建,三维容积成像、CT内窥镜成像.结果 贲门癌6例,贲门胃底癌18例,侵犯下段食管癌12例,胃体小弯癌14例,胃体胃窦癌6例,下段食管胃体胃窦癌4例.病灶厚度9～46 mm.淋巴结转移29例,肝转移7例.浆膜侵犯13例.结论 MSCT双对比剂充盈增强扫描三维重建对贲门胃底癌诊断效果良好,具有重要的临床应用价值.     

贲门胃底癌MSCT增强扫描及多平面重组的临床应用价值

目的:探讨MSCT增强扫描及多平面重建对贲门胃底癌临床应用价值。方法:48例经胃镜诊断为贲门胃底癌并经手术证实的患者行MSCT平扫、增强双期扫描及多平面重建,分析其CT表现。结果:局限贲门区5例;贲门胃底区43例,其中侵犯下段食管12例,侵至胃体小弯侧14例,胃体及胃窦均受累6例。病灶厚度11～42 mm,中位厚度20 mm。病灶分层强化41例,单层强化7例。周围淋巴结转移26例,肝脏转移5例。浆膜侵犯9例。结论:MSCT增强扫描及多平面重建对贲门胃底癌诊断效果良好,具有重要的临床应用价值。     

贲门癌的X线诊断

著者总结7O例证实的贲门癌并对41例胃底贲门和食管下端的正常X线表现作了研究。认为: 1.贲门癌侵犯食管下端是常见而重要的征象。诊断中应检出胃底贲门区的粘膜,必要时作气钡双重造影。     

胃底贲门区低张双重造影的一些体会

胃底贲门区用常规钡餐方法检查较难。而采用低张气钡双重造影,周定体位摄片,对显示胃底贲门区病变,尤其是早期癌的诊断有一定实用意义,现介绍我们的一些体会于下。检查前准备和操作方法一、检查前准备:1、检查前准备同胃双重造影法,需禁食、禁水十二小时。2、硫酸钡的选用:我们采用上海马陆厂生产的1号     

贲门癌的X线分析

本文根据130例正常人贲门区的双对比造影检查，对正常人贲门区X线形态及其与功能状态的关系和52例贲门癌X线征象进行分析。正常人贲门区X线表现基本概括有（1）长口型；（2）环行口；（3）放射口状；（4）混合型。在同一检查过程中，当贲门的功能状态发生变化时，贲门形态可从一种类型转变为另一种类型。52例贲门癌（1）胃底贲门块影变形；（2）胃底贲门区溃疡；（3）食管下端受累。     

二维超声和数字胃肠对照诊断贲门癌的价值

目的:探讨二维超声与数字胃肠检查对贲门癌的诊断价值。方法:将68例经胃镜活检或手术证实的贲门癌患者的超声及胃肠检查结果与病理结果进行对照。结果:超声与胃肠检查对贲门癌的诊断符合率分别为86.8%、92.6%,无明显差异。对早期贲门癌胃肠检查诊断符合率为77.3%,高于超声的诊断符合率59.1%。而在癌肿对周围组织浸润及远处转移方面的诊断,超声具有无法比拟的优势。结论:超声与胃肠检查相结合诊断贲门癌,可以为临床提供较全面的诊断信息,对临床决策及选取手术方案具有重要价值。     

Usefulness of electron beam tomography in the prone position for detecting atrial thrombi in chronic atrial fibrillation

OBJECTIVE: We compared the usefulness of electron beam tomography (EBT) in the prone position relative to that in the supine position for detecting atrial thrombi. METHODS: We studied 96 patients with chronic atrial fibrillation, of whom 71 were scanned in the supine position and 25 were scanned in the prone position. Electron beam tomography was performed twice after contrast medium injection to obtain early- and late-phase images. RESULTS: Filling defects were detected in 13 patients in the supine position by EBT. Transesophageal echocardiography (TEE) revealed a thrombus in the region of the filling defect in 9 patients. In 4 patients, filling defects in the left atrial appendage were not confirmed as thrombi by TEE. Filling defects were detected in 4 patients in the prone position, all of which were confirmed as thrombi by TEE. CONCLUSION: Electron beam tomography in the prone position is an effective technique for reducing false-positive results in the detection of atrial thrombi.     

Dominant maternal sleep position influences site of placental implantation.

The objective of this study was to determine if maternal sleeping position around the time of implantation influences eventual placental implantation site. Between November 1997 and April 1999, women with singleton pregnancies between gestational ages of 15 and 20 weeks presenting for ultrasound examinations were prospectively queried regarding their usual position of sleep during early gestation. Dominant position of sleep was noted as prone, supine, right side, or left side. At ultrasound examination, placental location was categorized as (1) fundal, (2) left high, (3) right high, (4) anterior high, (5) posterior high, (6) anterior low, (7) posterior low, (8) right low, (9) left low, or (10) central low. During the 18 months of this study, data were obtained from 1,500 patients. At the time of conception, front or prone sleeping was the most common (497 of 1,500, 33.1%), followed by right side (439 of 1,500, 29.3%) and left side (360 of 1,500, 24%), with the back being the least frequent position of sleep (204 of 1,500, 13.6%). Women who usually slept supine at the time of conception and implantation were significantly more likely to have a high or fundal placental location compared with those who usually slept in the prone position (p = 0.041). In addition, women who slept exclusively on their right side early in pregnancy were significantly more likely to have a right-sided placental location compared with women who slept exclusively on their left side (p = 0.025). The data from this investigation indicate that sleeping position early in gestation may influence the ultimate placental implantation site.     

贲门区常规钡餐造影的正常X线表现

目的分析贲门区常规钡餐造影的正常X线表现。材料与方法采用不使用低张药物和发泡剂的常规钡餐造影检查,取半立位左前斜位摄取贲门区正面X线照片。分析120例正常贲门区的形态。结果贲门区正面图像均可在半立位左前斜位照片上得以清晰显示。正常形态可归纳为四型Ⅰ隆起型,Ⅱ星芒型,Ⅲ环绕型,Ⅳ花朵型。结论正常贲门区域常规钡餐造影具有规律性表现,熟悉其正常形态有助于识别该区域的病变。     

Diagnostic accuracy of supine and prone thallium-201 stress myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in inferior wall of left ventricle

OBJECTIVE: Prone thallium-201 ((201)Tl) myocardial perfusion single-photon emission computed tomography (SPECT) reduces false-positive rates when evaluating inferior wall abnormalities by minimizing diaphragmatic attenuation. The present study investigates the diagnostic validity of prone (201)Tl stress myocardial perfusion SPECT for detecting coronary artery disease in the inferior wall of the left ventricle in Japanese patients. METHODS: Of the 104 consecutive patients who underwent (201)Tl stress myocardial perfusion SPECT to diagnose coronary artery disease, we evaluated 46 who underwent image acquisition in both the supine and prone positions, and coronary angiography within 3 months thereafter. Images were acquired in the routine supine position immediately following (201)Tl (111 MBq) injection and 4 h following early acquisition. Images were acquired in the prone position only during the early phase following supine acquisition. We evaluated the SPECT images of the inferior half segments of the left ventricle using a five-point defect scoring system. According to the coronary angiographic findings, we investigated the diagnostic accuracy of stress-rest supine, stress supine, stress prone, and combined supine-prone images. Reduced uptake in the stress supine image of the combined images was considered as attenuation when uptake was normal in the prone image. RESULTS: The sensitivity of the stress-rest supine, stress supine, stress prone, and stress-combined supine-prone images was 77%, 86%, 55%, and 55%, and the specificity was 71%, 54%, 79%, and 83%, respectively. Diagnostic accuracy was the highest in stress-rest supine images. CONCLUSIONS: Prone images tended to improve the specificity of detecting coronary artery disease in the inferior wall, but not diagnostic accuracy compared with stress-rest supine images because of decreased sensitivity.     

Prone mammoPET acquisition improves the ability to fuse MRI and PET breast scans

PURPOSE: This study compared prone acquisition of PET scans with traditional supine acquisition to improve fusion of PET scans with MRI scans and improve evaluation of enhancing breast lesions detected on MRI. MATERIALS AND METHODS: MRI breast scans are acquired in the prone position using a breast coil to allow the breasts to hang pendant. An apparatus was fabricated to allow prone acquisition of PET scans. Fused scans from 2 patients acquired both prone and supine were contrasted with those from 3 patients acquired supine only. All 5 MRI scans were acquired on standard scanners. The PET scans were acquired with a PET/CT unit using a low-dose CT scan for attenuation correction. The PET and MRI volumes were matched twice (using a semiautomated registration method) by different operators. The additional value of fusion was judged using reports from the original (nonfused) MRI and PET, joint rereading of the volumes side by side, and examination of fused images. RESULTS: Of 12 enhancing lesions on breast MRI, 7 demonstrated uptake on PET/CT. In the 3 supine-only cases, the fused images were not interpretable because of the marked distortion of the breasts. In the 2 prone cases, the fused images increased our confidence in characterizing a lesion as benign or malignant. Interpretations were confirmed by clinical follow up in 2 or histologic results in 3 patients. CONCLUSIONS: PET MRI fusion is feasible and may assist in localizing lesions detected on either study. A more extensive study is underway to confirm the value of this fusion technique.     

早期贲门癌的胃肠双对比造影X线征象分析

目的探讨早期贲门癌的X线表现,提高对本病的认识。方洼回顾性分析经手术及病理证实的36例早期贲门癌的X线表现。结果36倒患者在钡餐造影检查中,主要表现黏膜异常增粗、紊乱、肥大,钡剂通过贲门缓慢,贲门痉挛,黏膜纠集、中断,局部呈结节样或大小不一的颗粒状阴影等。结论双对比造影时体位变换和流动技术的合理应用及胃泡充气良好是诊断早期贲门癌的关键技术,仰卧左前斜一右侧位的动态观察方法是早期贲门癌不可缺少的流动观察体住。     

Study of the lymph flow of the cardia by endoscopic RI-lymphography with SPECT

Endoscopic RI-lymphography was performed in 29 patients, with single photon emission computed tomography (SPECT) also performed in 19 of them. The lymph flow from the cardia was directly evaluated in lymphograms and compared with the RI uptake of each lymph node and the incidence of lymph node metastasis of previously resected carcinoma of the cardia in patients according to the location of the lymph node. Endoscopic RI-lymphography performed in combination with SPECT was considered to be highly useful for imaging lymph flow of the cardiac region. SPECT and RI-lymphography indicated rich lymph flow from the cardia to the periaortic region, and this finding was consistent with the incidence of lymph node metastasis according to the location of the lymph node in patients who had previously undergone resection of cancer of the cardia. Careful examination for metastasis to lymph nodes around the abdominal aorta was considered to be necessary, especially in patients with carcinoma of the cardia.     

A survival after cardiac arrest during CT scan: The critical imaging findings

It obtains infrequently hemodynamic images of patients undergoing impending cardiac arrest. Heart pump failure causes blood stasis in the venous system and organs, which is demonstrated on imaging by the deposition and layering of contrast in the veins. We present a case of a multi-trauma patient undergoing imminent cardiac arrest during computed tomography scan under sedation. Signs of early cardiac arrest were immediately found during the examination, including contrast pooling in the inferior vena cava and hepatic veins, poor opacification of the left heart chambers and the aorta. Fortunately, the patient was quickly resuscitated, and his heart pump returned to normal. Although cardiac arrest on computed tomography scan is extremely rare, detecting imaging signs of this situation helps patients receive timely resuscitation and better survival.