双腔右心室75例临床诊断及分析

回顾性总结75例经临床检查并经手术证实有双腔右心室患者的临床资料,通过临床体征、X线胸片、心电图、超声心动图、右心导管检查和右室造影表现特点,总结诊断和鉴别诊断经验。结果显示,术前诊断有双腔右心室57例（76％）,其中单纯双腔右心室9例,合并其它心内畸形48例（64％）,同手术结果比较,术前有18例（24％）未诊断出双腔右心室,导管尖端进肺动脉记录肺动脉至右室流入道压力曲线和仔细分析右室造影征象是提高术前诊断率的关键。     

单发右心室发育不良的影像学诊断

目的 报道6例单发右心室发育不良并评价其影像学诊断方法。方法 6例单发右心室发育不良患者均行X线平片、心电图、超声心动图、心导管及心血管造影检查，2例经外科手术证实。结果 6例中，5例小梁部发育不全，1例三尖瓣、流入道及小梁部皆发育不良。6例均伴有Ⅱ孔型房间隔缺损。结论 单发右心室发育不良是少见的紫绀属先天性心脏病，确诊需行心血管造影检查。     

胃平滑肌肿瘤的X线气钡双对比造影与CT诊断

目的：探讨X线气钡双对比造影和CT检查对胃平滑肌肿瘤定位、定性的诊断价值。方法：对30例胃平滑肌肿瘤患者进行气钡双对比造影检查及CT强化检查并对其影像表现进行分析。结果：X线气钡双对比造影检查对腔内型肿瘤敏感，CT检查对非腔内型肿瘤诊断有优势，两种方法联合应用对各种胃平滑肌肿瘤定位诊断正确率达100％，定性准确率达84％。结论：X线气钡双对比造影和CT强化检查联合应用是诊断胃平滑肌肿瘤的有效影像检查方法。     

法乐氏五联症的X线和二维脉冲多普勒超声的诊断(附10例报告)

目的：评价Ｘ线和二维脉冲多普勒超声对法乐氏五联症的诊断价值。方法：１０例患者,男性５例,女性５例;年龄２．５～２４岁。平均１０．６岁。１０例Ｘ线胸片,其中７例曾行右心导管和右心室造影检查。１０例均行二维脉冲多普勒超声检查。结果：手术证实,１０例均为法乐氏五联症。结论：本组１０例法乐氏五联症患者的术前检查意见与手术中所见对比分析,认为右心导管和右心室造影是法乐氏五联症术前必不可缺的检查。Ｘ线和超声检查相结合,能对法乐氏五联症做出更全面的术前诊断。     

循环系统

198法鲁四联症右心室造影 X 线电影诊断1975—76两年间,All India Institute ofMed主cal Science:医院对65例法鲁氏四联症进行心导管检查术和两个体位的.单相心血管造影X线电影检查,57例为轻度(30一35。)右前斜位和深度 (7O一80。)左前斜位的右心室造影,8例为通常的正侧位右心室造影。     

主动脉弓离断三联征的放射诊断

目的：分析与评价主动咏弓离断(IAA)三联征的影像学表现及其诊断价值。方法：回顾性分析20例患者的X线平片、心导管检查和心血管造影资料,其中7例行电子束CT检查,11例行手术治疗,逐个分析其X线平片征象并与心血管造影及手术结果对照。结果：X线胸片显示肺血多,肺动脉段明显凸出和心脏增大(n=20);右上纵隔大血管影变窄(n=16);主动脉结观察不清(n=16);侧位或左前斜位见低位主动脉弓(n=12);降主动脉的顶端与主肺动脉处同一水平(n=8)。心导管检查均提示肺动脉高压、主动脉弓畸形、动脉导管未闭。心血管造影诊断IAA(A型)13例,IAA(B型)5例,其中合并主肺间隔缺损4例,合并右室双出口2例,右肺动脉起源异常1例。结论：X线平片对该畸形的诊断有一定的价值,多数病例可作诊断,心血管造影是诊断该病的最可靠方法。     

先天性心脏病第2次手术前心导管检查和临床评估

目的：探讨先天性心脏病(先心病)手术后心导管检查的适应证及临床评价。方法：选取1999年4月～2002年12月先心病术后患儿在心内科行心导管术65例，占同期先心病心导管术总数的2．2％，入院后常规行心电图、X线胸片及超声心动图检查，结合原手术方案选择相应的心腔、血管造影，检测相关部位的压力、血氧饱和度。结果：65例心导管术无一例出现严重并发症，综合心导管资料及其他辅助检查，需再次外科手术39例，暂不需手术而进一步随访观察9例，在心导管术中行介入治疗9例，4例需放置支架，无再次外科手术指征4例。结论：心导管术不仅能提供精确的病理生理参数，而且可提供详尽的解剖资料，对一些复杂的先心病，特别是外科手术后的先心病具有重要的临床价值。     

右心室双腔畸形的图像所见

右心室双腔畸形是由于肥厚的异常肌束发生狭窄,使右心室分为三尖瓣侧高压区和肺动脉侧低压区的一种先天性疾病。既往报道病例以超声心动及心导管检查为主,MRI报道极少。作者报道1例,男性44岁,主诉:劳累时呼吸困难一月余,第2～3肋间、胸骨左缘闻及收缩期杂音,向颈部传导。胸部X线上心胸比60％,心尖部饱满而突出,心尖部轻度隆起,肺野无显著变化。超声心动显示比较困难,右室蟹肥厚,腔内结构不清。经食管心动超声见左房的左外侧显示管腔结构,疑为左上腔静脉残留,同时可见右心室内狭窄性病变和高度扩张的右心室流出道。CT显示两侧上腔静脉,但与之相连的左头臂静脉未显示。左侧上腔静脉经过主动脉弓前方下行,与心腔     

主,肺动脉窗：附二例报告

报经手术或/及心血管造影检查证实的主、肺动脉窗2例。结合国内已报导的4例及国外部分文献,对本病的X线平片表现、心导管检查以及心血管造影进行了讨论。认为平片对诊断有一定的限度,导管检查及心血管造影常常是不可少的,强调造影时使用恰当的投照位置对鉴别诊断有重要作用。     

X线气钡双对比造影、MSCT检查对胃癌TNM分期的评估

目的：探讨X线气钡双对比造影、MSCT检查对胃癌术前TNM分期的评估。方法：经病理证实的160例胃癌患者，分析其X线气钡双对比造影、MSCT表现，并和手术、病理做对照分析。结果：X线气钡双对比造影、MSCT显示早期胃癌5例，进展期胃癌155例。浸润型（BorrmannⅢ、Ⅳ）淋巴结转移率（76．5％）明显高于局限型（BorrmannⅠ、Ⅱ）转移率（43．2％）。肿瘤直径〈4cm、4～8cm和〉8cm的淋巴结转移率依次增加，其差异有高度显著性（P〈0．01）。T分期诊断正确率83．0％，N分期诊断正确率68．1％，M分期诊断正确率79．0％。结论：X线气钡双对比造影、MSCT检查对进展期胃癌诊断价值较大，可指导临床手术和治疗方案的制定。     

Imaging procedures in the detection of cardiac tumors,with emphasis on echocardiography: A review

Although cardiac tumors are relatively rare, their diagnosis is important because successful treatment is usually feasible if the diagnosis is made preoperatively. An analysis of 219 reports of cardiac tumors described in the English literature from 1972 through 1977 demonstrated the predominance of benign tumors, in particular myxoma, which is in agreement with past reviews. The methods of diagnosis employed included plain chest films, echocardiography, cardiac catheterization, angiocardiography, and cardiac scintigraphy. Conventional x-ray examination of the chest was abnormal in 83% of cardiac tumors but non-specific and should lead to further evaluation, first by echocardiography. Echocardiography, the most efficient diagnostic procedure for screening possible cardiac tumors, was abnormal in 94% of the cases. Cardiac catheterization was abnormal in 80% of cardiac tumors while definitive detection was made by angiocardiography in 94% of the cases. Cardiac scintigraphy has had limited use in the diagnosis of cardiac tumors, but has been diagnostic in 100% of the cases in a small series of myxomas.     

法乐氏四联症的影像学诊断对手术指导意义的评价

目的：综合评价126例法四术前的影像学诊断对手术的指导意义、资料与方法：1986年6月—1996年10月间均已行矫治术的126例法四，临床资料较完整，男79例，女47例，平均年龄10．3岁。术前均采用胸部X光平片，二维超声心动图，二维彩色多普勒和心血管造影进行综合影像学检查，所得结果与手术所见对照。结果：胸部X光平片，二维超声心动图，二维彩色多普勒及心血管造影对法四的病理特征的显示各有侧重，综合应用可起互相印证相互补充的作用。结论：对法四有必要进行综合性影像学检查；应高度重视法四合并冠状动脉畸形的临床意义。     

Does digital acquisition reduce patients' skin dose in cardiac interventional procedures? An experimental study

OBJECTIVE: It is necessary to reduce the exposure doses from both fluoroscopy and angiocardiography. Pulsed fluoroscopy clearly reduces patients' exposure. By contrast, whether digital acquisition reduces patients' exposure is not clear. This study simulated the skin radiation doses of patients in cardiac catheterization laboratories with various radiography systems used in percutaneous transluminal coronary angioplasty to determine whether digital acquisition reduces patient exposure as compared with cine film recording. MATERIALS AND METHODS: The entrance surface doses with cineangiography and fluoroscopy of acrylic phantoms were compared for 11 radiography systems at seven facilities; each performs more than 100 cardiac intervention procedures per year. The entrance surface dose for an acrylic plate (20 cm thick) was measured using a skin-dose monitor. RESULTS: The maximum dose exceeded the minimum dose by 6.44 times for cineangiography and by 3.42 times for fluoroscopy. The entrance surface dose with acrylic plate was lower with digital-only acquisition (mean +/- SD, 3.07 +/- 0.84 mGy/sec) than with film recording (6.00 +/- 3.04 mGy/sec). By contrast, the entrance surface frame dose, after correction for the cine frame rate, tended to be higher with digital acquisition than with film recording (0.210 +/- 0.053 vs 0.179 +/- 0.058 mGy/frame, respectively). CONCLUSION. The entrance surface dose was approximately 50% less with digital-only acquisition than with film recording. However, after correcting the dose for cine frame rate, filmless acquisition did not in itself reduce the exposure. For the surface dose to be reduced for cardiac interventional radiography, even with digital filmless radiography systems, a low recording speed is necessary for angiocardiography.     

双腔右心室95例的外科治疗

目的总结双腔右心室(DCRV)的诊断和外科治疗经验。方法回顾性分析近10年收治的DCRV95例,其中男56例,女39例,年龄1～48岁。单纯DCRV13例,合并其他心脏畸形82例,其中合并室间隔缺损56例。采用右房和右室漏斗部联合切口57例,单纯右房切口8例,单纯右室漏斗部切口30例。结果肌隔型61例,肌束型34例。全组无手术死亡。术前超声心动图误诊为VSD 15例,误诊为PS 3例,均于术中探查确诊。结论单纯DCRV少见,以合并VSD多见。多普勒超声心动图对诊断有较高价值,但也有较高的误诊和漏诊率。术中探查很重要,应常规探查三尖瓣和肺动脉瓣。采用右室切口更有利于右室流出道狭窄的彻底解除。     

儿童完全性大动脉错位的X线诊断──附心血管造影152例报道

本文报道１５２例经心血管造影证实的完全性大动脉错位，患儿的年龄从３天到１１岁。１５２例中４７例为室间隔完整不伴肺动脉狭窄的单纯型完全性大动脉错位，４４例为室间隔缺损不伴肺动脉狭窄型，６０例为室间隔缺损伴肺动脉狭窄型，１例为室间隔完整伴肺动脉狭窄型。本文详细讨论了完全性大动脉错位的Ｘ线平片诊断、心血管造影技术及造影诊断，作者认为长轴斜位左心室造影是完全性大动脉错位心血管造影的最佳投照体位。     

Radiology in chest trauma (author's transl)]

In chest trauma, a routine chest film, preferably in the lateral as well as the frontal projection, is the basic part of the work-up. Occasionally valuable additional methods are fluoroscopy, tomography, bronchography, contrast studies of the GI Tract and angiography and angiocardiography. In 679 chest trauma patients, traffic accidents and falls were the main reason for the trauma. There were 248 fractures; then - in order of frequency - hemopneumothorax (76), lung contusion (58), subcutaneous emphysema (33) cardiac (16) and vascular trauma (12) and damage to other organs. While 20--30% mistakes are made in diagnosing rib fractures in acute trauma, there is high accuracy in the diagnosis of the other injuries. Many cases are shown to demonstrate the value of diagnostic radiology.