CT评价急性重症胰腺炎预后的价值

目的：探讨CT对急性重症胰腺炎病变范围的诊断价值及其与预后的关系。方法：回顾分析42例急性重症胰腺炎患者的病例资料,按胰腺增大、胰周及胰外间隙扩散范围进行CT分级,分析CT分级（Ⅱ～Ⅳ级）与临床Ranson评分标准[R1（0～2分）,R2（3～5分）,R3（〉6分）]及预后因素（死亡人数、手术例数、非手术例数）的相关性。结果：病变范围的CT分级Ⅱ级且临床Ranson评分与R1～R2级者16例,病程相对平稳;同属于Ⅲ～Ⅳ级和R2～R3级者共21例,病程迁延、反复、并发症多,病情危重;介于中间者,同属于CT分级Ⅲ级和R1级者共5例。病变范围的CT分级与临床Ranson评分标准呈正相关（r=0.429,P=0.005）。CT分级Ⅱ级16例均采用非手术治疗;Ⅲ级14例中10例采用非手术治疗,3例手术,1例死亡;Ⅳ级12例中1例采用非手术治疗,7例手术,4例死亡。病变范围CT分级与临床预后间呈正相关（r=0.711,P〈0.001）。结论：病变范围的CT分级对急性重症胰腺炎的临床严重程度和预后评估具有重要的作用,与临床Ranson标准结合更能提高早期预后判断的准确性和可靠性。     

Prospective evaluation of nonenhanced MR imaging in acute pancreatitis

PURPOSE: To compare the value of nonenhanced (NE) magnetic resonance imaging (MRI) (NE-MRI) with contrast-enhanced (CE) computed tomography (CT) (CE-CT) scan in assessing acute pancreatitis (AP) and in evaluating the severity index (SI) with clinical outcome. MATERIALS AND METHODS: Patients with AP were prospectively investigated by CE-CT scan and NE-MRI on admission. MRI was performed with fat-saturated T1-weighted imaging, T2-weighted imaging, and MR cholangiopancreatography (MRCP). Balthazar's grading system was used to evaluate the NE-MRI severity index (CTSI, MRISI) and it was compared to the clinical outcome. RESULTS: A total of 90 patients (median age = 55 years) were included in the study. AP was of biliary etiology in 37 patients (41%). On admission, AP was assessed as grade III by CTSI in four patients (4%), whereas 19 patients were classified grade III by MRISI. The coefficient correlation between CTSI and MRISI was good, with r = 0.6 (P < 0.001). Considering CE-CT scan as the gold standard, sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of NE-MRI for detecting severe AP based on imaging criteria were 100%, 82.6%, 100%, and 21%, respectively. NE-MRI discriminates normal pancreatic parenchyma from edema and necrosis with a correlation between morbidity (P < 0.008). CONCLUSION: NE-MRI seems to be a reliable method of staging AP severity in comparison to CE-CT scan.     

螺旋CT在腕舟骨骨折诊断中的临床价值

目的探讨螺旋CT(SCT)在腕舟骨骨折诊断中的临床应用价值。方法 60例早期腕舟骨骨折患者经腕关节常规X线检查后,采用SCT进行腕关节的螺旋扫描,并在工作站上作多平面重建(MPR)及表面遮盖显示(SSD)影像后处理。60例舟骨骨折病例均按Herbert分型,并对X线平片与螺旋CT影像进行比较及综合分析。结果 60例舟骨骨折病例中,A1型4例(6.6%),A2型5例(8.3%),B1型2例(3.3%),B2型29例(48.3%),B3型15例(25%),B4型5例(8.3%),X线平片漏诊12例,此12例X线平片漏诊的骨折均经螺旋CT确诊。结论螺旋CT能够明确腕舟骨骨折的诊断,多能清晰显示X线平片难以诊断的腕舟骨隐匿性骨折;SSD和MPR成像技术能立体直观观察腕舟骨的骨折线走行及移位情况,能对腕舟骨骨折作出准确的分型,从而为临床治疗方案的拟定提供重要参考。     

急性胰腺炎的CT诊断

目的探讨CT对急性胰腺炎的诊断价值。方法回顾性分析32例经临床证实急性胰腺炎患者的CT资料,观察其CT表现特征,全部患者均经腹部CT平扫,其中6例又经增强扫描。结果急性轻症胰腺炎19例,急性重症胰腺炎13例。CT主要表现为胰腺弥漫性增大,密度降低,其中,9例有不规则低密度区,17例有胰周积液,1例胰腺内见局限性斑点状高密度出血影。结论 CT检查是诊断急性胰腺炎及其并发症的重要方法。     

急性胰腺炎严重指数对临床预后的评估价值

目的：综合ＣＴ影像提出急性胰腺炎严重指数（ＡＰＳＩ）的评估方法并测定其敏感性,提高ＣＴ影像对急性胰腺炎预后评估的准确率。材料与方法：Ｑ发 胰腺炎患者６５例,以住院时间及禁食时间为应变量（Ｙ）、胰腺肿大、胰周和／或腹腔内渗出液及胰腺坏死情况作为自变量（Ｘ）,用多元线性回归分析法对ＡＰＳＩ、ＣＴ严重（ＣＴＳＩ）及简化急症生理（ＳＡＰ）计分法进行比较。并分析此三者对并发症发生率和死亡率的预评价值。结果：     

能谱CT虚拟平扫在肾癌中的应用

目的：探讨能谱CT虚拟平扫(VNC)替代常规平扫在肾癌中的临床应用价值。方法回顾分析32例经病理证实为肾癌的患者影像资料,均行能谱CT常规平扫及动脉期、静脉期能谱成像(GSI),采用MSI软件生成动脉期VNC和静脉期VNC图像。分别测量3组图像(常规平扫、动脉期VNC、静脉期VNC)肾脏病灶的CT值、病灶-正常肾脏的对比噪声比(CNR),同层面病灶的长径、橫径,采用单因素方差分析;由2位放射科医师对3组图像分别行5分制图像质量主观评分,3分制影像学征象主观评分,对2位医师评价结果的一致性行Kappa 检验,对3组图像的图像质量主观评分行单因素方差分析。结果2位医师对3组图像评价结果的一致性较好(Kappa 值均>0.700);3组图像间图像质量主观评分无统计学差异(P>0.05);影像学征象主观评分动脉期 VNC为2.88±0.34,静脉期VNC为2.84±0.37,均可接受。3组图像的CNR分别为0.52±0.11、0.72±0.16、0.69±0.12,动脉期VNC、静脉期 VNC的对比噪声比(CNR)均高于常规平扫,有统计学差异(P<0.05)。3组图像同层面病灶的长径和横径无统计学差异(P>0.05)。3组图像肾脏病灶的CT值分别为(30.04±4.09)HU、(32.69±4.07)HU、(32.56±3.52)HU,有统计学差异(P<0.05),常规平扫病灶的CT值低于动脉期 VNC和静脉期 VNC,但差值均在5 HU内。结论在肾癌检查中 VNC能替代常规平扫,可减少患者的扫描次数,降低辐射剂量。     

HIV相关型 Burkitt淋巴瘤的CT特征及其与预后的相关性

目的 探讨人类免疫缺陷病毒（HIV）相关型 Burkitt淋巴瘤的临床特征和CT影像特征,分析其与预后的相关性。 方法 收集国内多医学中心56例HIV阳性Burkitt淋巴瘤初次治疗前的临床和CT影像资料,男51例,女5例,平均年龄（42.87±12.63）岁。56例病人初次治疗前均行CT平扫检查,54例同时行增强CT扫描。根据Ann Arbor分期将病人分为2组,早期组（Ⅰ~Ⅱ期）14例,晚期组（Ⅲ~Ⅳ期）42例。由2名医师提取CT特征,分析国际预后指数（IPI）评分,同时定期随访病人并记录总生存时间（OS）。采用卡方检验比较2组间CT影像特征及受累淋巴区域。采用Cox单因素和多因素回归分析潜在预后因子。采用 Kaplan-Meier 法和log-rank检验对OS的独立预测因子进行生存分析,并绘制生存曲线。 结果 56例病人中,43例（76.8%）肿瘤边界不清,32例（57.1%）存在融合征象,17例（30.3%）病变有坏死,31例（55.3%）有巨块病变,21例（37.5%）CT平扫密度不均匀。41/54例（75.9%）增强CT呈不均匀强化。最常累及腋窝、腹部和头颈淋巴区域,脾受累极少见;最常累及腹部脏器（胰腺为著）,其次为肺,其他少见;最常外侵组织为肌肉和皮肤,其次为骨。晚期组病人腹膜和腹膜后淋巴受累比例高于早期组,肿瘤边界不清的比例也高于早期组（均P<0.05）。与OS有关的独立预测因子为IPI评分、累及肺、累及肝脏、肿瘤有融合征象及CT增强扫描病变呈不均匀强化。Kaplan-Meier生存曲线分析显示,IPI评分3~5分者较0~2分者死亡风险增加,肺和肝脏受累、CT增强扫描呈不均匀强化以及存在病变融合征象者的死亡风险均增加。 结论 HIV相关型Burkitt淋巴瘤的部分CT影像特征与OS相关,IPI评分和CT影像特征有利于预测病人的预后。     

急性胰腺炎胰腺微循环损害的MSCT灌注成像

目的：探讨急性胰腺炎胰腺微循环损害的特点及MSCT灌注成像的临床应用价值。方法：采用急性胰腺炎的临床分级和Balthazar CT分级标准,将入院后48h内的69例急性胰腺炎患者分为轻症组（MAP）42例（CT分级为A级16例,B级9例,C级17例）和重症组（SAP）27例（CT分级为D级11例,E级16例）,以12例无胰腺疾病的胸部CT检查患者作为对照组。所有患者均行MSCT胰腺灌注扫描,测量参数包括胰腺的时间-密度曲线（TDC）以及灌注参数：血流量（BF）、血容量（BV）、平均通过时间（MTT）和表面通透性（PS）。结果：急性胰腺炎时胰腺TDC上升斜率较小,峰值降低。正常胰腺、MAP和SAP三组中胰腺的BV值依次下降,且相互间差异均有显著性意义（P〈0.05）;SAP组胰腺BF、BV值均低于MAP组,MTT、PS均增高,差异有显著性意义（P〈0.05）。MAP组中CT分级为A级者较正常胰腺组BF值增高,B、C级较正常胰腺组BF、BV减低,PS增高（P〈0.05）。结论：急性胰腺炎患者的胰腺血流灌注状态与其严重程度关系密切,它呈先升后降的趋势。MSCT灌注成像可以定量评价胰腺的微循环状况,对急性胰腺炎的早期分级有潜在应用价值。     

多层CT评价TIA患者颈动脉狭窄及卒中预测的意义

目的 探讨颈动脉多层CT血管成像(CTA)及脑灌注成像(CTP)评价短暂性脑缺血发作(TIA)患者颈动脉狭窄的临床意义及随访价值.资料与方法 短期内行CT平扫、颈动脉CTA的TIA患者46例,其中25例行脑CTP,评价颈内动脉狭窄的发生率、与灌注异常的相性及部分病例随访情况.选择23例符合实验组年龄段且无TIA发作史、头CT平扫无异常的志愿者作为对照组.结果 46例中,平扫未见异常17例,29例有腔隙性脑梗死,其中多发13例.CTA显示颈内动脉狭窄38支,轻度11支(28.9%),中度20支(52.6%),重度7支(18.4%).对25例行脑CTP,发现异常22例,正常3例.随访15例中11例一年中发生卒中或TIA.结论 颈动脉CTA结合脑CTP能及时判断颈内动脉病变的存在及对脑血流的影响,并预测卒中发生的危险,对TIA患者的早期临床干预有重要的指导意义.     

多排螺旋CT后处理重建对评价急性坏死性胰腺炎临床严重度的意义

目的总结急性坏死性胰腺炎（ANP）的多排螺旋CT（MDCT）后处理重建影像特征并评价其对ANP临床分度的意义。方法搜集经16排MDCT常规平扫及增强扫描并确诊为ANP的病例45例,通过应用曲面重建等图像后处理进行了CT严重度指数（CT severity index,CTSI）计分为轻（小于3分）,中等（4～6分）和重度（7～10分）,同时还进行了临床Ranson分级为轻、中等和重度。结果 45例ANP中CTSI计分分级：轻度0例,中度25例（55.6%）,重度20例（44.4%）;按临床Ranson分级：轻度3例（6.7%）,中度20例（44.4%）,重度22例（48.9%）;CTSI计分分级与临床Ranson分级存在正相关性。结论 MDCT重建图像可以清晰显示ANP的胰腺实质坏死和腹膜后扩散等征象,尤其是胰腺曲面重建图像对ANP临床严重度的评价有重要价值。     

中枢神经系统白血病CT诊断

目的:探讨中枢神经系统白血病的CT表现,提高诊断水平。方法:总结经临床脑脊液细胞学检查找到白血病细胞共计17例CT表现,其中急性淋巴细胞白血病10例,急性非淋巴细胞白血病7例。CT平扫17例,增强扫描13例。结果:CT表现为脑池、沟消失,脑皮层区低密度,增强扫描呈斑片状及脑回样强化3例。脑实质内呈结节状及肿块状高密度影,周围伴水肿14例,增强扫描呈明显均匀强化。结论:结合临床,CT对中枢神经系统白血病诊断有帮助。     

Absence or interruption of the supra-acetabular line: a subtle plain film indicator of hip pathology

 Objective. To show that absence or interruption of the supraacetabular line is a subtle plain film indicator of pathology in the acetabulum. Design. Nineteen hips from 17 patients with known disease processes involving the acetabulum as demonstrated by subsequent magnetic resonance imaging, bone scan or plain film follow-up were evaluated with antero-posterior (AP) plain films of the pelvis. Three additional cases were diagnosed prospectively using interruption of the supra-acetabular line as the criterion for inclusion. Fifty AP plain films of the pelvis in patients without hip pain were examined prospectively to determine normal imaging criteria. Results and conclusions. The normal supra-acetabular line measures 2–3 mm in thickness superiorly and is a thin sclerotic line in the medial aspect. In all 22 hips (with pathology) in this series, the line was interrupted or absent. Loss or interruption of the supra-acetabular line may thus be a subtle pain film indicator of a disease process involving the acetabulum. This plain film sign has not previously been reported.     

脑内等密度占位性病变的CT诊断途径分析(附116例报告)

目的：分析总结脑内等密度占位性病变的CT征象及诊断途径，加强对此类疾病的认识，提高诊断准确率。方法：回顾分析经病理或治疗随访证实的116例脑内等密度占位性病变的CT征象特点，其中109例行CT增强检查。结果：116例中，确诊主要途径为：仅通过CT平扫确诊10例，结合CT平扫及增强确诊59例，结合病史确诊16例，结合临床查体确诊9例。结合其他影像或实验室检查确诊15例。脑瘤87例，其中胶质瘤34例、转移瘤31例、脑膜瘤10例、垂体瘸5例、其他7例，亚急性硬膜外或硬膜下血肿15例，脑脓肿7例，脑血管畸形4例，脑囊虫病3例。结论：通过仔细分析CT平片和全面结合病史、临床查体、其他检查，提示脑内占位性病变，并尽可能做出神经功能定位，再辅以CT增强，必要时随访，对于正确诊断脑内等密度占位性病变，减少漏诊，避免误诊，非常重要。     

螺旋CT平扫早期诊断肠和肠系膜钝性伤的临床价值

目的 探讨螺旋CT平扫对肠及肠系膜钝性伤的早期诊断价值.方法 回顾性分析32例经手术证实的急性肠及肠系膜钝性伤的CT表现和临床资料,所有病例均行CT平扫及增强检查,总结其CT征象的临床意义,并对CT平扫及增强检查结果进行对比分析.结果 螺旋CT平扫及CT增强在腹腔积液或血肿、腹腔游离气体、肠系膜渗出及血肿、肠壁肿胀、肠管破裂、肠管扩张伴积液方面,诊断率无显著性差异.结论 螺旋CT平扫对早期诊断急性肠和肠系膜钝性伤有较大临床价值,增强检查可作为CT平扫的重要补充.     

食管高密度异物(鱼刺)的CT诊断

目的探讨CT在食管异物诊断中的应用价值方法食管异物10例(均为鱼刺),均行常规CT平扫,必要时加CT薄层扫描,再将CT征象与手术及内镜结果比较结果10例食管异物(鱼刺)均为CT所显示,呈大小、形态不一的稍高或高密度影,其中合并食管出血2例,黏膜下血肿1例,脓肿3例及脓胸1例结论常规CT扫描及薄层扫描在食管异物检查中具有重要意义     

64排螺旋CT腹部血管成像低剂量扫描的可行性研究

目的 探索腹部血管成像64排螺旋CT低剂量扫描的可行性和合理性。方法 采用120 kV、200~30 mAs之间每次降低10 mAs的条件进行模体测试图像采集,测量其CT值的标准差(SD)、高对比密度分辨率与低对比密度分辨率,分析三者与扫描所用mAs值的联系,找到3个mAs值进行临床病例分析。随机选取90例行腹部血管检查的患者平均分为3组,采用以上mAs值进行图像采集,进行平扫常规剂量SD值测量,并对增强低剂量扫描进行三维容积重建(VR),再由3名CT诊断医师采用盲法评价进行VR图像质量评估,按优、中、差3个等级进行评定。3组平扫SD值与腹部血管成像VR图像进行质量相关性分析。结果 3组平扫SD值与腹部血管成像VR图像的质量相关性分析ROC曲线下面积分别为0.921、0.906、0.893。结论 腹部血管成像低剂量扫描切实可行,80 mAs可以较好地保证图像质量。在平扫SD值小于5.78时增强扫描可以采用60 mAs,而当平扫SD值大于11.8时增强扫描最好采用100 mAs或更高的mAs值。     

Multidetector row computed tomography of acute pancreatitis: Utility of single portal phase CT scan in short-term follow up

Objective

The purpose of this study is to evaluate the question of whether nonenhanced CT or contrast enhanced portal phase CT can replace multiphasic pancreas protocol CT in short term monitoring in patients with acute pancreatitis.

Materials and methods

This retrospective study was approved by the Institutional Review Board. From April 2006 to May 2010, a total of 52 patients having acute pancreatitis who underwent initial dual phase multidetector row CT (unenhanced, arterial, and portal phase) at admission and a short term (within 30 days) follow up dual phase CT (mean interval 10.3 days, range 3–28 days) were included. Two abdominal radiologists performed an independent review of three sets of follow up CT images (nonenhanced scan, single portal phase scan, and dual phase scan). Interpretation of each image set was done with at least 2-week interval. Radiologists evaluated severity of acute pancreatitis with regard to pancreatic inflammation, pancreatic necrosis, and extrapancreatic complication, based on the modified CT severity index. Scores of each image set were compared using a paired t-test and interobserver agreement was evaluated using intraclass correlation coefficient statistics.

Results

Mean scores of sum of CT severity index on nonenhanced scan, portal phase scan, and dual phase scan were 5.7, 6.6, and 6.5 for radiologist 1, and 5.0, 5.6, and 5.8 for radiologist 2, respectively. In both radiologists, contrast enhanced scan (portal phase scan and dual phase scan) showed significantly higher severity score compared with that of unenhanced scan (P < 0.05), while portal phase and dual phase scan showed no significant difference each other. The trend was similar regarding pancreatic inflammation and extrapancreatic complications, in which contrast enhanced scans showed significantly higher score compared with those of unenhanced scan, while no significant difference was observed between portal phase scan and dual phase scan. In pancreatic necrosis analysis, there was no significant difference between the three image sets for both radiologists. However, when only the patients having pancreatic necrosis (n = 13) was separately analyzed, significant differences were observed between the unenhanced and portal phase scan (P = 0.04, for radiologist 1), or unenhanced and dual phase scan (P = 0.013, for radiologist 2).

Conclusion

For short-term follow up imaging in assessment of patients with acute pancreatitis, single portal phase CT images without adding unenhanced or arterial phase images provide sufficient information, and thereby reduce radiation exposure.     

肾脏淋巴瘤的影像诊断

目的探讨肾脏淋巴瘤的CT、MRI及PET/CT特征。资料与方法回顾性分析18例经病理证实的肾脏淋巴瘤患者的临床及影像学资料。17例患者行CT检查,1例仅行平扫,其余16例行平扫及增强扫描,3例同时行PET/CT检查;1例患者行MRI平扫及增强扫描。结果 18例中表现为多发结节型6例,单发结节型3例,邻近腹膜后侵犯型5例,肾周型3例,弥漫浸润型1例。结论 CT、MRI及PET/CT均能显示肾脏淋巴瘤病变。肾脏内多发、单发肿块或腹膜后肿块直接侵犯,CT平扫表现为均匀等或稍低密度,MRI呈等T1、等T2信号,轻度强化是肾脏淋巴瘤的普遍特点,有一定的特征性。PET能更敏感地发现其他器官的隐匿性病灶。     

肝移植术后胆道并发症的影像学诊断

目的分析肝移植术后胆道并发症的影像学（ＣＴ、ＭＲＩ、“Ｔ”形管造影）表现。材料与方法回顾性分析了我院７例原位肝移植术后影像学资料,７例均为男性,年龄３３～５０岁,肝硬化病史４～１０年。术后１例行腹ＣＴ平扫,５例行平扫加增强扫描,１例行单纯增强扫描,其中３例作了ＭＲＩ检查。所有病例均行“Ｔ”形管造影。结果胆漏１例;肝内胆管狭窄１例,非吻合口胆总管狭窄１例。结论胆系造影是肝移植术后胆道系统并发症（胆漏、胆管狭窄）诊断的常规方法,ＣＴ及ＭＲＩ扫描可以显示间接征象。     

能谱CT 对良、恶性甲状腺结节的鉴别价值

目的：评价能谱C T鉴别甲状腺良、恶性结节的能力。方法入组58例甲状腺结节患者,共72个甲状腺结节,分成良性结节及恶性结节组。用能谱CT对其进行平扫及动脉期增强扫描,分别得到平扫和增强后结节的ICnod（碘浓度）及 NICnod（标准化碘浓度）值,并比较其在良、恶性组间的差别。结果平扫时恶性结节的ICnod、NICnod值明显低于良性组（ P ＜0．001）,其诊断恶性结节的敏感度及特异度分别为100％到92．3％和89．1％到87％。增强后良、恶性组结节的ICnod、NICnod值没有统计学差异。结论能谱CT平扫可以帮助鉴别甲状腺良、恶性结节。