正常纵隔淋巴结的数目与大小

根据美国胸科学会1983年新公布的纵隔淋巴结分区法,作者随机复习了56例正常病人的CT 片,对不同区域的纵隔淋巴结数目和大小进行了测量和比较。结果发现隆突下和右气管支气管区淋巴结最大,平均(短轴)径分别为6.2mm±2.2SD 和5.9     

嵴内型室间隔缺损的介入封堵治疗效果和短期随访研究

 目的 探讨经导管介入封堵治疗嵴内型室间隔缺损(IVSD)的适应证、可行性和安全性.方法 超声心动图筛查27例嵴内型室间隔缺损患者,男16例,年龄8～29岁;女11例,年龄10～27岁.超声测量缺损直径3～7 mm,平均(4.2±2.7)mm,左室和升主动脉造影后建立股动脉-室间隔缺损-股静脉的轨道行介入封堵治疗,5例采用Amplatzer非对称伞(AGA,美国);7例采用零边偏心封堵器(上海形状记忆合金材料有限公司);13例采用对称型VSD封堵器(上海形状记忆合金材料有限公司).结果 25例介入封堵成功,无左向右残余分流,2例术后主动脉微量反流,随访6～12个月,封堵器无移位、无心律失常.2例左室长轴切面缺损紧靠主动脉瓣的右冠瓣、缺损上缘为右冠瓣部分覆盖于缺损口处,造影后重新测量为巨大VSD而未行介入封堵.结论 嵴内型室间隔缺损无有冠瓣明显脱垂、覆盖缺损上缘、主动脉大量反流的患者可以采用经导管介入封堵治疗,根据缺损上缘距主动脉瓣的距离可以选择不同形状的封堵器,近期疗效可靠.     

不典型肺结核的CT诊断临床分析

目的 探讨与其他常见疾病的鉴别,以提高对该病的诊断能力.方法 收集经CT扫描的不典型结核病例30例做回顾性分析.所有病例均经穿刺活检、手术或经临床治疗证实.结果 节段性阴影8例;散在少数小结节样影6例;局灶性斑片及斑点状影5例;多发结节并空洞影5例;肺内弥漫分布的粟粒样结节影4例;肺内阴影伴有肺门淋巴结及纵隔淋巴结肿大者2例.右肺上叶9例;左上叶5例;右肺中叶3例;左肺舌叶1例;右下叶背段5例;左下叶背段2例;右肺下叶3例;左肺下叶基底段2例.结论 运用各种CT扫描和重建技术观察不典型肺结核CT影像学表现有助于诊断和鉴别诊断.     

CT三维重建心房颤动患者肺静脉前庭解剖形态学研究

目的应用CT三维重建方法描述并测量心房颤动患者肺静脉前庭的解剖形态。方法30例在三维标测技术下行肺静脉前庭线性消融术治疗心房颤动的患者,术前应用CT进行心脏扫描,三维重建后描述肺静脉解剖形态学特点并测量相关数据。结果左上肺静脉最大径(24.30±4.54)mm、最小径(17.76±4.24)mm;左下肺静脉最大径(19.10±4.45)mm、最小径(12.27±3.52)mm;右上肺静脉最大径(22.99±5.04)mm、最小径(16.19±4.87)mm;右下肺静脉最大径(18.63±4.60)mm、最小径(14.46±3.48)mm。左肺静脉间嵴:前缘(14.78±3.86)mm、中部(7.20±1.42)mm、后缘(14.94±3.82)mm;右肺静脉间嵴:前缘(15.86±5.14)mm、中部(7.91±3.35)mm、后缘(18.73±5.55)mm。左心耳与左肺静脉间嵴上缘、中部、下缘分别为(19.12±4.98)mm、(7.74±3.30)mm、(17.92±5.14)mm。结论CT三维重建图像能够真实反映肺静脉前庭的解剖结构,可作为术前了解肺静脉前庭的方法之一;肺静脉前庭结构个体差异大,术前须充分认识。     

CT指导微螺钉种植体支抗植入颧下嵴的应用

目的 评价CT指导微螺钉种植体支抗植入颧下嵴的临床应用价值.资料与方法 16例需上颌牙远中移动治疗患者,在CT指导下于颧下嵴种植微螺钉种植体支抗,对植入点和植入角度进行分析.结果 颧下嵴骨量相对丰富,可为微螺钉种植体提供最佳骨性支抗.植入点应选择在第一恒磨牙前缘前1mm与牙龈缘交点处,距离牙龈缘上方右侧(7.68±1.73) mm,左侧(7.88±2.00) mm;植入角度:右侧(38.5±11.4)°,左侧(34.5±11.6)°.左、右侧植入点与牙龈缘距离以及左、右侧植入角度差异均无统计学意义(P＞0.05).CT可客观地评估颧下嵴区骨质情况,指导临床植入.结论 颧下嵴区骨质情况可满足微螺钉种植体植入提供最佳骨性支抗;CT可个性化评估颧下嵴骨质分布情况,可确立最佳植入点和植入角度,并能指导微螺钉种植体植入.     

肺黏膜相关淋巴组织淋巴瘤的CT及PET-CT表现

目的 总结肺黏膜相关淋巴组织淋巴瘤的CT及PET-CT表现,提高对该病的认识.方法 回顾性分析21例经病理证实的肺黏膜相关淋巴组织淋巴瘤的CT及PET-CT的影像表现.结果 所有患者均行CT扫描,其中20例行增强扫描,1例平扫.病灶密度均匀,除1例可见钙化外,其余病变均未见钙化,未见明显低密度区,平扫平均CT值为(47±11)HU,增强后平均CT值为(77±13) HU.发病部位以跨叶分布为主,19例有右中叶或左舌叶病变;CT征象:多发实变15例,多发结节3例,单发肿块2例,单发结节1例(合并结节病,多发小粟粒病灶).其中病灶内支气管气相征16例,增强后病灶中出现血管造影征16例,病灶紧贴纵隔呈三角型灌注征13例.合并支气管扩张6例,有3例结节合并晕征,小叶间隔增厚9例,肺门及纵隔淋巴结增大9例,CT均显示为直径＜1.5 cm小淋巴结;胸腔积液7例,2例胸膜增厚,1例侵犯胸壁.6例行PET-CT检查,均显示病灶明显放射性浓聚,SUV值均＞2.5,为3.5～11.7,平均6.7±3.6;4例显示肺门及纵隔淋巴结有放射性浓聚,SUV值为2.7 ～3.4,平均3.0±0.3.结论 肺黏膜相关淋巴组织淋巴瘤部分病灶在CT上有较具特征性的表现,对于诊断有一定提示作用;PET-CT对于病灶活性的判断有一定优越性,最终确诊需要病理组织学和免疫组织化学.     

儿童结核性与非结核性纵隔肿大淋巴结的CT对照研究

目的:比较儿童结核性(TP)与非结核性(NTP)纵隔淋巴结的CT表现,初步探讨纵隔淋巴结肿大组数对二者的鉴别诊断价值。方法:对36例经临床或细菌学检查证实的胸膜炎患者(17例TP,19例NTP)进行CT检查。全部CT片由3位医师盲法观察,不同意见由3人讨论后决定。结果:TP的纵隔最大淋巴结短径为(13.3±4.8)mm,NTP为(4.8±4.9)mm(P<0.01)。TP病例的最大纵隔肿大淋巴结中短径最小者为7.7mm,NTP为5mm。除1例外,其余NTP病例的最大淋巴结短径均在10.7mm以下,而TP仅5例。NTP中,无1例出现3组或3组以上纵隔淋巴结肿大,而TP组有11例,占73%(P<0.01)。淋巴结环状强化或/和钙化、融合见于7例TP患者(64%、63%),NTP中无1例(P<0.05)。结论:除淋巴结环状强化、钙化和融合以外,纵隔淋巴结短径超过10.7mm及3组或3组以上纵隔淋巴结肿大均高度提示TP;反之,最大淋巴结小于7.7mm时,则提示NTP。纵隔淋巴结肿大组数是一颇有价值的新征象。     

宫颈癌(IB-IVA期)盆腔局部淋巴结转移的CT诊断

目的 探讨宫颈癌盆腔局部淋巴结转移的CT表现及诊断价值.方法 52例有完整手术病理资料的宫颈癌(IB-IVA期)患者,以结节最短直径为10 mm或边缘分叶毛刺为标准判断CT对盆腔局部区域存在淋巴结转移的诊断价值,再结合手术病理结果对CT显示的73枚淋巴结分转移组与非转移组,测量2组淋巴结最短径,判断边缘是否分叶或毛刺、强化是否均匀,比较2组结果差异.结果 CT显示转移与非转移性淋巴结大小[(9.1 ± 2.5) mm vs (7.2±3.8 mm),P<0.05]、边缘是否分叶或毛刺(70.4%vs30.4%,P<0.01)差异有统计学意义,转移性淋巴结多表现不均匀强化,但本组资料无统计学差异(59.3%vs 40.2%,P>0.05).以淋巴结最短直径为10 mm或边缘分叶毛刺判断盆腔局部区域存在淋巴结转移的敏感性为62%,特异性为94.5%,阳性预测值为60.5%,准确性为90.7%.结论 CT对判断盆腔局部存在转移性淋巴结有较高价值.     

活动性克罗恩病肠系膜淋巴结的CT 影像学研究

目的：探讨活动性克罗恩病(CD)肠系膜淋巴结的 CT 影像学特征。方法回顾性分析经内镜、病理证实的54例活动性 CD 患者的64排螺旋 CT 影像表现,重点观察肠系膜淋巴结的分布、大小、数目、形态及强化情况。结果38例(70.4%)CD 患者出现肠系膜淋巴结增大,总数为242个,其中83.5%(202/242)的淋巴结位于病变邻近肠系膜根部,16.5%(40/242)的淋巴结位于肠系膜周边部;肠系膜根部的淋巴结较周边部的淋巴结稍大,平均最大短径分别为(8.57±2.26)mm、(5.38±0.19)mm;73.6%(178/242)的淋巴结呈卵圆形;增强后淋巴结出现均匀明显强化,强化率为0.53±0.09。结论活动性 CD 常引起肠系膜淋巴结增大,以肠系膜根部淋巴结受累较为明显。     

隆突下淋巴结增大:X 线表现和 CT 关系

隆突下间隙的上界为气管隆突,右侧为右主支气管和中间支气管,左侧为左主支气管和左下叶纵隔胸膜,前方为升主动脉和右肺动脉,后方为食管。隆突下淋巴结增大较难由平片显示,但易由CT 发现。作者复习了60例正常及30例隆突下淋巴结增大的胸部平片与CT 检查。见到,CT 显示正常的60例中,隆突下淋巴结小于或等于15mm。胸部平片,奇静脉食管隐凹显示正常45例,未显示14     

How I Manage Heel Spur Syndrome

In brief: Plantar fasciitis and heel spurs are two contributing causes of heel spur syndrome and sometimes cannot be differentiated from one another. In any case, the syndrome is caused by trauma to the heel and is often accompanied by severe pain. Treatment methods include rest, anti-inflammatory medication, and various types of shoe padding. Cortisone may be injected into the heel if symptoms continue, and surgery may be necessary if conservative treatment is unsuccessful.     

Low-Dose Radiotherapy for Painful Heel Spur

PURPOSE: Retrospective analysis of 117 patients treated between 1996 and 2000 with low-dose radiotherapy (RT) for painful heel spurs. PATIENTS AND METHODS: 71 women and 46 men were irradiated on 136 painful heel spurs in one (n = 104) or two radiation series (n = 13). The painful spurs were located either at the plantar (n = 94), dorsal (n = 5) or bilateral heel (n = 18). 82 patients had prior treatments, in 35 patients RT was the primary treatment. Low-dose RT was performed twice a week with one 6-MV photon field. Ten fractions of 0.5 Gy were applied to a total dose of 5 Gy. Evaluation was done on completion and during follow-up using the four-scale von Pannewitz score. RESULTS: On completion of RT, 27 patients were free of pain, 40 were much improved, 31 reported slight improvement, and 19 experienced no change. After a mean follow-up of 20 months, 75 out of 100 patients were free of pain, twelve had marked and three some improvement. Ten patients reported no change of symptoms. Mean duration of pain before RT was 6 months. RT applied < or = 6 months after the onset of clinical symptoms resulted in improvement in 94%. By contrast, an interval of > 6 months until the initiation of RT resulted in only 73% of patients with clinical improvement. CONCLUSION: Low-dose RT reveals a benefit in > 80% of the patients. RT should start during the first 6 months of symptoms. Prospective clinical studies with validated symptom scores should be conducted to assess optimal dose and fractionation scheme of RT.     

颞叶癫痫的MRI研究

研究颞叶癫痫患者的ＭＲＩ表现，并测量ＴＬＥ患者海马结构的体积以确定癫痫灶的侧别。在１．０ＴＭＲ机对３８例ＴＬＥ患者进行研究，用正中矢状面定位，作平行于脑干的倾斜冠状面Ｔ１和Ｔ２加权像。在所有的倾斜冠状面Ｔ１加权像上手工描出ＨＰＦ的边界，把所有层在的体积相加即得到ＨＰＦ的体积，并进行标准处理以消除头颅大小的影响。     

MRI在颞叶癫痫的应用

颞叶癫痫(temporal lobe epilepsy,TLE)占顽固性癫痫的 70%～80%.常见病因有海马硬化(hippocampal sclerosis,HS)、皮质发育不良(malformation of cortical development,MCD)、脑肿瘤、脑血管病等,病理证实海马硬化同时可合并颞叶其他部分的病变,即双重病变(dual pathology,DP),其中海马硬化合并MCD最常见.手术切除致痫灶对TLE患者有良好的治疗效果.目前公认常规MRI检测TLE器质性病变最敏感、最有价值,然而事实上只有20%～30%的TLE患者MRI可见器质性病变.随着MRI技术的飞速发展,功能MRI的出现为TLE(特别是常规MRI阴性的TLE)潜在病因、病理及诊断、治疗研究开辟了更广阔的天地.本文就MRI的形态及功能成像在TLE中的应用展开综述.     

颞叶癫痫的MRI研究

目的：探讨颞叶癫痫的ＭＲＩ 表现及其诊断价值。材料和方法：对临床诊断为颞叶癫痫４３ 例患者,行自旋回波横断面、冠状面和矢状面ＭＲＩ 研究。结果：４３ 例中,３５ 例颞叶发现有异常ＭＲ 信号,并经手术病理证实。８ 例颞叶无异常发现。术前ＭＲＩ 定位诊断正确率为１００ ％ ,定性诊断正确率为８２ ．９ ％ 。３５ 例中,９ 例胶质细胞增生,Ｔ１ ＷＩ上无明显信号异常,Ｔ２ 加权图像上呈无占位效应的高信号;１５ 例胶质瘤, 表现为病灶呈长Ｔ１ 长Ｔ２ 信号, 并伴有不同程度的占位效应,灶周水肿不明显;７ 例胆脂瘤,表现为Ｔ１ ＷＩ 上呈高于脑脊液的低信号,Ｔ２ ＷＩ 上均呈高于脑脊液的高信号;４ 例海绵状血管瘤,Ｔ１ ＷＩ 上呈等高混合信号,Ｔ２ ＷＩ 上呈明显高信号,周边有低信号环与脑实质相隔。结论：ＭＲＩ 对确定颞叶癫痫病灶的部位和病因具有重要价值。     

正常成年人额叶代谢物水平及其影响因素的MRS分析研究

目的:探讨正常中国人额叶灰质和白质内代谢物含量的正常范围和影响代谢物浓度的因素.材料和方法:对46位健康被试进行1H MRS研究,检测NAA、Cre和Cho在额叶灰质和白质的浓度,对NAA/Cho、NAA/Cre、NAA/H2O、Cho/H2O和Cre/H2O等比值进行定量分析.结果:青年组和中年组的额叶白质的NAA含量有显著差异(P<0.05).结论:年龄是影响额叶白质区域NAA含量的重要因素,随着年龄的增大,NAA含量会逐渐下降,性别和半球偏侧化对额叶代谢物浓度没有影响.     

急性颞顶叶局灶性脑梗死后胼胝体DTI变化的初步研究

目的探讨一侧颞顶叶急性脑梗死梗死灶面积与胼胝体不同区域各向异性之间可能存在的变化。资料与方法连续采集病灶位于一侧颞叶、顶叶或一侧颞叶、顶叶均有病灶的急性脑梗死患者资料66例,男38例,女28例。年龄40～85岁,其中40～49岁10例,50～59岁18例,60～69岁20例,70岁以上18例。病灶面积≤200mm2者44例,>200 mm2者22例(剔除)。选取同期连续采集获得的与病变组44例匹配的正常成人作为对照分析组。病变组及正常组均行正中矢状位25梯度方向扩散张量成像(DTI)扫描,在正中矢状位部分各向异性(FA)图上分别测量胼胝体膝部、体部前1/3处、体部中部、体部后1/3处及压部的FA值,测量值进行统计分析。结果在胼胝体体部前1/3处、体部中部及体部后1/3处的FA值均为正常组大于病变组,其中体部前1/3处及体部后1/3处正常组与病变组之间差异存在统计学意义(t=2.838,P<0.05;t=8.223,P<0.05)。病变组胼胝体膝部及压部FA值均大于正常组,两组之间差异均有统计学意义(t=-3.428,P<0.05;t=-2.392,P<0.05)。结论颞顶部发生面积≤200 mm2的急性梗死时...     

Time-Shift Homotopic Connectivity in Mesial Temporal Lobe Epilepsy

BACKGROUND AND PURPOSE:Voxel-mirrored intrinsic functional connectivity allows the depiction of interhemispheric homotopic connections in the human brain, whereas time-shift intrinsic functional connectivity allows the detection of the extent of brain injury by measuring hemodynamic properties. We combined time-shift voxel-mirrored homotopic connectivity analyses to investigate the alterations in homotopic connectivity in mesial temporal lobe epilepsy and assessed the value of applying this approach to epilepsy lateralization and the prediction of surgical outcomes in mesial temporal lobe epilepsy.MATERIALS AND METHODS:Resting-state functional MR imaging data were acquired from patients with unilateral mesial temporal lobe epilepsy (n = 62) (31 left- and 31 right-side) and healthy controls (n = 33). Dynamic interhemispheric homotopic architecture seeding from each hemisphere was individually calculated by 0, 1, 2, and 3 repetition time time-shift voxel-mirrored homotopic connectivity. Voxel-mirrored homotopic connectivity maps were compared between the patient and control groups by using 1-way ANOVA for each time-shift condition, separately. Group comparisons were further performed on the laterality of voxel-mirrored homotopic connectivity in each time-shift condition. Finally, we correlated the interhemispheric homotopic connection to the surgical outcomes in a portion of the patients (n = 20).RESULTS:The patients with mesial temporal lobe epilepsy showed decreased homotopic connectivity in the mesial temporal structures, temporal pole, and striatum. Alterations of the bihemispheric homotopic connectivity were lateralized along with delays in the time-shift in mesial temporal lobe epilepsy. The patients with unsuccessful surgical outcomes presented larger interhemispheric voxel-mirrored homotopic connectivity differences.CONCLUSIONS:This study showed whole patterns of dynamic alterations of interhemispheric homotopic connectivity in mesial temporal lobe epilepsy, extending the knowledge of abnormalities in interhemispheric connectivity in this condition. Time-shift voxel-mirrored homotopic connectivity has the potential for lateralization of unilateral mesial temporal lobe epilepsy and may have the capability of predicting surgical outcomes in this condition.

Interhemispheric communication and coordination facilitate information processing in the human brain.^1,2 Thus homotopic connections represent a fundamental characteristic of brain anatomy and function^3,4 and have been considered an important indicator for depicting the physiologic and pathologic features of the brain. On the basis of resting-state functional MR imaging measurements, an approach based on voxel-mirrored homotopic connectivity (VMHC) quantifies the interhemispheric homotopic connections by measuring the functional connectivity between each voxel in 1 hemisphere and its mirrored counterpart.⁵ Zuo et al⁵ found age-related increases in interhemispheric functional connectivity in the primary sensorimotor areas and decreases in the higher order processing areas, which provided insight into the evolution of brain development. Studies have also revealed specific alterations of homotopic connection in a cohort of brain diseases.^6–8 Decreased VMHC in schizophrenia has been suggested to reflect the substantial impairment of interhemiespheric coordination in these patients.⁶ Anderson et al⁷ found homotopic connectivity alterations related to behavioral and developmental abnormalities in autism.⁷ More recently, studies have further correlated functional homotopic connectivity with microstructural impairment in multiple sclerosis⁸ and idiopathic generalized epilepsy.⁹In contrast to the brain disorders featuring abnormal connection pathways as mentioned above,^6,8 mesial temporal lobe epilepsy (mTLE) is a location-related disease characterized by hippocampal sclerosis.¹⁰ Unilateral mTLE can cause bilateral and distributed brain impairments due to seizure propagation via the mesial temporal epileptic network.^11–13 Resting-state fMRI studies have shown asymmetric connections between bihemispheres^14–16 and decreased connectivity between bilateral hippocampi in mTLE.^17,18 These findings suggest that there are intra- and interhemispheric connection abnormalities in unilateral mTLE. However, neither the homotopic alterations of whole-brain functional connectivity nor the relationship between asymmetric lesions and interhemispheric communication in this disease has been investigated.fMRI-based VMHC provides a feasible way to observe the whole-brain homotopic connectivity alterations in mTLE. However, the conventional nondirectional functional connectivity measure, as used in VMHC, cannot detect the connection abnormalities resulting from deficits of the seed or target region. Recently, Lv et al¹⁹ proposed a time-shift (ts) analysis for resting-state functional connectivity. They quantified the temporal shift correlation between time courses of each voxel and global mean signal¹⁹ and correlated the time shifts with the extent and degree of perfusion delay in patients with stroke.^19,20 In addition, our previous study used time-shift correlation analysis to demonstrate the sequential effects of epileptic discharges on intrinsic network connectivity in children with absence epilepsy.²¹ Thus, time-shift delays in resting-state spontaneous connectivity were assumed to reflect brain hemodynamics and could measure the degree of brain injury; time-shift analysis also provides directional information as a measure of functional connectivity.²¹ In the current work, we combined the time-shift connectivity with the VMHC technique and applied them to resting-state fMRI data from patients with unilateral mTLE. We hypothesized that this strategy would allow us to assess the whole-brain homotopic connection impairments resulting from different hemispheres and may potentially be a tool for epileptic focus lateralization and surgical outcome prediction in mTLE.     

海马、杏仁核和前颞叶体积测量对颞叶癫痫定侧诊断价值的研究

研究海马、杏仁核和前颞叶体积测量对颞叶癫痫定侧诊断价值。材料和方法：以50例海马硬化患者和30例健康志愿者为研究对象，分别测量双侧海马、杏仁核和前颞叶的体积，井根据颅内容积大小行标化处理。以正常组体积的平均值减2倍标准差作为正常下限值来判断异常，定侧诊断以双侧体积差值为标准。结果：50例海马硬化患者中，病侧海马绝对体积小于正常的占66％，其中双侧海马萎缩的占总数的20％。病侧杏仁核和前颞叶体积小于正常的各占1O％。双侧海马体积差值(DHF)准确定侧的占68％，双侧杏仁核体积差值(DAM)和双侧前颞叶体积差值（DATL）确定侧的各占8％和l2％。将海马绝对体积和DHF相结合定侧诊断率为76％。结论：MRI体积测量对颞叶癫痫具有重要定侧诊断价值，将海马绝对体积与DHF相结合可提高定侧诊断率。杏仁核和前颞叶体积测量不具有定侧诊断价值。     

症状性枕叶癫痫影像学诊断分析

目的 分析症状性枕叶癫痫的病变类型,总结各种病变的影像学表现特征.方法 回顾分析37例均经临床、病理或典型影像学表现证实的症状性枕叶癫痫患者的临床和CT、MRI、MRS和SPECT检查资料.结果 37例患者枕叶病变分别为枕叶脑皮质发育不良4例、灰质异位4例、脑裂畸形3例、脑软化灶及瘢痕10例,枕叶钙化3例,动静脉畸形3例,海绵状血管瘤1例、星形细胞瘤2例、脑膜瘤1例、炎性肉芽肿2例、脑脓肿1例,线粒体脑肌病2例、Sturge-Weber综合征1例.结论 症状性枕叶癫痫病变种类复杂多样,影像检查对致痫灶的定位定性诊断具有重要价值.