能谱CT对肾结石原子序数和CT值在体外震波碎石术的临床应用

目的探讨体外震波碎石术术前能谱CT体内所测成分与碎石难易程度的相关性。方法选择我院肾结石患者600例,根据术前是否接受能谱CT检测肾结石的原子序数和成分而将患者分为对照组和观察组。记录肾结石的平均原子序数、平均CT值、平均治疗次数。结果对照组研究对象肾结石的平均原子序数、平均CT值、平均治疗次数、平均冲击次数和平均碎石时间均显著大于观察组(P 0. 05);尿酸结石、磷酸镁铵结石、胱氨酸结石、磷酸钙结石和草酸钙结石的平均治疗次数、平均冲击次数、平均碎石时间、平均原子序数、平均CT值均具有显著性差异(P 0. 05)。结论能谱CT所测肾结石的成分和碎石的难易程度之间具有紧密的相关性,能谱CT扫描可提高治疗效果。     

Revolution能谱CT虚拟平扫在不同成分尿路结石检出中的应用价值

目的:探讨Revolution能谱CT虚拟平扫在不同成分尿路结石检出中的应用价值.方法:收集4种常见类型的尿路结石患者54例(共289个结石),包括一水草酸钙结石21例(97个结石),二水草酸钙结石11例(68个结石),碳酸磷灰石结石13例(90个结石),尿酸结石9例(34个结石).所有患者术前均先行常规CT平扫,然后...     

CT能谱成像对肾结石成分分析的初步研究

目的 探讨能谱CT在体外区分肾结石成分的价值.方法 168枚经外科手术取出的肾结石,分别置于猪肾中.行能谱扫描( GSI)及常规120 kVp扫描.测量计算GSI图像上结石的有效原子序数(Zeff)、钙水比值(CWR)、能谱衰减曲线斜率、50 keV单能量CT值及120 kVp混合能量CT值,并采用方差分析或秩和检验比较各组结石上述指标的差异.分别采用红外光谱分析仪测定其成分,成分单一的结石108枚,其中尿酸类结石组13枚、鸟粪石结石组24枚、胱氨酸结石组14枚、磷酸钙结石组18枚、草酸钙结石组39枚.结果 5组结石的Zeff、CWR、50 keV单能量CT值、120 kVp混合能量CT值及能谱衰减曲线斜率分别为:尿酸类结石组为7.4±0.4、0.0085±0.0021、(503±168) HU、(495±106) HU、-0.77、鸟粪石结石组为11.8±0.9、0.1743±0.0677、(1056±290) HU、(799±165) HU、18.72,胱氨酸结石组为11.2±0.6、0.1253±0.0297、(740±172)HU、(565±129) HU、12.79,磷酸钙结石组为16.0±0.4、0.6781±0.0952、(2567±178) HU、(1602±200) HU、37.14,草酸钙结石组为15.4 ±0.4、0.5683±0.0759、( 2267±385) HU、( 1489±284) HU、36.36,组间差异均有统计学意义(P值均＜0.01).组内两两比较,有效原子序数、钙水比值及50 keV单能量CT值差异均有统计学意义(P值均＜0.05).结论 能谱CT成像为区分肾结石成分提供了新的方法,有效原子序数、钙水比值及50 keV单能量CT值,3个指标均可以明显区分尿酸类、鸟粪石类、胱氨酸、磷酸钙类及草酸钙类结石.     

双源双能CT在尿路结石成分分析中的应用

目的:探讨双源CT双能量技术应用于尿路结石成分分析中的临床价值。方法:226例尿路结石患者行双源CT双能量扫描,对其结石成分进行分析,将结果与用红外光谱法分析结石成分的结果作对比,计算双源CT在体分析草酸钙结石、磷酸盐结石、胱氨酸结石及尿酸结石的灵敏度与特异度。结果:双源CT能够准确的区分尿酸结石和非尿酸结石(灵敏度和特异度均为100%),较准确的区分草酸钙结石(灵敏度为89.03%、特异度为85.62%),磷酸盐结石(灵敏度为67.28%、特异度为90.71%)及胱氨酸结石(灵敏度为73.56%、特异度为93.43%)。结论:双源CT双能量技术能在治疗前对尿路结石的成分进行初步分析,对了解结石成因,预防结石形成及指导治疗具有重要的意义。     

Dual source dual energy CT in the analysis of urinary calculi composition

目的:探讨双源CT双能量技术应用于尿路结石成分分析中的临床价值.方法:226例尿路结石患者行双源CT双能量扫描,对其结石成分进行分析,将结果与用红外光谱法分析结石成分的结果作对比,计算双源CT在体分析草酸钙结石、磷酸盐结石、胱氨酸结石及尿酸结石的灵敏度与特异度.结果:双源CT能够准确的区分尿酸结石和非尿酸结石(灵敏度和特异度均为100％),较准确的区分草酸钙结石(灵敏度为89.03％、特异度为85.62％),磷酸盐结石(灵敏度为67.28％、特异度为90.71％)及胱氨酸结石(灵敏度为73.56％、特异度为93.43％).结论:双源CT双能量技术能在治疗前对尿路结石的成分进行初步分析,对了解结石成因,预防结石形成及指导治疗具有重要的意义.     

能谱CT扫描钙基图及水基图区分泌尿系结石成分的初步实验研究

目的 探讨能谱CT扫描钙基图及水基图区分体外不同成分泌尿系结石的价值.方法 已知单一成分(尿酸结石8枚,六水磷酸铵镁结石10枚,胱氨酸结石6枚,碳酸磷灰石结石18枚,一水草酸钙结石24枚)的66枚肾结石,分别置于猪肾中,每肾上、下肾盏及肾盂各放2枚结石,并将其浸入水箱中,采用GE能谱CT行GSI(gemstone spectral imaging)扫描,测量GSI图像的钙基图值与水基图值,并采用方差分析比较各组间结石钙基图值与水基图值的差异.上述结石分别采用红外光谱分析仪测定其成分.结果 经统计学处理,钙基图及水基图中测量值差异有统计学意义(F值为304.327,67.407,P值均=0.000).组间两两比较,水基图上六水磷酸铵镁结石与胱氨酸结石(P=0.063)、一水草酸钙结石与碳酸磷灰石(P=0.347)无统计学差异,其余各组结石间钙基图及水基图测量值均有统计学意义(P<0.05).结论 能谱CT扫描水基图可以区分出尿酸类结石与非尿酸类结石.钙基图可以区分出尿酸结石、六水磷酸铵镁结石、胱氨酸结石、一水草酸钙及碳酸磷灰石.     

一水草酸钙结石的碎石脆性研究

 目的 探讨CT在预测一水草酸钙结石(COM)的碎石脆性中的价值.方法 选择50例开放手术取出的、经红外光谱法证实的COM标本行体外冲击波碎石,患者术前均行CT扫描结石,观察其结构特征并采用双盲法对其进行结构异质性分类,同时测量CT值,最后对COM的结构特征、CT值与碎石次数进行相关性分析.结果 对COM进行结构异质性分类有高度可重复性(K=0.83),同质COM所需碎石冲击次数为(1 883±813)次,异质COM所需碎石冲击次数为(908±527)次,同质COM较异质COM所需碎石冲击次数更多(P＜0.05),而CT值与COM的碎石脆性无相关性(P =0.82).结论 一水草酸钙结石的碎石脆性是由其结构决定的,与其CT值无相关性.     

CT值与上尿路结石气压弹道碎石易碎生关系初探

目的 探讨非增强螺旋CT值与上尿路结石气压弹道碎石(PL)易碎性的关系,为临床上选择合理的治疗方法提供更多依据.方法 93例行PL治疗的上尿路结石患者,按结石PL次数分成A、B、C 3组.将3组的平均CT值分别进行比较分析.结果 A、B、C 3组间的平均CT值差异均有统计学意义(F=3.271,P=0.000).结论 术前患者上尿路结石的平均CT值可以估计碎石的难易程度.在选择治疗方案和时机时要综合分析结石部位、数量、医师操作水平、设备性能、患者耐受性等因素.在结石易碎性因素上,建议对于CT值＜900 HU且结石大小适宜(最大直径＜2 cm)者首选PL治疗,而CT值＞1200HU且体积较大(最大直径＞2.5 cm)或超过4枚的多发结石者应选择手术取石.     

甲状腺结节内出血的能谱CT特征

目的:通过分析甲状腺结节内出血的能谱CT表现,探讨甲状腺结节内出血的能谱CT特征,并进一步讨论其价值以及甲状腺结节内出血的能谱成像原理。方法:收集18例病灶内发生出血新鲜甲状腺结节手术标本以及12例在体甲状腺结节内出血的患者进行能谱CT扫描。通过GSI-viewer软件进行图像分析,分析的参数包括:①在碘和水基物质图像上同时测量出血、病灶实性成分及周围甲状腺组织的碘和水的密度数据;②在能谱图像上(40keV到140keV)获得出血、病灶实性成分及周围甲状腺组织的CT能谱曲线,并计算各个感兴趣区的CT能谱曲线的斜率,斜率计算方法为:取40keV及100keV两点连线,与横坐标轴的角度计算,即斜率=(HU40keV-HU100keV)/60;③在有效原子序数图像上测量并分析出血、病灶实性成分及周围甲状腺组织的有效原子序数;④在65keV图像上测量并分析出血、病灶实性成分及周围甲状腺组织的CT值。结果:①病理结果:本组离体及在体的病灶中,离体组标本中其中14个结节为腺瘤伴出血,4例为结节性甲状腺肿伴出血,而在体组甲状腺结节中8例为腺瘤伴出血,4例为结节性甲状腺肿伴出血。②统计分析:经检验在体组和离体组结节内出血、病灶实性成分及周围甲状腺组织(背景)的碘浓度、水浓度、能谱曲线斜率、有效原子序数及CT值差异均无统计学意义(P>0.05),在体组和离体组病灶内出血与背景、出血与病灶实性成分的碘浓度、水浓度、有效原子序数及能谱曲线斜率差异有明显统计学意义,而在CT值的比较中,在体组及标本组的出血与实性、出血与背景的差异无明显统计学意义,将两组合并分析,出血与病灶实性成分的CT值差异无明显统计学意义。结论:甲状腺结节内的出血在能谱CT上具有特征性表现,表现为低碘含量、高水含量、低有效原子序数及低CT能谱曲线斜率。     

不同管电压CT扫描对泌尿系结石成分分析的价值探讨

目的:探讨CT不同管电压扫描对泌尿系结石成分分析的价值。方法:收集泌尿系结石153例,采用不同管电压(80、120、140 kV)对结石进行扫描,术后取得结石标本,经红外光谱分析结石成分。分析不同结石成分的平均CT值,并统计相同kV下不同结石成分的差异。结果:153例术后97例取得结石标本,包括83例纯结石,14例混合结石。83例纯结石包括55例草酸钙结石(66.27%),13例羟基磷灰石结石(15.66%),9例尿酸结石(10.84%),4例胱氨酸结石(4.82%),2例磷酸镁铵结石(2.41%)。不同成分结石的平均CT值随kV值的增加而逐渐减低;相同kV下,CT值从高到低依次为草酸钙结石、羟基磷灰石结石、胱氨酸结石、尿酸结石。不同种类结石在相同kV下(80、120、140 kV)CT值差异均有统计学意义(均P0.05)。80及120 kV下草酸钙结石和羟基磷灰石结石差异均无统计学意义(均P 0.05),与尿酸和胱氨酸结石差异有统计学意义;胱氨酸结石、尿酸结石在80及140 kV下的CT值差异均无统计学意义(均P 0.05)。结论:通过CT值可对泌尿系结石成分进行分析,准确性较高,对临床治疗及预后具有重要价值。     

能谱 CT 多模态参数对胃腺癌转移性淋巴结的诊断价值

目的：比较能谱 CT 多模态参数与传统 CT 征象对胃腺癌转移淋巴结的诊断价值。方法对37例胃腺癌患者采用腹部宝石 CT 能谱成像(GSI)增强模式扫描,进行 CT 图像分析,定位、标记胃周淋巴结,术中摘除相应淋巴结并送病理。运用受试者工作特征曲线(ROC)得出鉴别转移淋巴结各能谱 CT 定量指标的准确度及特异度,并与 CT 征象相比,评价其诊断效能。结果动脉期转移组淋巴结40~80 keV 单能量节段能谱曲线斜率(λHU )、标化碘基物质浓度(NIC)均低于非转移组,差异均有统计学意义(P <0.05);而静脉期无差异。动脉期λHU 和 NIC 联合诊断的效能较 CT 征象更具显著优势(P 均<0.01)：敏感度84.3% vs 61.4%、特异度88.4% vs 81.3%、准确度86.8% vs 73.6%。结论能谱 CT 为鉴别诊断胃腺癌转移与非转移淋巴结提供定量分析,能够明显提高诊断胃腺癌淋巴结转移的准确度。     

能谱CT鉴别鼻腔鼻窦良恶性肿物的研究

目的探讨双源CT最佳单能量CT值及能谱曲线斜率对鼻腔鼻窦良恶性肿物的鉴别诊断价值。方法搜集60例经病理证实且直径≥1 cm的鼻腔鼻窦肿物,术前均行常规CT平扫及双能量CT双期增强扫描。根据病变的常规形态学表现判断良恶性。测量病灶实性部分的最佳CNR单能量CT值(CTose)及能谱曲线斜率(K),另测量双期融合图像病灶实性部分的CT值。根据病理结果分为良性组(34例)和恶性组(26例),评价常规形态学分析的诊断效能。比较良性组与恶性组病灶CTose值、K值、CT值,并绘制各参数的ROC曲线,比较曲线下面积(AUC),评估其诊断效能。结果常规形态学诊断的敏感性、特异性及准确性分别为61.5%、88.2%、76.7%。动脉期:良性组的CTose值、K值、CT值分别为61.91±25.62、0.92±0.69、56.56±16.67,恶性组分别为80.16±16.07、1.97±1.18、67.85±11.41;静脉期:良性组的各参数分别为68.25±26.60、1.26±0.78、62.57±19.98,恶性组分别为95.31±16.72、2.50±0.95、79.08±12.61;双期恶性组3参数均高于良性组(P值均<0.05)。动脉期病灶CTose值、K值、CT值的AUC分别为0.813、0.883、0.736,静脉期分别为0.841、0.885、0.777;其中静脉期病灶K值的AUC最大(0.885),以K=1.77为诊断阈值,其诊断敏感性、特异性及准确性分别为88.5%、88.2%、88.3%。结论双源CT的最佳单能量CT值及能谱曲线斜率可更准确地反映病变血供情况及组织差异,有助于鼻腔鼻窦良恶性肿物的鉴别诊断。     

Three-dimensional CT imaging of flexor tendon ruptures in the hand and wrist

OBJECTIVE: The purpose of this study is to determine the applicability of 3D CT imaging in the evaluation of flexor tendon rupture in the hand and wrist. DESIGN: Twenty-four digits in 22 patients (18 adults, 4 children) with a spectrum of finger flexion disturbances were investigated by a multidetector-row CT scanner, and diagnosed by 3D CT image with the volume rendering technique. The accuracy of the image diagnosis was confirmed operatively in 20 digits. RESULTS: 3D CT imaging gave a precise analysis in all adult cases. It clearly depicted the location of rupture and tendon stump. All of the 12 digits diagnosed from the images as tendon rupture were operated on, and the operational finding correlated well with the diagnosis based on the image. In the children, the image analysis was equivocal. CONCLUSIONS: 3D CT imaging can be useful when the diagnosis of flexor tendon rupture cannot be made based on trauma history and clinical examinations, and can be helpful in surgical planning.     

Cholelithiasis: evaluation with CT

Computed tomography (CT) is often the first imaging modality used in the diagnosis of patients with suspected abdominal disease. While it is known that early generation CT scanners often detect gallstones, the detection rate of newer equipment is not widely known. Abdominal CT scans of 226 patients who had undergone ultrasonographic (US) studies of the gallbladder were reviewed in a blinded study to determine the accuracy of state-of-the-art CT scanning equipment in the detection of cholelithiasis. Of 110 patients with US or surgical evidence of cholelithiasis, gallstones were demonstrated on CT images of 87 (79.1% sensitivity). Overall accuracy was 89.8%, while specificity was 100%. On CT images stones could appear densely (48.3%) or slightly (11.5%) calcified, as an area with a rim of increased density (21.8%), as an area of soft-tissue density (14.9%), or as an area of low density (3.4%). Stone size, stone density, section incrementation, and the pericholecystic anatomy affected the detection rate. Understanding the spectrum of findings and the other factors involved can optimize success of diagnosis of cholelithiasis on the basis of CT examinations.     

肺部肿块性病变的能谱CT诊断价值

目的:探讨能谱CT成像对肺部肿块性病变的诊断与鉴别诊断价值。方法:回顾性分析59例肺部肿块患者的临床及影像资料,其中良性肿块22例,恶性37例。患者均行能谱CT扫描,得到动脉期和静脉期能谱曲线40~140keV区间能量水平的CT值及碘基图、水基图,并行数据分析。结果:动脉期和静脉期40~140keV能量水平CT值中,40~80keV区间的CT值良性肿块组均低于恶性肿块组,单能量越低时CT值差别越大;动脉期和静脉期碘基图上良性肿块组的碘浓度均低于恶性肿块组,差异有统计学意义(P0.05);动脉期和静脉期良性肿块组和恶性肿块组的水基值相比,差异无统计学意义(P0.05)。结论:不同性质肺部肿块在能谱成像上碘含量不同,可用以初步区分肺部良性和恶性肿块病变。     

能谱CT在儿童腹盆腔成熟及未成熟畸胎瘤定量及定性诊断中的应用价值

目的 探讨能谱CT物质定量参数及能谱曲线对儿童腹盆腔的成熟与未成熟畸胎瘤定量及定性诊断价值。 方法 回顾性选取经手术病理确诊为腹盆腔畸胎瘤的患儿20例,男2例,女18例,平均年龄（7.6±6.4）岁。均于术前1~2周内进行能谱CT检查,根据畸胎瘤术后病理结果将患儿分为成熟型组（12例）和未成熟型组（8例）。所有患儿经能谱CT检查所得影像数据应用GSI综合分析平台生成动、静脉期碘（水）浓度图,通过选定ROI分别测量2组病变120 kV混合能量影像CT值、40 keV和100 keV单能量影像CT值、有效原子序数以及碘浓度（IC）值,计算标准化碘浓度（NIC）值。2组的临床资料、常规CT特征及能谱CT参数比较采用t检验和Fisher确切概率检验。采用受试者操作特征（ROC）曲线分析能谱CT参数的诊断效能。 结果 成熟型畸胎瘤的直径大于未成熟型,且成熟型畸胎瘤的形态更规则（10/12例）,脂肪（12/12例）和钙化（12/12例）更多见（均P<0.05）,2组患儿年龄、性别以及病变边界和强化形式的差异均无统计学意义（均P>0.05）。未成熟型组的40 keV和100 keV单能量影像CT值、NIC值及有效原子序数均高于成熟型组（均P<0.05）。120 kV混合能量影像CT值以及IC值差异均无统计学意义（均P>0.05）。动、静脉期能谱CT各参数中NIC值的AUC值均最大,分别为0.914和0.891。2组病变能谱曲线斜率图走行均呈下降趋势,成熟型组曲线位置低于未成熟组,在低能量区间（40~70 keV）未成熟组斜率K值大于成熟组。 结论 能谱CT物质定量测量技术和能谱曲线分析图在定量和定性诊断儿童腹盆腔畸胎瘤成熟度方面具有重要辅助价值。     

Comparison of hydro-US and spiral CT in the staging of gastric cancer.

The purpose of this study was to compare the diagnostic accuracy of hydro-ultrasonography (US) and spiral computed tomography (CT) in the staging of gastric cancer. Forty-three patients with gastric cancers confirmed at surgery underwent hydro-US and spiral CT on the same day prospectively. Hydro-US and spiral CT were done after ingestion of water. US and CT images were independently analyzed. After surgery, pathological findings according to TNM classification were compared with US and CT findings. The detection rate for T1 tumors was 75% (12/16), and all T2-T4 tumors were detected (27/27). In the T class, good correlation with pathology occurred in 55.8% of cases for US and 58.1% for CT, and there was no difference in staging accuracy between US and CT (P=.7667). Overstaging occurred in 14% for US and CT. Understaging occurred in 30.2% for US and 27.9% for CT. In the N class, good correlation with pathology occurred in 60.5% for US and 55.8% for CT, and there was no difference in staging accuracy between US and CT (P=.0949). Overstaging occurred in 4.7% for US and 18.6% for CT, and understaging occurred in 34.9% and 25.6%, respectively. The diagnostic accuracy of hydro-US and spiral CT in the staging of gastric cancer was between 55.8% and 60.5%, and there was no significant difference in staging accuracy between hydro-US and spiral CT, except for a tendency to overstaging by CT and understaging by US in the N class (P<.05).     

A computer simulation method for low-dose CT images by use of real high-dose images: a phantom study

Practical simulations of low-dose CT images have a possibility of being helpful means for optimization of the CT exposure dose. Because current methods reported by several researchers are limited to specific vendor platforms and generally rely on raw sinogram data that are difficult to access, we have developed a new computerized scheme for producing simulated low-dose CT images from real high-dose images without use of raw sinogram data or of a particular phantom. Our computerized scheme for low-dose CT simulation was based on the addition of a simulated noise image to a real high-dose CT image reconstructed by the filtered back-projection algorithm. First, a sinogram was generated from the forward projection of a high-dose CT image. Then, an additional noise sinogram resulting from use of a reduced exposure dose was estimated from a predetermined noise model. Finally, a noise CT image was reconstructed with a predetermined filter and was added to the real high-dose CT image to create a simulated low-dose CT image. The noise power spectrum and modulation transfer function of the simulated low-dose images were very close to those of the real low-dose images. In order to confirm the feasibility of our method, we applied this method to clinical cases which were examined with the high dose initially and then followed with a low-dose CT. In conclusion, our proposed method could simulate the low-dose CT images from their real high-dose images with sufficient accuracy and could be used for determining the optimal dose setting for various clinical CT examinations.     

临近胸膜周围型肺癌的CT表现

目的:探讨临近胸膜周围型肺癌的CT征象,提高对临近胸膜周围型肺癌的诊断符合率。方法:对43例经病理证实的临近胸膜周围型肺癌患者的CT征象进行分析。结果:15例结节型临近胸膜周围型肺癌具有典型的周围型肺癌的CT表现,23例实变型临近胸膜周围型肺癌以临近胸膜实变影、胸膜改变、纤维条索聚集及肺大泡为主要CT征象,5例渗出型临近胸膜周围型肺癌表现为炎症CT征象。结论:全面分析CT征象可提高结节型与实变型临近胸膜周围型肺癌的诊断符合率,渗出型临近胸膜周围型肺癌应进行动态观察提高诊断符合率。     

CT灌注和X线摄影在乳腺疾病诊断中的价值

目的：探讨CT灌注和X线摄影对乳腺疾病的诊断价值。方法：45例乳腺病变均行X线摄影和CT灌注检查,并与病理结果进行对比分析。结果：X线摄影、CT灌注诊断符合率分别为77.28%和88.89%,综合X线摄影和CT灌注诊断符合率为95.56%,三者之间差异有统计学意义（P〈0.05）。在CT灌注中,乳腺恶性病变的血流量（BF）、血容量（BV）和表面通透性（PS）的均值均明显高于良性病变（P〈0.05）。CT灌注对病变范围、乳腺癌坏死灶的判别优于X线摄影（P〈0.05）。X线摄影对钙化灶的定性诊断优于CT灌注（P〈0.05）。结论：X线摄影和CT灌注具有互补性,两者结合可提高乳腺癌诊断符合率。