周围型小肺癌CT诊断--附36例分析

目的　在普通CT机薄层扫描图像中研究小肺癌的CT征象。方法　采用病灶 3mm憋气扫描法 ,对 3 6例得到病理证实的小肺癌进行CT征象分析。结果　周围型小肺癌的CT征象有 :分叶征 ,占 91.6% ;边缘毛刺征 ,占 77.8% ;空泡征 ,占 5 0 % ;胸膜凹陷征 ,占 88.9% ;蜂窝征 ,占 11.1% ;病灶胸膜侧放射影 ,占 11.1% ;空洞 ,占 2 .7% ;血管集束征 ,占 66.7%。结论　在周围型小肺癌的诊断上 ,可将CT征象分为基本CT征象和次要CT征象。其基本CT征象有 :分叶征、边缘毛刺征、空泡征、胸膜凹陷征和血管集束征 ,各不同组织类型的小肺癌具有的CT征象也不完全一致     

多层螺旋CT动静脉分离在周围型肺癌中的应用

目的:探讨多层螺旋CT(MSCT)三维后处理动静脉分离技术在周围型肺癌中的应用价值。方法:分析周围型肺癌97例和炎性结节35例,利用三维后处理技术分离出肺静脉,并与病理对照,分别观察周围型肺癌对肺动脉、静脉的侵犯情况。结果:97例周围型肺癌共侵犯肺血管351支,侵犯肺静脉244支,占69.5%;35例。对照组中,炎性结节侵犯肺血管120支,侵犯肺静脉56支,占46.7%,两者差别有统计学意义(P0.001)。以UICC肺癌分期标准,将患者分为Ⅰ期、Ⅱ期、Ⅲ期,分别计算其静脉侵犯率为51.2%、71.0%及88.0%,差异具有统计学意义(P0.001)。结论:多层螺旋CT增强扫描及三维后处理技术能够清晰显示肺癌侵犯肺动脉、肺静脉情况,周围型肺癌侵犯肺静脉数量明显多于肺动脉,在肺癌的诊断及判断病期中具有重要的应用价值。     

肺癌侵犯中央肺动脉继发肺低灌注的CT与DSA对照研究

目的　探讨肺癌侵犯中央肺动脉继发肺低灌注的CT特征及其诊断价值。方法　对2 0例手术及病理证实的肺癌侵犯中央肺动脉 (cancerousinvasionofcentralpulmonaryarteriesinlungcancer,CICPA)患者术前肺血管DSA及增强螺旋CT(含高分辨率CT ,即HRCT)征象行前瞻性对照研究。根据DSA和CT胸膜下末梢肺动脉分布和数量变化 ,即肺血管征、肺毛细血管充盈度和肺实质强化后密度及时间 密度曲线变化 (即肺实质征 ) ,行两者间的盲法对照 ,统计学分析CT与DSA征象及其一致性 ,评估CT对CICPA继发肺低灌注的诊断价值。结果　 2 0例手术病理证实的CICPA病例中 ,共3 0支肺叶动脉受累 ,DSA显示 90 % (2 7/3 0 )出现肺叶低灌注征象 ,CT诊断肺低灌注敏感度为 78%(2 1/2 7) ,特异度 10 0 % (3 /3 ) ,准确度 80 % (2 4/3 0 )。肺低灌注与CPA狭窄程度无明显相关性 (rs=0 40 ,P =0 0 73 )。CT与DSA的肺血管征一致性较好 (Kappa =0 69,P <0 0 0 1) ,而肺实质征一致性稍差 (Kappa =0 3 7,P =0 0 11)。结论　肺低灌注是肺癌侵犯中央肺动脉的常见表现 ,CT对其定性诊断具有重要价值 ,而定量判断有一定限度     

肺癌的多层螺旋CT诊断进展

肺癌已成为人类癌症死亡的主要原因之一,且发病率及死亡率增长迅速。5年生存率在近几十年来一直为12%~15%[1]。多层螺旋CT(MSCT)以其“扫描速度快、范围大,薄层扫描,各向同性的容积采集及强大的图像后处理技术”等优势能全面提供详细的有关原发病灶、胸腔淋巴结、纵隔、胸膜和胸壁的解剖病理信息,已成为当前肺癌临床分期最主要的工具。现将肺癌的MSCT诊断进展作一综述。1中央型肺癌(CLC)中央型肺癌是指发生在肺段以上支气管黏膜上皮的恶性肿瘤,约占所有肺癌的60%~70%,近年发病率有上升趋势。中央型肺癌CT表现分为直接征象和间接征象。…     

MSCT肺血管造影在肺动脉栓塞诊断中的应用

目的:探讨MSCT肺血管造影在肺动脉栓塞诊断中的应用.方法:10例肺动脉栓塞患者采用MSCT增强扫描,并进行多平面重建结果:应用16排螺旋CT扫描主肺动脉、叶肺动脉、段、亚段动脉显示良好,显示受累肺动脉72支,其直接征象为肺动脉充盈缺损,间接征象包括肺梗死、肺少血征、胸腔积液.结论:16层螺旋CT能清楚地显示肺栓塞的直接征象及间接征象,及时发现和诊断肺栓塞.     

64层螺旋CT多向调整多平面重组对周围型肺癌征象的检出

目的 探讨64层CT多向调整多平面重组(MPR)对周围型肺癌征象的检出.方法 收集病理证实的周围型肺癌45例,64层CT胸部各向同性扫描后行肿瘤靶重建及多向调整MPR重组,并与横断薄层重建图像对比分析.结果 (1)MPR对CT支气管征、血管集束征、深分叶征、叶间胸膜凹陷征及破坏征的检出率高于薄层横断面重建图像;对细短毛刺征、叶间裂以外胸膜凹陷征的检出与横断薄层重建图像无差别.(2)MPR对空泡征和CT支气管征的判别有优势.(3)MPR对3种及以上CT征象的显示率高于横断薄层重建图像.结论 64层CT多向调整MPR有利于提高周围型肺癌征象的检出.     

MSCT增强扫描与HRCT诊断周围型肺癌的临床分析

目的 探讨增强MSCT与高分辨率CT(HRCT)诊断周围型肺癌的临床诊断效能。方法 选择92例疑似周围型肺癌患者，均行MSCT增强扫描与HRCT扫描检查，以最终病理结果作为金标准，比较MSCT增强扫描与HRCT扫描检查周围型肺癌的影像学特征。结果 92例患者经病理检查最终确诊为周围型肺癌患者55例。HRCT对胸膜凹陷征、血管集束征、空泡征、棘突征、细支气管相、短毛刺征、分叶征检出率均高于MSCT，差异具有统计学意义（P<0.05）,MSCT诊断周围型肺癌的灵敏度明显低于HRCT，差异具有统计学意义（P<0.05），而二者的特异度、准确度、阳性预测值以及阴性预测值比较，差异无统计学意义（P> 0.05）。结论 MSCT增强扫描与HRCT扫描在诊断周围型肺癌方面均具有较高价值。     

原发性中心型肺癌侵犯肺动脉干的CT、MRI表现特征

目的　探讨肺癌侵犯肺动脉干方式、途径、范围的CT、MRI表现及其与手术的关系。方法　收集经手术及病理证实为肺癌侵犯肺动脉干的 2 3例 (CT 15例 ,MRI 13例 ) ,盲法观察其侵犯途径、范围等CT、MRI表现 ,并与手术发现进行对照分析。结果　本组 2 3例肺癌侵犯肺动脉干的CT和MRI征象中 ,发现管壁异常征CT 11例 (73 .3 % ) ,MRI 11例 (84.6% ) ;管腔异常征CT 8例 (5 5 .3 % ) ,MRI9例 (69.2 % ) ;肿瘤包埋征CT 5例 (3 3 .3 % ) ,MRI 6例 (4 6.2 % ) ;管周脂肪征CT 15例 ,MRI 13例均为 10 0 %。由于癌肿优势部位不同 ,可经纵隔胸膜及肺门侵犯肺动脉干 ,又因左、右肺动脉干解剖毗邻差异 ,其受侵犯部位、程度及累及邻近结构不同。肺癌还可沿肺动脉干向其他肺叶肺动脉及其分支浸润。手术术式选择与上述影像表现特征密切相关。结论　CT和MRI对肺癌侵犯肺动脉干可判断其受侵的方式、途径和范围 ,对手术方式的选择有一定指导意义。     

多层螺旋CT血管成像在肺动脉疾病中的临床应用

目的评价多层螺旋CT血管成像对探测肺动脉疾病的临床应用价值。方法 60例经临床或病理证实的肺动脉疾病患者均经MSCT肺动脉成像检查,对所有患者的影像表现进行回顾性分析。结果本组60例患者肺动脉CTA的图像质量完全满足诊断需要。研究证实,60例中38例为肺动脉栓塞,6例中央型肺癌侵犯肺血管,3例为肺动静脉瘘,5例为肺动脉高压,8例肺动脉成像未见异常。结论 MSCT的三维肺血管图像可立体、直观地显示肺血管的解剖结构及其与周围组织的空间关系,能及时发现和诊断肺动脉疾病,指导肺栓塞的治疗及评价疗效,也可为中央型肺癌制定手术方案提供准确的影像学信息。     

周围型小肺癌的CT征象分析

目的　进一步认识周围型小肺癌的CT征象 ,提高CT诊断正确率。方法　收集经手术病理证实直径≤ 3cm周围型小肺癌 63例 ,术前均行螺旋平扫。其中 2 8例加做了高分辨扫描 ,41例做了增强扫描。重点对病灶的形态、边缘征象、内部结构及增强程度进行总结分析。结果　 63例小肺癌中 ,具有深、浅分叶征 57例 ,毛刺征 56例 ,胸膜凹陷征 48例 ,血管束征 36例 ,小泡征 1 5例 ,空气支气管征 6例。 41例增强病例中 34例CT值增幅 >30HU。结论　CT显示有 3种边缘征象以上的肺部外围型结节应高度怀疑周围型肺癌 ;增强扫描对鉴别结节的良恶性很有帮助     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.