多层螺旋CT门静脉成像对门静脉高压症个体化治疗术前评估的作用

目的：评估多层螺旋CT门静脉成像（multi-slice spiral CT portography,MSCTP）在门静脉高压症个体化治疗术前评估的作用。方法：选择我院2008-01～2011-05门静脉高压症患者行CT门静脉成像并手术治疗患者61例,手术治疗前均依据MSCTP检查并结合肝功、凝血功能等情况,分别进行了内镜下治疗、脾切除或介入脾栓塞术、经皮经肝胃冠状静脉栓塞术、肝内门一腔静脉分流术、外科的断流、分流、联合断分流术。结果：61例全部显示食管和（或）胃底静脉曲张（100%）,伴胃冠状静脉曲张45例（73%）、伴脾肾静脉分流7例（11%）、伴胃肾分流15例（24%）,分别经内镜、介入造影、外科手术中证实。结论：MSCTP可无创性地显示门静脉及其侧支循环的形态、分流方式和程度,对门脉高压症患者的个体化治疗方案的选择具有重要作用。     

多层螺旋CT门静脉造影的临床应用

目的:探讨多层螺旋CT门静脉造影(MSCTP) 的成像方法及其临床应用价值.材料和方法:110例临床推荐行腹部增强扫描的患者.运用最大密度投影(MIP)和容积重建(VR)两种后处理成像方法,10例增加曲面重建(CPR).结果:MSCTP能很好显示肝静脉和门静脉系统的全貌及其与病变之间的空间解剖关系,直观地评价门静脉的位置、轮廓、有无门静脉受侵或癌栓形成, 了解门静脉高压侧支循环的分布范围和程度.结论:MSCTP是肝静脉和门静脉无创性检查的可靠方法, 有较高的临床应用价值.VR比MIP重建的血管图像更优.     

64排螺旋CT门静脉成像的临床应用分析

目的探讨64排螺旋CT门静脉成像(MSCTP)的临床应用价值。方法对61例肝病患者行64排螺旋CT门静脉扫描,CT图像原始数据传至工作站后均采用容积重建(VRT)、最大密度投影(MIP)、多平面重组(MPR)3种后处理方法显示门静脉系统血管。结果门静脉CTP正常4例;门脉先天变异1例;门静脉高压53例,其中伴侧枝血管开放50例,门脉或肠系膜上静脉栓子13例,脾/胃肾分流21例。MSCTP检查确诊病例后:行肝硬化行TIPS术及胃左静脉断流术后2例:在X线透视下,经静脉逆行阻塞胃静脉曲张术(BRTO)治疗3例;经皮经肝胃冠状静脉栓塞术(PTVE)治疗12例;内镜食管胃静脉硬化或套扎32例。结论 64排螺旋CTP清晰直观显示门静脉系统及与之相关的侧枝血管,并可明确是否存在血栓及栓塞范围,图像清晰可靠。     

多层螺旋CT肝脏双期血管成像及临床应用

目的　探讨多层螺旋CT(MSCT)肝脏多期扫描 ,肝动脉和门静脉双期血管成像的可能性及其临床应用。资料与方法　 14例正常者及 15例肝硬化患者 (包括 6例肝癌 )行MSCT多期扫描 ,准直 2 .5mm ,pitch 5 ,每期扫描时间约为 6～ 9s。分别于肝动脉期和门静脉期进行血管三维成像 ,重建方式为容积再现技术 (VR) ,最大密度投影(MIP) ,表面遮盖法重建技术 (SSD)。统计 3种成像方法对胃十二指肠上动脉 ,肝固有动脉 ,肝左、右动脉的显示率 ,并对门静脉显示情况进行评分。结果　肝动脉期血管成像可清晰显示扫描范围内的腹主动脉 ,腹腔干血管及其分支 ,VR、MIP及SSD对胃十二指肠动脉 ,肝固有动脉 ,肝左、右动脉的总显示率分别为 85 .3% ,85 .3% ,6 6 .4 %。门静脉期血管成像能清晰显示门静脉系统情况 ,正常人门静脉可显示 6级以上 ,VR及MIP优于SSD(P <0 .0 5 ) ,VR立体感强于MIP。结论　MSCT肝脏多期扫描 ,双期血管成像是了解肝脏供血动脉和门静脉系统情况的无创性检查方法 ,以VR血管成像最佳 ,可为临床提供更多的有关肝动脉和门静脉方面的信息     

多层螺旋CT肝门静脉成像对门脉高压分流侧支血管的研究

肝硬化门脉高压患者,门体之间侧支血管扩张,形成多处门体循环;在这些扩张的侧支血管中,食管胃底静脉曲张常导致上消化道出血,危及患者健康和生命,具有重要临床意义。在实施手术或介入治疗时,术前了解侧支血管的情况尤为重要;近年来,随着多层螺旋CT技术的发展及多种图像后处理技术的开发,多层螺旋CT门静脉成像能全面准确地显示肝硬化患者门体循环之间侧支血管的部位和范围,为肝硬化门脉高压患者治疗方法的选择和术前评估提供了可靠依据。     

64层螺旋CT门静脉造影在显示肝硬化门静脉高压侧支循环中的价值

目的：评价64层螺旋CT门静脉造影对肝硬化门静脉高压侧支循环显示的价值.材料和方法：肝硬化患者28例,采用64层螺旋CT行动脉期、门脉期及平衡期扫描后,运用容积重建法（VR）、多层面重建法（MPR）和最大密度投影法（MIP）对门静脉及其分支进行重建,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征.结果：64层螺旋CT门静脉造影能准确显示侧支循环分布范围,初步评估病变程度;门静脉高压时,门静脉属支管径显著扩张（门静脉主干、脾静脉、肠系膜上静脉、胃冠状静脉）.胃冠状静脉曲张24例、食管胃底静脉曲张21例、食管周围静脉曲张17例、胃短静脉曲张10例、脾/胃-肾分流6例、脐静脉和腹壁静脉曲张5例、腹膜后静脉曲张2例和直肠上静脉曲张2例,门静脉海绵状变性1例.结论：64层螺旋CT门静脉造影能够多角度、准确地显示门静脉高压时侧支循环开放的情况,对判断病变程度、预测其并发症、选择治疗方案具有重要意义.     

肝脏泡状棘球蚴病的多层螺旋CT影像特征

目的分析肝泡状棘球蚴病的多层螺旋CT（MSCT）表现特点，评价MSCT的诊断价值。方法26例病人全部进行MSCT检查，原始数据经过图像高级处理工作站行冠矢状面重建和血管成像处理，MSCT所见与手术病理结果行对照分析。结果26例共检出28个病灶，所有病例均表现为不均质的低密度肿块，平扫时界线欠清而增强后境界清楚；26例的主要影像学特征还包括病灶内出现数量不等的钙化（26／26）；中心液化坏死（20／26）；边缘区域的小囊泡征象（15／26）；病灶所在的肝脏边缘有收缩凹陷（12／26）和健叶代偿性肥大（18／26）。位于肝门区或者累及肝门的病灶伴有胆管扩张（9／26），脾肿大（12／26），腹水（1／26）。MSCT血管成像（MSCTA）显示24例伴有肝脏血管分支的受压、推移、包绕或者闭塞改变。MSCTA所见与手术结果比较，对肝动脉（HA）评价的敏感度、特异度和阳性预测值分别为88％、96％和93％；对门静脉（PV）分别为95％、100％和95％；而对肝静脉（HV）分别为96％、86％和96％。结论MSCT能够全面地显示肝脏泡状棘球蚴病特征性图像和血管侵犯的状况，为正确的诊断和合理的治疗提供了可靠的影像学依据。     

多层螺旋CT肝脏兼容性血管造影在肝癌介入治疗中的应用价值

目的 探讨多层螺旋CT（MSCT）肝脏兼容性血管造影在肝癌介入治疗中的应用价值。方法 MSCT肝癌CT检查患者45例,于动脉期22s、门静脉期55s行肝脏双期增强扫描,采用MPVR、MIP、VR、SSD重建技术行肝动脉、门静脉兼容性血管成像。其中22例作了肝动脉DSA造影及介入治疗。结果 动脉期肝动脉血管造影（SCTA）显示肿瘤血管31例,肿瘤染色17例,动-门脉分流（APS）9例。门脉期门静脉造影（SCTP）检出肿瘤对门静脉的侵犯25例,门静脉癌栓16例。MSCT显示的肿瘤血管、肿瘤染色、供血动脉的来源分布、APS及门静脉癌栓与DSA图像基本一致。MPVR、VR有利于检出肝癌供血动脉、肿瘤血管、肿瘤染色、APS及门静脉癌栓。结论 MSCT肝脏兼容性SCTA、SCTP血管造影,可为临床及肝癌介入治疗方案的制定提供更多信息。     

多层螺旋CT血管成像诊断肝脏病的价值

目的:探讨多层螺旋CT血管成像诊断肝脏疾病的应用价值.材料和方法:应用GELightSpeedQX/i4层螺旋CT机,对152例患者行肝脏CT3时相增强扫描,扫描后对原始数据行三维薄建重建,分析其结果.结果:152例中,原发性肝细胞癌41例、肝海绵状血管瘤52例、肝脏囊肿15例、脂肪肝8例、肝脓肿5例、肝脏转移瘤8例、胆囊癌3例、胆管癌4例和正常16例.动脉期均成功显示腹主动脉及其主要分支如腹腔干,肾动脉,肠系膜动脉等.143例可清晰显示肝总动脉与脾动脉,胃左动脉显示清晰者123例(VR像显示108例,MPR像显示123例),发现异常的分支16例.结论:多层螺旋CT血管成像在肝脏CT扫描中能直观地显示病变及周围血管的关系,对外科手术及介入治疗提供参考信息.     

多层螺旋CT门静脉成像在食管胃静脉曲张栓塞术前评估中的价值

目的 探讨多层螺旋CT门静脉成像(MSCTP)在食管胃静脉曲张栓塞术前评估中的价值.方法 对50例门静脉高压上消化道出血患者行64层螺旋CT增强扫描,每例病人均采用多平面重组(MPR)、最大密度投影(MIP)和容积显示(VR)3种后处理方法显示门静脉系统血管.对42例明确显示食管胃静脉曲张相关侧枝血管的患者进行了介入栓塞治疗,5例门静脉海绵样变难以分清相关侧枝血管及3例门静脉部分血栓形成不能行介入栓塞治疗的患者做了内镜套扎或硬化治疗.比较42例患者MSCTP和术中直接门静脉造影对食管胃静脉曲张相关侧枝血管显示的差异性.结果 MSCTP显示50例食管胃静脉曲张(100%),胃左静脉38例(76%),胃后或胃短静脉17例(34%),胃肾和/或脾肾分流5例(10%),门静脉血栓形成海绵样变5例(10%),2例门静脉和1例脾静脉血栓阻塞部分管腔.42例2种检查方法对食管胃静脉曲张相关侧枝血管显示的差异性检验(χ2=2.00,P>0.05),表明二者无显著差异.结论 MSCTP能直观显示食管胃静脉曲张及与之相关的侧枝血管.可明确曲张血管的供血血管,明确是否存在门静脉的血栓及栓塞范围,有助于治疗方案的选择和缩短手术治疗的时间.     

Ground-glass opacity: High-resolution computed tomography and 64-multi-slice computed tomography findings comparison

Objective

Comparative evaluation of ground-glass opacity using conventional high-resolution computed tomography technique and volumetric computed tomography by 64-row multi-slice scanner, verifying advantage of volumetric acquisition and post-processing technique allowed by 64-row CT scanner.

Methods

Thirty-four patients, in which was assessed ground-glass opacity pattern by previous high-resolution computed tomography during a clinical-radiological follow-up for their lung disease, were studied by means of 64-row multi-slice computed tomography. Comparative evaluation of image quality was done by both CT modalities.

Results

It was reported good inter-observer agreement (k value 0.78-0.90) in detection of ground-glass opacity with high-resolution computed tomography technique and volumetric Computed Tomography acquisition with moderate increasing of intra-observer agreement (k value 0.46) using volumetric computed tomography than high-resolution computed tomography.

Conclusions

In our experience, volumetric computed tomography with 64-row scanner shows good accuracy in detection of ground-glass opacity, providing a better spatial and temporal resolution and advanced post-processing technique than high-resolution computed tomography.     

MSCT尿路造影技术的临床应用价值

目的探讨MSCT尿路造影技术的临床应用价值。方法回顾性分析有临床症状并行CT尿路造影的病例50例,通过常规平扫、动脉期、静脉期、延迟期扫描将所获得的数据进行MPR、MIP、CPR及VR三维重建。然后对获得的影像进行分析。结果所有病例均可成功重建出双肾、输尿管和膀胱的三维图像,能够通过旋转、放大等清晰显示全尿路及其局部细微结构、形态、走形及与周围组织的关系。结论通过MSCT对全尿路的适当扫描,对采集的数据进行各种三维重建,能够大大提高病灶检出的阳性率和诊断率。     

多层螺旋CT和彩超对食管癌腹部淋巴结转移术前评估价值的比较

目的比较多层螺旋CT和彩超对食管癌腹部淋巴结转移的术前评估价值。方法对105例术后病理证实腹部淋巴结转移的食管癌病例进行回顾性分析,对比术前多层螺旋CT增强扫描与腹部彩超对贲门旁、胃左动脉干周围和胃小弯、肝总动脉旁等部位淋巴结转移检测的准确率和漏诊率的差异。结果多层螺旋CT增强扫描和腹部彩超对食管癌腹部淋巴结转移检测的总体准确率、漏诊率分别为84.8%（89/105）vs 63.8%（67/105）及15.2%（16/105）vs 36.2%（38/105）,多层螺旋CT增强扫描对食管癌腹部淋巴结转移检测的总体准确率显著优于彩超检查（P〈0.05）,漏诊率显著低于彩超检查（P〈0.05）。结论就食管癌腹部淋巴结转移术前检测而言,多层螺旋CT增强扫描显著优于彩超检查,为首选检查方法。     

左心耳封堵术MSCT三维成像测量可行性分析和临床应用

目的 采用心电门控多层螺旋CT(MSCT)三维成像技术重建心房颤动(AF)患者左心耳并进行测量,探讨其在经皮左心耳封堵术(PCLAA)中应用的可行性和临床价值.方法 入选AF患者27例,年龄43～80岁,平均(67.3±11.5)岁;非瓣膜性AF 25例,瓣膜性AF 2例.15例完成PCLAA术.术前行心电门控MSCT检查,通过AW4.4后处理工作站重建左心耳三维结构,空间向量测量左心耳开口长短径及深度,与术中经食管超声心动图(TEE)测量作比较,选择合适尺寸左心耳封堵器及植入位置,植入左心耳颈部.术后3个月TEE复查左心耳和(或)MSCT三维重建.结果 AW4.4后处理工作站重建下,外测法测量左心耳开口长径与封堵器最终选择有显著相关性(r=0.968),差异无统计学意义(P＞0.05);内侧法与封堵器最终选择有相关性(r=0.897),差异无统计学意义(P＞0.05).15例手术患者随访3个月,TEE或CT三维重建复查均未见血流渗漏.结论 心电门控MSCT三维成像技术能够重建AF患者左心耳三维结构,为PCLAA术前提供封堵器植入重要数据,也为术后随访提供可靠依据,具有临床可行性及应用价值.     

Virtual nonenhanced abdominal dual-energy MDCT: Analysis of image characteristics

AIM:To evaluate abdominal and pelvic image characteristics and artifacts on virtual nonenhanced(VNE) images generated from contrast-enhanced dual-energy multidetector computed tomography(MDCT)studies.METHODS:Hadassah-Hebrew University Medical Institutional Review Board approval was obtained;22 patients underwent clinically-indicated abdominal and pelvic single-source dual-energy MDCT(Philips Healthcare,Cleveland,OH,USA),pre-and post-IV administration of Omnipaque 300 contrast(100 cc).Various solid and vascular structures were evaluated.VNE images were generated from the portal contrast-enhanced phase using probabilistic separation.Contrast-enhanced-,regular nonenhanced(RNE)-,and VNE images were evaluated with a total of 1494 density measurements.The ratio of iodine contrast deletion was calculated.Visualization of calcifications,urinary tract stones,and image artifacts in VNE images were assessed.RESULTS:VNE images were successfully generated in all patients.Significant portal-phase iodine contrast deletion was seen in the kidney(61.7%),adrenal gland(55.3%),iliac artery(55.0%),aorta(51.6%),and spleen(34.5%).Contrast deletion was also significant in the right atrium(RA)(51.5%)and portal vein(39.3%),but insignificant in the iliac vein and inferior vena cava(IVC).Average post contrast-to-VNE HU differences were significant(P<0.05)in the:RA-135.3(SD 121.8),aorta-114.1(SD 48.5),iliac artery-104.6(SD 53.7),kidney-30.3(SD 34.9),spleen-9.2(SD 8.8),and portal vein-7.7(SD 13.2).Average VNE-toRNE HU differences were significant in all organs but the prostate and subcutaneous fat:aorta 38.0(SD 9.3),RA 37.8(SD 16.1),portal vein 21.8(SD 12.0),IVC 12.2(SD 11.6),muscle 3.3(SD 4.9),liver 5.7(SD 6.4),spleen 22.3(SD 9.8),kidney 40.5(SD 6.8),and adrenal 20.7(SD 13.5).On VNE images,196/213 calcifications(92%)and 5/6 renal stones(84%)were visualized.Lytic-like artifacts in the vertebral bodies were seen in all studies.CONCLUSION:Iodine deletion in VNE images is most significant in arteries,and less significant in solid organs and veins.Most vascular and intra-abdominal organ calcifications are preserved.     

The evaluation of anti-angiogenic treatment effects for implanted rabbit VX2 breast tumors using functional multi-slice spiral computed tomography (f-MSCT)

Objective

Investigate the benefit of functional multi-slice spiral computed tomography (f-MSCT) perfusion imaging in the non-invasive assessment of targeted anti-angiogenesis therapy on an implanted rabbit VX2 breast tumor model.

Method

69 female pure New Zealand white rabbits were randomly assigned to one of the 4 groups and received treatment accordingly: control (saline), Endostar, neoadjuvant chemotherapy (Cyclophosphamide, Epirubicin and 5-Fluorouracil, CEF), combination therapy (Endostar and CEF). After 2 weeks of treatment, f-MSCT perfusion scannings were performed for all rabbits and information about blood flow (BF), blood volume (BV), mean transit time (MTT) and surface permeability (SP) was collected. After perfusion imaging, tumor tissues were sampled for immunohistochemistry and the Western blot test of VEGF protein expression.

Results

(1) The VEGF expression level, measured by immunohistochemistry and Western blot, decreased by treatment group (control > Endostar > CEF > combination therapy). The same was true for the mean BF, BV, MTT and PS, which decreased from the control group to the combination therapy group gradually. The mean MTT level increased in reverse order from the control to the combination therapy group. The difference between any 2 groups on these measures was statistically significant (P < 0.05). (2) There was moderate positive correlation between VEGF expression and BE, BV, or PS level (P < 0.05) and a negative correlation between VEGF expression and MTT level for all 4 groups (P < 0.05).

Conclusion

Therefore, f-MSCT can be used as a non-invasive approach to evaluate the effect of anti-angiogenic therapy for implanted rabbit VX2 breast tumors.     

Multislice computed tomography perfusion imaging for visualization of acute pulmonary embolism: animal experience

The purpose of our animal study was to evaluate a new computed tomography (CT) subtraction technique for visualization of perfusion defects within the lung parenchyma in subsegmental pulmonary embolism (PE). Seven healthy pigs were entered into a prospective trial. Acute PE was artificially induced by fresh clot material prior to the CT scans. Within a single breath-hold, whole thorax CT scans were performed with a 16-slice multidetector-row CT scanner (SOMATOM Sensation 16; Siemens, Forchheim, Germany) before and after intravenous application of 80 ml of contrast medium with a flow rate of 4 ml/s, followed by a saline chaser. The scan parameters were 120 kV and 100 mAs_eff, using a thin collimation of 16×0.75 mm and a table speed/rotation of 15–18 mm (pitch, 1.25–1.5; rotation time, 0.5 s). Axial source images were reconstructed with an effective slice thickness of 1 mm (overlap, 30%). A new automatic subtraction technique was used. After 3D segmentation of the lungs in the plain and contrast-enhanced series, threshold-based extraction of major airways and vascular structures in the contrast images was performed. This segmentation was repeated in the plain CT images segmenting the same number of vessels and airways as in the contrast images. Both scans were registered onto each other using nonrigid registration. After registration both image sets were filtered in a nonlinear fashion excluding segmented airways and vessels. After subtracting the plain CT data from the contrast data the resulting enhancement images were color-encoded and overlaid onto the contrast-enhanced CT angiography (CTA) images. This color-encoded combined display of parenchymal enhancement of the lungs was evaluated interactively on a workstation (Leonardo, Siemens) in axial, coronal and sagittal plane orientations. Axial contrast-enhanced CTA images were rated first, followed by an analysis of the combination images. Finally, CTA images were reread focusing on areas with perfusion deficits indicating PE on the color-coded enhancement display. Subtraction was feasible for all seven studies. In one animal, opacification of the pulmonary arteries was suboptimal owing to heart insufficiency. In the remaining six pigs, a total of 37 perfusion defects were clearly assessable downstream of occluded subsegmental arteries, showing lower or missing enhancement compared with normally perfused lung parenchyma. Indeterminate findings from CTA showed typical PE perfusion defects in four out of six cases on CT subtraction. Additionally, 22 peripheral triangular-shaped enhancement defects were delineated. Nine of these findings were reclassified as definitely being caused by PE on second reading of the CTA data sets. Our initial results have shown that this new subtraction technique for perfusion imaging of PE is feasible, using routine contrast delivery. Dedicated examination protocols are mandatory for adequate opacification of the pulmonary arteries and for optimization of data sets for subsequent subtraction. Perfusion imaging allows a comprehensive assessment of morphology and function, providing more accurate information on acute PE.This paper contains data on behalf of the Amersham Health Research Fellowship Grant, ECR 2003.     

Visualisation of intracerebral haemorrhage with flat-detector CT compared to multislice CT: results in 44 cases

The aim of the study was to test the reliability of intracerebral haemorrhage (ICH) detection with C-arm-mounted flat-detector computed tomography (FD-CT) in the angio suite as compared to multislice CT (MSCT). In this study 44 patients with 45 ICH were included. All patients were investigated with MSCT and FD-CT during angiographic evaluation. As a control group we included 16 patients without ICH. In each haematoma we assessed volumetric data of the ICH and counted the numbers of ICH-positive slices. Using interobserver ratings, we additionally investigated the potential of FD-CT to serve as a diagnostic tool to detect ICH. In FD-CT three haematomas were not detected because of motion and beam-hardening artefacts in the region close to the skull base. The r value for the degree of interobserver agreement for the number of slices was 0.95 for MSCT and 0.94 for FD-CT. Measurements of the area and the calculated volume of the ICH showed high inter- and intraobserver agreement. Our results indicate that FD-CT is a helpful tool in the daily emergency management of ICH patients as detection of ICH was found to be nearly as reliable as in MSCT. Limitations of this technology are motion and beam-hardening artefacts that may mask small haematomas located in the posterior fossa or the skull base.     

Evaluation of computed tomography coronary angiography in patients with a high heart rate using 16-slice spiral computed tomography with 0.37-s gantry rotation time

The aim of our study is to evaluate computed tomography (CT) coronary angiography in patients with a high heart rate using 16-slice spiral CT with 0.37-s gantry rotation time. We compare the image quality of patients whose heart rates were over 70 beats per minute (bpm) with that of patients whose heart rates were 70 bpm or less. Sixty patients with various heart rates underwent retrospectively ECG-gated multislice spiral CT (MSCT) coronary angiography. Two experienced observers who were blind to the heart rates of the patients evaluated all the MSCT coronary angiographic images and calculated the assessable segments. A total of 620 out of 891 (69.6%) segments were satisfactorily visualized. On average, 10.3 coronary artery segments per patient could be evaluated. In 36 patients whose heart rates were below 70 bpm [mean 62.2 bpm±5.32 (standard deviation, SD)], the number of assessable segments was 10.72±2.02 (SD). In the other 24 patients whose heart rates were above 70 bpm [mean 78.6 bpm±8.24 (SD)], the corresponding number was 9.75±1.74 (SD). No statistically significant difference was found in these two subgroups t test, P>0.05. The new generation of 16-slice spiral CT with 0.37-s rotation time can satisfactorily evaluate the coronary arteries of patients with high heart rates (above 70 bpm, up to 102 bpm).     

Detection of simulated vertical root fractures; which is better multi-detector computed tomography or cone beam computed tomography?

Objectives

Multi-detector computed tomography (MDCT) and cone beam computed tomography (CBCT) were compared regarding their ability to detect vertical root fractures.