Ileoanal pouches: comparison of CT, scintigraphy, and contrast enemas for diagnosing postsurgical complications

The value of CT of the pelvis, 111In-labeled leukocyte scintigraphy, and contrast enema (pouchography) for detecting postsurgical complications was assessed in 44 patients with total colectomy, rectal mucosectomy, and ileoanal pouches. Ileoanal pouches were created as reservoirs from an ileal loop that was anastomosed to the dentate line of the anus and stayed connected to the remainder of the ileum. This pouch preserves the normal defecatory pathway and eliminates disease-producing mucosa. A total of 57 sets of examinations revealed 22 cases of normal postoperative findings, 22 of pouchitis, 13 of abscess, and three of fistula. Overall sensitivity for detecting complications with pouchography was 60% (18 of 30 findings); with CT, 78% (28 of 36 findings); and with scintigraphy, 79% (23 of 29 findings). Pouchitis was best diagnosed by scintigraphy (sensitivity, 80%), followed by CT (sensitivity, 71%) and pouchography (sensitivity, 53%). Only CT correctly diagnosed all cases of abscess. Fistulas were frequently missed by all three methods. If tests were combined, the overall sensitivity rose to 93% for the combination CT/scintigraphy and to 86% for CT/pouchography, but did not improve for pouchography/scintigraphy (78%). For evaluation of complications in patients with ileoanal pouches, CT should be the initial test. If an abscess is found, no further tests are needed. If CT findings are negative, a scintigram should be obtained. Our data did not establish a clear role for pouchography.     

64排螺旋CT血管造影评价左心房囊样结构

目的探讨64排螺旋CT心电门控血管造影评价左心房囊样结构的形态和分布规律。方法回顾性分析2007-08—2007-12间160例行64排MSCT心电门控心脏血管造影检查病人的左心房解剖,通过工作站后处理利用最大密度投影,多平面重建及容积重建图像发现突出左心房表面的囊样结构,评价其临床价值。结果160例患者中有左心房囊样结构者25例,其中男21例,女4例,年龄38～74岁,平均57岁。25(约16%)例中共发现囊样结构29个,有4例存在2个囊样结构。在分布上19个(65.51%)位于左心房右顶壁,其中6个为Ⅰ型,13个为Ⅱ型;6个(20.69%)位于左顶壁,3个为Ⅰ型,3个为Ⅱ型;4个(13.80%)位于左心房左下壁,3个为Ⅰ型,1个为Ⅱ型;未发现位于右下壁者。结论64排CT心电门控心脏血管造影能够很好地发现和评价左心房囊样结构。     

中风先兆证的头颅CT影像及其与血液流变学关系研究

目的 :通过对 5 3例中风先兆证患者头颅CT影像及相关血液流变学检查研究 ,探索中风先兆证的CT影像规律性及相关血液流变学变化。方法 :对 5 3例中医诊断为中风先兆证的患者进行前瞻性双盲法CT影像研究 ,观察其病变性质、部位、大小范围、脑实质弥漫性病变与陈旧病变等情况 ,同时进行血液流变学的观测。结果 :中风先兆证的头颅CT影像有一定的规律性 ,其血液流变学也有相应的变化 ,但具体各证候之间缺乏显著性差异。结论 :头颅CT扫描可以为中风先兆证的患者提供一定的辨证、辨期客观依据。     

鼻窦低剂量螺旋CT扫描的可行性探讨

目的:探讨鼻窦低剂量CT扫描的可行性,评估其影像效果。方法:对40例受检者在行鼻窦常规剂量(200mA)CT扫描后,再行低剂量(30mA)CT扫描;由2名医师盲法评价图像,按正常图像、图像有少许伪影、图像有严重伪影的等级对每一幅图像进行质量评判,并进行统计学处理。结果:98%以上鼻窦低剂量CT图像可以满足诊断需要,与常规剂量CT图像相比无显著性差异(P>0.05)。结论:鼻窦低剂量CT扫描是切实可行的,正确应用可以有效地保护病人和保证图像质量。     

CT在乳腺疾病诊断中的应用

目的:探讨CT在乳腺疾病检查与诊断中的应用价值,以提高对乳腺疾病的诊断水平。方法:对152例乳腺疾病患者行CT平扫、薄层扫描、增强扫描等,并对检查结果加以分析。结果:152例中发现乳腺疾病十余种,乳腺癌、乳腺纤维腺瘤、乳腺小叶增生、男性乳腺发育症占了其中大多数。CT诊断准确的共134例,准确率为88.2%。结论:CT对乳腺疾病的检出率及对病变定位、定性的准确性总体上高于钼靶片,可检查到钼靶摄影中存在的一些盲区,具有较高的临床应用价值。其缺点是对细小钙化的敏感性不高。     

低剂量螺旋CT检出肺结节的价值

目的 :评价低剂量螺旋CT检出肺结节的价值。材料和方法 :对 3 0例肺外恶性肿瘤肺内多发转移患者分别行低剂量螺旋CT( 5 0mA ,螺距 2 .0 )及常规螺旋CT( 2 5 0mA ,螺距 1.0 )扫描 ,采用双盲法对结节数目、大小及分布进行分析。结果 :3 0例患者采用低剂量及常规螺旋CT检出结节数分别为 872个、876个 ,二者对结节的检出无明显差异 ,部分患者低剂量螺旋CT显示的结节略小。结论 :低剂量螺旋CT与常规螺旋CT对肺结节的显示相仿 ,可用于恶性肿瘤患者术前检查及高危人群肺癌筛选。     

56例肾细胞癌CT分期与手术病理对照研究

目的 :探讨肾细胞癌术前 CT分期的方法 ,提高肾细胞癌 CT分期的准确率。方法 :5 6例肾细胞癌均经手术病理证实 ,用盲法根据 CT征象判断肾包膜、肾静脉和下腔静脉、区域淋巴结及邻近器官组织的侵犯情况 ,并按 Robson分期法进行 CT分期 ,将手术病理结果与 CT分期进行对照研究。结果 :CT判断肾包膜侵犯的敏感性为 82 % ,特异性为 85 % ;静脉侵犯的敏感性 80 % ,特异性 93% ;区域淋巴结转移敏感性 91% ,特异性 88% ;邻近器官组织侵犯敏感性 86 % ,特异性 97%。 CT分期与手术病理分期总体符合率为 91%。结论 :CT是肾细胞癌术前分期的有效方法。采用薄层、动态扫描、仔细观察 CT征象 ,结合 MRI及超声检查 ,能提高肾细胞癌术前 CT分期的准确率     

The effect of gastrografin and glucagon on CT scanning of the pancreas: a blind clinical trial

The effect of Gastrografin and glucagon on pancreatic CT scanning was studied in a blind clinical trial. Twenty-five patients had a pancreatic CT scan performed on an 18-second scanner and a repeat pancreatic CT scan following administration of Gastrografin and glucagon. The results were statistically significant: decreased streak artifacts; improved pancreatic head, body and tail delineation; and improved overall pancreatic visualization. Gastrografin-glucagon administration is recommended prior to pancreatic CT scanning if the scanning cycle is 18 seconds or longer.     

降低照射剂量在头颅多排CT中的临床应用

目的:对比降低照射剂量前后头颅多排CT的图像质量,探讨低剂量头颅CT临床应用的可行性。方法:头颅CT受检者随机分组,用原设置的标准条件和不同的低剂量条件分别扫描,采用不同重建卷积函数成像,对图像质量行等级盲法评价。结果:半剂量条件下采用适当的重建卷积函数,其图像质量与标准条件下差异并无显著性意义。结论:利用现有设备,适当降低头颅CT的照射剂量,同时确保成像质量是完全可行的。     

CT引导纤支镜对肺周围病灶活检的价值

通过本方法的研究进一步提高对肺周围病灶的诊断正确率。材料和方法：对４３例肺周围部病灶在ＣＴ引导下经纤维支气管镜活检,共采集５８个部位,钳夹组织１２９块,毛刷涂片９７张。结果：ＣＴ引导纤支镜对肺周围病灶活检的准确性为１００％,特异性为９５．２４％。与Ｘ线定位纤支镜活检及纤支镜盲检均存在高度显著性差异（Ｐ＜０．０１）;并与经皮肺活检间存在显著性差异（Ｐ＜０．０５）。结论：ＣＴ引导下经纤支镜对肺周围部病灶内的准确多点活检,能极大地提高诊断正确率     

螺旋CT多期增强扫描诊断小肝癌的价值

目的 :分析小肝癌的螺旋CT多期增强扫描的表现特征 ,评价其应用价值。材料和方法 :2 1例经手术病理或临床证实的小肝癌患者 ,全部接受螺旋CT多期增强扫描检查 ,以双盲法分析其各期的CT表现。结果 :2 1例共发现 2 4个病灶。平扫呈低密度或等密度 ;肝动脉期 87.5 %均匀或不均匀增强 ,12 .5 %无明显增强 ;门脉期均呈低或稍低密度 ;延迟扫描全部为低密度。病灶密度变化的主要形式是“低—高—低—低”的模式。结论 :多期螺旋CT增强扫描能反映小肝癌的血供变化特点 ,从而为准确诊断提供了可靠的影像学依据     

白血病肺部浸润的HRCT表现

目的：探讨白血病肺部浸润的HRCT表现。方法：15例经组织病理学证实的白血病肺部浸润患者,其中慢性粒细胞性白血病6例,慢性淋巴细胞性白血病4例,T细胞白血病2例,急性粒细胞白血病2例,急性淋巴细胞性白血痛1例。采用双盲法,由两位放射科医师回顾性分析其HRCT表现。结果：15例患者均显示有小叶间隔增厚、支气管血管束增粗和多发肺结节,7例有磨玻璃状改变和肺实变。其中3例急性粒细胞或急性淋巴细胞性白血病显示小叶间隔和支气管血管束线状增粗;10例慢性粒细胞或慢性淋巴细胞性白血病显示支气管血管束结节状增粗;2例成人T细胞白血病显示支气管血管束线状增粗,但主要改变为局灶性肺实变。结论：白血病肺部浸润的HRCT表现反映了白血病细胞倾向于浸润外周肺小动脉、支气管和细支气管周围肺间质的特点,白血病肺部浸润程度受白血病类型的影响。     

Comparison of CT, low-field-strength MR imaging, and high-field-strength MR imaging. Work in progress

To assess objectively the sensitivity and specificity of low-field-strength (0.064 T) magnetic resonance (MR) imaging, a prospective blind study of 280 examinations was performed to compare low-field-strength MR imaging with computed tomography (CT) and with high-field-strength (1.5-T) MR imaging of the cranium. The sensitivity (defined as the true-positive rate) with high-field MR imaging was superior to that with low-field MR imaging and CT in helping detect overall abnormalities. Sensitivities were generally similar over a broad range of specific cranial central nervous system diseases. Low-field and high-field MR imaging were equivalent in the blind diagnoses of neoplasms and white matter disease, whereas low-field MR and CT were equivalent in the blind diagnoses of contusion, subdural and epidural hematoma, sinus disease, normality, and abnormality. The specificities with low-field MR imaging and CT were substantially better than those with high-field MR imaging.     

Hand exercise during contrast medium delivery at thoracic helical CT: a simple method to minimize perivenous artifact

PURPOSE: The purpose of this work was to assess the effects of hand exercise on perivenous artifact caused by undiluted venous contrast material at thoracic helical CT. METHOD: Eighty patients were prospectively and randomly assigned to thoracic helical CT with (n = 42) or without (n = 38) intermittent squeezing of a hand-sized ball during delivery of a contrast material. Two radiologists graded perivenous artifact and arterial enhancement in a blind fashion. CT attenuation values were obtained by region-of-interest measurements from arteries and veins. RESULTS: Both qualitative and quantitative analyses showed statistically significant differences in the assessment of perivenous artifact (p < 0.01). Perivenous artifact from the subclavian vein was significantly reduced in patients subjected to thoracic helical CT by using a hand exercise method. CONCLUSION: Hand exercise during contrast material delivery at thoracic helical CT minimizes perivenous artifact and improves image quality.     

中风病急性期病灶CT定性定位规律研究

目的:探索中风病急性期各证病灶性质及分布的规律性。方法:通过采用前瞻性、双盲法对117例中风病急性期患者头颅CT表现,包括病变的性质、病灶部位、脑室的改变等进行观察,并做统计学处理。结果:中经络证与中脏腑证在病变性质上由缺血性病变逐渐向出血性病变发展所占比例增多,各证的病变部位有一定的变化规律:随病情的加重,中经络证(1型、2型)到中脏腑闭证(阴闭、阳闭)、中脏腑脱证的病变部位从外围脑叶至脑干脑室所占比例逐渐增加。结论:中风急性期各证的病变性质与病变部位有一定的规律性,临床辨证与治疗时可以作为客观参考指标。     

肾上腺髓脂瘤的CT诊断

目的:探讨肾上腺髓脂瘤的CT特征,以提高其CT诊断水平.方法:由两位有经验的放射学医生共同回顾性分析18例经手术病理证实的肾上腺髓脂瘤的CT表现,并达成一致意见.结果:多脂肪型11例,少脂肪型7例.7例合并钙化,2例合并出血,13例增强扫描无明显强化.CT诊断符合率为88.9%.结论:CT对肾上腺髓脂瘤的诊断具有较高的敏感性和特异性,其内的脂肪成分有利于诊断与鉴别诊断.     

肝细胞癌的双时相螺旋CT扫描

目的：描述肝细胞癌的双时相螺旋ＣＴ的特征，评价其应用价值。材料与方法：对４９例肝细胞癌患者进行了双时相螺旋ＣＴ扫描。记录病变增强形态、特征，并与病理和血管造影对照。由两位放射科医生以双盲法观察诊断。结果：７４％的肝细胞癌在动脉期呈高密度，７６％在门静脉期呈低密度。１０例门静脉期等密度的病灶在动脉期均呈高密度。动脉期和门静脉期肝细胞癌的检出率为９１％和８１％。结论：双时相螺旋ＣＴ能显示肝细胞癌的增强特点，并提高病变检出率。可在肝细胞癌的检查中作为常规方法应用。     

Improvement of sensitivity and interrater reliability to detect acute stroke by dynamic perfusion computed tomography and computed tomography angiography

OBJECTIVE: To assess the benefits of additional computed tomography perfusion (CTP) and computed tomography angiography (CTA) on the detection of early stroke, vessel occlusion, estimated infarct size, and interrater reliability. METHODS: Sixty-seven consecutive patients underwent nonenhanced computed tomography (CT) imaging, CTA, and CTP. The final diagnosis of stroke was made from follow-up neuroimaging. A first diagnosis was made on-site by the physician on duty. Three experienced neuroradiologists blinded to follow-up findings analyzed the data set off-line, evaluated CT for signs of acute stroke, and subsequently evaluated CTP and CTA for infarction-related perfusion deficits and vessel abnormalities. RESULTS: Computed tomography perfusion and CTA increased the time from CT start to diagnosis from 2 minutes to 10 minutes. Sensitivity to detect acute stroke increased significantly in all investigators from 0.46-0.58 to 0.79-0.90 compared with CT (<0.005). The interrater weighted kappa value increased from 0.35 to 0.64. Estimation of infarct size was not improved. CONCLUSION: Computed tomography perfusion and CTA provide an effective add-on to standard CT in acute stroke imaging by significantly increasing the sensitivity and reliability of infarct detection.     

CT平扫诊断钝性伤脾破裂

探讨CT平扫诊断钝性伤脾破裂的标准。材料与方法回顾性分析60例钝性脾破裂患者(其中55例手 术,5例临床证实)的CT片及临床资料,放射科医生双盲读片分析。结果60例患者有明确的外伤史,经CT平扫发现脾 实质密度不均匀(包括脾实质血肿、脾包膜下血肿、脾撕裂等)、脾包膜中断或呈“葱皮”样改变共39例(65％),“哨兵血块 征”54例(90％),腹腔积血46例(76.7％),脾肿大34例(56.7％),脾附近软组织挫伤、骨骼骨折17例(28.3％)。结论CT 平扫诊断钝性脾破裂的直接征象是脾包膜中断或呈“葱皮”样改变,其余皆为间接征象。     

Use of contrast-enhanced ultrasound in follow-up after endovascular aortic aneurysm repair.

PURPOSE: To investigate the use of contrast-enhanced ultrasound in the detection of endoleak after endovascular repair of abdominal aortic aneurysm. MATERIALS AND METHODS: Eighteen patients underwent follow-up on 20 occasions after endovascular aortic aneurysm repair by arterial-phase contrast-enhanced spiral computed tomography (CT). All patients had unenhanced color Doppler ultrasound and Levovist-enhanced ultrasound on the same day. The ultrasound examinations were reported in a manner that was blind to the CT results. CT was regarded as the gold standard for the purposes of the study. RESULTS: There were three endoleaks shown by CT. Unenhanced ultrasound detected only one endoleak (sensitivity, 33%). Levovist-enhanced ultrasound detected all three endoleaks (sensitivity, 100%). Levovist-enhanced ultrasound indicated an additional six endoleaks that were not confirmed by CT (specificity, 67%; positive predictive value, 33%). In one of these six cases, the aneurysm increased in size, which indicates a likelihood of endoleak. Two of the remaining false-positive results occurred in patients known to have a distal implantation leak at completion angiography. CONCLUSION: In this small group of patients, contrast-enhanced ultrasound appears to be a reliable screening test for endoleak. The false-positive results with enhanced ultrasound may be due to the failure of CT to detect slow flow collateral pathways. Although the number of patients in this study is small, enhanced ultrasound may be more reliable than CT in detecting endoleak.