CT导向下组织间植入~(125)Ⅰ粒子治疗胰腺癌

70年代后期 ,欧美一些发达国家相继开展了肿瘤内植入放射性粒子治疗恶性肿瘤的研究。随着CT设备的出现 ,CT引导下肿瘤内植入粒子的新兴微创方法悄然兴起。我们在CT导向下对 10例胰腺癌患者肿瘤内植入了12 5Ⅰ粒子 ,现将结果报告如下。一、资料与方法1.临床资料 :2 0 0 3年 7月至 2 0 0 3年 10月间 ,CT引导下肿瘤内植入12 5Ⅰ粒子治疗胰腺癌患者 10例 ,男 6例 ,女 4例。年龄 4 8～ 72岁 ,平均 5 6 .6岁。其中胰头癌 4例 ,胰颈癌 2例 ,胰体癌 3例 ,胰尾癌 1例。2 .方法 :应用Philips产MX80 0 0多层螺旋CT及Pinpiont穿刺引导系统 ,放射性…     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

双源CT低剂量扫描在小儿主动脉缩窄诊断中的临床应用

目的 应用超声斑点追踪技术(STI)评价高血压病患者的左心室收缩功能,探讨当左心室构型改变时,二尖瓣环位移(MAD)作为评价左心室整体收缩功能指标的可行性和准确性。方法 选择原发性高血压患者40例,其中左心室构型正常(LVN组)20例,左心室重构(LVR组)20例。健康志愿者30名作为对照组。应用STI技术计算左心室收缩期整体峰值纵向应变(GLs)、圆周应变(GCs)、径向应变(GRs)、左室心扭转(LVtw)、二尖瓣环中点处收缩期最大位移(MAD),并应用实时三维超声心动图计算左心室射血分数(LVEF)。比较对照组及高血压患者组在心肌不同方向上应变的改变规律,并分析左心室应变参数、扭转参数与MDA和LVEF之间的关系。结果 ①与对照组比较,各参数除LVtw 外,LVN 组无明显变化,LVR组均明显减低(P均<0.01);LVN及LVR组LVtw均显著高于对照组(P均<0.01)。②对照组、LVN 及LVR组的MAD与LVEF显著相关,r值分别为0.84、0.83和0.76。③LVR组的GCs、LVtw 为LVEF的独立预测因子,beta值分别为-0.40、0.47(P<0.05)。④LVR组的GLs、GRs、GCs及LVtw与MAD显著相关,MAD是GLs的独立预测因子,beta值为-0.79(P<0.05)。结论 超声二维斑点追踪技术可以评价高血压病患者左心室发生构型改变时的整体功能变化,MAD有望成为临床评价高血压病患者左心室收缩功能的快捷方法。     

64层CT对先天性心脏病肺动脉发育异常的术前评价

目的 前瞻性研究64层CT心血管造影评价先天性心脏病肺动脉发育异常的可行性和准确性. 资料与方法对心脏超声诊断先天性心脏病并临床怀疑有肺动脉发育异常的49例患儿于手术前7天内行64层CT心血管造影榆查.对所有各向同性扫描的薄层图像行任意方向多平面重组(MPR)及容积再现(VR)重组以显示肺动脉形态及密度,并与手术所见对照分析.结果 49例先天性心脏病患儿术前心血管CT造影诊断肺动脉发育异常42例,其中肺动脉扩张6例,肺动脉广泛变细8例,肺动脉局限性狭窄18例,肺动脉闭锁6例,肺动脉部分缺如4例.与手术结果对照,64层CT造影诊断肺动脉发育异常的敏感性为96.2%,特异性为99.3%,阳性预测值为96.2%,阴性预测值为99.3%,准确性为98.8%.结论 64层CT心血管造影是评价先天性心脏病肺动脉发育异常的可行和准确的方法.     

前瞻性心电门控100kV在非肥胖患者冠脉CTA检查中的可行性研究

目的评价前瞻性心电门控100k V扫描在非肥胖患者冠状动脉CT血管造影(CTA)检查中的可行性。方法对临床疑诊冠心病而在我院行冠脉CTA检查的118例非肥胖患者随机分为4组,分别采用回顾性心电门控120k V(组1)、100k V(组2)及前瞻性心电门控120k V(组3)、100k V(组4)四种扫描方案。测量升主动脉根部的CT值及噪声,计算信噪比、对比噪声比,并对图像质量进行主观评分。定量数据表示为平均数±标准差,分类数据表示为比例和百分比。结果 118例患者均顺利完成检查,组间体重指数(BMI)差异无统计学意义(P>0.05)。组1、组3的CT值及图像噪声低于组2和组4,差异有统计学意义(P<0.05);组1的SNR及CNR高于其余各组,差异均具有统计学意义(P<0.05);组2、组3、组4的信噪比及对比噪声比组间差异均无统计学意义(P>0.05)。四组间图像主观评分差异无统计学意义(P>0.05)。组4辐射剂量显著降低,平均有效辐射剂量为(1.60±0.16)m Sv,组间差异具有统计学意义(P<0.05)。结论对于非肥胖且心律平稳的患者,前瞻性心电门控100k V扫描方案在降低辐射剂量的同时,可获得满意的图像质量。     

急性有机磷农药中毒持久肌颤2例报告

我们遇到两例有机磷农药中毒病人,分别在服毒后121天与87天肌颤方消失,兹报告如下。例1,男,95岁。空腹误服敌百虫严重中毒,经抢救第3天神志转清,阿托品改肌注并逐步减量,第13天中毒症状消失,改口服阿托品0.3mg,每日3次,则出现头昏、头痛、恶心、纳减,并伴四肢肌颤,诉“呼气时嗅到敌     

3.0 T MRI心肌灌注储备指数与X线冠状动脉造影所示血管狭窄的相关性研究

目的：探讨3.0 T MRI心肌灌注储备指数（MPRi）与冠状动脉狭窄之间的关系。方法：对20例临床拟诊冠状动脉性心脏病的住院患者,在接受X线冠状动脉造影前2周内行3.0 T MRI腺苷负荷心肌灌注成像检查。测量负荷与静息心肌灌注TIC的上升斜率,进行半定量分析。结果：半定量分析共获得299个心肌节段的MPRi（全层心肌ROI的心肌灌注储备指数）和MPR_inner（内层心肌ROI的心肌灌注储备指数）。以X线冠状动脉造影为标准,将各心肌节段分为狭窄组与非狭窄组,2组MPRi值差异有统计学意义（Z=-6.552,P<0.001）。各冠状动脉分支供血区最小MPR_inner值与血管最大狭窄率之间存在中度负相关（r=-0.644,P<0.001）。在ROC曲线分析中,当MPR_inner截断值取1.29时,半定量分析预测血管显著狭窄的敏感度和特异度分别87.5%和66.7%。比较ROC曲线下面积,半定量分析和肉眼观察的总体诊断效能差异无统计学意义（Z=-0.830,P>0.05）。结论：3.0 T MRI心肌灌注成像结合半定量分析可发现有血流动力学意义的冠状动脉狭窄导致的心肌缺血。     

双源CT在颈动脉体瘤术前的指导意义

Objective To explore the value of dual-source CT（DSCT）cerebral and carotid angiography in carotid body tumor (CBT) diagnosis. Methods DSCT cerebral and carotid angiography was performed on nine patients with carotid body tumor. Two-dimensional and three-dimensional reconstruction images were performed by means of multiple planar reconstructions (MPR), maximum intensity projection (MIP) and volume rendering (VR). All patients were subjected to color Doppler flow imaging (CDFI) examination. Two kinds of examinations were performed in 3 days, and all patients were confirmed by surgery. Results All patients were successful in DSCT angiography. Carotid body tumors were diagnosed in 9 patients with 10 lesions as; 1 case had multiple bilateral CBTs. The largest lesion was 12 cm in diameter, and the smallest one was 1.6 cm in diameter. All patients head and neck vessels, tumor angiogenesis, and the tumor relationship with the surrounding blood vessels were demonstrated clearly. Internal and external carotid artery (ICA, ECA) were involved in 2 cases. There were 7 cases with basilar artery ring integrity, and 1 case had the posterior communicating artery absent; 1 case had middle cerebral artery stenosis; 4 cases (4 tumors) showed arterial phase homogeneous enhancement; 5 cases (6 tumors) had obvious heterogeneous enhancement where irregular low-density necrosis could be seen in the tumors. CDFI could demonstrate the tumor and nearby blood vessels, instead of tumor angiogenesis. However, DSCT could display both the tumor and the peripheral vascular tumor angiogenesis consistent with surgical findings. Conclusion DSCT cerebral and carotid angiography might be a valuable carotid body tumor diagnostic method by showing accurate views of the carotid body tumor along with the bilateral neck and brain blood vessels, providing reliable information for the operation.     

双源CT前瞻性心电门控扫描在急性胸痛诊断中的临床应用

目的 探讨双源CT(DSCT)前瞻性心电门控扫描在急性胸痛诊断中的临床应用,并比较前瞻性心电门控与回顾性心电门控2种扫描技术的图像质量和辐射剂量.方法 连续搜集30例[A组,平均心率≥85次/min(bpm)]临床症状表现为急性胸痛并行DSCT前瞻性心电门控心胸联合血管成像的患者,连续搜集30例(B组,所有患者平均心率≥85 bpm)表现为急性胸痛行DSCT回顾性心电门控扫描的患者.对2组患者的冠状动脉、肺动脉及主动脉分别进行靶重组,评价2组图像质量,并对疾病进行诊断;应用x2检验和两独立样本t检验比较2组患者的图像质量和有效剂量.结果 A、B组可评价冠状动脉节段比例分别为98.44%(379/385)和98.48%(390/396),差异无统计学意义(x2=0.002,P=0.961);A、B组间图像噪声[分别为(16.23±5.75)、(16.31±3.32)HU]、信噪比(分别为26.85±9.94、24.78±9.91)及对比度噪声比(分别为20.99±9.31、18.65±8.72)差异均无统计学意义(t值分别为0.069、0.908、1.224,P值均＞0.05);A、B 2组有效剂量分别为(8.37±2.69)和(20.05±5.52)mSv,差异有统计学意义(t=9.401,P=0.000).结论 DSCT前瞻性心电门控心胸联合血管成像可以获得与回顾性心电门控扫描相似的图像质量,且辐射剂量降低.

Abstract：

Objective To evaluate the application of prospective ECG-gated dual source CT (DSCT) in patients with acute chest pain, and compare it's image quality and radiation dose with those of retrospective ECG-gated spiral scan. Methods Thirty consecutive patients (Group A, average HR ≥85 bpm) with acute chest pain were scanned with prospective ECG-gated scan and another 30 consecutive patients (Group B, average HR ≥85 bpm)were analyzed by retrospective ECG-gated scan. Tube voltage and tube current were adapted by the BMI of patients. MPR, MIP, CPR and VR were used to display pulmonary arteries (PA), thoracic aorta and coronary arteries (CA). Image quality as well as radiation dose were assessed in 2 groups. Qualitative image quality was compared with chi-square test between the two groups,while quantitative image quality [the image noise ( IN ), signal-to-noise ratio ( SNR ) and contrast-to-noise ratio(CNR)] and radiation dose were evaluated with x2 test and Student's t test. Results The proportion of valid coronary segments for diagnosis were 379/385 ( 98. 44% ) and 390/396 ( 98.48% ) respectively in Group A and Group B with no significant difference(x2 =0. 002,P =0. 961 ). The IN [( 16. 23 ±5.75)vs ( 16. 31 ±3. 32) HU] ,SNR (26. 85 ±9. 94 vs 24. 78 ±9. 91 ) and CNR (20. 99 ±9. 31 vs 18. 65 ±8. 72)showed no significant differences between 2 groups ( t = 0. 069,0. 908 and 1. 224, P ＞ 0. 05, respectively).The ED was on average ( 8. 37 ± 2. 69 ) mSv in Group A, whereas on average ( 20. 05 ± 5.52 ) mSv in Group B. There was a statistical difference between 2 groups ( t = 9. 401, P = 0. 000). Conclusion Low dose prospective ECG-gated DSCT angiography can show similar image quality as retrospective ECG-gated spiral scan with radiation dose.