肺淋巴管肌瘤病X线及CT影像学诊断

目的探讨肺淋巴管肌瘤病的X线及CT影像学特点,提高对该病的认识和诊断水平。方法回顾分析我院及外院近一年来经病理证实的肺淋巴管肌瘤病8例,全部病例均行胸部X线检查及HRCT检查。结果胸部X线表现无明显特异性,HRCT的特征性表现为双肺弥漫分布小囊状影及囊腔影,囊腔直径0.2～0.6cm,最大3.5cm,囊壁厚薄均匀,多伴发液气胸。结论肺淋巴管肌瘤病是一种罕见病,其影像学表现有特征性,尤以HRCT对该病的诊断有重要价值。     

Role of high resolution CT and radiography in postoperative evaluation of cochlear implantation

Objective

To assess the role of HRCT and Radiography in postoperative evaluation of cochlear implants.

Patients and methods

Radiography; including Stenver’s and modified Chause III positions, as well as HRCT were carried out in 12 patients with cochlear implants. HRCT images were obtained utilizing 0.625 mm slice thickness followed by reconstruction using 0.3-mm reconstruction increment and high-resolution algorithm.

Results

On HRCT, complete insertion of electrode array was noted in one patient, incomplete insertion in two and partial insertion in nine patients. The position of the electrode array as compared to CT and radiography revealed agreement in 11 patients; and disagreement in one. The radiologic position of the electrode array was compared to intra-operative electrophysiological testing and surgical data. In three patients, there was agreement. In one patient, contacts 11 and 12 were nonfunctioning with good impedance and were extra-cochlear. One patient had nonfunctioning contact 12 with high impedance and absent stapedial reflex and was extra-cochlear. In one patient, contacts 11 and 12 showed high impedance and were extracochlear. In nine patients, intra-operative electrophysiological testings were satisfactory with three having high impedance of last contact. Facial twitches were encountered in two patients.

Conclusion

Technological advances will expand the applications of HRCT in cochlear implant recipients.     

特发性肺纤维化患者血清热休克蛋白47和血管内皮生长因子的动态变化及其临床意义

目的 探讨特发性肺纤维化（IPF）患者血清热休克蛋白47（HSP47）和血管内皮生长因子（VEGF）的动态变化及其临床意义。方法 选取2017年1月—2019年8月天津市胸科医院收治的加重期IPF患者、稳定期IPF患者及同期该院体检的健康者共141例为研究对象,分别纳入加重期组、稳定期组及健康对照组,每组47例。采用酶联免疫吸附试验检测各组血清HSP47、VEGF水平及肺功能,采用高分辨率CT（HRCT）评分法评价各组肺纤维化程度,分析血清HSP47、VEGF、肺功能及HRCT评分之间的相关性。结果 加重期组、稳定期组及健康对照组的血清HSP47、VEGF水平比较,差异有统计学意义（P <0.05）,加重期组血清HSP47、VEGF水平高于稳定期组,稳定期组高于健康对照组;加重期组动脉血二氧化碳分压（PaCO₂）、HRCT评分高于稳定期组（P <0.05）;加重期组动脉血氧分压（PaO₂）水平低于稳定期组（P <0.05）。加重期组第1秒用力呼气容积（FEV₁）、用力肺活量（FVC）、第1秒用力呼气容积占用力肺活量比值（FEV₁%）、一氧化碳弥散量占预计值百分比（DLCO%pred）低于稳定期组。Pearson相关性分析显示,HSP47与FEV₁、FVC、FEV₁%、DLCO%pred、PaO₂呈负相关（r =-0.735、-0.579、-0.612、-0.642和-0.636,均P <0.05）,与PaCO₂、HRCT评分呈正相关（r =0.683和0.517,均P <0.05）;VEGF与FEV₁、FVC、FEV₁%、DLCO%pred、PaO₂呈负相关（r =-0.757、-0.583、-0.644、-0.656和-0.663,均P <0.05）,与PaCO₂、HRCT评分呈正相关（r =0.597和0.525,均P <0.05）;HSP47与VEGF呈正相关（r =0.685,P<0.05）。结论 IPF患者血清HSP47、VEGF水平随着病情的加重而升高,检测血清HSP47、VEGF水平有利于辅助评估IPF患者的病情。     

高分辨率CT显示听小骨能力的研究

目的 探讨高分辨率CT（HRCT）单侧密集骨重建技术对听小骨细微结构的显示能力及对疾病的诊断价值。方法：收集45人，81只耳的资料，全部病例行HRCT扫描，后进行单侧局部密集骨重建，观察轴冠位的正常及异常HRCT图像对听小骨（包括砧骨豆状突，砧镫关节，镫骨前后脚、脚板）的显示情况。结果：慢性中耳乳突炎31只，外耳道先天性闭锁伴中耳发育畸形2只，颞骨骨折波及中耳1只。HRCT密集骨重建，轴冠位结合扫描，能清晰显示听小骨炎症的微小破坏，骨折等病变；结合中耳仿真内镜可清晰地显示发育畸形的听小骨。结论：HRCT能清晰，准确地显示听小骨细微结构。优于传统的CT图像，可为临床诊断和治疗提供可靠的依据。     

颞骨HRCT三维重建测量乳突气房表面积与容积的临床意义

目的 通过颞骨HRCT三维重建测量乳突气房表面积(SA)、容积(V),以揭示健康气化型乳突气房SA、V、表面积容积比(SA/V)的参考值范围及特征,为进一步乳突气房功能研究、生理建模及功能重建提供依据.方法 回顾性分析2016年1月-2017年6月广州市红十字会医院108例(216耳)乳突气化型成年患者的颞骨HRCT资...     

COVID-19 and pulmonary tuberculosis – A diagnostic dilemma

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Meanwhile, pulmonary tuberculosis(TB) is one of the most common infective lung diseases in developing nations. The concurrence of pulmonary TB and COVID-19 can lead to poor prognosis, owing to the pre-existing lung damage caused by TB. Case presentation: We describe the imaging findings in 3 cases of COVID-19 pneumonia with co-existing pulmonary TB on HRCT thorax. The concurrence of COVID-19 and pulmonary TB can be a diagnostic dilemma. Correct diagnosis and prompt management is imperative to reduce mortality and morbidity. Hence it is pertinent for imaging departments to identify and report these distinct entities when presenting in conjunction.     

Chronic Schistosomiasis Presenting with Migrating Pulmonary Manifestation after Recent COVID-19 Infection: HRCT Findings

Teaching Point: Chronic pulmonary schistosomiasis should be suspected in symptomatic patients with an endemic background presenting with migrating pulmonary lesions on high resolution computed tomography scan.     

高分辨螺旋CT在支气管哮喘气道重塑中的预测价值研究

目的 研究高分辨螺旋CT对中度哮喘患者气道重塑的评估.方法 本研究为单中心开放研究,通过纳入30例中度持续哮喘组和对照组30例行肺功能测试、高分辨螺旋CT扫描.比较对照组、哮喘组的肺功能指标、气道反应性,并与HRCT测试的气道壁厚度(WT)和气道壁相对面积(WA%)值做相关分析.结果 哮喘患者气道壁厚度(WT)较对照组增厚,相对气道壁面积(WA%)增加;WT和WA%与受试者气道高反应性正相关,而与FEV1/FVC、FEV1%呈负相关.近端气道相关程度强于远端气道.结论 高分辨螺旋CT影像能有效评估哮喘患者的气道重塑,并与哮喘患者症状、肺功能检查密切相关,可用于评估哮喘的严重性、分型和哮喘患者的预后,评定治疗效果和随访观察.