双源CT在肺栓塞与下肢深静脉血栓形成联合成像中的应用价值

目的：探讨第二代双源CT一次性造影在肺栓塞（PE）与髂股深静脉血栓形成（DVT）联合成像中的应用价值。方法共185例临床疑诊PE的患者进行了双源CT肺动脉造影和深静脉造影联合成像检查。肺动脉扫描采用单能量大螺距采集模式,髂股静脉扫描采用双能量技术。结果185例中28例（15.14%）患者同时患有PE及DVT,8例（4.32%）患者仅有PE而没有DVT,7例（3.78%）患者仅有DVT而没有PE。PE的直接征象表现为肺动脉管腔内大小不等、形态多样的充盈缺损和管腔完全阻塞影像。DVT表现为管腔中央类圆形、长条形不均匀低密度性充盈缺损。结论双源CT一次性联合成像在肺栓塞与髂股深静脉血栓形成中具有较高价值,适用于伴有下肢静脉循环障碍的可疑肺栓塞患者。     

半导体制冷系统设计及其在C型臂X线机中的应用

从工作原理、基本功能、系统结构3个方面介绍了半导体制冷系统的设计,阐述了半导体制冷系统的主要特点,分析了半导体制冷系统在C型臂中的应用及效果,指出了半导体制冷系统在临床使用中能达到较好的效果．值得在其他C型臂X线机上推广。     

十堰市手术室医护人员对X线辐射防护认知情况调查

目的了解十堰市手术室医护人员对X线辐射防护知识的认知、防护意识及自身防护行为的状况,为开展辐射防护工作提供参考资料。方法对3所医疗机构249名手术室医护人员采用自行设计的X线辐射防护认知、防护意识和防护行为问卷进行调查评估,并对医生组和护士组的问卷结果进行简要的统计学分析。结果医护人员对X线辐射防护基本知识知晓率低,医生组掌握情况均优于护士组,但仅部分知识点存在差异性（P〈0．05）。91．57％的医护人员均担心工作中受到辐射伤害并认为“防护培训”是有必要的。护士组对这方面的担心和需求较医生组更为强烈（P〈0．05）。249名医护人员仅8．84％的人员“行X线检查时曾经向检查技师要求过对不照射部位进行防护”。249名医护人员均一致认可“非必要时妊娠妇女不应该行下腹部X线照射”,略超过半数的医护人员在“胸部X线照射时,选择X线透视还是胸部摄片”和“胸部X线摄片是否可以作为儿童常规体检项目”2项中有正确的认识,但医生组识别能力优于护士组（P〈0．05）。结论该市手术室医护人员对X线辐射防护意识高,对实际工作中的放射防护案例有一定的辨别能力,但辐射防护相关知识薄弱,自身采取的防护行为差,相关部门应加强对手术室医护人员薄弱环节的培训。     

The Clinical Experience of Computed Tomographic-Guided Navigation System in C1-2 Spine Instrumentation Surgery

Objective

To identify the accuracy and efficiency of the computed tomographic (CT)-based navigation system on upper cervical instrumentation, particularly C1 lateral mass and C2 pedicle screw fixation compared to previous reports.

Methods

Between May 2005 and March 2014, 25 patients underwent upper cervical instrumentation via a CT-based navigation system. Seven patients were excluded, while 18 patients were involved. There were 13 males and five females; resulting in four degenerative cervical diseases and 14 trauma cases. A CT-based navigation system and lateral fluoroscopy were used during the screw instrumentation procedure. Among the 58 screws inserted as C1-2 screws fixation, their precise positions were evaluated by postoperative CT scans and classified into three categories : in-pedicle, non-critical breach, and critical breach.

Results

Postoperatively, the precise positions of the C1-2 screws fixation were 81.1% (47/58), and 8.6% (5/58) were of non-critical breach, while 10.3% (6/58) were of critical breach. Most (5/6, 83.3%) of the critical breaches and all of non-critical breaches were observed in the C2 pedicle screws and there was only one case of a critical breach among the C1 lateral mass screws. There were three complications (two vertebral artery occlusions and a deep wound infection), but no postoperative instrument-related neurological deteriorations were seen, even in the critical breach cases.

Conclusion

Although CT-based navigation systems can result in a more precise procedure, there are still some problems at the upper cervical spine levels, where the anatomy is highly variable. Even though there were no catastrophic complications, more experience are needed for safer procedure.     

Chinese Journal of Traumatology won the financial aid from ＂Global Influ- ence Promotion Project for Chinese Scientific and Technical Journals＂

Objective： To determine the frequency of adrenal injuries in patients presenting with blunt abdomi- nal trauma by computed tomography （CT）. Methods： During a 6 month period from January 1, 2011 to June 30, 2011, 82 emergency CT examinations were performed in the setting of major abdominal trauma and ret- rospectively reviewed for adrenal gland injuries. Results： A total of 7 patients were identified as having adrenal gland injuries （6 males and 1 female）. Two patients had isolated adrenal gland injuries. In the other 5 patients with nonisolated injuries, injuries to the liver （1 case）, spleen （1 case）, retroperitoneum （2 cases） and mesentery （4 cases） were identified. Overall 24 cases with liver injuries （29 %）, 11cases with splenic injuries （13%）, 54 cases with mesenteric injuries （65%）, 14 cases （17%） with retroperitoneal injuries and 9 cases with renal injuries were identified. Conclusion： Adrenal gland injury is identified in 7 patients （11.7%） out of a total of 82 patients who underwent CT after major abdominal trauma. Most of these cases were nonisolated injuries. Our experience indicates that adrenal injury resulting from trauma is more common than suggested by other reports. The rise in incidence of adrenal injuries could be attributed to the mode of injury.     

髌骨形态异常与膝关节骨关节炎之间相关性

目的利用计算机辅助测量技术,对一定样本量的甘肃省中医院影像科膝关节X线片进行骨形态测量和相关比值分析研究,得出膝关节相关参数的正常范围,确立膝关节发育缺陷与膝关节骨关节炎之间相关性,找出导致髌股关节骨关节炎的骨性致病因素。方法测量指标:股骨髁宽度、胫骨髁宽度、髌骨宽度、髌骨纵径、髌骨关节面高度、髌骨厚度、髌骨下缘与关节间隙距离、股骨内髁前后径、胫骨平台前后径、髌骨关节面距胫骨平台距离、髌骨中点距股骨纵轴距离,采用SPSS 17.0软件对各有关比值进行处理和分析,采用90%(p5~p95)医学参考范围为正常参考范围描述;计数资料采用χ2检验,设检验水平为0.05,P0.05为差异有显著性意义。结果通过测量136例正常膝关节X线片各骨形态数据及相关比值,以90%医学参考范围为正常范围,得出髌骨厚度/股骨内髁前后径:0.162 362~0.335 135,髌骨纵径/髌骨关节面高度:1.217 105~1.643 902为正常范围。以此标准在481例膝关节骨关节炎病例中,髌骨厚度/股骨内髁前后径异常率6.4%,髌骨纵径/髌骨关节面高度异常率23.5%。结论髌骨偏厚、髌骨偏薄等形态异常在膝骨关节炎中占有一定的比例且女性发病率高于男性。     

Heavy ion and X-ray irradiation alter the cytoskeleton and cytomechanics of cortical neurons

Heavy ion beams with high linear energy transfer exhibit more beneifcial physical and biological performance than conventional X-rays, thus improving the potential of this type of radiotherapy in the treatment of cancer. However, these two radiotherapy modalities both cause inevitable brain injury. The objective of this study was to evaluate the effects of heavy ion and X-ray irra-diation on the cytoskeleton and cytomechanical properties of rat cortical neurons, as well as to determine the potential mechanism of neuronal injury after irradiation. Cortical neurons from 30 new-born mice were irradiated with heavy ion beams at a single dose of 2 Gy and X-rays at a single dose of 4 Gy;subsequent evaluation of their effects were carried out at 24 hours after irradiation. An immunolfuorescence assay showed that after irradiation with both the heavy ion beam and X-rays, the number of primary neurons was signiifcantly decreased, and there was ev-idence of apoptosis. Radiation-induced neuronal injury was more apparent after X-irradiation. Under atomic force microscopy, the neuronal membrane appeared rough and neuronal rigidity had increased. These cell changes were more apparent following exposure to X-rays. Our ifnd-ings indicated that damage caused by heavy ion and X-ray irradiation resulted in the structural distortion and rearrangement of the cytoskeleton, and affected the cytomechanical properties of the cortical neurons. Moreover, this radiation injury to normal neurons was much severer after irradiation with X-rays than after heavy ion beam irradiation.     

螺旋CT动态增强扫描对直肠癌分期诊断的应用价值

目的：探讨多层螺旋CT增强扫描在直肠癌术前诊断、分期中的应用价值。方法：回顾性分析经病理证实的直肠癌患者38例CT影像表现,统计直肠癌局部影像特点、邻近组织侵润情况及远处脏器转移情况,并与术后病理对照。结果：38例患者中癌灶为腔内肿块15例,腔内肿块伴有肠壁增厚12例,肿瘤突破浆膜层并周围组织侵犯7例;肿瘤侵犯邻近器官或伴有远处转移4例。所有病例术后病理对照符合率为81.5%（31/38）。结论：多层螺旋CT增强扫描对直肠癌的诊断、分期和术后病理的对照一致性较高,术前螺旋CT增强扫描为手术方式的选择具有指导意义,并具有较高的临床应用价值。     

PET/CT工作场所合理布局设计的探讨与分析

目的：探讨PET/CT工作场所布局设计内容,为医院PET/CT工作场所新建和改建设计提供参考。方法：根据相关文献资料和工作经验,结合PET/CT工作场所放射防护特点,对具有放射性的PET/CT工作场所布局的合理性进行分析。结果：针对PET/CT工作场所存在的不足,提出合理可行的布局设计要求。结论：对PET/CT工作场所合理的布局设计对降低辐射水平、实现辐射防护最优化以及满足工作人员、受检者和公众照射最小化要求等方面具有重要意义。     

320排CT双入口灌注技术在肺结核化疗疗效评价中的应用

目的：探讨运用320排CT双入口灌注成像技术,评估结核病灶灌注参数值对肺结核化疗近期效果的预测作用。方法：将30例肺结核按形态学分为结核球、空洞型病灶和浸润型病灶三组。化疗前7 d内CT检查与化疗后30 d的CT平扫结果进行比较,根据标准评定疗效分成缓解组与未缓解组。化疗前7 d内及化疗后14 d行2次CT灌注扫描,比较化疗前、化疗后早期CT灌注参数的变化与化疗疗效的关系。结果：30例患者中缓解组20例,非缓解组10例;化疗前与化疗后早期病灶大小进行比较,均未见明显变化。化疗前及化疗后早期CT各灌注参数在两组中均有变化。缓解组结核的治疗前PF、BF值高于未缓解组,其差异有统计学意义（t=6.23,t=7.61;P＜0.001）,缓解组中结核病灶灌注值治疗前后有显著性差异,灌注值有所下降,未缓解组中治疗前后结核病灶灌注值升高,BF值治疗前14.06＆#177;4.09,治疗后升至36.68＆#177;4.41,其差异显著。PF值虽轻度升高,但无显著性差异。结论：320排双入口灌注技术对肺结核化疗后早期疗效的评估有一定的价值。肺结核治疗后的灌注值变化与近期疗效相关,BF值升高提示结核病灶进展,预后较差。