Potentials of laser guidance system for percutaneous musculoskeletal procedures

 Early experience using a new laser guidance device to assist CT-guided percutaneous musculoskeletal procedures is presented. We describe six cases which demonstrate typical musculoskeletal applications of laser guidance. In our experience laser guidance for these procedures resulted in improved accuracy with no significant increase in biopsy time when a short learning period is considered. Other musculoskeletal procedures may benefit from laser guidance compared with current standard CT-guided techniques, particularly when precision and accuracy are essential.     

CT引导穿刺透明隔囊肿-腹腔分流术12例

目的探讨CT引导下穿刺透明隔囊肿-腹腔分流术治疗透明隔囊肿的可行性。方法采用CT引导穿刺透明隔囊肿-腹腔分流术治疗有症状的透明隔囊肿12例，其中8例合并脑积水，术前常规行头颅CT冠状扫描，确定囊肿的中心位置与所定基线的关系，术中正确穿刺。结果12例头痛、头晕症状均消失；癫痫发作3例术后未再复发；意识障碍2例术后清醒。无术后并发症。12例随访2～24个月，平均11个月，术后复查CT和MRI，10例囊肿消失，2例囊肿较术前减小（最大横径减小3～18mm，平均减小12．6mm）；8例脑积水脑室形态术后均回缩30％以上。结论CT引导穿刺透明隔囊肿-腹腔分流术治疗透明隔囊肿可行，具有微创、操作简便、疗效好、并发症少等优点。     

Dosimetric comparison between CT-guided free-hand intracavity/interstitial adaptive brachytherapy and conventional point-A brachytherapy in the treatment of cervical cancer

Objective To analyze the dosimetric differences between CT-guided free-hand intracavity/interstitial brachytherapy[image-guided adaptive brachytherapy (IGABT)] and conventional point-A plan (CP) in the treatment of cervical cancer. Methods Twenty-six cervical cancer patients who received four cycles of IGABT in Sun Yat-sen University Cancer Center were enrolled in this study. Two sets of CT images were obtained before and after applicator adjustment to aid in the design of CP and IGABT plans. The high-risk clinical target volume (HRCTV), point A, and organs at risk (bladder, rectum, and sigmoid colon) were defined on CT images. CP and IGABT plans were designed on CT images. Parameter differences between CP and IGABT plans were analyzed with paired t-test and Wilcoxon test. Results According to the coverage index (CI) of CP, plans were divided into two groups:in group A (CI≥0.90), 20 CP and corresponding IGABT plans were included, and 84 CP and corresponding IGABT plans in group B (CI<0.90). The mean volume of HRCTV and mean tumor diameter in group A were significantly smaller than those in group B (46.7 cm³ vs. 62.1 cm³, P<0.001 and 3.1 cm vs. 4.4 cm, P<0.001). Compared with CP, IGABT significantly improved the value of D90% in all plans and group B, whereas lowered the bladder dose. IGABT also reduced the dose of sigmoid colon in group A. IGABT significantly improved conformal index and dose homogeneity index. Conclusions IGABT can significantly improve the target coverage, conformal index and dose homogeneity index, protect organs at risk. Compared with CP, IGABT has advantages in the treatment of patients with bulky tumor.     

CT引导下神经根周围阻滞治疗椎间盘源性腰骶神经根痛

目的 探讨CT引导下神经根周围阻滞治疗椎间盘源性腰骶神经根痛的方法和疗效。方法 对有腰腿痛的79例腰椎间盘突出症的患者，采取CT引导下神经根周围注射皮质类固醇加局麻药，观察患者腰骶神经根痛的变化情况。结果 79例均成功完成CT引导下的神经根阻滞术，43例完成了治疗后6个月的随访，其中25例(58．1％)效果好，11例(25．6％)效果较好，7例(16．3％)效果较差。结论 CT引导下神经根周围阻滞治疗腰椎间盘突出症所致的腰骶神经根痛，操作方法简便、安全、有效、微创，值得临床推广。     

PET-CT选择肺内多发病灶再穿刺病灶的价值

目的评价PET-CT引导下精准选择病灶并进行穿刺活检诊断的价值。方法 52例肺内多发病灶直接使用胸部CT定位穿刺活检后,对首次诊断不明确需要第二次活检病例,根据PET-CT定位来选择穿刺病灶,并对诊断结果进行分析。结果 52例多发肺部病变患者,51例有明确的病理诊断,其中恶性肿瘤36例,良性病变15例;1例因不能耐受第二次穿刺最终未取得病理结果。首次穿刺活检诊断准确度为73.1%(38/52),敏感度75.7%(28/37),特异度66.7%(10/15),假阳性率33.3%,假阴性率24.3%;结合PET-CT定位的第二次活检诊断准确度98.1%(51/52)、敏感度97.3%(36/37)、特异度达100%,无假阳性,假阴性率2.7%(P0.01)。全部病例未发生严重并发症。结论根据PET-CT表现,该方法诊断准确度、特异度及灵敏性均较高,安全性好,在肺内多发病灶患者二次穿刺诊断的定位上有重要价值。     

胸腔镜术前低剂量CT引导下Hook-wire联合亚甲蓝定位肺局灶性磨玻璃样病变

目的探讨低剂量CT(low-dose CT,LDCT)引导下Hook-wire联合亚甲蓝定位在胸腔镜下肺局灶性磨玻璃样病变(focal ground-glass opacity,fGGO)切除术中的临床应用价值。方法 2010年11月～2012年4月对21例单侧fGGO(直径5～17 mm,平均11.5 mm,距壁层胸膜0～28 mm)行胸腔镜肺楔形切除术,术前皆行LDCT引导下Hook-wire定位,并辅以亚甲蓝染色。结果 LDCT引导下Hook-wire联合亚甲蓝定位成功率为100%,定位时间15～28 min,平均21 min。1例术中金属钩脱落,胸腔镜下观察肺组织表面血肿和亚甲蓝染色而成功手术切除;1例亚甲蓝染色失败,但Hook-wire锚定病灶亦成功手术切除。6例(28.6%)发生并发症,其中无症状气胸4例,无症状左上叶出血1例,无症状气胸和右下叶出血1例。VATS手术时间15～43 min,平均22 min;术中出血量23～38 ml,平均31 ml。术后住院5～12 d,平均7 d。fGGO术后病理:原位癌4例,微浸润腺癌3例,肺腺癌1例,不典型腺瘤样增生5例,错构瘤1例,间质性肺炎3例,肺内淋巴结增生2例,炎性肉芽肿2例。结论 LDCT引导下Hook-wire联合亚甲蓝定位fGGO的准确率高,并发症轻微。     

CT引导经皮椎体成形术治疗骨质疏松性压缩骨折疗效观察

目的探讨CT引导下经皮椎体成形术治疗骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析行CT引导经皮椎体成形术治疗骨质疏松性椎体压缩骨折106例患者的临床资料。结果106例手术均获成功,术后视觉模拟评分（visualanaloguescale,VAS）（（2．31±0．75）分）较术前（（7．62±0．62）分）明显降低（P〈O．05）,治疗优良率72％,有效率97％;术后患者疼痛症状明显缓解或消失,无肺栓塞、神经损伤等并发症。结论CT引导经皮椎体成形术治疗骨质疏松性压缩骨折疗效确切,具有微创、安全等优点。     

神经导航系统引导穿刺抽吸与CT定位穿刺抽吸治疗高血压性脑出血疗效比较

目的：比较神经导航系统引导多靶点穿刺与CT定位单靶点穿刺两种手术方法治疗高血压性脑出血的疗效。方法98例患者按就诊顺序随机分成两组。神经导航系统组46例,多靶点穿刺抽吸脑内血肿;CT定位组52例,根据CT片直接穿刺、抽吸血肿。术后随访3个月,行格拉斯哥预后评分（GOS）判断疗效。结果两组患者手术持续时间、引流天数、术中血肿抽吸率、住院天数和GOS评分差异均有统计学意义（P〈0.05﹚。结论神经导航多靶点技术微创穿刺抽吸手术治疗高血压脑出血较CT定位单靶点穿刺安全、有效。     

多种肺穿刺活检术对老年疑似Ⅰ～ⅢA期肺癌的诊断运用评价

目的评价多种肺穿刺活检术对老年疑似Ⅰ～ⅢA期肺癌中的诊断价值。方法对疑似Ⅰ～ⅢA期151例肺癌老年患者分别采取经纤维支气管镜肺活检(TBLB)、CT或彩色多普勒超声(CDU)引导下经皮肺穿刺活检并进行临床诊断,所得结果与病理结果进行对照。结果联合3种活检方法诊断率与单一活检方法诊断率比较,差异有统计学意义(P<0.05)。结论多种肺穿刺活检术联合应用可明显提高对老年疑似Ⅰ～ⅢA期肺癌的诊断率。     

CT引导下经皮肺穿刺活检在肺部占位性病变诊断中的诊断价值

目的探讨cT引导下经皮肺穿刺活检在肺部占位性病变诊断价值。方法分析62例CT引导下经皮肺穿刺活检术的临床资料,评价其临床应用价值,对并发症进行分析。结果62例肺占位病变中,穿刺病理诊断56例,准确率达90．3％,并发肺出血19．34％,气胸16．13％。结论CT引导下经皮肺穿刺活检是一种微创、安全、准确、简便的获得组织病理的诊断方法,具有重要的临床诊断意义。