翼腭窝的CT影像与断层标本对照研究及临床意义

目的:为翼腭窝病变的影像诊断及手术入路提供解剖学资料.方法:选取志愿者40名,在螺旋CT机上以眦耳线(CML)为基线对翼腭窝结构进行层厚1mm连续扫描.选取成人尸体头颈部标本20例,以CML为基线制成厚5 mm的连续断层标本.在经蝶骨体层面和翼突层面的CT影像及断层标本上,观察翼腭窝及其周围结构的解剖学关系,测量其长径、宽径和面积.结果:在经蝶骨体的CT影像及断层标本上的翼腭窝形态较固定.在CT影像和断层标本上,经蝶骨体层面和翼突层面的翼腭窝面积分别为(113.40±3.33)mm2和(115.86±2.58)mm2、(92.24±2.73)mm2和(93.60±3.17)mm2.CT影像及断层标本可清晰显示翼腭窝前、后、内侧壁上的结构和翼上颌裂、眶下裂、翼管、蝶腭孔等相关通道.结论:翼腭窝的CT影像与解剖对照研究对翼腭窝病变的影像诊断及指导手术入路具有重要临床意义.     

手腕骨解剖计算机辅助模拟系统的构建

目的 构建人体腕骨解剖计算机辅助模拟系统(3DCACAS),实现腕骨三维分割、腕骨解剖、诊断分析、手术设计、疗效评价和三维测量.方法 系统基于Windows XP,使用Microsoft Visual C++开发平台,借助OpenGL辅助开发工具.采用优化的Marching Cube(MC)算法,以CT数据进行三维重构,OpenGL工具进行三维显示与控制.采用基于空间的方法进行三维局部分割.通过像素叠加进行三维量化处理.结果 建立了人体手腕骨解剖计算机辅助模拟系统,功能包括图像三维真实感显示、三维分割、三维测量以及腕骨手术内置固定钢板辅助设计.结论 3DCACAS的建立,为研究手腕骨运动学改变、诊断腕关节疾病的病理变化及腕骨手术术前计划提供了参考.

Abstract：

Objective To design and construct a 3-dimensional carpal anatomy computer-aided simulation system (3DCACAS) which can realize three-dimensional segmentation and anatomical dissection of the carpal, diagnose and analysis, surgical design, outcome evaluation and 3D measurement. Methods The software ran on Windows XP operating system, was developed with Microsoft Visual C + + platform and was in virtue of OpenGL. In the system, optimized Marching Cube(MC)was used in 3D reconstruction. 3D display and control was designed by OpenGL. 3D arbitrary region segmentation was realized by spatial segmentation and pixels superimposition was used in 3D measurement. Results A computer-aided surgical simulation system for carpal anatomy was developed. Its functions included 3D reality display of images, 3D segmentation, 3D measurement and computer-aided surgical design of internal fixation of the carpus. Conclusion The construction of 3DCACAS provides a reference for studying carpal kinematics, diagnosing pathological changes of carpal ailment and planning surgeries around the carpus.     

应用256层螺旋CT灌注技术研究兔肝I/R后血流动力学变化

目的：应用256层螺旋CT灌注成像分析兔部分肝脏缺血再灌注损伤（I/R）后阶段血流动力学的变化规律及其价值。
方法：新西兰大白兔阻断肝左叶血供60min后,恢复血供,按缺血再灌注的时间分为6,12,24 h和假手术（S）组,每组6只。各组分别采用256层螺旋CT行全肝灌注成像和病理学分析。在灌注图上测量肝动脉灌注量（HAP）,门静脉灌注量（HPP）,总灌注量（TLP）以及肝动脉灌注指数（HPI）。
结果：(1)在I/R 6,12,24 h组肝脏血流出现差异性分布（低灌注的肝组织,即梗死区）。(2)在梗死的肝组织中,与S组相比,I/R 6 h 组中HPP,TLP外,I/R12 h和24 h组HAP,HPP,TLP均低于对照组,而HPI则高于对照组.在灌注相对正常的肝组织中各灌注参数均呈下降趋势。(3)I/R组梗死与未梗死肝组织CT灌注参数之间差异有显著性。
结论：CT灌注参数能够客观准确地反映肝I/R病理过程中血流动力学的变化。     

Hysterosalpingography versus sonohysterography for intrauterine abnormalities

Objective:

The hysterosalpingogram is commonly used to evaluate the uterine cavity and the fallopian tubes in the workup of infertile couples. The sonohysterogram is gaining popularity as part of this evaluation. This study compares hysterosalpingography to sonohysterography for the detection of polyps, cavitary fibroids, adhesions, and septae in infertile patients.

Methods:

We conducted a retrospective chart review of 149 infertility patients seen at a University Hospital Center, divisions of Reproductive Endocrinology and Interventional Radiology. Patients underwent hysterosalpingography and sonohysterography as part of their infertility evaluation. The reports were reviewed and findings like polyps, fibroids, adhesions, and septae were compared to the findings obtained at the time of hysteroscopy. Sensitivity, specificity, and accuracy of radiologic tests were the main outcome measures.

Results:

The sensitivity of hysterosalpingography and sonohysterography was 58.2% and 81.8%, respectively. The specificity for hysterosalpingography and sonohysterography was 25.6% and 93.8%. The differences in sensitivity and specificity were both statistically significant. Hysterosalpingography had a general accuracy of 50.3%, while sonohysterography had a significantly higher accuracy of 75.5%.

Conclusion:

Although hysterosalpingography is the standard screening test for the diagnosis of tubal infertility and can provide useful information about the uterine cavity, sonohysterography is more sensitive, specific, and accurate in the evaluation of the uterine cavity.     

快速成型模型在制定胫骨平台复杂骨折手术方案中的指导作用

目的 探讨快速成型技术制备的模型在胫骨平台复杂骨折手术方案制定中的指导作用. 方法 2006年11月至2010年11月收治16例胫骨平台复杂患者,男10例,女6例;年龄27～68岁,平均39岁.术前根据X线片和CT进行AO分型;41B2.2型4例,41B3.2型3例,41B3.3 型2例,41C2.1型1例,41C3.1型2例,41C3.2型2例,41C3.3型2例.术前均进行三维螺旋CT扫描,所得数据经转化输入决速成型机,制备出了1:1等大的快速成型胫骨平台骨折模型,明确骨折类型并指导制定手术方案,术后随访了解骨折愈合与患膝功能情况. 结果 2例患者骨折分型由AO41B2.2型修正为41B3.1型,1例患者骨折分型由41C2.1型修正为41C3.1型.模型上进行了损伤机制的分析和手术方案的制定.所有患者术后获9～22个月(平均14个月)随访,骨折均获骨性愈合,愈合时间4～6个月(平均4.7个月),术后膝关节功能参照改良HSS膝关节评分系统评定:优11例,良3例,可2例,优良率为87.5％.结论 采用快速成型技术制备的1:1等大胫骨平台骨折模型使骨折伤情更直观,骨折分型更加准确;可根据骨折模型制定手术方案,并可对内固定钢板进行预先塑形,对复杂类型的骨科手术方案的制定有较强的指导作用.     

结节性硬化症39例CT及MRI影像学特点分析

目的 探讨结节性硬化症（TS）的CT、MRI影像学特征表现及诊断价值.方法 回顾性分析39例经临床和手术确诊为TS患者的影像学资料,根据脑内病灶所处的位置以及合并脑内或其他脏器病变进行影像学分型.结果 Ⅰ型10例分布在室管膜下,Ⅱ型21例,除分布在室管膜下外,还分布在皮层、白质等部位,Ⅲ型8例合并其它脏器肿瘤.结论 CT、MRI表现是脑内TS确诊的主要依据,二者相互结合对明确诊断有重要意义;对TS进行影像学分型发现结节位置及合并症是TS预后的决定因素.     

位相对比乳腺摄影与全数字化乳腺摄影影像质量的比较研究

目的 探讨和比较位相对比乳腺摄影(Phase-contrast Mammography,PCM)与全数字化乳腺摄影(Full Field Digital Mammography,FFDM)的影像质量.方法 选用ACR RMI-156模型,分别于PCM乳腺摄影机与FFDM乳腺摄影机拍摄,除自动曝光条件,其余选用的曝光条件...     

Assessment of scaphoid fracture healing

Scaphoid fractures are among the most common hand fractures in adults. The geometry of the scaphoid as it relates to its retrograde blood supply renders it particularly prone to avascular necrosis and other fracture complications. Though there has been long-standing debate over the optimal method of diagnosing scaphoid fractures, the best and most cost-effective methods combine clinical exam with other imaging modalities such as navicular view plain films, CT, and MRI for particularly questionable presentations. Once a scaphoid fracture is diagnosed, it should be followed by an orthopaedic surgeon and treated with cast immobilization or operative management in the case of displaced fractures. Fractures should be followed to monitor healing progress in order to ensure the eventual development of bridging bone across the fracture line, usually best appreciated on CT. Proper treatment of scaphoid fractures and assessment of fracture healing can minimize the occurrence of non-unions and associated arthritic changes.     

多轴全方位机器人造影系统在内镜治疗胆道结石中的应用价值初探

目的探讨在行内镜逆行胰胆管造影（ERCP）时使用Artiszeego机器人对胆道进行3D旋转采集和三维重建的应用价值。方法对12例B超提示胆道扩张的病例,在行ERCP同时使用Artis zeego机器人进行3D旋转采集,并经工作站处理进行三维胆道重建,以内镜和手术取石结果为最终诊断,观察其对肝内外胆管结石诊断的符合率。结果12例患者均完成3D旋转采集和三维重建检查,其诊断结果与ERCP取石和手术取石结果均相符,诊断符合率100％,其中,ERCP诊断中2例肝外胆管结石数量不明,1例可疑结石及2例疑似肝内胆管结石病例均得到明确诊断。结论使用Artis zeego机器人对胆道进行3D旋转采集和三维重建有助于ERCP诊疗中对胆道病变做出精准判断。     

功能性消化不良患者水负荷试验时大脑感知作用的fMRI研究

背景：应用功能性核磁共振成像（fMRI）可提示内脏感觉转导作用和内脏高敏感的中枢机制。目前水负荷试验（WLT）致中枢反应的fMRI研究尚少见。目的：研究功能性消化不良（FD）患者WLT时大脑皮质的信息反应特点,探讨其内脏高敏感的中枢机制。方法：纳入符合罗马Ⅲ标准的11例餐后不适综合征（PDS）、13例上腹痛综合征（EPS）患者以及12名对照者。受试者行WLT时接受fMRI检查。结果：PDS和EPS组胃初次饱足阈值、最大饱足阈值均显著低于对照者（P〈0.05）。三组激活脑区大部分集中于双侧大脑半球的前扣带回、颞叶、额叶、岛叶（左侧为主）、楔叶（左侧为主）、丘脑、小脑。PDS组胃初次饱足时颞叶、小脑以及最大饱足时小脑、岛叶的fMRI最大信号变化幅度均显著高于对照者（P〈0.05）;EPS组胃初次饱足时以及最大饱足时前扣带回、枕叶均显著高于对照者（P〈0.05）;除最大饱足时枕叶外,两个FD亚组之间均无明显差异（P〉0.05）。结论：WLT时FD患者大脑感知作用可能与健康对照者相似,中枢在边缘系统（主要为岛叶、前扣带回）以及颞叶、小脑、枕叶等脑区的加工、处理或调节存在异常,导致内脏敏感性增高：而FD亚型之间无明显差异。