动脉插管介入注射联合用药治疗晚期乳腺癌疗效观察

目的观察晚期乳腺癌患者应用动脉插管介入技术注射吡柔比星等联合治疗的临床疗效.方法经股动脉行Seldinger法穿刺插管进入患者乳腺癌供血动脉,注射联合化疗药物治疗38例晚期乳腺癌患者.单次用药剂量吡柔比星60～80 mg,顺铂60～80 mg,氟尿嘧啶1000～1500 mg,静脉推注亚叶酸钙300 mg.结果初治组有效率为85.6%,复治组为61.2%,初治组疗效明显优于复治组.毒副反应主要为恶心及周围血像数略有下降.结论联合化疗药物采用动脉插管技术介入治疗晚期乳腺癌是安全有效的.     

下肢动脉闭塞性疾病64层CT血管成像中腘动脉小剂量对比剂试验的意义

目的 探讨下肢动脉闭塞性疾病采用64层CT血管成像时,在腘动脉行小剂量对比剂试验的意义.方法 连续选取28例临床怀疑下肢动脉闭塞性疾病患者,应用64层CT在两侧腘动脉(膝关节层面)各设置一ROI进行小剂量对比剂试验,明确显示峰值及达峰时间者认为曲线获取成功.分析两侧腘动脉峰值、达峰时间、左右两侧的差异,及其对下肢动脉CTA的影响,并采用Pearson相关法分析达峰时间与峰值的相关性.根据达峰时间采用快速模式启动扫描,并将图像质量分为优、良、差3个级别按节段进行评价,计算优和良的动脉节段数占总节段数的百分比即优良率.结果 28例患者中获取腘动脉小剂量对比剂曲线的成功率为96%(54/56).26例获得双侧小剂量对比剂曲线的患者中,腘动脉峰值及达峰时间差异较大,分别为60～178(135±28)HU,21～46(31±6)s.左右腘动脉峰值及达峰时间差异亦较大,19例左右峰值不一致,差值10～80 HU,平均(32±18)HU;21例左右达峰时间不一致,差值1～12 s,平均(5±3)s.达峰时间与峰值呈负相关(r= -0.526,P<0.01).下肢CTA 616个动脉节段中,成像质量优598个,良12个,优良率为99%(610/616).结论 下肢动脉闭塞性疾病采用64层CT血管成像时,应用腘动脉小剂量对比剂试验可以准确把握扫描时机,从而获得良好的血管成像质量.

Abstract：

Objective To investigate the clinical value of the test injection at popliteal arteries on 64-slice CTA in lower extremity peripheral arterial occlusive disease (PAOD). Methods Twenty-eight patients with PAOD referred for 64-slice CTA were enrolled consecutively in the study. Test injection was performed at bilateral popliteal arteries (the level of knee joints) and the clinic value of the peak value and the time to peak was analyzed. The relationship between the time to peak and the peak value was evaluated with Pearson test. The time to peak was used for programming of the CT angiographic acquisitions with fast scanning mode. The quality of visualization of each arterial segment was determined independently by two radiologists. Results Fifty-four (96%, 54/56) time-attenuation curves were obtained in 28 patients. The wide interindividual variation in the peak value and the time to peak was observed in 52 curves of 26 patients with range of 60-178 HU,21-46 s and an average of (135±28) HU,(31±6) s, respectively. The difference in the peak value and the time to peak between bilateral popliteal arteries was also observed with range of 10-80 HU and an average of (32±18) HU in 19 patients,with range of 1-12 s and an average of (5±3) s in 21 patients. There was negative relationship between the peak value and the time to peak (r=-0.526, P<0.01). The CTA images were of good (598 segments) or medium quality (12 segments) in 99% segments (610/616). Conclusions The test injection at popliteal arteries was useful for 64-slice CTA in the patients with PAOD, as it could accurately specify the delay time of CT angiographic acquisitions.     

冠状动脉扩张的64排螺旋CT表现及临床意义

目的探讨冠状动脉扩张的64排螺旋CT表现及临床意义。方法收集2009年10月—2010年12月之间经MDCT诊断为冠状动脉扩张的患者13例,分析病变发生的部位、大小(横径)、病变范围(长度)、血管腔内有无血栓形成、数目以及是否合并心肌缺血。结果在13例患者中共有15个节段可以评价,其中病变发生在单支血管者11例,病变发生在两支冠状动脉者2例。弥漫性冠状动脉扩张10例,局限性冠状动脉扩张3例(2例为球形动脉瘤,1例为梭形动脉瘤)。扩张率为1.5~2.8,发生部位为:RCA 7例(7/15),LM 1例(1/15),LAD 3例(3/15),LCX 3例(3/15),Ramus 1例(1/15);9例伴硬化斑块形成,1例缺血性心脏病。结论冠状动脉扩张的多排螺旋CT表现具有其特征性,64排螺旋CT冠状动脉造影是诊断冠状动脉扩张的一种良好的手段。