肝内胆管囊腺癌合并囊肿1例

患者男性，65岁。因上腹部胀痛5年余收住本院。3年前因同样症状，在其它医院行腹部超声示：肝脏多发囊肿，朱给予特殊诊治。患者自诉腹部胀痛．油腻饮食后加重，性质不剧烈，不伴有寒颤、高热，无皮肤、巩膜黄染，无明显消瘦、乏力。患者烟酒少量，无疫水、疫区接触史。5年内多次复查腹部超声“肝多发囊肿”逐渐增大。入院时查体：T37．2℃，P80次／分，R20次/分，BP140／85mmHg。皮肤、巩膜无黄染，结膜无苍白，浅表淋巴结未触及肿大。腹平，未见胃肠蠕动波，腹软无压痛、反跳痛，未触及肿大胆囊，肝肾脾未触及。     

16层螺旋CT脑血管造影的临床应用

目的探讨16层螺旋CT脑血管造影（CTA）的临床应用价值。方法利用16层螺旋CT对159例临床怀疑脑血管疾病的患者做脑血管增强扫描，采用VR、MIP和MPR后处理技术重建脑血管图像。结果本组159例，其中正常74例，血管变异44例，动脉瘤11例，大脑中动脉栓塞2例，脑动脉狭窄29例，脑动静脉畸形1例，Moyamoya病1例。结论CTA能多方位清晰显示脑血管病变，为病变与邻近血管的关系提供更精确具体的解剖图像，可发展作为脑血管疾病的一种筛选手段，部分代替数字减影血管造影术（DSA）。     

85例老年患者下肢动脉血管成像技术检查结果分析

目的 评价16层螺旋CT下肢动脉成像在诊断老年患者下肢动脉硬化闭塞症合并其它不同基础疾病中的临床价值.方法 对85例临床疑似下肢动脉硬化的老年患者行16层螺旋CT下肢动脉血管成像（CT angiography,CTA）扫描,以容积再现（volume rendering,VR）,最大密度投影（maximum intensity projection,MIP）以及曲面重建（curved reformate,CR）技术重建.按糖尿病、高血压病因分组,比较下肢动脉CTA检查结果.结果 CTA检查可以清晰显示双下肢动脉及主要分支病变的部位、范围及侧枝循环.49例血管不同程度钙化患者中,高血压组、糖尿病合并高血压组较糖尿病组下肢动脉管壁钙化的病例出现更多（P＜0.05）.43例不同程度的下肢动脉狭窄及闭塞患者中,糖尿病合并高血压组较高血压组、糖尿病组的闭塞病例出现更多（P＜0.05）.结论 糖尿病合并高血压组患者的下肢动脉硬化闭塞症表现较糖尿病组及高血压组患者更为严重.对存在易患因素的老年人群,尤其是同时具有高血压和糖尿病病因者,下肢动脉CTA检查具有筛选价值.     

CT灌注成像在超早期脑梗死中的应用

Objective To investigate the role of computed tomography perfusion (CTP)in the diagnosis and differential diagnosis of hyperacute cerebral infarction. Methods After CT scan was performed in 33 patients who were clinically diagnosed as cerebral infarction ＜5 hours of symptom onset,CTP imaging was performed. CT was reexamined after 24 hours.Results CT scan did not fred abnormality in 33 patients. CTP imaging showed 15 were normal and 18 were abnormal. The regional cerebral blood flow (rCBF),regional cerebral blood volume (rCBV),and regional mean transit time (rMTT) in patients with normal CTP imaging were 32.588±5.877 ml/(100 g · min),1.205 ±0.261 ml/100 g,and 2.937±0.887 s,respectively. There were no significant differences compared to the contralateral sides (33. 208 ± 6. 740)ml/(100 g · min),1. 233 ± 0. 290) ml/100 g,and 2. 854 ± 0. 799 s) (all P ＞ 0. 05).Clinical follow up and CT reexamination confirmed that 11 patients were diagnosed as transient ischemic attack (TIA),2 were hypoglycemia,and 2 were brain stem infarction. The rCBF,rCBV,and rMTT in the ipsilateral sides of 18 patients with CTP imaging abnormality were 6. 580 ±3. 457 ml/(100 g·min),0. 803 ±0. 285 ml/100 g,and 14. 947 ±4. 665 s,respectively. There were significant differences compared to the contralateral sides (34. 756 ± 4. 126 ml/(100 g·min),1. 622 ±0.708 ml/100 g,and (3.794 ± 1. 775 s) (all P ＜0. 05). Clinical follow up and CT reexamination confirmed as cerebral infarction in the basal ganglia region. Conclusions CTP imaging can be used for the diagnosis of hyperacute cerebral infarction and has the significance of differential diagnosis.     

肝内胆管囊腺癌合并囊肿一例报告

患者，男性，65岁，因“上腹部胀痛5年余”收住本院。3年前因同样症状在其它医院行腹部超声提示“肝脏多发囊肿”，未给予特殊诊治；患者自诉腹部胀痛，油腻饮食后加重，性质不剧烈；不伴有寒颤、高热，无皮肤、巩膜黄染，无明显消瘦、乏力。患者烟酒少量，无疫水、疫区接触史。5年内多次复查腹部超声“肝多发囊肿”逐渐增大。入院时查体：T37．2℃，P：80次／min，R：20次／min，BP140／85mmHg。皮肤、巩膜无黄染，结膜无苍白，浅表淋巴结未触及肿大。     

CT灌注成像在超早期脑梗死中的应用

Objective To investigate the role of computed tomography perfusion (CTP)in the diagnosis and differential diagnosis of hyperacute cerebral infarction. Methods After CT scan was performed in 33 patients who were clinically diagnosed as cerebral infarction ＜5 hours of symptom onset,CTP imaging was performed. CT was reexamined after 24 hours.Results CT scan did not fred abnormality in 33 patients. CTP imaging showed 15 were normal and 18 were abnormal. The regional cerebral blood flow (rCBF),regional cerebral blood volume (rCBV),and regional mean transit time (rMTT) in patients with normal CTP imaging were 32.588±5.877 ml/(100 g · min),1.205 ±0.261 ml/100 g,and 2.937±0.887 s,respectively. There were no significant differences compared to the contralateral sides (33. 208 ± 6. 740)ml/(100 g · min),1. 233 ± 0. 290) ml/100 g,and 2. 854 ± 0. 799 s) (all P ＞ 0. 05).Clinical follow up and CT reexamination confirmed that 11 patients were diagnosed as transient ischemic attack (TIA),2 were hypoglycemia,and 2 were brain stem infarction. The rCBF,rCBV,and rMTT in the ipsilateral sides of 18 patients with CTP imaging abnormality were 6. 580 ±3. 457 ml/(100 g·min),0. 803 ±0. 285 ml/100 g,and 14. 947 ±4. 665 s,respectively. There were significant differences compared to the contralateral sides (34. 756 ± 4. 126 ml/(100 g·min),1. 622 ±0.708 ml/100 g,and (3.794 ± 1. 775 s) (all P ＜0. 05). Clinical follow up and CT reexamination confirmed as cerebral infarction in the basal ganglia region. Conclusions CTP imaging can be used for the diagnosis of hyperacute cerebral infarction and has the significance of differential diagnosis.     

胸腺上皮肿瘤的多层螺旋CT表现与其病理学分型的对照研究

目的:探讨胸腺上皮肿瘤多层螺旋CT(MSCT)影像特征与其WHO组织病理学分型间的相关性。方法:回顾性分析44例经手术病理证实的胸腺上皮肿瘤患者的术前MSCT表现,并将其按WHO组织病理学分型的简化型分组进行对比。结果:胸腺上皮肿瘤的MSCT侵袭性征象包括轮廓不规则、肿瘤-心脏-大血管接触面(MCI)呈灌注型、纵隔脂肪线消失及瘤-肺界面毛刺影,这些特征在高危胸腺瘤及胸腺癌中均较低危胸腺瘤中更常见(P均<0.05),而肿瘤周围淋巴结肿大在胸腺癌中出现频率较低危胸腺瘤及高危胸腺瘤高(P均<0.05)。结论:MSCT能够反映胸腺上皮肿瘤的生物学特性,具有预测其组织学类型的潜力。     

16层螺旋CT冠状动脉成像的临床应用价值

[目的]评价16层螺旋CT诊断冠心病的临床价值.[方法]对本院67例临床疑诊或确诊的冠心病患者同时行16层螺旋CT冠状动脉血管成像(MSCTA)和冠状动脉造影(CAG),以CAG为金标准,对照二者符合率.采用经肘静脉用双管高压注射器以3.5mL/s注入优维显70～95mL后再注入20mL生理盐水,在心电图R-R不同问期重建冠脉轴位图像,并行容积成像、曲面重建等后处理.[结果]67例中,冠脉造影示明显狭窄27例,40例正常.16层MSCTA诊断冠脉中度以上狭窄敏感性81.5%(22/27),特异性90.o%(36/40),阳性预测值84.6%(22/26),阴性预测值87.8%(36/41),准确性86.6%(58/67).[结论]16层MSCTA简便、安全,其较高质量CTA图像可作为冠心病筛选、冠脉术前评价和术后复查的重要手段.     

头颅CT灌注成像指导下脑梗死溶栓观察

目的观察头颅CT灌注成像（CTP）指导下静脉溶栓治疗急性脑梗死的时机选择。方法采用开放性非随机的研究方法。18例发病3～6h临床诊断为脑梗死的患者,行CTP检查,有影像学改变且有缺血半暗带者进行溶栓治疗。评定病灶中心、病灶周边、周围正常脑组织相对脑血流量（rCBF）、相对脑血容量（rCBV）及平均通过时间（MTT）。比较溶栓前、溶栓后2h、24h、7d、90d NIHSS的变化;溶栓后7h、90h Bather指数（BI）、mRS的变化。结果CTP检查,18例病人均出现灌注异常,病灶中心区域与周边区比较差异有统计学意义（P〈0．05）。溶栓后2h、24h、7d NIHSS评分与溶栓前比较差异无统计学意义（P〉0．05）,溶栓后90d NIHSS评分与溶栓前比较差异有统计学意义（P〈0．05）。溶栓后7d BI、mRS与溶栓前比较差异无统计学意义（P〉0．05）,溶栓后90d BI、mRS与溶柃前比较差异有统计学意义（P〈0．05）。结论CTP可以帮助选择病人,在有影像学支持的前提下,适当扩大溶栓时间窗,在发病6h内予重组组织型纤溶酶原激活剂（rt-PA）溶栓治疗安全有效。     

磁共振灌注加权成像在原发性痛经子宫肌层血流动力学研究中的应用

目的 运用磁共振灌注加权成像技术探讨原发性痛经患者痛经发作期子宫肌层血流动力学特点.方法 对符合选择标准的原发性痛经患者30例及正常志愿者19例进行子宫常规磁共振成像扫描及子宫肌层磁共振灌注加权成像检查,分别获取子宫内部肌层及外部肌层感兴趣区的时间-信号强度(TIC)曲线及灌注参数.采用SPSS13.0软件进行两独立样本Wilcoxon秩和检验,P＜0.05表示差异有统计学意义.结果 痛经组在发作期内部肌层与外部肌层的TIC曲线大致相似,在注入造影剂后即出现一段陡峭的上升段,然后为一段时间较长的缓慢上升段,达到峰值后进入较为平缓的平台期.对照组在注入造影剂后即出现一段较为陡峭的上升段,然后内部肌层快速达到峰值随即开始下降;而外部肌层继续经历一段相对缓慢的上升段达到峰值后进入较为平缓的平台期.痛经组与对照组的子宫内部肌层的峰值时间差异有统计学意义(P =0.031),子宫外部肌层的峰值时间及子宫内、外部肌层强化峰值差异无统计学意义(P =0.050 3、0.075 0、0.067 1).结论 痛经发作期子宫内部肌层的动脉,尤其是细小动脉的血流阻力显著增加,这可能是引发痛经的重要因素.