自发性气胸的胸膜窗MSCT及CT仿真内镜表现

目的 评价CE-MRA脊髓造影鉴别脊髓血管畸形（SCVM）和脊髓非血管畸形所致继发性血管纡曲的价值。方法 回顾性分析30例CE-MRA疑诊SCVM患者资料，根据DSA或手术结果分为SCVM组（16例）及脊髓非血管畸形组（14例），对比分析2组CE-MRA脊髓纡曲血管的数量、长度、位置、纡曲程度及纡曲血管周围是否存在异常供血动脉差异。结果 与脊髓非血管畸形组比较，SCVM组脊髓纡曲血管数量更多，纡曲血管长度更长，血管纡曲程度评分更高。SCVM组仅2例（2/16，12.50%）血管纡曲局限于下胸椎段（T7~T12椎体），而脊髓非血管畸形组11例（11/14，78.57%）局限于下胸椎段（T7~T12椎体），2组间纡曲血管位置差异有统计学意义（P=0.020）。结论 CE-MRA脊髓血管造影可鉴别SCVM与脊髓非血管畸形引起的继发性血管纡曲。

Manifestation of MSCT and CT virtual endoscopic images of pleural windows in spontaneous pneumothorax

Objective To observe the manifestations of MSCT and CT virtual endoscopy (CTVE) images of pleural windows in spontaneous pneumothorax. Methods MSCT data of 73 patients of spontaneous pneumothorax were analyzed. Taking pneumatized sac as the center, thin cross-sectional planer (1 mm thickness) MPR and CTVE were reconstructed. Then the size and location of pleural windows, form of pleural surface defect or niche and the relationship with the chest were observed. Results In all 73 patients of spontaneous pneumothorax, 27 pleural windows were detected in 15 patients with MSCT thin cross-sectional planer reconstruction image. Pleural windows were observed on the left side in 11 patients, while on the right side in 4 patients. Most of pleural windows located at apex (15/27, 55.56%), followed by anterior chest wall (7/27, 25.93%) and mediastinum (5/27, 18.52%). The connection of pleura window with thorax was shown in 23 (23/27, 85.19%). Small defection on parietal pleural with pneumatized sac bulging was seen in all pleural windows, with circular, elliptic, short columnar or hockey shapes. On the front view of CTVE, pleural windows showed niche on parietal pleural surface with round or oval form, and the bottom of the pneumatized sac could be straightly seen in 19 pleural windows. The walls were flat, tunnel shaped in 6 pleural windows, while cavernous shaped in other pleural windows. Conclusion Pleural windows often displayed as small diverticulum-like shadows on parietal pleural surfaces, and the pathogenesis might be associated with negative pressure increased in local pleural cavity and pleural damages.