肝脏上皮样血管内皮瘤的螺旋CT表现

肝上皮样血管内皮瘤(hepatic epithelioid haemangioendothelioma,HEHE)是一种少见的血管源性肿瘤,国内文献报道不足30例,且多以临床和病理表现为主[1,2].笔者回顾分析了4例经病理证实的HEHE的螺旋CT表现,并与病理所见对照,探讨其CT表现特征,并进行相关的文献复习.

Objective. To evaluate the respective value of dual-phase helical CT arterial portography (CTAP) and conventional angiography in preoperative predicting resectability of pancreatic ductal adenocarcinoma. Subjects and methods. Tumor resectability was prospectively evaluated in 54 patients with pathologically proven pancreatic ductal adenocarcinoma who later underwent surgery. Both dual-phase helical CT scanning and selective angiography were obtained in each patient preoperatively. For optimal enhancement of pancreas and major peripancreatic vessels, two catheters connected to an automatic injector via a Y-shaped tube were placed after selective angiography,one in celiac trunk, the other in superior mesenteric artery. Then the patient underwent dual-phase helical CTAP of pancreas and liver. The criteria of irresectability for CTAP include: tumor diameter≥ 5 cm,extrapancreatic invasion, distant metastases and vascular involvement(occlusion, stenosis or semicircular encasement of superior mesenteric artery, hepatic artery, splenic artery, celiac axis; portal vein, superior mesenteric vein or splenic vein). The results of both modalities were correlated with findings from surgery or pathology. Results. Thirty-eight of 54 patients had nonresectable disease. In prediction the irresectability, sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy were 94.7％ ,100％ ,100％ ,88.9％ ,96.3％ respectively for helical CTAP and 63.2％ ,93.8％ ,96.0％ ,51.7％ ,72.2％ respectively for selective angiography. In assessing vascular involvements, dual-phase helical CTAP was also superior to selective angiography. Conclusion. Dual-phase helical CTAP is superior to angiography in assessing resectability of pancreatic ductal adenocarcinoma. The combination of the two modalities may further improve overall accuracy of assessment.

低剂量CT扫描技术的临床应用

1 CT扫描剂量的基本概念 自20世纪70年代CT开始应用于临床,经历了数次技术创新,已经成为医学影像诊断的重要手段,与普通X线摄片相比, CT明显提高了病变的检出能力,但其X线照射剂量也明显增高.世界范围内,比例为5%的CT检查产生的照射剂量约占医学照射剂量的34%[1].

胸腹联合CT增强扫描技术在大肠癌患者中的运用

我院是全国中医肛肠诊疗中心,每年有大量大肠癌患者需要进行胸腹CT增强扫描对疾病进行术前诊断和术后监测,以观测肿瘤有无转移及转移病灶的具体状况,为明确手术指征以及进一步治疗提供帮助.

老年性蛛网膜下腔出血非典型症状30例分析

CLINICAL DATASubjects came from 30 patients with senile subarachnoid hemrrhagetreated in our hospital from January 1999 to December 2001 in-cluding 12 males and 18 females aged 60-78(mean: 65) yearsold. 24 patients presented with onset in action, 6 patients at rest; 26cases presented with acute onset and 4 cases subacute onset. Acuteheadache as first symptom was in 13 cases; pain at neck, waist,sacral as first symptom in 7 cases. 3 patients searched medical ser-vice for headache within 1 week; 2 patients for severe pain of bothlimbs and unable to walk; 2 patients for headache and vomiting at 2week. 7 patients were once treated out of our hospital and sciaticawas diagnosed in 4 cases, cold in 3 cases. Pain at shoulder, back,upper limb in action occurred in 2 cases as first symptom, consciousdisturbance was the first symptom in 4 cases, grand mal of epilepsyas first symptom in 3 cases. 1 patient searched medical service forright head pain, auricle pain for 20 days. Stiff neck ( + ) appeared in25 patients at hospitalization and (-) in 5 patients. 24 patientspresented with positive Kernig' s sign. 21 patients were complicatedwith hypertension, 1 patient was complicated with peripheral facialparalysis and left hemihypoesthesia, 3 patients with transient hemi-paresis of both lower limhs, 2 cases with bilateral ptosis, 1 case withexotropia of bilateral eyeball, pupil dilation, 6 cases with consciousdisturbance. Auxilliary examination: (1) Skull CT scanning: Sub-arachnoid hemorrhage was found in 20 cases, no abnormality in 7cases and 3 cases didn't undergo CT scanning. (2) Examination ofspinal fluid: patients with positive CT findings didn' t undergo lumbarpuncture, even hemic spinal fluid was found in 6 patients and yellowspinal fluid and shrinking red blood cell in 4 cases. Prognosis: Allcases were treated according to subarachnoid hemorrhage, 6 patientsdied and other 24 patients were cured after 6 - 8 weeks of treatment.

中度额颞底部脑损伤脑干基底池CT变化的临床意义

本文统计本院从2003年1月至2004年6月,收治的中度额颞底部脑损伤135例资料,分析其脑干基底池CT征像改变与预后的关系,以及对治疗方案选择的意义.

头、全身CT检查中患者甲状腺、性腺辐射剂量与防护

自从1973年的初使用以来,CT在放射诊断中的使用日益广泛,有些部位的检查已经列入常规体检项目中,接受照射的受检查者与患者日益增多,它在带给人们清晰、准确、便利的医学诊断信息的同时,受检查者与患者的辐射防护问题越来越引起世界各国的普遍关注.根据联合国原子辐射效应科学委员会(UNSCEAR)的报告,医疗照射是公众所受电离辐射的大人工来源.医疗照射防护已成为涉及所有公众成员及其后代的重要公共卫生问题.多个权威组织均出版各自的标准和报告书,欧盟更将其与介入放射和放射治疗列为一类,同属病人的高剂龄应用,并在法律上要求对病人的剂量进行评估[1].国际原子能机构(IAEA)等组织1997年出版的<国际电离辐射防护和辐射源安全的基本标准>(IBSS)对CT受检者推荐了剂量指导水平:头部为50mGy,腰椎为35mGy,腹部为25mGy[2].

64层螺旋CT低剂量扫描在胸部疾病诊断中的应用价值

自上个世纪70年代CT问世以来,给胸部疾病的诊断提供了一种简单易行、无创伤、准确率高的诊断方法.但其X线照射剂量也明显高于X线胸片,给受检者带来了大剂量X线照射的危害,为解决这一问题,目前低剂量扫描越来越广泛应用.

In the management of traumatic skull defect, the classical treatment has usually been adopted, i.e.,primary debridement and secondary repair of bone defect, especially in cases of open lacerated skull fracture. 1 In general, the use of prosthetic material in repair is often not so satisfactory either in China or abroad. Decalcificated human dentin matrix (DHDM)has been used in autogenous repair of traumatic skull defect in primary operation and a good curative effect has been gained since the time from September 1996 to March 1998. Clinical results and CT scanning observation are reported in the following.