Imaging features of solid pseudopapillary tumor of the pancreas on multi-detector row computed tomography

AIM： To retrospectively analyze the imaging features of solid-pseudopapillary tumors （SPTs） of the pancreas on multi-detector row computed tomography （MDCT） and define the imaging findings suggestive of malignant potential. METHODS： A total of 24 consecutive cases with surgically and pathologically confirmed SPTs of the pancreas underwent preoperative abdominal MDCT studies in our hospital. All axial CT images, CT angiographic images, and coronally and sagittally reformed images were obtained. The images were retrospectively reviewed at interactive picture archiving and communication system workstations. RESULTS： Of the 24 cases of SPTs, 11 cases （45.8%） occurred in the pancreatic head and seven （29.1%） in the tail. Eighteen were pathologically diagnosed as benign and six as malignant. MDCT diagnosis of SPTs was well correlated with the surgical and pathological results （Kappa = 0.6, P 〈 0.05）. The size of SPTs ranged from 3 to 15 cm （mean, 5.8 cm）. When the size of the tumor was greater than 6 cm （including 6 cm）, the possibilities of vascular （8 vs 1） and capsular invasion （9 vs 0） increased significantly （P 〈 0.05）.Two pathologically benign cases with vascular invasion and disrupted capsule on MDCT presented with local recurrence and hepatic metastases during follow-up about 1 year after the resection of the primary tumors. CONCLUSION： Vascular and capsular invasion with superimposed spread into the adjacent pancreatic parenchyrna and nearby structures in SPTs of the pancreas can be accurately revealed by MDCT preoperatively. These imaging findings are predictive of the malignant potential associated with the aggressive behavior of the tumor, even in the pathologically benign cases.

Comparison of pancreatic acinar cell carcinoma and adenocarcinoma using multidetector-row computed tomography

AIM:To distinguish acinar cell carcinoma(ACC)from pancreatic adenocarcinoma(AC)by comparing their computed tomography findings.METHODS:Patients with ACC and AC were identified on the basis of results obtained using surgically resected pancreatectomy specimens.The preoperative computer tomographic images of 6 acinar cell carcinoma patients and 67 pancreatic adenocarcinoma patients in 4 phases(non-contrast,arterial,portal venous,and delayed phase)were compared.The scan delay times were 40,70,and 120 s for each contrast-enhanced phase.The visual pattern,tomographic attenuation value,and time attenuation curve were assessed and compared between AC and ACC cases using the 2test,Wilcoxon signed-rank test,and Mann Whitney U test.RESULTS:The adenocarcinomas tended to be hypodense in all 4 phases.The acinar cell carcinomas also tended to be hypodense in the 3 contrast-enhancedphases,although their computed tomographic attenuation values were higher.Further,5 of the 6 acinar cell carcinomas(83%)were isodense in the non-contrast phase.The time attenuation curve of the adenocarcinomas showed a gradual increase through the 4 phases,and all adenocarcinomas showed peak enhancement during the delayed phase.The time attenuation curve of the acinar cell carcinomas showed peak enhancement during the portal venous phase in 4 cases and during the arterial phase in 2 cases.None of the 6 acinar cell carcinomas showed peak enhancement during the delayed phase.CONCLUSION:The tumor density in the non-contrast phase and time attenuation curve pattern clearly differ between acinar cell carcinomas and adenocarcinomas,and multidetector-row computed tomography can thus distinguish these tumors.

Acquired renal arteriovenous malformation:the diagnostic value of three-dimensional multidetector-row computed tomography

Objective To evaluate the diagnostic value of three-dimensional multidetector-row computed tomogra- phy （MDCT） in detecting acquired renal arteriovenous malformation （RAVM） and to compare its perfor- mance with that of ultrasonography and digital subtraction angiography （DSA）. Methods The institutional review board approved this retrospective study and written informed consent was obtained from all patients before examination. All 14 patients with acquired RAVM underwent MDCT, including cortical and medullary phase enhancement angiography and three-dimensional （3D） reconstruc- tion. Five and nine patients were further examined and their diagnoses confirmed by DSA and surgery, respectively. The MDCT images, including 3D reconstructions, were analyzed for RAVM independently and in consensus by two observers using a workstation. Results Among the 14 patients with acquired RAVM, 12 with maximum lesion diameter 〉 10 mm, and one with a maximum lesion diameter between 5 and 10 ram, were correctly diagnosed with MDCT angiog- raphy. Among these patients, four diagnoses were confirmed by DSA. One patient with a lesion 5-10 mm in diameter was misdiagnosed with a renal aneurysm by MDCT angiography. The other one with the maxi- mum diameter of the lesion between 5 mm and 10 mm was misdiagnosed as renal aneurysm with MDCT angiography, which was diagnosed as renal arteriovenous malformation with DSA. Among 14 lesions in 14 patients, eight and six originated in the left and right kidney, respectively. Conclusion MDCT angiography can accurately diagnose RAVM and improve our understanding of the disease, which will allow clinicians to provide better care.

Evaluation of myocardial infarction patients after coronary revasculation by dual-phase multi-detector computed tomography:Now and in future

Multidetector-row computed tomography(MDCT) has become one of the major tools in diagnosing and evaluating patients with coronary artery disease in recent years.In selected patients,MDCT has been shown to provide more reliable accuracy in detection of stent patency than invasive coronary angiography.Chiou et al reported a delicate infarcted myocardium at-risk score.According to their results,the MDCT-based myocardium at-risk score had a good correlation with the thallium 201 ST-segment elevation myocardial infarction-based summed difference score(r = 0.841,P < 0.001).They claimed that dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk.In this commentary,we discuss the current status of the clinical application of MDCT in patients with myocardial infarction in relation to evaluating the myocardial perfusion defect,detecting reversible myocardial ischemia,assessing myocardial viability,estimating target lesion restenosis,and calculating of fractional flow reserve from MDCT.

A spontaneous strangulated transomental hernia: Prospective and retrospective multi-detector computed tomography findings

Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography(CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.

Improvement of distension and mural visualization of bowel loops using neutral oral contrasts in abdominal computed tomography

AIM: To assess and compare the image quality of 4% sorbitol and diluted iodine 2%(positive oral contrast agent) in abdomino-pelvic multi-detector computed tomography.METHODS: Two-hundred patients, referred to the Radiology Department of a central educational hospital for multi-detector row abdominal-pelvic computed tomography, were randomly divided into two groups: the first group received 1500 m L of 4% sorbitol solution as a neutral contrast agent, while in the second group 1500 m L of meglumin solution as a positive contrast agent was administered in a one-way randomized prospective study. The results were independently reviewed by two radiologists. Luminal distension and mural thickness and mucosal enhancement were compared between the two groups. Statistical analysis of the results was performed by Statistical Package for the Social Sciences software version 16 and the Mann-Whitney test at a confidence level of 95%. RESULTS: Use of neutral oral contrast agent significantly improved visualization of the small bowel wall thickness and mural appearance in comparison with administration of positive contrast agent(P < 0.01). In patients who received sorbitol, the small bowel showed better distention compared with those who received iodine solution as a positive contrast agent(P < 0.05). CONCLUSION: The results of the study demonstrated that oral administration of sorbitol solution allows better luminal distention and visualization of mural features than iodine solution as a positive contrast agent.

Computed tomography diagnosed left ovarian venous thrombophlebitis after vaginal delivery:A case report

BACKGROUND Postpartum ovarian vein thrombophlebitis(POVT)is a rare but serious postpartum complication that affects mostly postpartum women.A high index of suspicion is required when faced with sudden postpartum abdominal pain.CASE SUMMARY A 25-year-old healthy woman who accepted a vaginal delivery procedure suffered fever(temperature 39.6℃)one day after delivery,accompanied with left lower abdominal pain.Physical examination indicated mild tenderness in the left lower abdomen,accompanied with rebound pain.The patient was confirmed to have left ovarian venous thrombosis with inflammation after receiving a multidetector row computed tomography scan.CONCLUSION POVT is a rare and dangerous postpartum complication.A high index of suspicion is required for the occurrence of ovarian venous thrombosis when faced with postpartum abdominal pain and fever.Early application of Doppler ultrasound,computed tomography,magnetic resonance imaging and other auxiliary examinations is conducive to timely and accurate diagnosis of POVT,thus reducing maternal mortality.

Differentiation of Lymphoma Presenting as Retroperitoneal Mass and Retroperitoneal Fibrosis： Evaluation with Multidetector-row Computed Tomography

Background： Retroperitoneal fibrosis （RPF） and lymphoma presenting as retroperitoneal mass may closely resemble each other and misdiagnosis may occur. This study investigated the differential imaging features of RPF and lymphoma which presented as a retroperitoneal soft tissue using multidetector-row computed tomography （MDCT）. Methods： The 42 consecutive patients were included in this retrospective review, including 19 RPF patients （45.2%; including 13 males and 6 females; mean age： 56.7 ± 6.2 years） and 23 patients with lymphoma （54.8%： including 14 males and 9 females： mean age： 57.4 ± 12.3 years）. An array of qualitative computed tomography （CT） features of lesions in 42 consecutive patients with newly diagnosed untreated RPF and lymphoma were retrospectively analyzed. The quantitative size of the lesion at the para-aortic region and attenuation in the precontrast, arterial, and portal phases were calculated in regions of interest and compared between the patients with newly diagnosed untreated RPF and with lymphoma. Receiver operating characteristic curve analysis was used to assess the potential diagnostic value of each quantitative parameter. Inter-reader concordance was also calculated. Results： Mean ages between patients with RPF and lymphoma were not significantly different （56.7 ±6.2 years vs. 57.4 ± 12.3 years P = 0.595）. Compared to those in patients with lymphoma, homogeneous enhancement （65.2% vs. 94.7%, P = 0.027） and pelvic extension （52.2% vs. 89.5%, P= 0.017） were significantly more common while the involvement of additional nodes （78.3% vs. 5.3%, P 〈 0.001）, suprarenal extension （60.9% vs. 15.8%, P = 0.004）, and aortic displacement （43.5% vs. 5.3%, P 0.006） were significantly less common in patients with RPF. Lesion size at the para-aorta was significantly greater in patients with lymphoma, compared with RPF patients （3.9 ± 1.2 cm vs. 1.8 ± 0.6 cm; P 〈 0.001 ）. The attenuation values in three phases were not significantly different between patients with RPF and lymphoma. Inter-reader concordance for subjective features ranged from very good to excellent （range： 85.7 100.0%）. Conclusions： This study showed that MDCT can help differentiate between untreated RPF and lymphonla on the basis of qualitative CT features and lesion sizes. Differentiating RPF from lymphoma on the basis of attenuation values in the precontrast, arterial, and portal phases was difficult to accomplish.

Utility of multi-detector row computed tomography angiography versus Doppler in localization of perforators of anterolateral thigh flaps

Aim:Anterolateral thigh(ALT)flap is widely used in reconstruction of various defects.Preoperative imaging facilitates perforator mapping,overcoming intraoperative uncertainty.The purpose of this study was to investigate the utility of multi-detector row computed tomography angiography(MDCTA)and a handheld Doppler in locating ALT perforators.Methods:Twenty patients were randomized into two groups.Group 1 patients received MDCTA and Doppler studies whereas Group 2 received only a Doppler study.The number,location,course,and source of all cutaneous and sizable perforators were compared with intraoperative findings.Surgeons’stress levels during flap harvest and flap harvest time were compared.Results:MDCTA findings correlated well with intraoperative findings for perforator type and segmental distribution with 100%concordance.Doppler alone had a 52%rate of concordance.The sensitivity and specificity for MDCTA in demonstrating the presence of perforators were 85.71%and 97.22%,respectively;whereas for Doppler alone the sensitivity and specificity were 80%and 87.91%,respectively.In demonstrating perforator source,MDCTA showed a sensitivity of 100%and specificity of 91.66%,with 100%accuracy.Sensitivity and specificity for sizable perforators were 90%each,with 88.88%accuracy.Doppler studies were unable to provide this information.Comparison of surgeon stress levels showed no differences between the two groups,although the time for flap harvest was significantly shorter in Group 1.Conclusion:MDCTA compared to Doppler is more sensitive,specific,and accurate with respect to location,course,and source of perforators.

64排螺旋CT血管造影在下肢动脉硬化闭塞症患者介入治疗中的应用研究

目的:分析64排螺旋CT血管造影在下肢动脉硬化闭塞症患者的诊断效能及介入治疗后进行筛查的应用价值。方法:回顾性分析2020年7月至2022年6月北京怀柔医院收治的76例下肢动脉硬化闭塞症患者,所有患者均行64排螺旋CT血管造影,并以数字减影血管造影检查动脉狭窄结果为“金标准”,分析下肢动脉硬化闭塞症患者动脉狭窄度、诊断效能,以及介入治疗后动脉再狭窄情况。结果:76例患者共有1238个动脉结节,64排螺旋CT血管造影结果中有1170个动脉结节与数字减影血管造影一致,一致率为94.51%,其中64排螺旋CT血管造影高估率为4.44%(55/1238),低估率为0.57%(7/1238);以“金标准”为对比,动脉狭窄中度以上准确率为91.84%,灵敏度为86.91%,特异度为93.86%,阳性预测值85.25%,阴性预测值84.61%,64排螺旋CT诊断血管造影动脉闭塞准确率为98.38%,灵敏度为85.71%,特异度为99.56%,阳性预测值94.74%,阴性预测值98.69%;76例患者经介入治疗随访1年后,经64排螺旋CT血管造影检查再狭窄率为13.16%(10/76),共有168个血管结节,64排螺旋CT血管造影诊断符合率为97.62%(164/168)。结论:采用64排螺旋CT血管造影检查可评估下肢动脉硬化闭塞症患者下肢动脉闭塞程度,具有良好的诊断效能,与数字减影血管造影有较高的一致性,有助于治疗方案的制定,且对介入治疗后再狭窄的诊断也有良好的应用价值。

多排螺旋计算机断层扫描血管造影在儿童主动脉弓发育异常中的诊断价值

目的评估多排螺旋计算机断层扫描(multi-detector computed tomography,MDCT)血管造影在患儿主动脉弓发育异常中的诊断价值,以及进一步了解患儿先天性主动脉弓发育异常的影像学表现。方法收集泰康同济(武汉)医院2010年至2022年经MDCT血管造影和经胸超声心动图(transthoracic echocardiography,TTE)检查诊断为先天性心脏病的362例患儿(年龄范围为5 d~12岁,平均年龄为3.3岁)。所有诊断结果均经手术和(或)心血管造影所证实。结果362例被诊断为先天性心脏病的患儿中,198例为先天性主动脉发育异常,包括主动脉缩窄、主动脉弓离断、右位主动脉弓和迷走右锁骨下动脉以及主动脉双弓,例数分别为134、32、20、10及2例。6例罕见先天性主动脉弓异常:2例双主动脉弓,2例孤立右锁骨下动脉伴动脉导管未闭(patent ductus arteriosus,PDA),1例孤立颈总动脉伴PDA,1例双侧PDA合并单心室和肺动脉闭锁。32例主动脉弓离断患儿中,27例为A型、5例为B型。MDCT血管造影诊断先天性心脏病的敏感度、特异度、准确率分别为100%(198/198)、98%(161/164)和99%(359/362)。TTE的诊断敏感度、特异度、准确率分别92%(182/198)、81%(133/164)和87%(315/362)。结论MDCT血管造影诊断患儿先天性主动脉弓发育异常是一个可靠的、无损伤的活体检查方法,可获得比传统的血管造影术更多的解剖信息及影像学表现。

MRI多b值成像联合64排螺旋CT在乙型肝炎肝硬化患者肝脏再生结节诊断中的价值

目的分析磁共振成像(MRI)多b值成像联合64排螺旋计算机断层扫描(CT)在乙型肝炎肝硬化患者肝脏再生结节诊断中的价值。方法将2020年3月—2022年7月南通市第二人民医院收治的69例乙型肝炎肝硬化占位性病变患者的临床资料进行回顾性分析,以病理诊断结果分成对照组(n=24,肝脏癌变结节)与研究组(n=45,肝脏再生结节)。所有患者均接受MRI多b值成像检查、64排螺旋CT检查,对比两组患者一般资料,对比两组患者门静脉、主动脉不同期扫描的CT值,对比两组患者肝实质不同期扫描的CT值,以病理诊断为金标准,分析64排螺旋CT检查及MRI多b值成像检查与病理诊断结果间的一致性,制作受试者工作特征曲线(ROC),采用曲线下面积(AUC)评价MRI多b值成像检查、64排螺旋CT检查及二者联合对乙型肝炎肝硬化患者肝脏再生结节的诊断价值。结果病理结果显示,对照组中共检出37个癌变结节,研究组中共检出98个再生结节。两组性别、年龄、肝硬化朔伊尔分期及结节直径对比无显著差异(P>0.05)。研究组门静脉的延迟期、动脉期扫描的CT值比对照组高(P<0.05)。研究组主动脉的门脉期、动脉期扫描的CT值比对照组高(P<0.05)。研究组肝实质的动脉期、门脉期及延迟期扫描的CT值高于对照组(P<0.05)。MRI多b值成像检查、64排螺旋CT检查及二者联合诊断乙型肝炎肝硬化患者肝脏再生结节与病理诊断的Kappa值分别为0.821、0.758、0.897,具有较好的一致性(P<0.05)。ROC曲线结果显示,MRI多b值成像检查、64排螺旋CT检查及二者联合诊断乙型肝炎肝硬化患者肝脏再生结节的AUC值分别为0.792、0.739、0.942(P<0.05)。结论MRI多b值成像联合64排螺旋CT在诊断乙型肝炎肝硬化患者肝脏再生结节价值更高。

多层螺旋CT在脊柱病变检查中的应用

目的 比较脊柱多层螺旋CT(MSCT)与单层螺旋CT(SSCT)图像质量的差异 ,探讨MSCT在脊柱病变检查中的应用价值。材料与方法 选择分别行MSCT和SSCT扫描的腰椎退行性病变者各 10例进行图像质量比较。应用LightSpeedQX/i型MSCT检查和诊断 3 1例脊椎病者。结果 在相同扫描条件下 ,腰椎MSCT图像质量明显优于SSCT ,MSCT所需扫描时间明显短于SSCT(均为P <0 .0 5 )。MSCT可为 3 1例脊椎病患者的临床诊断提供更多信息。结论 MSCT在脊柱病变检查中具有明显优势。

多平面重建在弥漫性肺疾病中的应用价值

目的评价多层螺旋CT(MDCT)多平面重建(MPR)对肺弥漫性病变的诊断价值。资料与方法对67例经临床确诊表现为肺内弥漫性病变的病例进行MDCT扫描和薄层冠状位MPR,并与轴位高分辨率CT(HRCT)比较。图像分析共分3组,2人3次完成阅片。结果轴位HRCT和冠状位MPR评价磨玻璃密度影、气腔样实变和小结节等高密度病灶和含气病灶的敏感度分别是100%和87%～100%,特异性分别为100%和97%～100%,差别无显著性。HRCT和MPR图像在显示肺内细网状影、线样影和牵张性细支气管扩张的敏感度分别为92%～100%和71%～100%,特异性分别为88%～100%和90%～100%,差别无显著性。HRCT和MPR图像在评价肺弥漫性病变的分布上无显著性差别。观察者对MPR评价磨玻璃密度影、气腔样实变和蜂窝影、肺气肿、肺大泡的满意度较高(95%～100%);对线样影、细网状影、小结节或微结节、牵张性支气管扩张等的满意度较低(10%～68%),差别有显著性(P<0.05)。结论目前采用1.25mm准直的MDCT扫描所得的MPR图像在评价磨玻璃密度影、肺实变、蜂窝影和肺气肿、肺大泡等病变的能力等同于轴位HRCT;评价线样影、细网状影及牵张性支气管扩张和微结节等病变的能力不及轴位HRCT。

MDCT小肠造影技术在小肠疾病中的临床应用研究

目的:探讨多排螺旋CT小肠造影(MDCTE)扫描技术在小肠疾病诊断中的临床应用价值。方法:对181例临床怀疑小肠病变患者术前行MDCTE平扫及多期增强扫描,图像行后处理,并与手术结果相对照。结果:本组181例患者中,58例MDCTE诊断为小肠病变,并与最终临床诊断相符。123例患者MDCTE诊断为阴性,108例符合,9例漏诊,6例误诊。MDCTE诊断小肠疾病的敏感性为79.45%,特异性为100%,诊断正确率为91.71%,阳性预测值为100%,阴性预测值为87.80%。本组资料中小肠肿瘤15例,其中腺癌5例,间质瘤3例,淋巴瘤1例,平滑肌瘤1例,肠系膜转移5例。小肠炎症性病变27例,其中克罗恩病16例,溃疡性结肠炎2例,小肠结核1例,病毒性肠炎1例,小肠黏膜一般炎症7例。肠梗阻22例,其中腹内外疝9例,小肠扭转6例,小肠粘连性梗阻2例,幽门梗阻2例,胆石症2例,因克罗恩病肠壁增厚引起不全性小肠梗阻1例。小肠憩室2例,其中Meckel憩室1例,盲肠憩室伴慢性阑尾炎、阑尾结石1例。血管性病变3例,其中肠系膜上动脉栓塞1例,肠系膜上静脉血栓形成1例,肠道血管畸形1例。其他病变包括腹茧症2例,肠息肉1例,过敏性紫癜(腹型)1例。结论:小肠肿瘤、炎症、肠梗阻等病变在MDCTE上具有特征性的表现,MDCTE能全景式、多方位展示小肠肠道、肠系膜和系膜血管,对小肠疾病的诊断具有重要价值。

多层螺旋CT评估组织胶栓塞治疗食管静脉曲张出血疗效

目的采用多层螺旋CT随访观察改良的经皮经肝组织胶(TH)栓塞治疗食管静脉曲张术(PTVE)的远期疗效。方法 2005年10月至2012年1月收治肝硬化患者156例,行PTVE治疗。采用螺旋CT观察曲张静脉栓塞术前后的变化。术后3、6、12个月及以后每年行上腹部CT扫描随访。结果156例均穿刺、栓塞成功。根据TH胶栓塞范围,将患者分为三组,完全栓塞组82例,即TH胶至少栓塞食管下段5 cm以上食管曲张静脉、食管旁及食管周围静脉丛,胃底曲张静脉;部分栓塞组49例,TH胶栓塞胃底贲门曲张静脉,但未栓塞食管下段曲张静脉;静脉主干组25例,TH胶仅到达胃冠状静脉及胃左静脉组,未达胃底及贲门曲张静脉。随访期间再出血36例,总出血率为23.1%(36/156)。其中完全栓塞组再出血7例,再出血率8.5%(7/82);部分栓塞组再出血11例,再出血率为22.4%(11/49);静脉主干组再出血18例,出血率为72%(18/25)。三组间再出血率差异有统计学意义(P=0.000)。结论 TH胶的栓塞范围及程度对治疗和预防静脉曲张复发、维持远期疗效具有重要意义,多层螺旋CT能对PTVE术栓塞疗效评价提供临床指导。

256层多排螺旋CT小肠成像(MDCTE)对小肠疾病的诊断价值

目的:探讨256层多排螺旋CT小肠造影(MDCTE)扫描技术在小肠疾病诊断中的临床应用价值。材料和方法:对118例临床怀疑小肠疾病患者,男53例,女65例,平均年龄48.5岁。行256-MDCTE平扫及增强扫描,通过横断面及多平面重建,观察病变部位、大小、形态、周围侵犯及转移情况,结果与最终临床诊断对照分析。结果:本组118例患者中,56例MDCTE诊断为小肠病变,并与最终临床诊断相符。另外62例MDCTE诊断为阴性,其中47例符合,9例漏诊,6例误诊。并且通过统计分析得出MDCTE对小肠疾病诊断的灵敏度为78.87%(56/71),特异度为100%(47/47),正确率为87.29%((56+47)/118),阳性预测值为100%(56/56),阴性预测值为75.80%(47/62)。结论:小肠肿瘤、炎症、肠梗阻等病变在MDCTE上具有特征性的表现,MDCTE对小肠疾病的临床诊治具有重要价值。

256层多排螺旋CT小肠成像对小肠炎症性病变的临床应用研究

目的:探讨256层多排螺旋CT小肠造影(MDCTE)扫描技术在小肠炎症性病变诊断中的临床应用价值。材料和方法:对118例临床怀疑小肠疾病患者(男53例,女65例,平均年龄48.5岁)行256-MDCTE平扫及增强扫描,通过横断面及多平面重建,观察病变部位、大小、形态、周围情况等与病理结果对照分析。结果:本组118例患者中,小肠炎症性病变25例(男13例,女12例,平均年龄45.5岁),其中Crohn病12例(因克隆恩病肠壁增厚引起不全性小肠梗阻1例),溃疡性结肠炎2例,小肠结核1例,病毒性肠炎1例,小肠黏膜一般炎症7例,另外2例临床无法确诊。MDCTE诊断21例,4例漏诊者均为一般炎症。结论:小肠炎症性病变在MDCTE上具有特征性的表现,MDCTE能全景式、多方位展示小肠肠道、肠系膜和系膜血管,对小肠炎症性疾病的诊断具有重要价值。

320排动态容积CT诊断颈内动脉颅内段动脉瘤的价值

目的:评价320排动态容积CT在颈内动脉颅内段动脉瘤诊断中的价值。方法:2010年4月～2010年11月间经320排动态容积CT检出颈内动脉颅内段动脉瘤48例,回顾性分析其临床资料,评价CTA图像质量及动脉瘤特征,并与DSA结果对照。结果:320排动态容积CT脑血管成像动脉瘤显示优良率为94%。48例患者共检出颈内动脉颅内段动脉瘤53个,其中单发31例,多发17例;囊状动脉瘤45例,梭形动脉瘤3例。囊状动脉瘤中,最大径<5mm的小动脉瘤有44个,发生在交通段数目最多,为25个。结论:320排动态容积CT能够准确发现和评价颈内动脉颅内段动脉瘤,特别在颈内动脉颅内段动脉瘤的筛查中具有重要价值。

多层CT辐射剂量与防护研究进展

多层CT(MDCT)可进行快速扫描和大范围容积扫描。与单层CT(SDCT)相比,MDCT特有的参数可能增加或减少受检者剂量。早期研究表明MDCT所致受检者剂量高于SDCT,但目前越来越多的研究表明两者剂量相似甚至MDCT的剂量较低。多层CT主要依靠CT的合理使用来降低辐射剂量。CT检查正当化判断是临床医生与放射医师共同的责任。扫描参数应根据扫描指征、受检者体形、年龄及扫描范围设置,并使用自动曝光控制等降低辐射剂量的技术。对临床医生和CT工作人员进行CT辐射防护培训有助于CT检查正当化及扫描方案与辐射剂量的最优化。