Effectiveness of magnetic resonance imaging and spiral computed tomography in the staging and treatment prognosis of colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a prevalent cancer type in clinical settings;its early signs can be difficult to detect,which often results in late-stage diagnoses in many patients.The early detection and diagnosis of CRC are crucial for improving treatment success and patient survival rates.Recently,imaging techniques have been hypothesized to be essential in managing CRC,with magnetic resonance imaging(MRI)and spiral computed tomography(SCT)playing a significant role in enhancing diagnostic and treatment approaches.AIM To explore the effectiveness of MRI and SCT in the preoperative staging of CRC and the prognosis of laparoscopic treatment.METHODS Ninety-five individuals admitted to Zhongshan Hospital Xiamen University underwent MRI and SCT and were diagnosed with CRC.The precision of MRI and SCT for the presurgical classification of CRC was assessed,and pathological staging was used as a reference.Receiver operating characteristic curves were used to evaluate the diagnostic efficacy of blood volume,blood flow,time to peak,permeability surface,blood reflux constant,volume transfer constant,and extracellular extravascular space volume fraction on the prognosis of patients with CRC.RESULTS Pathological biopsies confirmed the following CRC stages:23,23,32,and 17 at T1,T2,T3,and T4,respectively.There were 39 cases at the N0 stage,22 at N1,34 at N2,44 at M0 stage,and 51 at M1.Using pathological findings as the benchmark,the combined use of MRI and SCT for preoperative TNM staging in patients with CRC demonstrated superior sensitivity,specificity,and accuracy compared with either modality alone,with a statistically significant difference in accuracy(P<0.05).Receiver operating characteristic curve analysis revealed the predictive values for laparoscopic treatment prognosis,as indicated by the areas under the curve for blood volume,blood flow,time to peak,and permeability surface,blood reflux constant,volume transfer constant,and extracellular extravascular space volume fraction were 0.750,0.683,0.772,0.761,0.709,0.719,and 0.910,respectively.The corresponding sensitivity and specificity values were also obtained(P<0.05).CONCLUSION MRI with SCT is effective in the clinical diagnosis of patients with CRC and is worthy of clinical promotion.

Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection

BACKGROUND Recurrence is the major challenge facing endoscopic submucosal dissection(ESD)-based treatment therapies for early gastric cancer(EGC).Urgent development of simple and easy surveillance approaches will enhance clinical treatment of the disease.AIM To explore the role of computed tomography(CT)recurrence in evaluating EGC after ESD treatment.METHODS We retrospectively recruited patients from our endoscopy department,between January 2002 and December 2015,and analyzed their basic characteristics,including symptoms,CT results,and results of endoscopy with biopsy,among others.RESULTS Among a total of 2150 patients EGC patients surveyed,1362 met our inclusion and exclusion criteria and were therefore enrolled in our study.The cohort’s sensitivity of CT for recurrent GC and specificity were 44.22%and 43.86%,respectively,with negative and positive predictive values of 40.15%(275/685)and 48.01%(325/677),respectively.The area under the curve of arterial and venous CT values for recurrent EGC were 0.545,and 0.604,respectively.Receiver operating characteristic curve revealed no statistically significant differences between arterial and venous CT values for recurrent EGC.CONCLUSION Enhanced CT has superior diagnostic efficacy,but less accuracy,compared to gold standard techniques in patients with recurrent EGC.

Segmental radiofrequency ablation of pulmonary vein ostia for patients with refractory paroxysmal atrial fibrillation using multi-slice spiral computed tomography guidance

Objective： To evaluate the safety and clinical efficacy of segmental radiofrequency ablation of pulmonary vein （PV） ostia for patients with refractory paroxysmal atrial fibrillation （AF） under multi-slice spiral computed tomography （MSCT） guidance before the procedure. Methods： A series of 58 consecutive patients with refractory paroxysmal AF were enrolled to undergo segmental radiofrequency ablation ofPV ostia. The 36 male and 22 female patients with mean age of （57.4±9.5） （32-79） years and no obvious organic heart disease. Before ablation, patients received MSCT to generate 3-dimentional image of the left atrium （LA） and proximal PVs. Patients then underwent segmental radiofrequency ablation ofPV ostia using PV circular mapping catheter manipulated several times to ensure complete isolation between PVs and LA. Results： No complications occurred during the procedure. One patient developed delayed cardiac tamponade, which was drained percutaneously. The mean follow-up time was （17.1±9.3） months. Forty-one patients （95%） experienced improved quality of life one month after the procedure. Thirty-six patients （83%） showed stable sinus rhythm, while 10 patients （23%） required additional anti-arrhythmic drugs. AF returned≥1 time in 6 （14%） patients who underwent anti-arrhythmic drug therapy, but the number of episodes was less than that before the procedure. However, one patient experienced recurrent episodes of atrial flutter. Conclusion： It is safe and effective to perform segmental radiofrequency ablation of PV ostia for patients with refractory paroxysmal AF using MSCT guidance mappening.

Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization

BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.

Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps,and gastric stromal tumor risk stratification assessment

BACKGROUND The biological characteristics of gastric stromal tumors are complex,and their incidence has increased in recent years.Gastric stromal tumors(GST)have potential malignant tendencies,and the probability of transformation into malignant tumors is as high as 20%-30%.AIM To investigate the value of multi-slice spiral computed tomography(MSCT)in the differential diagnosis of GST and benign gastric polyps,and GST risk stratification assessment.METHODS We included 64 patients with GST(GST group)and 60 with benign gastric polyps(control group),confirmed by pathological examination after surgery in PLA General Hospital,from January 2016 to June 2021.The differences in the MSCT imaging characteristic parameters and enhanced CT values between the two groups before surgery were compared.According to the National Institutes of Health’s standard,GST is divided into low-and high-risk groups for MSCT imaging characteristic parameters and enhanced CT values.RESULTS The incidences of extraluminal growth,blurred boundaries,and ulceration in the GST group were significantly higher than those in the control group(P<0.05).The CT values and enhanced peak CT values in the arterial phase in the CST group were higher than those in the control group(P<0.05).The MSCT differential diagnosis of GST and gastric polyp sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and areas under the curve(AUCs)were 73.44%,83.33%,26.56%,16.67%,0.784,respectively.The receiver operating characteristic curves were plotted with the arterial CT value and enhanced peak CT value,with a statistical difference.The results showed that the sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and AUC value of arterial CT in the differential diagnosis of GST and gastric polyps were 80.18%,62.20%,19.82%,37.80%,and 0.710,respectively.The sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and AUC value of the enhanced peak CT value in the differential diagnosis of GST and gastric polyps were 67.63%,60.40%,32.37%,39.60%,and 0.710,respectively.The incidence of blurred lesion boundaries and ulceration in the high-risk group was significantly higher than that in the low-risk group(P<0.05).The arterial phase and enhanced peak CT values in the high-risk group were significantly higher than those in the low-risk group(P<0.05).CONCLUSION Presurgical MSCT examination has important value in the differential diagnosis of GST and gastric benign polyps and can effectively evaluate the risk grade of GST patients.

3D Reconstruction with Spiral Computed Tomography in Choroidal Osteoma

Choroidal osteoma (CO) is a rare, ossifying benign tumor originated in the choroid that typically occurs in otherwise healthy young women (1,2). It is characterized by a yellowish, well demarcated lesion in the juxtapapillary or macular area. The diagnosis is clinical and can be confirmed with the use of fluorescein or indocyanine angiography, optical coherence tomography, computed tomography or magnetic resonance imaging. Choroidal neovascularization or subretinal fluid, the main causes for vision loss, can be treated with laser therapy, photodynamic therapy or intravitreal antivascular endothelial growth factor therapy. We present a case of choroidal osteoma, showing the role of the high resolution 3D spiral computed tomography.

Diagnostic ability of multi-detector spiral computed tomography for pathological lymph node metastasis of advanced gastric cancer

BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.METHODS A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study.The nodal sizes measured on computed tomography(CT)images were compared with the pathology results.A receiver-operating characteristic curve was constructed,from which the critical value(CV)was calculated by using the data of the first 69 patients retrospectively.By using the CV,sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients.This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping.The intranodal pathological metastatic patterns were classified into the following four types:Small nodular,peripheral,large nodular,and diffuse.RESULTS Although all the cases were clinically suspected as having metastasis,81 had lymph node metastasis and 27 had no metastasis.The number of dissected,detected on CT,and metastatic nodes were,4241,897,and 801,respectively.The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis.The sensitivity was 91.4%and the specificity was 47.3%in the prospective phase.The large nodular and diffuse metastases were easy to diagnose becausemetastatic nodes with a large axis often exhibit these forms.CONCLUSION The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping,using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data.The sensitivity was as high as 91%,and would be improved when referring to the enhanced patterns.However,its specificity was as low as 47%,because most of metastatic nodes in gastric cancer being small in size.The small nodular or peripheral type metastatic nodes were often small and considered difficult to diagnose.

Portal vein computed tomography imaging characteristics and their relationship with bleeding risk in patients with liver cirrhosis undergoing interventional therapy

BACKGROUND This study aimed to analyze the predictive value of multi-slice spiral computed tomography(CT)perfusion imaging for upper gastrointestinal bleeding in patients with cirrhotic portal hypertension.A total of 62 patients with cirrhotic portal hypertension and 28 healthy individuals were included.The results showed that multi-slice spiral CT perfusion imaging had a significant predictive value for upper gastrointestinal bleeding in patients with cirrhotic portal hypertension.The vascular area,number of vascular cross-sections,and gastric coronary vein diameter(GCVD)showed high predictive values,with the vascular area having the best predictive value.AIM To investigate the predictive accuracy of multi-slice spiral CT perfusion imaging for upper gastrointestinal bleeding in patients with cirrhosis and portal hypertension.METHODS This study included 62 patients with cirrhotic portal hypertension(disease group)and 28 healthy individuals(control group).The disease group was further divided into two subgroups:Group A(n=27,bleeding)and group B(n=35,no bleeding).All patients underwent multi-slice spiral CT perfusion imaging at our hospital,and we compared various parameters such as liver blood flow,vein size,number of blood vessels,and blood vessel area between the two groups.We employed statistical analysis to identify factors associated with upper gastrointestinal bleeding and created a graph comparing the predictive value of different factors for bleeding.RESULTS We found no difference in hepatic artery(HAP)levels among the three groups(all P>0.05).The portal vein levels in groups A and B were much lower than in the control group;group A was much lower than group B(all P<0.05).The HAP perfusion index levels in groups A and B were much higher than in the control group;group A was much higher than group B(all P<0.05).The portal vein diameter,splenic vein diameter,and GCVD levels in groups A and B were much higher than in the control group;those in group A were much higher than those in group B(all P<0.05).The number of blood vessels and blood vessel area in groups A and B were much higher than in the control group;those in group A were much higher than those in group B(all P<0.05).The statistical method showed a strong link between GCVD,number of blood vessels,blood vessel area,and upper gastrointestinal bleeding(odds ratio=1.275,1.346,1.397,P<0.05).The graph showed that GCVD,number of blood vessels,and blood vessel area could predict bleeding well,with blood vessel area having the best prediction power.CONCLUSION That multi-slice spiral CT perfusion imaging can predict upper gastrointestinal bleeding well in patients with cirrhosis and high blood pressure in the portal vein.GCVD,number of blood vessels,and blood vessel area had high prediction power.The blood vessel area had the best prediction power,with an area under the curve of 0.831.

Expression of nm23, KAI1 and spiral computed tomography findings in primary gallbladder carcinoma

Primary gallbladder carcinoma is the most common malignant tumor of the biliary system. There is a reduced likelihood for radical cure of primary gallbladder carcinomas because of the insidious onset.1 Spiral computed tomography （SCT） scanning is an important means for diagnosing lesions involving the gallbladder. We determined the expression of anti-metastasis protein nm23 and KAI1 using immunohistochemical method and analyzed the relationship between their expression and the pre-operatively SCT imaging findings, the histopathologic grade, clinical stage, 5-year survival rate in 35 cases of primary gallbladder cancer.

Particulate flow modelling in a spiral separator by using the Eulerian multi-fluid VOF approach

The Euler-Euler model is less effective in capturing the free surface of flow film in the spiral separator,and thus a Eulerian multi-fluid volume of fluid(VOF)model was first proposed to describe the particulate flow in spiral separators.In order to improve the applicability of the model in the high solid concentration system,the Bagnold effect was incorporated into the modelling framework.The capability of the proposed model in terms of predicting the flow film shape in a LD9 spiral separator was evaluated via comparison with measured flow film thicknesses reported in literature.Results showed that sharp air–water and air-pulp interfaces can be obtained using the proposed model,and the shapes of the predicted flow films before and after particle addition were reasonably consistent with the observations reported in literature.Furthermore,the experimental and numerical simulation of the separation of quartz and hematite were performed in a laboratory-scale spiral separator.When the Bagnold lift force model was considered,predictions of the grade of iron and solid concentration by mass for different trough lengths were more consistent with experimental data.In the initial development stage,the quartz particles at the bottom of the flow layer were more possible to be lifted due to the Bagnold force.Thus,a better predicted vertical stratification between quartz and hematite particles was obtained,which provided favorable conditions for subsequent radial segregation.

CT双能量成像参数对肺结节病变性质的鉴别价值研究

目的:研究CT双能量成像参数对肺结节病变性质的鉴别价值。方法:2021年12月一2023年1月合肥市第二人民医院收治的102例恶性肺结节患者作为恶性组,同期收治的106例良性肺结节患者作为良性组,所有患者均经病理学检查确诊,比较两组患者影像学特征及CT双能量成像参数,进行肺结节病变性质的CT双能量成像征象、参数多因素分析,采用受试者工作特征(ROC)曲线分析CT双能量成像参数对肺结节病变性质的鉴别价值。结果:恶性组强化不均匀、淋巴结增大、结节边缘毛刺/分叶、血管受累患者占比高于良性组(P<0.05)。恶性组动脉期、静脉期能谱曲线斜率及容积CT剂量指数均高于良性组(P<0.05)。多因素Logistic回归分析结果显示,动脉期、静脉期能谱曲线斜率及容积CT剂量指数较高是肺结节恶性病变的危险因素(OR=1.451、1.502、1.640,P<0.05)。动脉期、静脉期能谱曲线斜率及容积CT剂量指数联合鉴别肺结节病变性质的曲线下面积(AUC)值高于三者单独检测(P<0.05)。结论:肺结节良性病变和恶性病变患者之间影像学特征、动脉期及静脉期能谱曲线斜率、容积CT剂量指数存在明显差异,且动脉期、静脉期能谱曲线斜率及容积CT剂量指数是肺结节恶性病变的危险因素,三者联合对肺结节病变性质的鉴别具有较好价值。

超高端螺旋CT单心跳心脏技术判别冠脉狭窄和斑块性质的临床价值及合并基础疾病对准确性的影响

目的:研究超高端螺旋CT单心跳心脏技术判别冠脉狭窄和斑块性质的临床价值及合并基础疾病对准确性的影响。方法:本研究采用前瞻性研究方法,以我院2022年7月—2023年1月诊断并进行治疗的冠心病患者96例作为研究对象,根据患者的冠脉狭窄程度,Ⅰ级病变患者33例,Ⅱ级病变患者22例,Ⅲ级病变患者41例。根据斑块性质分析,其中稳定性斑块患者55例,不稳定性斑块患者41例,所有患者入组后均接受256排CT行单心跳心脏冠脉成像、冠脉造影(ICA)和血管内超声(IVUS)检查,比较单心跳心脏冠脉成像诊断冠脉血管狭窄以及不稳定性斑块的诊断效能,研究合并基础疾病对准确性的影响。结果:本研究中,单心跳心脏冠脉成像诊断冠脉血管狭窄Ⅲ级病变的灵敏度为80.49%,单心跳心脏冠脉成像诊断冠脉血管狭窄Ⅲ级病变的ROC曲线下面积为0.771,合并高血压、糖尿病、高脂血症等,会造成单心跳心脏冠脉成像诊断冠脉血管狭窄Ⅲ级病变的效能下降。单心跳心脏冠脉成像诊断冠脉血管不稳定斑块的灵敏度为80.21%,单心跳心脏冠脉成像诊断冠脉血管不稳定斑块的ROC曲线下面积为0.775,合并高血压、糖尿病、高脂血症等,会造成单心跳心脏冠脉成像诊断冠脉血管不稳定斑块的诊断效能下降。结论:超高端螺旋CT单心跳心脏技术判别冠脉狭窄和斑块性质的灵敏度均超过80%以上,合并高血压、糖尿病以及高脂血症患者,会造成冠脉狭窄和斑块性质的判定准确性以及灵敏度的下降。

CT与MRI在膝关节软骨损伤分级诊断中的效能分析

目的:探究CT与MRI在膝关节软骨损伤分级诊断中的效能。方法:回顾性选取我院2021年1月-2023年1月收治的80例膝关节软骨损伤患者为研究对象,对所有患者行CT、MRI和关节镜检查,通过关节镜检查的结果,评估二者的分级诊断效能,并比较CT与MRI在膝关节软骨损伤分级诊断中的诊断价值。结果:患者经CT检查诊断的分级结果为Ⅰ级28例,Ⅱ级34例,Ⅲ级及以上18例;经MRI检查诊断的分级结果为Ⅰ级31例,Ⅱ级29例,Ⅲ级及以上20例。与关节镜检查的结果对比,CT的分级诊断准确率为81.25%(65/80),MRI的分级诊断准确率为95.00%(76/80)。MRI检查诊断膝关节软骨损伤患者的Ⅰ级诊断准确率、总准确率要高于CT检查,差异有统计学意义(P<0.05)。结论:CT与MRI均可对膝关节软骨损伤进行分级诊断,但MRI对膝关节软骨损伤分级的诊断准确率高于CT,具有更高的诊断效能。

大型岔管内螺旋流涡带数值分析研究

岔管部件广泛应用于常规水电站、抽水蓄能电站等重要水力发电工程。大型岔管(D主≥6 m)由于岔管外形,肋板结构及内部流态三因素耦合可能导致螺旋流涡带,其对岔管的水力损失具有不可忽略的消极后果。本文基于经典k-ε湍流模型联合考虑实际岔管材料壁面粗糙率,构建了考虑壁面真实粗糙度的钢岔管内部流态k-ε湍流模型。计算结果与实验数据对比验证了本文构建数值模型的有效性及准确性。随后采用导流叶片策略有效消除了大型岔管内的螺旋流涡带现象。研究结果表明:多导流叶片优化方案可有效减少和消除大型岔管中的螺旋流态,并减少岔管水力损失。具体地,对岔管支管路中不同流量工况,优化后的主管路部分流线分布均匀,最大流速位于岔管支管路弯管(内弯)附近;优化后岔管肋板两端涡旋流态基本消除。对岔管支管流量不均匀工况,支管路内螺旋流涡带流态明显减缓,只存在少量螺旋流态。本文研究结果可对岔管水力优化设计及相近研究领域提供一定参考。

螺旋CT三维扫描重建联合3D打印用于髋臼骨折手术的价值研究

目的:探讨螺旋CT三维扫描重建联合3D打印技术在髋臼骨折外科手术中的应用价值。方法:选取2018年1月至2020年12月新疆维吾尔自治区人民医院收治的71例髋臼骨折并接受手术治疗的患者,依据治疗方式的不同将其分为观察组(38例)和对照组(33例),观察组采用螺旋CT三维重建,并以3D打印辅助内固定治疗,对照组采用常规手术治疗。比较两组患者手术效果及恢复情况。结果:观察组骨折复位质量评分及分项百分制髋功能评分高于对照组,术中出血量、术中透视次数、手术用时及住院时间均明显低于对照组,差异均有统计学意义(t=23.426、4.216、3.425、17.783,P<0.05);观察组和对照组骨折复位优良率分别为94.74%和78.79%,差异有统计学意义(x^(2)=4.059,P<0.05);观察组患者髋关节功能评分中疼痛、功能及关节活动均高于对照组,差异有统计学意义(t=-4.873、-5.776、-6.247,P<0.05);观察组并发症发生率明显低于对照组,差异有统计学意义(x^(2)=4.059,P<0.05)。结论:在髋臼骨折围术期应用螺旋CT三维重建结合3D打印可进一步保证手术的安全性和可行性,提高手术质量和效率,促进术后恢复。

多模式CT指导下动脉溶栓对急性致残性非大血管脑梗死患者氧化应激、炎症反应及神经功能的影响

目的探讨多模式CT指导下动脉溶栓在急性致残性非大血管脑梗死患者治疗中的应用价值。方法回顾性分析2022年1月至2023年12月收治的急性致残性非大血管脑梗死患者80例的临床资料,根据治疗方案分为观察组和对照组各40例。观察组行多模式CT指导下应用动脉溶栓,对照组行静脉溶栓。比较2组临床疗效、溶栓前后神经功能损伤程度(NIHSS评分)、氧化应激反应指标[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)]、炎症反应指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]、血管再通情况及不良事件发生率。结果2组总有效率比较差异无统计学意义(P>0.05);溶栓后2 h、24 h、7 d及30 d,观察组NIHSS评分低于对照组(P<0.05);溶栓后7 d及30 d,观察组SOD、GSH-Px水平高于对照组,MDA、IL-6、hs-CRP、TNF-α水平低于对照组(P<0.01);2组血管再通率、不良事件发生率比较差异无统计学意义(P>0.05)。结论多模式CT指导下动脉溶栓与静脉溶栓效果及安全性相当,但动脉溶栓能减轻炎症反应及氧化应激损伤,改善神经功能。

不典型痛风性关节炎误诊分析并文献复习

目的探讨不典型痛风性关节炎的临床特点及误诊原因、防范措施。方法回顾性分析2020年1月—2023年1月收治的曾误诊的痛风性关节炎4例的临床资料,并复习相关文献。结果本组4例中1例因关节对称肿痛及类风湿因子阳性误诊为类风湿关节炎;1例双膝关节肿痛,因关节X线检查提示退行性改变误诊为膝关节骨性关节炎;1例因炎性下腰部疼痛及强直性脊柱炎常见查体阳性误诊为强直性脊柱炎;1例因右足跟疼痛符合足底部筋膜炎特点误诊为足底部筋膜炎。误诊时间3个月~5年。后经追问病史,4例长期存在高尿酸血症且原治疗方案无效,遂进行双能CT检查,均确诊为痛风性关节炎。给予相应治疗,症状皆明显缓解。随访6个月,病情平稳。结论临床表现不典型痛风性关节炎患者容易误诊。临床上对合并高尿酸血症关节炎患者要考虑到痛风性关节炎可能,对高度怀疑该病患者可采用无创双能CT检查进行诊断,以减少或避免误诊误治。

多层螺旋计算机断层扫描多维重建参数、血管活性药物评分在急性主动脉夹层预后中的预测价值

目的探讨多层螺旋计算机断层扫描(CT)多维重建(MPR)参数、血管活性药物评分(VIS)在急性主动脉夹层预后中的预测价值。方法收集2017年4月至2022年4月于聊城市第二人民医院(山东第一医科大学附属聊城二院)进行手术治疗的68例急性主动脉夹层患者的临床资料,根据是否发生院内死亡将其分为死亡组(n=24)和对照组(n=44)。对比两组患者的主动脉夹层的MPR参数、血管活性药物评分(VIS),绘制受试者工作特征(ROC)曲线分析MPR参数与VIS预测急性主动脉夹层患者院内死亡的价值,采用Logistic回归模型分析MPR参数、VIS与患者术后发生院内死亡风险的关系。结果死亡组患者侵犯血管条数、假腔面积占主动脉管腔面积之比、VIS均高于对照组患者,差异均有统计学意义(P﹤0.05)。中性粒细胞与淋巴细胞计数比值(NLR)越高、输血量越大、呼吸机使用时间越长、合并败血症、合并肺部感染、并发意识障碍、假腔面积占主动脉管腔面积之比升高、VIS升高均是急性主动脉夹层患者术后发生院内死亡的独立危险因素(P﹤0.05)。ROC曲线分析显示,侵犯血管条数、假腔面积占主动脉管腔面积之比、VIS预测急性主动脉夹层患者术后死亡风险的曲线下面积(AUC)分别为0.611、0.861、0.949。结论假腔面积占主动脉管腔面积之比、VIS可在一定程度上预测急性主动脉夹层患者术后发生院内死亡的风险,值得在临床上进一步推广应用。

CT及磁共振血管成像诊断颅内动脉瘤的价值

目的分析CT血管成像(computed tomography angiography,CTA)、磁共振血管成像(magnetic resonance angiography,MRA)诊断颅内动脉瘤的价值。方法选取2020年6月-2023年1月广西贵港市人民医院90例疑似颅内动脉瘤患者,均接受CAT及MRA检查,将数字减影血管成像(digital subtraction angiography,DSA)或手术病理学检查结果作为金标准,比较两种方法检出情况、测量颅内动脉瘤瘤体直径与瘤颈宽度、对比不同大小的颅内动脉瘤检出情况,分析两种方法单独及联合诊断颅内动脉瘤的价值。结果90例疑似颅内动脉瘤患者经CTA检查后诊出64例单发颅内动脉瘤,经MRA检查后诊出61例单发颅内动脉瘤,两种方法检出情况比较无明显差异(P>0.05);当瘤体<3 mm时CTA检出率93.33%高于MRA 60.00%(P<0.05);CTA诊断颅内动脉瘤的准确率83.33%、敏感度83.56%、特异度82.35%、Kappa值=0.548;MRA诊断颅内动脉瘤的准确率82.22%、敏感度80.82%、特异度88.24%、Kappa值=0.543;CTA联合MRA诊断颅内动脉瘤的准确率95.56%、敏感度95.89%、特异度94.12%、Kappa值=0.861。结论CTA与MRA均可用于诊断颅内动脉瘤,其中CTA可明显提高<3 mm的微小颅内动脉瘤诊出率,但联合应用时的敏感度更高。

老年小量脑出血患者误诊脑梗死临床分析

目的总结老年小量脑出血误诊脑梗死的原因及其防范措施。方法分析2021年1月至2023年1月收治的早期误诊为脑梗死的老年小量脑出血10例病案资料。结果本组男7例,女3例;年龄61~72岁;均有高血压史;急性发病,静态(睡眠、休息)发病3例,动态发病7例;发病时10例血压均升高;9例出现头晕,2例轻微头痛,6例言语不利,3例轻微中枢性面、舌瘫,偏瘫7例,未出现意识障碍或呕吐症状。于当地乡镇卫生院或诊所初步诊断为脑梗死。给予对症治疗,临床症状无明显好转或加重,遂转我院。全面分析病情后行头颅CT检查发现基底节区出血5例,丘脑出血4例,颞叶出血1例,中线结构居中,侧脑室受压变窄4例;出血量2.9~7.3 mL,平均5.1 mL。均确诊为小量脑出血。误诊时间4~5 d。确诊后10例给予控制血压、脱水、维持水电解质平衡,以及营养脑神经、活血化瘀等药物治疗,3~4周后症状体征基本恢复正常,复查头颅CT示血肿均已明显吸收,预后良好。结论老年小量脑出血因老年人生理病理特点,导致早期无典型颅内压升高、脑膜刺激征表现,加之出血量少,无显著占位效应,使得未行CT等影像学检查前易考虑为脑梗死。加强接诊医生对老年小量脑出血的认识,提高警惕性,重视血压升高表现及发病时状态,及早行CT等影像学检查,可提高本病早期确诊率。