定量分析急性胰腺炎胸部损害的CT表现及其评估病情严重度和预后的价值

目的定量分析急性胰腺炎胸部损害的CT表现,并分析其对患者病情严重度和预后的评估价值。方法选取2020年2月至2022年9月我院收治的72例急性胰腺炎患者,所有患者均进行胸部、上腹部CT平扫检查,部分行腹部CT增强检查,根据病情严重程度分为轻症组45例和重症组27例,另根据合并胸腔积水、肺实变的情况分为A组(合并双侧肺实变与双侧胸腔积水)20例、B组(合并双侧胸腔积水与单侧肺实变或同时合并双侧肺实变与单侧胸腔积水)15例、C组(合并双侧肺实变或双侧胸腔积水)16例、D组(单侧肺实变或(和)单侧胸腔积水)10例、E组(均无肺实变与胸腔积水)11例。检测并比较各项指标。结果重症组的EPIC、CTSI以及BISAP、APACHE-Ⅱ评分、左侧肺实变/胸腔厚度比、左侧胸腔积水/胸腔厚度比、右侧的肺实变/胸腔厚度比均高于轻症组,差异有统计学意义(P<0.05)。A~E组的EPIC、CTSI、BISAP及APACHE-Ⅱ评分相比,差异有统计学意义(P<0.05);左右两侧的肺实变/胸腔厚度比、胸腔积水/胸腔厚度比与EPIC、CTSI、BISAP及APACHE-Ⅱ评分均呈正相关(P<0.05)。急性胰腺炎合并双侧胸腔积水32例、合并双侧肺实变47例患者的死亡率分别为3.12%、2.13%。结论临床上对于急性胰腺炎胸部损害的CT表现情况进行定量分析,有助于评估患者病情严重程度,对患者预后评估方面亦有较高的应用价值。

百草枯中毒致胸部损害的CT分析

目的探讨CT在百草枯中毒胸部损害的应用价值。方法回顾性分析5例口服百草枯中毒致胸部损害的CT资料。结果 5例患者首次CT检查4例表现为肺内斑点状、斑片状、线条状密度增高影,伴少量胸腔积液;1例胸部未见明显异常。5例首次CT复查肺部病变和胸腔积液同时吸收1例,仅肺部病变吸收1例;1例首次CT检查胸部未见明显异常者出现肺部病变和胸腔积液;2例肺部病变范围增大;1例胸腔积液增多。4例第2次复查2例肺部病变和胸腔积液增多。3例第3次复查胸部病变基本吸收。结论 CT对百草枯中毒后胸部损害的评估、治疗和判断疗效有一定的指导价值。

淋巴瘤的胸部表现

分析了５０例经病理确诊的淋巴瘤病例，重点是有呼吸系统症状及胸片、胸部ＣＴ异常的病例。５０例中１３例以呼吸系统症状为首发表现，３０例有胸片异常，９例胸部ＣＴ异常，表现为胸水、纵隔增宽、肺内结节影等。提示淋巴瘤胸部受累影像学表现多种多样，缺乏特征性，需与多种胸科疾病鉴别。胸部ＣＴ能准确显示肺门及纵隔淋巴结肿大影。双侧胸水并纵隔增宽者、心包积液者预后差。淋巴瘤有胸部受累者６３．３％预后不良。

百草枯中毒胸部CT表现

目的:分析探讨百草枯中毒致胸部损害的CT特征和诊断价值。方法:分析70例口服百草枯中毒致胸部损害的CT影像学资料。结果:早期(3 d内)主要表现为肺纹理增多、磨玻璃样改变、胸膜下线和心脏增大;早中期(4～7 d)主要表现为磨玻璃样改变、肺间质纤维化、胸膜下线、胸腔积液和心脏增大;中期(8～14 d)主要表现为肺纹理增多、磨玻璃样改变、肺间质纤维化、胸膜下线、胸膜增厚、心脏增大;中后期(15～28 d)主要表现为磨玻璃样改变、肺间质纤维化、胸膜下线、胸膜增厚;后期(>28 d)则以肺间质纤维化、胸膜下线多见。结论:百草枯中毒的胸部CT表现具有一定特征性,其影像学变化对病情发展及指导临床治疗具有重要意义。

系统性红斑狼疮的胸部表现

许多资料表明，系统性红斑狼疮（SLE）胸部损害屡见不鲜但缺乏特征性，往往诊断困难。现对65例SLE患者的胸部X线表现分析、讨论如下。

百草枯中毒患者早期胸部CT表现及对患者临床预后的影响

目的探讨百草枯中毒患者早期胸部CT表现及对患者临床预后的影响。方法选取2012年1月至2019年11月本院收治的百草枯中毒患者50例为研究对象,分为死亡组和生存组,每组25例。两组患者均进行胸部CT检查,观察服用剂量对患者胸部损害程度以及存活率并对其进行评估。结果生存组早期CT值、中期CT增加值以及中期肺部损伤范围扩大指标均低于死亡组(P<0.05)。生存组服用剂量≤10 mL 12例,死亡组8例,死亡率为32.0%;生存组服用剂量10~30 mL 12例,死亡组9例,死亡率为36.0%;生存组服用剂量≥30 mL 1例,死亡组8例,死亡率32.0%;生存组肺纹理增多10例,胸膜下线8例,胸膜增厚7例,肺过度充气6例,支气管扩张3例,胸腔积液8例;死亡组肺纹理增多22例,胸膜下线21例,胸膜增厚18例,肺过度充气16例,支气管扩张8例,胸腔积液16例。结论早期胸部CT表现可以有效的帮助主治医师更好的了解患者的情况、中毒后患者的胸部损害部位、程度以及服用剂量与死亡率的关系等,从而给出具有针对性的治疗方案,提高患者的生存率,在临床上具有重要的意义。

某耐火材料厂作业工人胸部X线片分析

目的 了解耐火材料作业工人胸部损害。方法 对某耐火材厂210名接尘工人进行胸部X线摄片和肺功能检查。结果耐火材料作业工人胸部X线改变以肺纹理增强为主,次为肺门密度增高,部分有小结节影和胸膜改变,发病工龄较长。肺功能改变以阻塞性通气功能障碍为主。结论 Al2O3对SiO2粉尘有一定缓冲作用,可以降低后者致纤维化作用,然而高浓度Al2O3和SiO2粉尘则能导致混合性尘肺,肺功能改变与上述结论相符合。

Breast Lesions： Correlation of Dynamic Contrast Enhancement Patterns on MR images with Tumor Angiogenesis

OBJECTIVE To determine whether dynamic contrast-enhanced MRI features of the early -phase enhancement rate, enhancement amplitude, and signal-intensity (SI) time course are associated with the microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of malignant and benign breast lesions. METHODS Sixty patients with breast lesions, detected with physical examination or conventional mammography, were examined pre-operatively with dynamic contrast-enhanced MRI from December 1998 to June 2000. Of these 60 patients, histopathological correlation was available in 38. These 38 patients(aged 29-73 years) formed the basis of this study. SI changes during dynamic scanning were assessed quantitatively. Early-phase enhancement rate and enhancement amplitude were calculated. Time-Sl curves of the lesions were obtained and classified according to their shapes as type I (which was steady enhancement to the end of the dynamic data acquisition at 7.5rain.), type Ⅱ (plateau of SI after avid initial contrast enhancement), or type Ⅲ (washout of SI after avid initial contrast enhancement). The mean MVD and VEGF expression of the lesions were measured with immunohistochemical staining methods in all the pathologic specimens by a pathologist without knowledge of the results of the MR examination. Care was taken to ensure identical location in the plane of the MR image and pathologic specimens. The relationships among dynamic contrast-enhanced MRI features, MVD, and VEGF expression of benign and malignant breast lesions were analyzed. RESULTS Histology revealed 21 malignancies and 17 benign lesions. The mean MVD and VEGF expression for the 21 malignant lesions were significantly higher than the mean MVD and VEGF expression for the 17 benign lesions (P<0.01). High VEGF expression of benign and malignant breast lesions showed a significant association with increased MVD (P<0.01). Among all 38 lesions, greater (>60%) MR early-phase enhancement rate and time-SI curve type Ⅱ or Ⅲ showed a significant association with MVD and VEGF expression. All the differences mentioned above showed statistical significance (P <0.01) except the difference between VEGF expression and the distribution of curve types which had no statistical significance (P=0.069). No significant relationships were observed between the enhancement amplitude and MVD (P>0.05) and VEGF expression (P>0.05). Regarding the distribution of MVD, the study showed that the greater MVD was most frequently observed at the marginal region of the breast cancers, although the distribution of MVD was heterogeneous in each lesion. CONCLUSIONS MVD and VEGF affect the contrast medium enhancement of breast lesions. The early-phaseenhancement rate and time-SI curve types of benign and malignant breast lesions are closely related to MVD and VEGF. As a noninvasive method, contrast-enhanced MRI has a potential role in estimating the degree of angiogenesis of breast neoplasms.

Fine Needle Aspiration Cytology of Breast Lesions：Analysis of 323 Cases

To compare the fine needle aspiration cytology (FNAC) diagnostic accuracy of breast lesions with that of histopathology. Methods: The FNAC results of 323 cases of breast lesions were analyzed and compared with those of histological diagnosis. Results: In this group, the FNAC sensitivity, specificity, false-positive rate, false-negative rate and the rate of diagnostic coincidence was 97.1%, 97.3%, 2.7%, 2.9% and 97.2%, respectively. Conclusion: FNAC was a useful method with high value for breast lesions.