Observation of the effect of targeted therapy of 64-slice spiral CT combined with cryoablation for liver cancer

AIM to observe the effect of targeted therapy with 64-slice spiral computed tomography (CT) combined with cryoablation for liver cancer. METHODS A total of 124 patients ( 142 tumors) were enrolled into this study. According to the use of dual-slice spiral CT or 64-slice spiral CT as a guide technology, patients were divided into two groups: dual-slice group (n = 56, 65 tumors) and 64-slice group (n = 8, 77 tumors). All patients were accepted and received targeted therapy by an argon-helium superconducting surgery system. The guided scan times of the two groups was recorded and compared. In the two groups, the lesion ice coverage in diameter of >= 3 cm and < 3 cm were recorded, and freezing effective rate was compared. Hepatic perfusion values [ hepatic artery perfusion (HAP), portal vein perfusion (PVP), and the hepatic arterial perfusion index (HAPI)] of tumor tissues, adjacent tissues and normal liver tissues at preoperative and postoperative four weeks in the two groups were compared. Local tumor changes were recorded and efficiency was compared at four weeks post-operation. Adverse events were recorded and compared between the two groups, including fever, pain, frostbite, nausea, vomiting, pleural effusion and abdominal bleeding. RESULTS Guided scan times in the dual-slice group was longer than that in the 64-slice group (t = 11.445, P = 0.000). The freezing effective rate for tumors < 3 cm in diameter in the dual-slice group (81.58%) was lower than that in the 64-slice group (92.86%) (chi(2) = 5.707, P = 0.017). The HAP and HAPI of tumor tissues were lower at four weeks post-treatment than at pretreatment in both groups (all P < 0.05), and those in the 64-slice group were lower than that in the dual-slice group ( all P < 0.05). HAP and PVP were lower and HAPI was higher in tumor adjacent tissues at post-treatment than at pre-treatment ( all P < 0.05). Furthermore, the treatment effect and therapeutic efficacy in the dual-slice group were lower than the 64-slice group at four weeks post-treatment (all P < 0.05). Moreover, pleural effusion and intraperitoneal hemorrhage occurred in patients in the dual-slice group, while no complications occurred in the 64-slice group (all P < 0.05). CONCLUSION 64-slice spiral CT applied with cryoablation in targeted therapy for liver cancer can achieve a safe and effective freezing treatment, so it is worth being used.

Clinical Effect of Magnetic Resonance Imaging and 64-slice Spiral CT in the Diagnosis of Ischemic Heart Disease Patients

Objective:To explore the clinical methods and clinical effects of applying magnetic resonance imaging(MRI)and 64・slice spiral computed tomography(CT)in the diagnosis of patients with ischemic heart disease.Methods:100 patients with ischemic heart disease were selected as the research objects.Selecting the patients from May 2020 to May 2021 as a sample,the patients were divided into two groups,and different diagnostic methods were used to compare the clinical diagnosis effects.Results:In terms of the diagnostic accuracy of the two groups of patients,the maximum value was 92.00%(experimental group)and the minimum value was 80.00%(control group).There was a big difference in data between the two groups,P<0.05,which was statistically significant.The patient9s(experimental group)diagnosis accuracy rate is highe Conclusion:In the process of research work for patients with ischemic heart disease,it is particularly important to diagnose the patients.The combined application of and 64-slice spiral CT can improve the clinical diagnosis efficiency and achieve significant results.

Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

Background: Factors that can predict the presence and number of noncalcified coronary plaques (NCP) in Japanese patients with zero coronary artery calcium scores (CACS) essentially remain undefined. Methods and Results: We assessed independent predictors of the presence and number of segments with NCP in 111 Japanese patients with zero CACS who underwent 64-slice multi-detector computed tomography at our hospital. Thirty five patients (32%) had NCP, and 24 patients (22%) had ≥ 2 NCPs. Multiple logistic regression analysis revealed that significant predictors for the presence of NCP were age (odds ratio [OR]: 1.06, 95% confidence interval [CI] 1.01 - 1.11, p = 0.021), male (OR: 3.61, 95% CI 1.40 - 9.35, p = 0.008) and diabetes mellitus (OR: 3.10, 95% CI 1.02 - 9.45, p = 0.046), and those for the presence of ≥ 2 NCPs were age (OR: 1.08, 95% CI 1.02 - 1.15, p = 0.007) and a current smoking habit (OR: 5.09, 95% CI 1.00 - 25.74, p = 0.049). Multiple linear regression analysis identified advanced age, male gender and diabetes mellitus as independent predictors of the number of NCPs. A novel score calculated from the above four predictors showed moderate accuracy for a diagnosis of NCP and ≥ 2 NCPs, with areas under receiver operating curves of 0.738 and 0.736, respectively. Conclusions: Male Japanese patients with zero CACS, advanced age, diabetes mellitus and a current smoking habit might have NCPs.

Imaging Effect and Accuracy Analysis of 64-Slice Spiral CT in the Diagnosis of Coronary Artery Stenosis

Objective:To analyze the imaging effect and accuracy of 64-slice spiral CT in the diagnosis of coronary artery stenosis.Methods:30 patients with suspected coronary heart disease admitted to our hospital from March 2022 to March 2023 were selected.All patients underwent both 64-slice spiral CT and digital subtraction angiography(DSA).DSA is considered the gold standard for diagnosis,so it was used to analyze the diagnostic performance of 64-slice spiral CT.Results:(1)The diagnostic results of digital subtraction angiography and 64-slice spiral CT was analyzed and compared with each other.The 64-slice spiral CT had an accuracy of 96.67%(29/30),a sensitivity 96.55%(28/29),and a specificity of 100.00%(1/1)in diagnosing coronary artery stenosis.(2)There was no significant difference between 64-slice spiral CT and digital subtraction angiography in the positive detection rate of anterior descending artery lesion,the positive detection rate of left main lesion,the positive detection rate of left circumflex artery lesion and the positive detection rate of right coronary artery lesion(P>0.05).(3)There was no significant difference between 64-slice spiral CT examination and DSA examination in identifying mild stenosis,moderate stenosis,and severe stenosis of coronary arteries(P>0.05).Conclusion:64-slice spiral CT examination can accurately determine the degree of occlusion of coronary arteries,which allows for the accurate diagnosis of coronary artery stenosis.

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。

64层螺旋CT对颌骨埋伏牙定位的应用研究

目的探讨64层螺旋CT三维重建技术在颌骨内埋伏牙定位中的应用。方法对27例埋伏牙患者行64层螺旋CT扫描,通过容积再现、最大密度投影、多层面重建和曲面重建等技术对扫描图像进行后期处理,通过各种技术的综合应用,对颌骨内埋伏牙进行准确定位。结果 27例患者共有41颗埋伏牙。通过64层螺旋CT多种重建技术的组合应用,均得以清晰显示埋伏牙的位置、形态、大小、萌出方向及其与周围组织的关系,对选择正畸牵引还是外科手术治疗埋伏牙提供了依据。结论 64层螺旋CT扫描和后处理技术可提供埋伏牙位置的准确数据,为治疗方案的选择提供客观依据,具有重要的临床应用价值。

64层螺旋CT对主动脉根部形态结构的评价

目的研究主动脉根部及临近组织结构64层螺旋CT(MSCT)成像技术、影像解剖及其临床意义。方法 60例无明显主动脉、主动脉瓣膜疾病患者行MSCT检查,采用多平面重建(MPR)、容积再现(VR)及仿真内镜(VE)等方法重建并测量相关数据。结果 测得主动脉根部直径(22.79±3.31)mm,主动脉窦间距(33.43±3.34)mm,冠脉开口处直径(30.06±2.70)mm,升主动脉内径(30.39±3.42),窦底平面至窦顶平面距离(19.18±2.21)mm。左右冠状动脉开口距主动脉根部距离分别为(15.71±3.53)mm、(15.96±3.78)mm。结论应用MSCT增强扫描可清楚显示主动脉开口大小、冠脉开口位置、有无发育畸形及与周边结构关系,为带瓣膜支架的设计与经皮主动脉瓣膜植入手术顺利施行提供影像学依据。

64层螺旋CT冠状动脉血管造影应用技术的初探

目的初步探讨64层螺旋CT冠状动脉血管造影技术。方法120例受检者行64层螺旋CT冠状动脉血管成像检查,使用美国GE公司64层螺旋CT,进行回顾性心电门控平扫及增强,原始采集的图像从心动周期的相位窗35%～85%,每间隔5%进行重建,采用平面重建(MPR)、最大密度投影法重建(MIP)、曲面重建(CPR)和容积再现技术(VR)进行图像后处理重建,显示冠状动脉主干及主要分支。结果心率平稳,心率少于80次/分,64层CT对冠状动脉冠节段图像质量可以用于评价,可较准确地显示冠状动脉通畅情况及管壁病变。心率大于90次/分时,冠状动脉的主要分支显示欠规整。结论心率平稳且小于80次/分,合理运用重建时相和三维重建技术,64层CT冠状动脉成像可显示较细节段的冠状动脉,可以比较准确诊断冠状动脉病变,具有较高的临床应用价值。

64层螺旋CT肺肿瘤灌注感兴趣区选择对数据可重复性影响的研究

目的:探讨64层螺旋CT肺肿瘤灌注中,不同感兴趣区选择的方法对测量结果可重复性的影响。方法:对15例经临床确诊为肺癌的病例行肺肿瘤CT灌注扫描。将所得图像传入工作站后以CT灌注成像处理软件处理,感兴趣区的选择采用最高灌注区、高灌注区均值和最大层面全肿瘤区域3种方式,分别获得血流量、血容量和表面渗透性等灌注参数。以SPSS 13.0软件对所获得的各种灌注参数值进行变异系数、Kappa值等参数的比较。结果:采用最大层面全肿瘤法选择感兴趣区,所得到的灌注参数具有最高的Kappa值,并且大部分的变异系数最小。而最高灌注区法测得的灌注参数Kappa值最小,并且大部分的变异系数最大。结论:在肺肿瘤CT灌注的后处理中,以最大层面全肿瘤区域法和高灌注区均值法划定感兴趣区,可得到比最高灌注区法可重复性更高的数据,而两种方法中又似以前者为优。

心率、心率波动及重建时相的选择对64层螺旋CT冠状动脉图像质量的影响

目的:评价心率、心率波动及重建时相的选择对西门子64层螺旋CT冠状动脉成像的影响。方法:51例临床疑诊冠心病或冠状动脉粥样硬化的患者,进行64层螺旋CT冠状动脉成像检查。将扫描数据从心动周期的R-R相位0～95%每间隔5%进行重建。使用西门子Syngo MMWP VE23A后处理工作站,进行容积再现、多平面重组、最大密度投影、曲面重组等处理。按扫描时平均心率及心率波动幅度分组,获得最佳重建时相,进而评价不同心率及心率波动幅度中的图像质量。结果:心率<65次/min冠状动脉最佳重建时相为60%～75%R-R间期;心率65～70次/min冠状动脉最佳重建时相为65%～70%R-R间期;心率>70次/min冠状动脉最佳重建时相为30%～40%R-R间期。图像质量随心率的增加及心率波动幅度的变大而下降。心率及心率波动幅度与图像质量呈负相关(P<0.05)。结论:西门子64层螺旋CT冠状动脉成像的图像质量受心率及心率波动幅度影响。控制心率、减小心率波动以及选择最佳重建时相可提高图像质量。

64排螺旋CT对Ⅳ期胃癌术前分期的价值

目的评价64排螺旋CT对Ⅳ期胃癌术前分期的准确性。方法收集2007年7月至2008年4月期间我院胃肠外科收治的49例Ⅳ期胃癌患者的临床资料,对其中术前行64排螺旋CT(64MDCT)检查的29例患者进行回顾性分析并按日本胃癌规约对肿瘤进行分期。将CT术前分期结果与临床-手术-病理分期结果进行对照分析。结果本组病例经64MDCT术前分期,其中65.2%(15/23)T分期准确,47.8%(11/23)N分期准确,70.8%(17/24)M分期准确,58.6%TNM分期准确(17/29)。而腹膜转移患者中6/9未能经术前64MDCT检出。结论64MDCT可以对Ⅳ期胃癌进行较准确的分期,其分期准确率降低的主要原因为腹膜转移的漏诊,但64MDCT分期降低并不增加剖腹探查率。

64排螺旋CT对主动脉夹层的诊断价值

目的探讨64排螺旋CT血管成像(MSCTA)对主动脉夹层的诊断价值。方法回顾性分析8例主动脉夹层CT表现,应用原始数据在工作站进行MPR、MIP及VR等后处理。结果 8例中DeBakeyⅠ型2例,Ⅱ型0例、Ⅲ型5例,不典型夹层1例,均很好地显示了主动脉全程及其分支,对主动脉夹层的破口位置、累及范围、真假腔、内膜片及夹层的旋转方向、血栓的形成得到满意显示。结论 MSCTA对主动脉夹层诊断具有重要的应用价值,应作为首选检查方法。

64层螺旋CT诊断不同程度冠状动脉狭窄的临床价值

目的用传统的冠状动脉造影作对照,评价64层螺旋CT诊断冠状动脉不同程度狭窄的准确性。方法 116例患者临床怀疑冠状动脉粥样硬化性心脏病并同期接受64层螺旋CT冠状动脉造影及常规冠状动脉造影,计算冠状动脉不同程度狭窄的敏感性、特异性、准确性、阳性预测值、阴性预测值。结果 64层螺旋CT诊断可评估冠状动脉中度、重度及轻度狭窄的敏感性为95.73%、89.7%、70.0%,特异性为98.7%、95.7%、88.1%,准确性为98.7%、95.7%、88.1%,阳性预测值为83.0%、80.7%、36.3%,阴性预测值为99.7%、97.9%、96.8%。结论 64层螺旋CT是一种有效的无创性的检测冠状动脉狭窄的工具。

64层螺旋CT在活体肝门静脉三维重建中的应用

目的：探讨64层螺旋CT应用于正常人体肝门静脉研究的可行性，观察三维重建肝门静脉的一般形态及变异。方法：153例正常受试者经肘正中静脉注射造影剂后，使用64层螺旋CT进行上腹部扫描，图像采集后经容积再现（VR）技术重建肝门静脉。结果：肝门静脉分5型：a型：83．7％；b型：7．8％；C型：7．8％；d型：无；e型：0．7％。结论：64层螺旋CT可以作为研究活体肝门静脉形态的有效手段，三维重建能更准确、全方位地显示肝门静脉的正常解剖类型和变异。

64排螺旋CT检查在冠脉小血管病变中的诊断价值分析

目的探讨64排螺旋CT在冠脉小血管病变中的诊断价值。方法收集80例冠心病（CAD）患者的影像资料，评估64排螺旋CT在其小冠状动脉（直径为1．0～2．75mm）病变中的准确性。结果64排螺旋CT诊断小冠状动脉大于或等于50％及小于50％的狭窄性病变敏感性依次为75．0％、65．2％，特异性分别为85．3％、84．9％；阳性预测值分别为46．9％、46．4％；阴性预测值依次为95．2％、92．4％。结论64排螺旋CT在判定冠心病患者小冠状动脉痛变中是一种较可靠的、无创的检查方法。

64层螺旋CT三维重建活体肝动脉的研究

目的:探讨64层螺旋CT应用于正常活体肝动脉研究的可行性,观察三维重建肝动脉的一般形态及走行规律。方法:选取行上腹部64-MSCT扫描检查的病例共153例,在智能追踪技术(smart prep)对腹主动脉腹腔干层面连续检测下,启动扫描。并将所得数据在GEADW4.2工作站进行图像处理。结果:依据Michels标准153肝动脉分型如下:①I型,占80.4%(123例);②II型,占2.0%(3例);③III型,占2.6%(4例);④Ⅳ型,占2.0%(3例);⑤V型,占4.0%(6例);⑥VI型,占1.3%(2例);⑦Ⅶ型,占1.3%(2例);⑧Ⅷ型,无;⑨IX型,占2.6%(4例);⑩X型,无。其他型,占4.0%(6例)不能归入Michels分型。结论:64层螺旋CT可以作为研究活体肝动脉形态的有效手段,三维重建能准确显示肝动脉的正常解剖类型和变异,对于活体肝动脉的研究有较好的临床应用价值。

原发性高血压合并冠心病患者64排螺旋CT检查的诊断价值分析

目的探讨64排螺旋CT对原发性高血压合并冠心病(CAD)的冠状动脉病变的诊断价值。方法收集90例原发性高血压合并冠心病(CAD)患者的影像资料,评估64排螺旋CT在其冠状动脉性病变中的准确性。结果64排螺旋CT诊断冠状动脉大于或等于50%、大于或等于70%及小于50%狭窄性病变的敏感性依次为93.8%、87.5%、85.6%,特异性依次为94.8%、97.6%、93.7%;阳性预测值依次为91.6%、83.2%、77.2%;阴性预测值依次为96.2%、98.3%、96.3%。结论64排螺旋CT是诊断原发性高血压合并CAD冠状动脉病变较可靠的、无创的检查方法。

64排螺旋CT脑成像在诊断脑血管畸形中的应用价值

目的探讨64排螺旋CT血管成像对脑血管畸形的诊断价值。方法利用64排螺旋CT对20例脑动静脉畸形、2例脑静脉畸形、2例海绵状血管瘤患者行CT血管成像检查。对扫描图像分别进行多平面重组、容积再现及最大密度投影。结果 CT血管造影术(CTA)能显示脑动静脉畸形(AVM)的病变形态及准确部位,有效显示供血动脉、引流静脉及血管巢。能清晰显示脑静脉畸形静脉血管的组成及引流静脉的数目和方向。但不能显示海绵状血管瘤的血管结构,对其诊断价值不大。结论 64排螺旋CT血管成像能清晰显示具有较粗大供血动脉或引流静脉、血管巢的脑血管畸形,对脑血管畸形的诊断及治疗具有重要的临床价值。

64层螺旋CTA对变异肾动脉与主肾动脉和对应肾脏的研究

目的：分析变异肾动脉的特点及其与主肾动脉和对应肾脏的关系,为临床诊断及手术方案提供参考。方法：回顾性分析518例疑有肾血管性高血压或肾脏病变患者的64层螺旋CT血管影像资料,其中210例患者存在肾动脉变异（40.5%）,主要观察变异肾动脉的特点及其与同侧主肾动脉的位置关系、双侧主肾动脉管径及肾脏结构形态的对比。结果：单侧肾动脉变异141例,占67.1%,双侧肾动脉变异69例,占32.9%;肾脏形态结构、位置异常178例,正常32例;变异侧主肾动脉管径小于无变异侧主肾动脉管径112例,占79.4%（112/141）;195支变异肾动脉开口于腹主动脉,其与同侧主肾动脉距离范围为0~112mm,其中0~20mm共130支,占66.7%;高于同侧主肾动脉72支,占36.9%,低于同侧主肾动脉118支,占60.5%,与主肾动脉等高5支,占2.6%;入肾上极130支,入肾门113支,入肾下极100支;开口于腹主动脉的变异肾动脉起源于T12~L5椎体段范围,其中L1上缘至L2椎体下缘范围149支,占76.4%（149/195）。结论：64层螺旋CTA可直观、准确地显示变异肾动脉的起源、数目及其与相应主肾动脉、肾脏的关系。

64层CT血管成像技术对脑血管病的诊断价值

目的探讨64层螺旋CT血管成像技术对脑血管病的诊断价值。方法回顾性分析160例头颈部CT血管成像检查患者的影像资料。图像后处理采用多平面重组、最大强度投影和容积再现技术。由两名放射科医师共同对原始及重组图像进行分析。结果94例显示异常,其中狭窄梗阻性病变50例,动脉瘤21例,动脉瘤支架术后1例,夹闭术4例,动静脉畸形3例,烟雾病4例,颈内动脉海绵窦瘘4例,静脉窦血栓4例,直窦闭塞伴永存镰状窦1例,大脑大静脉和直窦瘤样扩张1例,永存舌下动脉1例。结论64层螺旋CT血管成像技术对脑血管病的诊断具有肯定价值和明显优势。