Impact of computed tomography/magnetic resonance imaging registration on rehabilitation after percutaneous endoscopic decompression for lumbar stenosis: Retrospective study

BACKGROUND Percutaneous endoscopic lumbar decompression(PELD)shows promise for lumbar spinal stenosis(LSS)treatment,but its use is limited by the disease's complexity and procedural challenges.AIM In this study,the effects of preoperative planning and intraoperative guidance with computed tomography(CT)/magnetic resonance imaging(MRI)registration techniques on PELD for LSS and postoperative rehabilitation outcomes were evaluated.METHODS This retrospective study was conducted with data from patients who underwent PELD for LSS between January 2021 and December 2023.Patients were assigned to preoperative CT/MRI registration and control groups.Data collected included the operative time,length of hospital stay,visual analog scale(VAS)scores for low back and leg pain,and the Japanese Orthopaedic Association(JOA)lumbar spine score.Differences between groups were assessed using Student’s t test.RESULTS Data from 135 patients(71 in the CT/MRI registration group,64 in the control group)were analyzed.The operative time was significantly shorter in the CT/MRI registration group(P=0.007).At 2 months postoperatively,both groups showed significant reductions in VAS leg and low back pain scores(all P<0.001)and improvements in the JOA score(both P<0.001).No complication or death occurred.Preoperatively,pain and JOA scores were similar between groups(P=0.830,P=0.470,and P=0.287,respectively).At 2 months postoperatively,patients in the CT/MRI registration group reported lower leg and low back pain levels(P<0.001 and P=0.001,respectively)and had higher JOA scores(P=0.004)than did patients in the control group.CONCLUSION Preoperative CT/MRI registration for PELD for LSS reduced the operative time and VAS pain scores at 2 months and improved JOA scores,demonstrating enhanced effectiveness and safety.

Values of high-resolution computed tomography and pulmonary function tests in managements of patients with chronic hepatitis C virus infection

AIM:To investigate pulmonary involvement via pulmonary function tests (PFT) and high-resolution computed tomocjraphy (HRCT) in patients with chronic hepatitis C virus (HCV) infection. METHODS:Thirty-four patients with chronic HCV infection without diagnosis of any pulmonary diseases and 10 healthy cases were enrolled in the study,PFT and HRCT were performed in all cases. RESULTS:A decrease lower than 80% of the predicted value was detected in vital capacity in 9/34 patients,in forced expiratory volume in one second in 8/34 patients,and in forced expiratory flow 25-75 in 15/34 patients,respectively.Carbon monoxide diffusing capacity (DLCO) was decreased in 26/34 patients.Findings of interstitial pulmonary involvement were detected in the HRCT of 16/34 patients.Significant difference was found between controls and patients with HCV infection in findings of HRCT (X^2=4.7,P=0.003).Knodell histological activity index (KHAI) of 28/34 patients in whom liver biopsy was applied was 9.0±4.7.HRCT findings,PFT values and DLCO were not affected by KHAI in patients with HCV infection.In these patients,all the parameters were related with age. CONCLUSION:We suggest that chronic hepatitis C virus infection may cause pulmonary interstitial involvement without evident respiratory symptoms.

Utility of Spiral Computed Tomography in the Study of Dislocation of Cricoarytenoid Joint

The cricoarytenoid relationship presented with spiral computed tomography was demonstrated and the reconstruction of arytenoid dislocation was presented by using multiplanar reconstruction algorithms. Fifteen patients with arytenoid dislocation documented by fiberoptic laryngoscopy and strobovideolaryngoscopy and 10 normal persons were displayed by spiral computed tomography (CT). A making design of our own had been used to diagnose arytenoid dislocation on axial CT image. Results showed that dislocation of cricoarytenoid joint was consistently demonstrated on several of the overlapping thin axial reconstructions in each of the 15 patients, in whom asymmetry of the bilateral cricoarytenoid joints was noted on axial images. It was found that on the glottic-fissure level the basal angle on abnormal side was larger in 8 patients than that on the normal side and smaller in 7 patients in patient group, whereas right basal angle was equal to the left in 8 subjects, except 2 in control group. There was statistically significant difference in the number of the equal to two basal angles of glottic fissure between control group and patient group (P<0.025). High-quality sagittal and coronal reconstructive images often were helpful in confirming or clarifying the complex arytenoid orientations. The findings that two-side basal angle was not equal in triangle of glottic fissure can be used as an objective parameter to diagnose arytenoid dislocation. Spiral CT is a useful adjunct in the diagnosis and treatment of dislocation of cricoarytenoid joint.

Chest CT quantitative parameters in patients with acute exacerbation of chronic obstructive pulmonary disease:Correlations with blood eosinophil level

Objective To observe the correlations of chest CT quantitative parameters in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with blood eosinophil(EOS)level.Methods Chest CT data of 162 AECOPD patients with elevated eosinophils were retrospectively analyzed.The patients were divided into low EOS group(n=105)and high EOS group(n=57)according to the absolute counting of blood EOS.The quantitative CT parameters,including the number of whole lung bronchi and the volume of blood vessels,low-attenuation area percentage(LAA%)of whole lung,of left/right lung and each lobe of lung,as well as the luminal diameter(LD),wall thickness(WT),wall area(WA)and WA percentage of total bronchial cross-section(WA%)of grade 3 to 8 bronchi were compared between groups.Spearman correlations were performed to analyze the correlations of quantitative CT parameters with blood EOS level.Results LAA%of the whole lung,of the left/right lung and each lobe of lung,as well as of the upper lobe of right lung LD grade 4,middle lobe of right lung WT grade 5,upper lobe of right lung WA grade 4,middle lobe of right lung WA grade 5 and lower lobe of left lung WA grade 3 in low EOS group were all higher than those in high EOS group(all P<0.05).Except for the upper lobe of right lung LD grade 4,the above quantitative CT indexes being significant different between groups were all weakly and negatively correlated with blood EOS level(r=-0.335 to-0.164,all P<0.05).Conclusion Chest CT quantitative parameters of AECOPD patients were correlated with blood EOS level,among which LAA%,a part of WT and WA were all weakly negatively correlated with blood EOS level.

Bone diseases in rabbits with hyperparathyroidism: computed tomography, magnetic resonance imaging and histopathology

Background Hyperparathyroidism （HPT） occurs at an early age and has a high disability rate. Unfortunately, confirmed diagnosis in most patients is done at a very late stage, when the patients have shown typical symptoms and signs, and when treatment does not produce any desirable effect. It has become urgent to find a method that would detect early bone diseases in HPT to obtain time for the ideal treatment. This study evaluated the accuracy of high field magnetic resonance imaging （MRI） combined with spiral computed tomography （SCT） scan in detecting early bone diseases in HPT, through imaging techniques and histopathological examinations on an animal model of HPT. Methods Eighty adult rabbits were randomly divided into two groups with forty in each. The control group was fed normal diet （Ca：P = 1：0.7）; the experimental group was fed high phosphate diet （Ca：P = 1：7） for 3, 4, 5, or 6-month intervals to establish the animal model of HPT. The staging and imaging findings of the early bone diseases in HPT were determined by high field MRI and SCT scan at the 3rd, 4th, 5th and 6th month. Each rabbit was sacrificed after high field MRI and SCT scan, and the parathyroid and bones were removed for pathological examination to evaluate the accuracy of imaging diagnosis. Results Parathyroid histopathological studies revealed hyperplasia, osteoporosis and early cortical bone resorption. The bone diseases in HPT displayed different levels of low signal intensity on T1WI and low to intermediate signal intensity on T2WI in bone of stage 0, Ⅰ, Ⅱ or Ⅲ, but showed correspondingly absent, probable, osteoporotic and subperiosteal cortical resorption on SCT scan. Conclusion High field MRI combined with SCT scan not only detects early bone diseases in HPT, but also indicates staging, and might be a reliable method of studying early bone diseases in HPT.

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Fluorodeoxyglucose positron emission tomography/computed tomography(FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy(SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection(ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node(IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observationssuggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.

Differential diagnosis of coronavirus disease 2019 from community-acquired-pneumonia by computed tomography scan and follow-up

Objective Coronavirus disease 2019(COVID-19)is currently the most serious infectious disease in the world.An accurate diagnosis of this disease in the clinic is very important.This study aims to improve the differential ability of computed tomography(CT)to diagnose COVID-19 and other community-acquired pneumonias(CAPs)and evaluate the short-term prognosis of these patients.Methods The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province,China from January 21 to February 28,2020 were retrospectively analysed.The CT manifestations of the two groups were recorded and compared.A correlation analysis was used to examine the relationship between COVID-19 and age,size of lung lesions,number of involved lobes,and CT findings of patients.The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity.Results The typical CT findings of COVID-19 are simple ground-glass opacities(GGO),GGO with consolidation or grid-like changes.The sensitivity and specificity of the combination of age,white blood cell count,and ground-glass opacity in the diagnosis of COVID-19 were 92.7 and 66.1%,respectively.Pulmonary consolidation,fibrous cords,and bronchial wall thickening were used as indicators to exclude COVID-19.The sensitivity and specificity of the combination of these findings were 78.0 and 63.6%,respectively.The follow-up results showed that 67.8%(112/165)of COVID-19 patients had abnormal changes in their lung parameters,and the severity of the pulmonary sequelae of patients over 60 years of age worsened with age.Conclusions Age,white blood cell count and ground-glass opacity have high accuracy in the early diagnosis of COVID-19 and the differential diagnosis from CAP.Patients aged over 60 years with COVID-19 have a poor prognosis.This result provides certain significant guidance for the diagnosis and treatment of new coronavirus pneumonia.

Impact of X-radiation in the management of COVID-19 disease

Coronaviruses are a diverse group of viruses that infect both animals and humans.Even though the existence of coronavirus and its infection to humans is not new,the 2019-novel coronavirus(nCoV)caused a major burden to individuals and society i.e.,anxiety,fear of infection,extreme competition for hospitalization,and more importantly financial liability.The nCoV infection/disease diagnosis was based on non-specific signs and symptoms,biochemical parameters,detection of the virus using reverse-transcription polymerase chain reaction(RTPCR),and X-ray-based imaging.This review focuses on the consolidation of potentials of X-ray-based imaging modality[chest-X radiography(CXR)and chest computed tomography(CT)]and low-dose radiation therapy(LDRT)for screening,severity,and management of COVID-19 disease.Reported studies suggest that CXR contributed significantly toward initial rapid screening/diagnosis and CT-imaging to monitor the disease severity.The chest CT has high sensitivity up to 98%and low specificity for diagnosis and severity of COVID-19 disease compared to RT-PCR.Similarly,LDRT compliments drug therapy in the early recovery/Less hospital stays by maintaining the physiological parameters better than the drug therapy alone.All the results undoubtedly demonstrated the evidence that X-ray-based technology continues to evolve and play a significant role in human health care even during the pandemic.

明胶海绵-凝血酶原-碘海醇用于封堵CT引导下经皮肝穿刺活检针道

目的 观察明胶海绵-凝血酶原-碘海醇用于封堵CT引导下经皮肝穿刺活检针道的安全性及可行性。方法回顾性分析101例因不明原因肝病、肝硬化、肝占位性病变并发凝血功能异常而接受CT引导下肝穿刺活检患者,穿刺取材后均以明胶海绵颗粒-人凝血酶原复合物-碘海醇混合物封堵针道;观察穿刺活检效果、并发症及穿刺前后凝血及肝功能指标。结果 101例均穿刺取材成功,技术成功率及组织学标本充分度均为100%,并均获得明确病理诊断。18例(18/101,17.82%)出现并发症,包括穿刺部位轻微疼痛、封堵剂渗透至肝包膜下或皮下;未见出血、气胸及胆管损伤等严重并发症。穿刺活检前、后凝血及肝功能差异均无统计学意义(P均>0.05)。结论 明胶海绵颗粒-凝血酶原-碘海醇用于封堵经皮肝穿刺活检针道安全、可靠,可减少出血等并发症。

CT引导下经皮肺穿刺的临床应用价值(附32例报告)

目的：分析CT引导下经皮肺穿刺活检的临床应用价值。材料与方法：对32例病变(包括肺周围性结节29例，肺门1例，纵隔1例，胸膜1例)行CT引导下穿刺活检，采用COOK公司21G抽吸针和自动弹射活检枪，选择最佳层面、进针点、进针角度和深度，作多点抽吸结合活检枪取材。结果：穿刺成功率为100％，肺部病变穿刺活检总阳性率为100％，气胸发生率为6％。结论：CT引导下肺部病变穿刺活检成功率高，并发症少、安全可靠、为临床提供细胞学、组织学、病原学依据，值得临床推广应用。

门诊应用CT引导下经皮肺穿刺活检术的安全性

目的评价CT引导下经皮肺穿刺活检术的价值及其应用于门诊患者的安全性。方法回顾性分析CT引导下经皮肺部切割针穿刺活检的门诊患者782例。穿刺后即刻CT复查,患者留院观察1h后无症状者出院。计算诊断准确率、敏感度、特异度和并发症发生率。结果 782例全部穿刺成功。诊断准确率、敏感度、特异度分别为95.65%、94.54%、100%。气胸、咯血发生率分别为19.31%(151/782)和6.52%(51/782)。6例(6/782,0.77%)患者穿刺后需入院治疗,其中2例接受胸腔闭式引流,2例出现血胸,另2例离院后出现呼吸困难再次入院治疗。结论 CT引导下经皮肺穿刺活检术是一种安全有效的检查手段,可安全应用于门诊患者。

522例肺部病变CT引导经皮切割针活检总结

目的总结CT引导经皮切割针穿刺活检术对肺部病变诊断的准确性、灵敏度、特异度和并发症。方法收集1992年以来,取材成功并有完整资料的522例CT引导经皮肺部切割针穿刺活检病例作回顾性分析。其中肺部结节或肿块性病变467例,其他病变55例。统计该法诊断灵敏度、特异度和并发症,并分析其影响因素。结果476例获得组织标本并有病理学结果,取材成功率为91.2%(476/522)。301例病理确诊为恶性肿瘤,包括腺癌107例,鳞状细胞癌84例,不能分型恶性肿瘤59例,小细胞未分化癌16例,肺转移瘤22例,低度恶性肿瘤3例,肺肉瘤3例,细支气管肺泡细胞癌2例,5例病理报告为"癌变可疑",后证实为支气管肺癌。17例穿刺病理为"癌变可疑",后证实为良性病变。穿刺未发现癌细胞者204例,其中明确诊断为良性病变102例(结核41例,非特异性肺炎21例,慢性炎症18例,支气管扩张7例,炎性假瘤6例,曲霉感染5例,隐球菌性肺炎3例,良性纤维组织细胞瘤1例)。非特异性病理结果的良性病变73例。另29例穿刺未发现肿瘤组织,而后证实为恶性肿瘤,系假阴性。阳性预测值为94.7%〔301/(301+17)〕,灵敏度为91.2%〔301/(301+29)〕,特异度为91.1%〔175/(175+17)〕,假阴性率为14.2%(29/204)。54例发生气胸,占10.3%(54/522),仅1.5%的病例(8/522)行抽气或置管闭式引流处理。肺出血42例,咯血36例,均未经特殊处理而自愈。结论CT引导经皮切割针肺部病灶活检具有较高的诊断灵敏度和特异度,有助于提高良性病变的诊断准确性,同时并不显著增加气胸和出血等并发症的发生率。

^(18)F-FDG PET/CT高摄取对于CT引导下经皮肺穿刺活检靶点选择的临床价值

目的:探讨结合18F-FDG PET/CT高摄取选择活检靶点在CT引导下肺穿刺活检术中的临床价值。方法 :回顾性分析2013—2014年间在我院行CT引导下经皮肺穿刺切割活检术的22例病例,术前行PET/CT检查,靶点的选择参考18F-FDG PET/CT显像浓聚情况。采用栅标记法体表定位,使用多层螺旋CT引导行经皮肺穿刺切割活检。结合病理和随访结果分析PET/CT确定穿刺靶点协同常规CT引导经皮肺穿刺活检的临床价值。结果:40.9%(9/22)病灶高摄取区位于边缘或偏心处,穿刺靶点进行相应调整。22例患者穿刺活检均一次完成,并发症表现为少量气胸3例,肺内少量出血6例,无咯血。穿刺活检病理回报腺癌13例、鳞癌5例、小细胞癌1例、炎性肉芽肿2例、真菌感染1例。与术后及长期随访结果相比较,1例肺癌误诊为炎性假瘤,一针活检准确率95.65%,阳性预测值100%、阴性预测值66.7%、敏感性95%、特异性100%。结论:参考18F-FDG PET/CT图像选择经皮肺穿刺活检靶点,对提高活检的准确度有重要临床价值。

CT引导下肺内直径小于等于30mm以下结节穿刺活检:探讨穿刺活检准确率的影响因素及其安全性

目的：探讨在CT引导下经皮肺穿刺直径≤30mm的肺内结节的准确率的影响因素及其安全性分析。方法：经伦理委员会批准，每例患者均经知情同意后，回顾性分析本院2013年1月-2014年3月期间行经皮穿刺肺活检的155例肺部直径≤30mm结节患者的临床及病理资料，分析患者年龄、性别、吸烟史、结节是否与胸膜粘连、穿刺深度、结节大小、穿刺次数对穿刺准确率的影响及其相关主要并发症（出血、气胸）的发生率的影响。所有患者的影像学资料由两位资深的放射线科医生重新判断患者有无气胸、出血等并发症，若出现意见分歧，由第三名放射科医生做最终的诊断。结果：155例结节中，穿刺准确率为90132％（140／155）。直径≤10mm，穿刺准确率85．71％（6／7）、直径〉10～20mm结节，穿刺准确率85．00％（68／80）直径〉20～30mm结节，穿刺准确率97．06％（66／68），差异有统计学意义（X^2=6．293，P〈O．05）。与胸膜粘连的结节穿刺准确率100％（31／31），与胸膜不粘连的结节穿刺准确率87．90％（109／124），差异有统计学意义（X^2=4．152，P〈0．05）；穿刺次数4～6次的气胸及出血的发生率要远大于穿刺次数3次之内的发生率，且差异有统计学意义；直径越小、穿刺深度越大、穿刺次数越多越容易发生出血，且差异有统计学意义。年龄、性别、吸烟史、穿刺次数、穿刺深度对穿刺准确率无明显影响。其中肺腺癌114例，肺鳞癌10例，肺慢性炎症4例，肺转移癌4例，肺结核3例，肺泡细胞原位癌1例，肺球孢子菌病1例，肺腺鳞癌1例，肺小细胞肺癌1例，恶性间皮瘤1例，肺组织及坏死组织15例。结论：结节大小、结节是否与胸膜粘连对CT引导下肺内≤30mm结节穿刺准确率具有较大的影响，而随着穿刺次数的增多，患者更容易出现主要并发症，而以上两点与结节大小、结节是否与胸膜粘连、年龄、性别、吸烟史、穿刺深度无明显相关性。CT引导下经皮肺穿刺活检术在直径≤30mm孤立小结节诊断中具有准确率高、操作简单、安全实用，可作为临床诊断肺内≤30mm孤立结节定性诊断的主要方法，掌握肺内小结节的穿刺技巧可以有效的提高穿刺准确率，并且值得临床广泛推广。

CT导引经胸组织芯活检术的临床应用

目的 探讨CT导引经胸组织芯活检 (TCNB)的临床应用价值。方法 应用CookQC 18、19或 2 0G弹枪式活检针 ,对 12 1例肺部疾病行CT导引经胸肺活检。 10 5例系孤立结节状病灶 ,直径 0 .8～ 9.5cm ,平均 (3.4± 1.9)cm ;另 16例为两个以上病灶或弥漫性病变。取材后常规CT复查观察有无气胸、出血等并发症。结果 12 1例中 ,恶性病变 86例 ,TCNB阳性 79例 ,诊断敏感性为 91.9% ,假阴性7例 ,没有假阳性 ,诊断特异性 10 0 % ,确定组织学类型 70例 ,特异诊断率 81.4 % ;良性病变 35例 ,TCNB诊断准确 32例 ,敏感性 91.4 % ,其中 2 6例做出特异性诊断 ,特异诊断率 74 .3% ;总准确率 91.7% (111/12 1)。并发症有 :少量气胸 2 2例 (18.2 % ) ,肺出血 19例 (15 .7% ) ,少量咯血或痰中带血 9例 (占 7.4 % ) ,均未做特殊处理而自愈。结论 CT导引下经胸组织芯肺活检是一种安全、可靠的检查方法 ,诊断准确率高 ,特别是在非肺癌的恶性病变和良性肺疾病的特异性诊断中有较高的应用价值。

骨断层显像与同机定位CT进行图像融合对诊断脊柱骨转移性病变的临床应用价值

目的:探讨带有低能量CT的99mTc-MDPSPECT骨显像所产生的骨断层、CT及融合图像对鉴别脊柱良恶性病变的临床价值,评价同机定位CT在诊断中的作用。方法:49例在常规全身骨显像中表现为仅脊柱出现异常核素浓聚灶(病灶数目≤3个)的患者,行局部骨断层,同时获得局部骨断层图像、同机定位CT图像以及两者的融合图像。所有病例均以病理、1个月内磁共振结果或1年以上随诊为最终诊断结果。结果:局部骨断层、同机定位CT和融合图像对49例患者的94个病变椎体诊断的灵敏性分别为81.4%、86.0%和100%,特异性分别为72.5%、98.0%和96.1%。说明融合图像不但可以对病灶的解剖位置精确定位,而且明显提高了诊断的灵敏性和特异性。此外同机定位CT图像在诊断过程中比较令人满意,但是在细小病变的判断时还应慎重以免造成假阳性;当局部骨断层与同机定位CT在诊断时不一致时,应反复对比图像和相互补充信息,也可以避免一些假阳性产生。结论:局部骨断层与同机定位CT所产生的融合图像对恶性肿瘤椎体转移的诊断具有较高的临床应用价值,应该作为全身骨显像必要的补充检查方法。

CT引导经皮骨穿刺活检术的临床应用

目的探讨CT引导下经皮骨穿刺活检技术在骨骼病变中的应用价值。方法回顾性分析于我院接受CT引导下穿刺活检术的857例骨骼病变患者。经扫描定位,按照病灶距离体表最近和安全性原则选择最佳进针层面与路径,采用8～13G骨穿针或16～18G弹枪式活检针,根据病变位置及性质运用不同穿刺技术获取标本行病理学检查。结果操作过程耗时20～40 min。所有患者取得的标本量均符合病理诊断要求,穿刺病理与手术病理相符者766例,占穿刺总数89.38%,无假阳性病例。术后27例患者出现并发症,发生率为3.15%,包括局部血肿22例,神经损伤1例,感染4例。结论经皮骨穿刺活检安全、诊断准确率高,可用于转移性肿瘤、原发性骨肿瘤、肿瘤样病变及炎症性病变的诊断。合理地选择穿刺路径、穿刺器械及活检方法可提高穿刺活检的成功率。

CT引导下经皮胸部穿刺活检术的临床应用研究

目的:探讨CT引导下经皮胸部穿刺活检术的准确性、并发症及临床意义。材料与方法:96例病变,其中肺部病变88例,胸膜病变5例,纵隔病变3例。病变大小1.0cm×1.2cm×2.0cm～9.0cm×10.5cm×8.5cm。在CT引导下用细针经皮胸部穿刺活检,病变经手术病理、细胞学及临床随访证实。结果:96例病变中,肺癌68例,肺转移瘤3例,结核6例,胸膜间皮瘤5例,胸腺瘤3例,炎症11例。穿刺准确率为91.7%(88?96),发生气胸14例。结论:CT引导下经皮胸部穿刺活检是一种相对安全、简单准确的诊断方法。

256层螺旋CT全脊髓血管造影诊断脊髓动静脉瘘的临床应用价值

目的:探讨256层螺旋CT全脊髓血管造影(CTA)在诊断脊髓动静脉瘘中的临床应用价值。方法:13例临床表现及MRI符合脊髓血管病变的患者进行CTA检查,其中11例3～5 d内做DSA检查,8例手术治疗。结果:13例患者7例诊断为硬脊膜动静脉瘘(SDAVF),6例髓周动静脉瘘(SPMAVF),与DSA或手术诊断一致;CTA全部较好的显示了异常血管病变的范围;7例SDAVF中有5例CTA与DSA或手术对供血动脉的诊断一致,6例对瘘口的诊断一致,1例DSA阴性;6例SPMAVF中3例CTA与DSA或手术对供血动脉的诊断一致,5例对瘘口的诊断一致。结论:256层螺旋全脊髓CTA可以清晰的显示脊髓动静脉瘘的病变范围、供血动脉及瘘口的位置,较DSA相比安全、无创、快速,可以作为DSA检查前、指导手术及术后随访必要的检查手段,部分可取代DSA检查。

64层螺旋CT脊髓血管造影诊断脊髓血管畸形的临床应用研究

目的:探讨64层螺旋CT脊髓血管造影在诊断脊髓血管畸形中的价值。材料与方法:17例MRI及临床表现符合脊髓血管病的病人,做CT脊髓血管造影检查,其中14例于1周内做DSA检查。CT扫描方法:Toshiba Aquilion 64 Slice CT扫描机,0.5mm层厚,0.5/r,120kV,350mA,主动脉弓层面为监测平面,造影剂自动跟踪技术,CT阈值180HU。造影剂为碘海醇(370mgI/ml),注射流率6ml/s,总量80ml。从血管畸形的分型、病变范围、供血动脉、瘘口及引流静脉等方面对CT脊髓血管造影图像进行评价,并与DSA及手术结果对比。结果:17例脊髓CTA均明确显示脊髓血管的异常及病变的范围,其中1例MRI及脊髓CTA诊断为动静脉瘘,并经手术证实,但DSA却未显示出病变;除1例DSA为AVM合并AVF的病例脊髓CTA只看到了AVM未诊断出AVF外,其余病例均与DSA的分型结果一致;13例做脊髓CTA并DSA阳性结果的病例共有20根供血血管,脊髓CTA16根诊断正确,4根未显示,并出现了2根假阳性结果;6例脊髓CTA未看到瘘口;所有病例均清楚显示了引流静脉并与DSA一致。结论:CT脊髓血管造影对脊髓血管畸形的诊断有很大价值,可作为DSA检查前的筛选检查,并对DSA有指导作用,可缩短DSA检查时间。