Analysis of The Value of Multi-Slice Spiral CT and Magnetic Resonance Imaging in The Diagnosis of Carpal Joint Injury

Objective:To analyze the value of multi-slice spiral computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of carpal joint injury.Methods:A total of 130 patients with suspected wrist injuries admitted to the Department of Orthopedics of our hospital from January 2023 to January 2024 were selected and randomly divided into a single group(n=65)and a joint group(n=65).The single group was diagnosed using multi-slice spiral CT,and the joint group was diagnosed using multi-slice spiral CT and magnetic resonance imaging,with pathological diagnosis as the gold standard.The diagnostic results of both groups were compared to the gold standard,and the diagnostic energy efficiency of both groups was compared.Results:The diagnostic results of the single group compared with the gold standard were significant(P<0.05).The diagnostic results of the joint group compared with the gold standard were not significant(P>0.05).The sensitivity and accuracy of diagnosis in the joint group were significantly higher than that in the single group(P<0.05).The specificity of diagnosis in the joint group was higher as compared to that in the single group(P>0.05).Conclusion:The combination of multi-slice spiral CT and MRI was highly accurate in diagnosing wrist injuries,and the misdiagnosis rate and leakage rate were relatively low.Hence,this diagnostic program is recommended to be popularized.

Serum Tumor Markers Combined with 18F-FDG PET/CT Volumetric Metabolic Parameters in the Prognosis of Ovarian Cancer

Ovarian cancer (OC) is the most fatal gynecological malignancy, and identifying reliable prognostic indicators can help guide therapeutic treatment. Various tumor marker-guided treatment regimens can considerably improve patient prognosis with a better understanding of the molecular underpinnings of ovarian cancer recurrence and metastasis. Fluorine-18-fluorodeoxyglucose Positron emission tomography/computed tomography (18F-FDG PET/CT) is a molecular imaging tool that provides anatomical and functional information about the tumor, and its volume-based metabolic parameters allow for quantifiable observation of ovarian cancer recurrence, prognosis, and therapeutic efficacy. The combined utilization of serological and radiologic markers has been found to provide increased clinical benefit. This article reviewed the predictive value of serum tumor markers and 18F-FDG PET/CT volumetric metabolic parameters for the prognosis of patients with ovarian cancer.

Three-dimensional Imaging of Multi-slice Spiral CT in Bronchial Artery Correlative Study on Blood Supply of Central Lung Cancer and Its Clinical Significance

Objective: To evaluate three-dimensional bronchial artery imaging charactersin central lung cancer and applied values with multi-slice spiral CT (MSCT) to provide theoreticalevidence on blood supply and intervention therapy. Methods: Eighteen patients with central lungcancer underwent MSCT with real time helical thin-slice CT scanning. Three-dimensional bronchialartery reconstruction was done at the console work-station. The space anatomical characters ofbronchial artery were observed through different rotations. Results: For 6 cases, thethree-dimensional images of bronchial artery (33.33%) could exactly show the origins, the routes(lung inner segment and mediatism segment) and the diameters of bronchial arteries. Vision rate ofbronchial arteries was the highest in pulmonary artery stricture and truncation groups, and thevessels' diameter became larger apparently. These characters demonstrated blood supply of this kindof central lung cancer come from bronchial artery. Volume rendering images were the best ones amongthree-dimensional images. Conclusion: Three-dimensional imaging with MSCT in bronchial artery canreveal the anatomical characters of bronchial artery and provide theoretical evidence on bloodsupply and intervention therapy of central lung cancer.

Multi-slice Spiral CT Three-dimensional Portography in Portal Vein Tumor Thrombus of Hepatic Cancer

Objective: To study the clinical significance of multi-slice spiral CT 3-dimensional (3D) portography in portal vein tumor thrombosis of hepatocellular cacinoma.Methods: 57 cases undergoing 3D portography were collected, of which 6 cases were normal, 5 cases were subjected to cirrhosis and hypertension of portal vein, 42 cases had portal tumor thrombus of hepatic cancer, and the remaining 4 cases showed lymph node enlargment in hilar of liver. All data of the patients came from conventional multi-slice spiral CT double phase of liver. Contrast media was 1.5–2 ml/kg with the injection rate being 2.5–3 ml/s. Axis and 3D portography was analyzed and compared in 42 cases of portal tumor thrombus of hepatic cancer.Results: According to portal tumor thrombus position, 42 cases were fallen into three categories: left (13 cases), right (20 cases), main (9 cases) of potal vein. There was no difference between axis and 3D portography in displaying portal tumor thrombus of hepatic cancer (P>0.05), but 3D portography showing collateral branches was better than axis portography after main portal vein thrombus.Conclusion: Multi-slice spiral CT 3D portography can display the position and types of portal tumor thrombus of hepatic cancer. 3D combined with axis portography can better evaluate the portal tumor thrombus of hepatic cancer and guide to select the therapies. Key words portal vein - tumor thrombus - multi-slice CT - 3 dimension imaging

CT机双列角接触球转盘轴承建模与振动特性分析

为了提高CT机主轴承的运转特性,确保CT机医学成像的稳定性,以洛阳LYC轴承有限公司研制的双列角接触球转盘轴承为研究对象进行建模与振动特性分析。首先,基于Hertz接触理论建立轴承在承受复合载荷作用下的力学模型;其次,结合Newton运动定律确立轴承外圈3自由度非线性动力学微分方程;最后,采用4阶Runge-Kutta法对微分方程组进行求解,获得轴承外圈的振动特性。在此基础上,通过分析影响轴承振动特性的因素如轴承内、外圈沟曲率半径系数、滚动体数量、游隙、预紧力等,从而确定满足CT机主轴承低振动下的最优结构参数。结果表明:轴承振动幅值随着内、外圈沟曲率半径系数的增加呈现出先减小后增大的趋势,将其分别控制在0.515~0.525、0.510~0.525更有利于降低轴承的振动;随着滚动体数量的增加,轴承的振动幅值也随之增加,但变化平稳,故在满足设计条件的前提下减少滚动体的数量可以降低轴承振动;随着轴承游隙的增加,轴承的振动幅值先减小后急剧增大,在18μm处振动达到最小;合适的轴向载荷可以有效降低轴承的振动幅值。

术前能谱CT多参数成像对晚期肺癌患者淋巴结转移的预测价值

目的探讨晚期肺癌患者术前采用能谱CT多参数成像检查对淋巴结转移的预测价值。方法回顾性收集2023年1—6月在医院经手术病理检查诊断为晚期肺癌的60例患者的临床资料,所有患者术前均接受能谱CT多参数成像检查,以手术病理学检查结果为金标准,绘制受试者工作特征(ROC)曲线分析能谱CT多参数成像参数预测晚期肺癌患者淋巴结转移的价值。结果经手术病理检查确诊,60例晚期肺癌患者中淋巴结转移患者19例,非淋巴结转移患者41例;淋巴结转移患者淋巴结能谱曲线斜率(λ_(HU))、淋巴结λ_(HU)/原发病灶λ_(HU)、淋巴结标准化碘密度(NIC)、淋巴结NIC/原发病灶NIC、淋巴结Neff-Z/原发病灶Neff-Z参数低于非淋巴结转移患者,原发病灶λ_(HU)、原发病灶NIC参数高于非淋巴结转移患者(P<0.05);绘制ROC曲线结果显示,淋巴结λ_(HU)/原发病灶λ_(HU)、淋巴结NIC/原发病灶NIC、淋巴结Neff-Z/原发病灶Neff-Z参数评估晚期肺癌患者淋巴结转移的曲线下面积均>0.7,具有一定预测价值。结论术前应用能谱CT多参数成像有助于诊断晚期肺癌患者是否存在淋巴结转移,且晚期肺癌患者术前采用能谱CT多参数成像检查对淋巴结转移具有一定的预测价值。

CTCA定量参数对冠心病患者短期病死预测价值

目的探讨CT冠状动脉造影(CTCA)定量参数对冠心病患者短期病死预测价值。方法选取2021年3月—2023年3月收治的冠心病200例,比较不同冠状动脉病变程度冠心病患者CTCA定量参数(动脉阻力指数、总斑块负荷和斑块最小密度CT值),分析CTCA定量参数与冠心病患者冠状动脉病变程度相关性,探讨术后1年冠心病患者病死情况,分析CTCA定量参数与冠心病患者短期病死风险关联性,评价CTCA定量参数对冠心病患者短期病死预测价值。结果不同冠状动脉病变程度冠心病患者动脉阻力指数、总斑块负荷逐渐升高,斑块最小密度CT值逐渐降低(P<0.05)。冠心病患者动脉阻力指数、总斑块负荷与疾病类型、病变支数及狭窄程度呈正相关,斑块最小密度CT值与疾病类型、病变支数及狭窄程度呈负相关(P<0.05)。冠心病200例中39例(19.50%)术后1年病死。动脉阻力指数、总斑块负荷和斑块最小密度CT值与冠心病患者短期病死有关(P<0.01)。对冠心病患者短期病死预测的受试者工作特征曲线下面积动脉阻力指数、总斑块负荷和斑块最小密度CT值三者联合明显高于单独预测(P<0.05)。结论CTCA定量参数与冠心病患者冠状动脉病变程度密切相关,且联合各参数预测冠心病患者短期病死价值较高。

IQon光谱CT冠状动脉CTA多参数成像对冠心病的诊断价值

目的探讨IQon光谱计算机断层扫描(CT)冠状动脉CT血管造影(CTA)多参数成像对冠心病的诊断价值,包括斑块性质、心肌缺血、心肌纤维化等方面。方法于2021年1—12月采用IQon光谱CT多参数成像对福建中医药大学附属第二人民医院的100例患者进行检查,其中50例健康体验者为正常组,50例为疑似冠心病组。对所有受试者行光谱冠状动脉平扫检查,并进行钙化评分。对疑似冠心病组受试者注入对比剂,行冠状动脉CTA检查,并通过后处理软件获得虚拟平扫图像、有效原子序数图、碘密度图、多期相心肌碘密度图和延迟扫描心肌图像。对各种图像进行分析,评价其对冠心病诊断的价值,并计算最佳碘密度阈值。结果普通平扫和虚拟平扫所得钙化评分具有良好的一致性(Kappa=0.871)。有效原子序数图能够区分钙化和非钙化斑块,碘密度图能够反映斑块内碘分布。多期相心肌碘密度图能够显示心肌灌注情况,受试者工作特征曲线分析显示,碘密度阈值为30 HU时,对心肌缺血的诊断敏感度为90%,特异度为94%。结论IQon光谱CT冠状动脉CTA多参数成像对冠心病具有较高的诊断价值,能够提供综合的解剖和功能信息,为临床诊断和治疗提供依据。

冠状动脉CT血管成像斑块纹理参数对初诊冠心病患者主要不良心血管事件的预测价值分析

目的:分析冠状动脉CT血管成像(CCTA)斑块纹理参数对初诊冠心病患者主要不良心血管事件(MACE)的预测价值。方法:选择2022年2月—2023年8月中国人民解放军联勤保障部队庐山康复疗养中心收治的116例初诊冠心病患者,以是否发生MACE为依据,将患者分为MACE发生组(n=37)和MACE非发生组(n=79)。依次为患者进行CCTA,比较两组的斑块纹理参数及既往用药史。进行多因素logistic回归分析,绘制通受试者操作特征(ROC)曲线,分析斑块纹理参数预测初诊冠心病患者MACE的准确性。结果:在本次116例初诊冠心病患者中共有37例患者发生MACE,其中有17例为血运重建的不稳定性心绞痛,占比为45.95%。两组对比度、峰度、偏度及既往用药史比较,差异均无统计学意义(P>0.05);MACE发生组熵、方差高于MACE非发生组,而角二阶矩、平均值低于MACE非发生组,差异均有统计学意义(P<0.05)。logistic回归分析显示,熵、方差为初诊冠心病患者发生MACE的危险因素,而角二阶矩为初诊冠心病患者发生MACE的保护因素(P<0.05)。ROC曲线分析显示,方差和熵预测初诊冠心病患者发生MACE的AUC分为0.882、0.789,角二阶矩预测初诊冠心病患者发生MACE的AUC为0.287。结论:CCTA斑块纹理参数在初诊冠心病患者MACE的预测中具有较高的诊断效能。

Multi-slice spiral CT angiography in evaluating donors of living-related liver transplantation

BACKGROUND: During the past years, the number of liver transplantation has increased greatly, but the number of available organs has not increased. In view of the critical shortage of organs, the indications for living-related liver transplantation (LRLT) have broadened since experience with the procedure has been achieved. This study was undertaken to assess the value of multi-slice spiral CT (MSCT) angiography in evaluating the hepatic arterial and veinous anatomy of potential donors for LRLT. METHODS: MSCT was performed after intravenous injection of contrast material at 3 ml/s. The total dose was calculated as 2 ml/kg. Twenty LRLT donors (2 men and 18 women) were subjected to MSCT angiography of hepatic blood vessels. These were generated by volume rendering and maximum intensity projection, while curved planar reformation was added in 5 patients. RESULTS: We identified 10 important hepatic vascular variants in 9 of the 20 donors (4 arterial, 4 venous, and 2 portal venous variants). In hepatic arterial variants, two had a replaced right hepatic artery arising from the superior mesenteric artery, an accessory right hepatic artery from the superior mesenteric artery and a replaced left hepatic artery arising from the left gastric artery. In hepatic venous variants, three had an accessory inferior right hepatic vein and one had two accessory inferior right hepatic veins. In hepatic portal venous variants, two had trifurcation of the main portal vein. CONCLUSIONS: As a non-invasive and reliable method, MSCT angiography is of value in the clinical evaluation of LRLT donors. MSCT angiography should be recommended as a routine preoperative examination for potential LRLT donors.

冠状动脉周围脂肪衰减指数与CT图像重建参数的相关性研究

目的 评估冠状动脉周围脂肪衰减指数(fat attenuation index, FAI)与卷积核、迭代重建算法以及层厚等计算机断层扫描(CT)冠状动脉造影重建参数的相关性。方法 前瞻性纳入44例行CT冠状动脉造影的患者,采用以下3种参数组合进行图像重建:(1)迭代重建算法(KARL5)和层厚(0.5 mm)不变,采用4种卷积核(Soft_AA、Soft_BA、Soft_CA、Soft_DA,锐利度由低至高)重建;(2)保持卷积核(Soft_AA)和层厚(0.5 mm)不变,采用滤波反投影(filtered back projection, FBP)和迭代重建算法(KARL5)进行重建;(3)保持卷积核(Soft_AA)和迭代重建算法(KARL5)不变,采用不同层厚(0.5 mm, 1.0 mm)进行重建。经专用分析软件自动提取上述3种参数组合中所有图像的左前降支(left anterior descending artery, LAD)、左回旋支(left circumflex artery, LCX)、右冠状动脉(right coronary artery, RCA)对应的FAI。采用配对t检验、方差分析进行统计分析。结果 对于LAD、LCX和RCA:(1)不同卷积核间的差异均具有统计学意义(P<0.001),且FAI随卷积核锐利度的提高而降低;(2)相比于FBP,KARL5重建图像的FAI显著提高(P<0.001);(3)相比于0.5 mm, 1.0 mm层厚图像的FAI均显著降低(P<0.001)。结论 卷积核、迭代重建算法及图像层厚对各支冠状动脉的FAI均具有显著影响,临床应用FAI进行诊断时应充分考虑CT重建参数的影响。

Correlation of the quantifiable parameters of blood flow pattern derived with dynamic CT in solitary bronchogenic adenocarcinoma

Objective:To evaluate the correlation of the quantifiable parameters of blood flow pattern derived with dynamic CT in solitary bronchogenic adenocarcinoma(SBA).Methods:46 patients with solitary bronchogenic adenocarcinomas (SBA)(diameter≤4 cm)underwent multi-location dynamic contrast material-enhanced(nonionic contrast material was administrated via the antecubital vein at a rate of 4 mL/s by using an autoinjector 90 mL,4×5 mm or 4×2.5 mm scanning mode with stable table were performed)serial CT.Precontrast and postcontrast attenuation on every scan was recorded.Perfusion (PBA),peak height(PHBA),ratio of peak height of the SPN to that of the aorta(BA-to-A ratio)and mean transit time(MTT)were calculated.The correlation between peak height of the aorta(PHA)and parameters of the SBA(PHBA,BA-to-A ratio,PBA,and MTT)and those among parameters of the SBA were assessed by means of linear regression analysis.Regression equation among parameters of the SBA were obtain by means of stepwise regression.Results:The correlation between the SBA peak height(PHBA,36.78 HU±12.02)and the aortic peak height(PHA)was significant(r=0.506,P<0.0001).No significant cor- relation was found between the BA-to-Apeak height ratio(15.33%±4.55)and the aortic peak height(r=0.130,P=0.388> 0.05)as it was between the SBA perfusion(PBA,31.86 mL/min/100 g±9.74)and the aortic peak height(r=0.049,P=0.749 >0.05).The SBA perfusion correlated with the PHBA and the BA-to-A peak height ratio(r=0.394,P=0.007<0.05;r=0.407, P=0.005<0.05).The PHBA correlated positively with the BA-to-A peak height ratio(r=0.781,P<0.0001).Mean transit time was 14.84 s±5.52.PBA=18.500+0.872×BA-to-A ratio.BA-to-A ratio=4.467+0.295×PHBA.Conclusion:The linear correlation between the SBA perfusion and BA-to-Aratio and that between BA-to-Aratio and PHBA can be expressed by equation. It is possible to design a simpler scanning procedure of investigation of bronchogenic adenocarcinoma angiogenesis.

Influence analysis of complex crack geometric parameters on mechanical properties of soft rock

Soft rocks, such as coal, are afected by sedimentary efects, and the surrounding rock mass of underground coal mines is generally soft and rich in joints and cracks. A clear and deep understanding of the relationship between crack geometric parameters and rock mechanics properties in cracked rock is greatly important to the design of engineering rock mass struc‑tures. In this study, computed tomography (CT) scanning was used to extract the internal crack network of coal specimens. Based on the crack size and dominant crack number, the parameters of crack area, volume, length, width, and angle were statistically analyzed by diferent sampling thresholds. In addition, the Pearson correlation coefcients between the crack parameters and uniaxial compression rock mechanics properties (uniaxial compressive strength UCS, elasticity modulus E) were calculated to quantitatively analyze the impact of each parameter. Furthermore, a method based on Pearson coefcients was used to grade the correlation between crack geometric parameters and rock mechanical properties to determine threshold values. The results indicated that the UCS and E of the specimens changed with the varied internal crack structures of the specimens, the crack parameters of area, volume, length and width all showed negative correlations with UCS and E, and the dominant crack played an important role both in weakening strength and stifness. The crack parameters of the angle are all positively correlated with the UCS and E. More crack statistics can signifcantly improve the correlation between the parameters of the crack angle and the rock mechanics properties, and the statistics of the geometric parameters of at least 16 cracks or the area larger than 5 mm2 are suggested for the analysis of complex cracked rock masses or physical reproduction using 3D printing. The results are validated and further analyzed with triaxial tests. The fndings of this study have important reference value for future research regarding the accurate and efcient selection of a few cracks with a signifcant infuence on the rock mechanical properties of surrounding rock mass structures in coal engineering.

Correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size

Objective： To evaluate the correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size. Methods： Sixty-eight patients with malignant solitary pulmonary nodules （SPNs） （diameter 〈4 cm） underwent multi-location dynamic contrast material-enhanced （nonionic contrast material was administrated via the antecubitai vein at a rate of 4mL/s by using an autoinjector, 4×5 mm or 4×2.5 mm scanning mode with stable table were performed）. Precontrast and postcontrast attenuation on every scan was recorded. Blood flow （BF）, peak, height （PHSPN）, ratio of peak height of the SPN to that of the aorta （SPN-to-A ratio） and mean transit time （MTT） were calculated. The correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size were assessed by means of linear regression analysis. Results： No significant correlations were found between the tumor size and each of the peak height （PHSPN） （35.79±10.76 Hu）, ratio of peak height of the SPN to that of the aorta （SPN-to-A ratio）, （14.27%±4.37） and blood flow （BF） （30.18 mL/min/100 g±9.58） （r=0.180, P=0.142〉0.05; r=0.205, P=0.093〉0.05; r=0.008, P=0.947〉0.05）. Conclusion： No significant correlations were found between the tumor size and each of the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules.

腰椎骨折患者螺旋CT设计钉道行腰椎椎弓根置钉的准确性及安全性分析

目的探讨基于螺旋CT影像中钉道位置判断腰椎骨折患者椎弓根置钉的参数变化、准确性及安全性。方法选取2020年1月—2022年1月120例采用螺旋CT设计钉道行腰椎椎弓根置钉的腰椎骨折患者作为观察组,另选取采用传统Weinstein法进行腰椎椎弓根置钉的腰椎骨折患者120例作为对照组。分析观察组螺旋CT测定腰椎椎弓根钉道参数,并对比2组腰椎椎弓根置钉准确率、安全率、完成钉道准备时间及置钉出血量。结果观察组L 1~5节段椎弓根轴线与棘突轴线成角、椎弓根宽度逐渐增大(P<0.05);L 1~4节段入钉点至椎体前缘距离无明显变化,到L 5节段明显减小(P<0.05)。同一椎体左右两侧椎弓根轴线与棘突轴线成角、椎弓根宽度、入钉点至椎体前缘距离比较差异无统计学意义(P>0.05)。男性L 1~5节段椎弓根轴线与棘突轴线成角、椎弓根宽度、入钉点至椎体前缘距离均大于女性(P<0.05,P<0.01)。双侧最小椎弓根宽度为(8.13±0.59)mm,为安全进钉区域,可安全容纳3.5 mm螺钉。术后3 d,复查螺旋CT了解腰椎椎弓根置钉情况,观察组共置入椎弓根螺钉235枚,对照组共置入椎弓根螺钉229枚。观察组置钉准确率为91.49%(215/235)、安全率为99.15%(233/235)均高于对照组置钉准确率72.05%(165/229)、安全率90.39%(207/229)(P<0.05);观察组完成钉道准备时间短于对照组,置钉出血量少于对照组(P<0.01)。结论基于螺旋CT影像中L 1~5节段椎弓根轴线与棘突轴线成角、椎弓根宽度、入钉点至椎体前缘距离各腰椎节段间及不同性别间存在差异,可为腰椎椎弓根置钉提供解剖依据,能缩短完成钉道准备时间,减少置钉出血量,提高置钉准确性及安全性。

光谱CT鉴别胃肠道异位胰腺与间质瘤的价值

目的探讨双层探测器光谱CT(DLCT)多参数成像对胃肠道异位胰腺(HP)及间质瘤(GIST)的鉴别诊断价值。方法回顾性分析经术后病理证实胃肠道HP及GIST患者的临床及DLCT影像资料,分别在动脉期和静脉期图像上测量胃肠道HP与GIST的碘浓度(IC)、有效原子序数(Zeff)。对所有的光谱CT参数进行单因素、二元Logistic回归分析筛选出预测因子,采用受试者工作特征(ROC)曲线分析其诊断效能。结果男21例,女26例,其中胃肠道HP 22例,中位年龄43(38.7,50.5)岁;GIST 25例,中位年龄57(50.5,67)岁。单因素分析显示,动静脉期IC值、Zeff值均具有统计学差异(P<0.05)。二元Logistic回归分析显示静脉期IC值、动脉期Zeff值为HP的独立预测因子,P值分别为0.008、0.013。ROC曲线显示两者能量参数区分HP和GIST的曲线下面积分别为0.792和0.786,敏感度分别为72.7%和68.2%,特异度为88%和92%,最佳阈值为2.065 mg/mL、8.295。结论DLCT的IC值、Zeff值对有效区分HP与GIST具有一定诊断意义,当静脉期IC值大于等于2.065 mg/mL,动脉期Zeff值大于等于8.295时模型诊断HP性能最佳。

成人烟雾病不同临床表现患者全脑CTP与CTA影像特征研究

目的通过观察分析成人烟雾病的脑动脉CT血管成像(CTA)及全脑CT灌注成像(CTP)图像的特点,探讨成人烟雾病出血型、缺血型及无症状型患者的影像学特征。方法回顾性分析82例成人烟雾病患者的临床资料、全脑CTA和CTP图像,以20例健康人作为对照组。根据82例成人烟雾病患者临床表现分为脑出血组(32例,64个大脑半球)、脑缺血组(26例,52个大脑半球)和无症状组(24例,48个大脑半球),分析各组CTA改良法Suzuki分级差异、CTP灌注参数值[脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)]的差异。结果CTA改良法Suzuki分级结果为无症状组患者多为Ⅰ级(39.6%),脑缺血组患者多为Ⅳ级(59.6%),脑出血组患者多为Ⅱ~Ⅲ级(68.7%),无症状组、脑缺血组、脑出血组任意两组间改良法Suzuki分级情况比较,差异均有统计学意义(P<0.05)。无症状组CBV、CBF、MTT及TTP与对照组比较,差异均无统计学意义(P>0.05)。脑缺血组CBV、CBF明显低于对照组,MTT、TTP较对照组明显延长,差异均有统计学意义(P<0.05)。脑出血组CBV、CBF与对照组比较,差异均无统计学意义(P>0.05),但MTT、TTP较对照组明显延长(P<0.05)。脑缺血组CBV、CBF与脑出血组相比,差异均有统计学意义(P<0.05);无症状组的CBV、CBF、MTT、TTP与脑缺血组相比,差异均有统计学意义(P<0.05);无症状组MTT、TTP与脑出血组相比,差异均有统计学意义(P<0.05)。结论成人烟雾病出血型、缺血型及无症状型患者的脑动脉CTA改良法Suzuki分级及全脑CTP灌注参数具有一定的差异,对临床个性化诊疗具有指导意义。

呼出气一氧化氮结合CT三维重建定量小气道参数评估慢性阻塞性肺疾病患者肺功能的价值

目的 探究呼出气一氧化氮(FeNO)结合CT三维重建定量小气道参数评估慢性阻塞性肺疾病(COPD)患者肺功能的价值。方法 回顾性选取2022年6月至2023年6月马鞍山市人民医院收治的80例COPD患者,对患者进行COPD全球倡议(GOLD)分级标准评估,33例评定为1~2级的患者纳入轻度组,47例评定为3~4级的患者纳入重度组。比较两组患者的FeNO、白细胞总数、中性粒细胞百分比及相关肺功能[第1秒用力呼气容积占预计值的百分比(FEV1%pred)、1秒用力呼气量(FEV1)/用力肺活量(FVC)、用力呼出25%、50%、75%肺活量时的平均呼气流速(MEF25%pred、MEF50%pred、MEF75%pred)]水平。所有患者均接受CT三维重建,记录相关小气道参数[气道壁面积百分比(WA%)、壁厚外径比(TDR)、主肺动脉∶升主动脉(PA∶A)、低衰减区域百分比(LAA%-950HU)],采用Pearson相关性分析探究患者的FeNO、CT三维重建参数与患者肺功能的相关性,采用受试者工作特征(ROC)曲线探究其对COPD病情严重程度的诊断价值。结果 重度组患者的FeNO水平为(29.55±1.56) ppb,高于轻度组[(23.66±1.23) ppb],差异有统计学意义(P<0.05);轻度组和重度组患者的白细胞总数及中性粒细胞百分比组间比较,差异均无统计学意义(P>0.05)。重度组的FEV1/FVC、FEV1%pred、MEF25%pred、MEF50%pred、MEF75%MEFpred分别为(40.11±3.56)%、(39.49±5.49)%、(20.88±2.38)%、(29.74±2.46)%、(39.23±3.11)%,均低于轻度组[(69.89±5.12)%、(54.22±6.12)%、(26.81±2.13)%、(36.22±2.34)%、(53.55±4.12)%],差异均有统计学意义(P<0.05)。重度组患者的WA%_(7~8)、TDR_(7~8)、PA∶A、全肺LAA%-950HU分别为(86.98±3.45)%、32.78±4.15、0.85±0.05、(10.88±2.16)%,均高于轻度组[(85.44±3.11)%、31.16±5.15、0.79±0.08、(2.98±0.61)%],差异均有统计学意义(P<0.05)。经Pearson相关性分析,患者的FEV1%pred、FEV1/FVC、MEF25%pred、MEF50%pred、MEF75%pred与一氧化氮、PA∶A、全肺LAA%-950HU、TDR_(7~8)、WA%_(7~8)呈负相关(P<0.05)。经ROC曲线分析,一氧化氮、TDR_(7~8)、WA%_(7~8)、PA∶A、全肺LAA%-950HU对重度COPD具有一定诊断价值,其曲线下面积值分别为0.840、0.763、0.752、0.781、0.818(P<0.05)。结论 FeNO及CT三维重建定量小气道参数与患者的肺功能存在一定相关性,对COPD患者肺功能和疾病严重程度的诊断具有一定价值,有助于更全面地了解COPD患者的病情,并指导临床诊断和治疗决策。

Study on the combined value of multi-slice spiral CT in the diagnosis of elderly colorectal cancer colorectal cancer tumor markers

Objective:To investigate the value of tumor markers in colorectal cancer with multi-slice spiral CT in the diagnosis of elderly colorectal cancer.Methods:From January 2016 to September 2017 year period, 73 elderly patients with colorectal cancer treated in our hospital were selected as observation group;64 elderly patients with intestinal benign lesions were selected as control group during the same period. Serum samples were collected to detect contents of CEA, CA72-4, CA19-9 and CYFRA21-1 by Roche luminous immunoassay analyzer, and multi slice spiral CT was used.Results:Serum levels of CEA, CA72-4, CA19-9 and CYFRA21-1 levels of the observation group were significantly higher than that of the control group;the positive rate of CEA, CA72-4, CA19-9, CYFRA21-1 and their combined detection were all significantly higher than that of the control group;positive rate of MSCT in the observation group was higher than the control group;positive rates of tumor markers combining with MSCT examination of colorectal cancer were higher than that of combined detection of tumor markers and MSCT examination;but there was no significant difference in positive rate of combined detection of tumor markers and the positive rate of MSCT detection of colorectal cancer.Conclusion:Colorectal cancer tumor markers combined with multi-slice spiral CT in the diagnosis of colorectal cancer in elderly has important research value, can significantly improve the positive rate of diagnosis.

多参数MRI联合螺旋CT预测ⅢCr期宫颈癌同步放化疗后复发的临床价值

目的研究多参数MRI联合SCT预测ⅢCr期宫颈癌同步放疗(CCRT)后复发的临床价值。方法回顾性分析医院2018.01~2020.01间70例行同步放化疗后出现复发的ⅢCr期宫颈癌患者(复发组)以及66例无复发者的多参数MRI以及SCT检查资料,以临床诊断作为“金标准”,采用McNemar检验,分别计算多参数MRI以及SCT在诊断宫颈癌复发中的灵敏度、特异度及准确度,并绘制ROC曲线,分析多参数MRI联合SCT诊断宫颈癌复发的价值。结果经局部穿刺以及随访发现,共70例患者被证实为宫颈癌复发,66例患者为非复发,其中复发组患者MRI检查参数ADC_(min)、ADC_(max)、ADC_(mean)、K^(trans)、K_(ep)以及V_(e)水平显著低于对照组(P<0.05);以临床诊断作为“金标准”,检验发现,多参数MRI在诊断宫颈癌复发中的灵敏度及特异度分别为85.71%、89.39%。SCT在诊断宫颈癌复发中的灵敏度及特异度分别为55.71%、81.82%。绘制ROC曲线证实多参数MRI联合SCT在预测ⅢCr期宫颈癌同步放化疗后复发中的的AUC=0.941,95%CI(0.895~0.987),灵敏度及特异度分别为94.30%与93.90%。结论多参数MRI在诊断ⅢCr期宫颈癌CCRT后复发中的价值高于SCT,但两者联合使用能有效提高宫颈癌复发的临床诊断效果。