Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake

BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most often in cirrhotic patients(4%-32%) and has been shown to be detrimental to functional status,quality of life,and survival.The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e.,diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects,preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient,respectively.AIM To compare brain and whole-body uptake of technetium for diagnosing HPS.METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included.Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs,respectively.RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhancedechocardiography.The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71±0.18 mg/dL vs 0.83±0.23 mg/dL;P=0.041),alveolararterial oxygen gradient (23.2±13.3 mmHg vs 16.4±14.1 mmHg;P=0.043),and arterial partial pressure of oxygen (81.0±12.1 mmHg vs 90.1±12.8 mmHg;P=0.004).Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0%±6.1%vs 40.1%±8.1%;P=0.001).The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54;P=0.025).The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7%and 42.5%,respectively,based on Youden’s index.The sensitivity,specificity,and accuracy of brain uptake> 5.7%and whole-body uptake> 42.5%for detecting IPVD were23%,89%,and 59%and 100%,52%,and 74%,respectively.CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS.

Perfusion characterization of liver metastases from endocrine tumors:Computed tomography perfusion

AIM:To assess prospectively parameters of computed tomography perfusion(CT p) for evaluation of vascularity of liver metastases from neuroendocrine tumors.METHODS:This study was approved by the hospital's institutional review board.All 18 patients provided informed consent.There were 30 liver metastases from neuroendocrine tumors.Patients were divided into three groups depending on the appearance of the liver metastases at the arterial phase of morphological CT(hyperdense,hypodense and necrotic).Sequential acquisition of the liver was performed before and for 2 min after intravenous injection of 0.5 mg/kg contrast medium,at 4 mL/s.Data were analyzed using deconvolution analysis to calculate blood flow(BF),blood volume(BV),mean transit time(MTT),hepatic arterial perfusion index(HAPI) and a bi-compartmental analysis was performed to obtain vascular permeability-surface area product(PS).Post-treatment analysis was performed by a radiologist and regions of interest were plotted on the metastases,normal liver,aorta and portal vein.RESULTS:At the arterial phase of the morphological CT scan,the aspects of liver metastases were hyperdense(n=21),hypodense(n=7),and necrotic(n=2).In cases of necrotic metastases,none of the CT p parameters were changed.Compared to normal liver,a significant difference in all CT p parameters was found in cases of hyperdense metastases,and only for HAPI and MTT in cases of hypodense metastases.No significant difference was found for MTT and HAPI between hypo-and hyperdense metastases.A significant decrease of PS,BV and BF was demonstrated in cases of patients with hypodense lesions PS(23±11.6 mL/100 g per minute) compared to patients with hyperdense lesions;PS(13.5±10.4 mL/100 g per minute),BF(93.7±75.4 vs 196.0±115.6mL/100 g per minute) and BV(9.7±5.9 vs 24.5 10.9 mL/100 g).CONCLUSION:CT p provides additional information compared to the morphological appearance of liver metastases.

Value of spiral CT perfusion parameters for evaluating acute pancreatitis and their correlation with inflammatory factor and JAK2/STAT3 signaling pathway

Objective: To study the value of spiral CT perfusion parameters for evaluating acute pancreatitis and their correlation with inflammatory factor and JAK2/STAT3 signaling pathway. Methods: Patients with acute pancreatitis and patients with pancreatic trauma who underwent surgical resection in Liaocheng Dongchangfu People's Hospital between May 2014 and March 2017 were selected and enrolled in the AP group and the control group of the research respectively;spiral CT perfusion scanning was conducted before surgery to measure the blood flow (BF), blood volume (BV), and mean transit time (MTT), and the serum was collected to determine the contents of inflammatory factors;pancreatitis tissue and normal pancreatic tissue were collected after surgical resection to determine the expression of JAK2/STAT3 signal molecules. Results: pancreatic tissue BF and BV levels of AP group were significantly lower than those of control group while MTT level was not different from that of control group;CRP, PCT, HMGB-1, Ghrelin and sTREM-1 contents in serum as well as JAK2, STAT3, Bcl-2 and Bcl-xL mRNA expression in pancreatic tissue of AP group were significantly higher than those of control group and negatively correlated with BF and BV levels in pancreatic tissue. Conclusion: Spiral CT perfusion parameters BF and BV can reflect the microcirculatory disorder of acute pancreatitis and are associated with the increased secretion of inflammatory factors and the activation of JAK2/STAT3 signaling pathway in the course of disease.

氧疗联合俯卧位呼吸治疗急性呼吸衰竭的临床效果

目的:分析急性呼吸衰竭(ARF)应用氧疗联合俯卧位呼吸治疗的效果。方法:选取2022年7月—2023年12月新疆医科大学第六附属医院收治的21例清醒急性呼吸衰竭患者为研究对象。比较分析不同时间患者的心电监测指标和动脉血气指标。结果:初始位、俯卧位0.5h、俯卧位1h患者的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、氧灌注指数(PI)水平比较,差异均无统计学意义(P>0.05);俯卧位0.5h时患者的血氧饱和度(SpO_(2))与初始位比较,差异无统计学意义(P>0.05);俯卧位1h患者的SpO_(2)与初始位比较,差异有统计学意义(Ρ<0.05);初始位与俯卧位1h时患者的pH值、二氧化碳分压(PaCO_(2))水平比较,差异无统计学意义(P>0.05);但动脉血氧分压(PaO_(2))、氧合指数水平比较,差异有统计学意义(Ρ<0.05)。21例患者中无患者发生血液动力学异常情况。结论:氧疗联合俯卧位呼吸治疗ARF患者疗效显著,可以改善患者氧合状况,可作为基层医疗机构和急诊进行急救的一种方法。

对比肺通气/灌注显像和CT肺动脉造影对急性肺栓塞患者发生慢性血栓栓塞性肺动脉高压的预测价值

目的:比较肺通气/灌注(ventilation/perfusion,V/Q)显像和CT肺动脉造影(pulmonary angiography,PA)预测急性肺栓塞(acute pulmonary embolism,APE)后慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension,CTEPH)发生的价值。方法:回顾性收集了2012年1月至2020年8月,确诊为APE患者的资料,所有患者经至少3个月规范化抗凝后复查肺V/Q显像和CTPA。分别评估并计算肺V/Q显像和CTPA图像中的残余肺栓塞,并分别记录为肺灌注缺损百分比(percentage of pulmonary defect scores,PPDs%)和CT肺动脉阻塞指数(pulmonary artery obstruction index,PAOI)。评价PPDs%和CTPAOI预测CTEPH发生的一致性。绘制受试者工作特征(ROC)曲线,评估PPDs%和CTPAOI对APE后CTEPH发生的预测效能。结果:共纳入224例APE患者,1年内随访,共有26例进展为CTEPH。Bland-Altman图示两检查评估APE治疗后残余肺栓塞的一致性较好。ROC分析示PPDs%的AUC>CTPAOI(0.958 vs.0.868,P=0.03);预测CTEPH发生的阈值分别为20.5%和15.0%,相应的敏感性和特异性分别为92.3%、88.9%和76.9%、89.4%,差异均无统计学意义(敏感性:P=0.13;特异性:P>0.999)。结论:肺V/Q显像预测APE后CTEPH发生率比CT PA更敏感,但特异性略低。

磁共振药代动力灌注扫描在鉴别段样强化肉芽肿性乳腺炎与浸润性导管癌中的价值研究

目的 探讨基于压缩感知技术的磁共振药代动力灌注扫描对段样强化的特发性肉芽肿性乳腺炎(idiopathic granulomatous mastitis,IGM)与浸润性导管癌(invasive ductal carcinoma,IDC)的鉴别诊断价值。材料与方法 回顾性分析27例段样强化、无脓肿型IGM和15例IDC患者的临床及影像资料,均行磁共振药代动力灌注扫描。采用Fisher精确检验、t检验、χ^(2)检验比较两组月经状态、年龄、内部强化方式的差异,采用t检验、Mann Whitney U检验筛选出两组容积转运常数(volume transport constant,K^(trans))、速率常数(rate constant,K_(ep))、血管外细胞外间隙容积分数(extravascular extracellular volume fraction,Ve)值中的差异项,用二元logistic线性回归分析其与IDC的危险系数,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线。结果 两组年龄、月经状态差异均有统计学意义(P=0.001、0.003),而内部强化方式差异无统计学意义(P=0.883)。磁共振药代动力灌注扫描:IGM组K^(trans)值[(0.274±0.163)min^(-1)]低于IDC组[(0.451±0.257) min^(-1)],IGM组K_(ep)值[(0.618±0.245)min^(-1)]低于IDC组[(0.856±0.420) min^(-1)],且两组间K^(trans)及K_(ep)值的差异有统计学意义(P=0.013,0.012)。两组Ve值为IGM组(0.531±0.320)min^(-1)、IDC组(0.629±0.323)min^(-1),差异无统计学意义(P=0.182)。二元logistic线性回归:K^(trans)值的优势比(odds ratios,OR)=2.243[95%置信区间(confidence interval,CI):0.652~6.294](P=0.021),绘制ROC曲线显示,约登指数、敏感度、特异度分别为0.585、73.3%、85.2%,曲线下面积(area under the curve,AUC)=0.778 (95%CI:0.623~0.891)(P=0.001)。结论 基于压缩感知技术的磁共振药代动力灌注扫描所得K^(trans)值对以段样强化为表现的IGM、IDC有鉴别诊断价值。

腺苷负荷CT心肌灌注扫描、24h动态心电图联合检查在冠心病心肌缺血诊断中的效能

目的:观察腺苷负荷CT心肌灌注扫描、24h动态心电图联合检查在冠心病心肌缺血诊断中的效能。方法:选取2020年12月至2022年12月该院收治的80例疑似冠心病心肌缺血患者进行前瞻性研究,所有患者均接受24h动态心电图和腺苷负荷CT心肌灌注扫描检查,以核素心肌灌注显像检查诊断结果为金标准,比较腺苷负荷CT心肌灌注扫描、24h动态心电图单项及联合检查诊断冠心病心肌缺血的效能。结果:核素心肌灌注显像检查结果显示,阳性52例,阴性28例。24h动态心电图检查结果显示,阳性46例,阴性34例;腺苷负荷CT心肌灌注扫描检查结果显示,阳性46例,阴性34例;联合检查结果显示,阳性51例,阴性29例。腺苷负荷CT心肌灌注扫描、24h动态心电图联合检查诊断冠心病心肌缺血的灵敏度、特异度、准确度、阳性预测值、阴性预测值均高于二者单项检查,差异有统计学意义(P<0.05)。结论:腺苷负荷CT心肌灌注扫描、24h动态心电图联合检查诊断冠心病心肌缺血的效能高于二者单项检查。

肝硬化合并原发性肝癌患者CT动态增强扫描变化及诊断价值

目的观察肝硬化(HC)合并原发性肝癌(PLC)患者CT动态增强扫描变化,分析其诊断价值。方法回顾性分析2020年4月—2022年7月我院125例HC患者资料,所有受试者均行病理组织学检测及CT动态增强扫描,统计所有患者病灶大小及分布情况,CT动态增强扫描动脉期、静脉期、延迟期病灶检出情况,以病理检查为金标准,分析CT动态增强扫描对HC患者PLC的诊断价值、HC患者与HC并PLC患者血流灌注参数大小及不同肝功能CTP分级下血流灌注参数变化。结果125例HC患者共检出161个病灶,其中直径<1 cm 8个,1~3 cm 53个,4~5 cm 63个,>5 cm 37个,肝右前叶、肝右后叶者居多,分别为45及69个;CT动态增强扫描动脉期检出病灶149个,检出率92.55%;门脉期检出病灶134个,检出率83.23%;延迟期检出病灶142个,检出率88.20%;125例HC患者中病理学检查显示75例PLC阳性,50例PLC阴性,CT动态增强扫检测HC并PLC的敏感度为94.67%,特异度为94.00%,准确率为94.40%,阳性预测值为95.95%,阴性预测值为92.16%,Kappa值为0.884,具有较高的一致性;HC组HAP、HPI值均显著低于HC并PLC组,PVP、TLP值均显著高于HC并PLC组(P<0.05);125例HC并PLC患者中CTP A级41例,CTP B级46例,CTP C级38例,CTP A级HAP、HPI值显著低于CTP B、C级(P<0.05),PVP、TLP值均显著高于CTP B、C级(P<0.05),CTP B级HPI值与CTP C级比较,差异均无统计学意义(P>0.05)。结论CT动态增强扫描可多方位多角度显示HC病灶情况,且对PLC具有较好的诊断价值,其中肝脏血流灌注参数具有一定的特征性,可为PLC诊断和肝功能分级提供参考。

早产儿机械通气常频模式对无创灌注指数的影响及其临床意义

目的:对比早产儿撤机前后右手掌(导管前)和右脚掌(导管后)的无创灌注指数(PI)的差异,探讨机械通气(MV)常频模式是否对其产生影响,阐明呼吸系统严重程度评分(RSS)与PI的相关性。方法:选择胎龄(GA)≥32周,体质量(BW)≥1500 g的早产儿,出生后因呼吸窘迫,行无创辅助通气治疗,脉搏血氧饱和度(SpO_(2))<90%,需要常频MV辅助呼吸。共纳入符合标准病例55例。出生24 h后符合撤机标准,进行撤机。记录撤机前后右手掌和右脚掌PI稳定后的30 s内数值,取其中位数。同时记录撤机前呼吸机参数吸入气体氧浓度分数(FiO_(2))和平均气道压(Pmean)。使用配对样本t检验比较撤机前后患儿右手掌和右脚掌PI差异。采用多元线性回归分析患儿GA、BW和RSS与撤机前右手掌(导管前)PI的相关性及FiO_(2)和Pmean与PI的相关性。结果:撤机前右手掌PI低于撤机后(P<0.05),撤机前右脚掌PI低于撤机后(P<0.05);GA、BW、RSS与PI线性回归分析,GA与PI无相关性(P>0.05),BW与PI存在正相关关系[b=0.44,标准化回归系数(β)=0.25,P<0.05],RSS与PI存在负相关关系(b=-0.56,β=-0.68,P<0.05),回归方程PI=1.9+0.44×BW-0.56×RSS;进一步对构成RSS的呼吸机参数FiO_(2)和Pmean进行多元线性回归分析,FiO_(2)(b=-2.52,β=-0.27,P<0.05)和Pmean(b=-0.39,β=-0.63,P<0.05)均与PI存在线性关系,且为其危险因素,回归系数中Pmean的β值大于FiO_(2),前者对PI影响更大。结论:常频MV模式可以影响PI,该模式下RSS是PI的危险因素,较高的RSS可对循环产生不利影响,其中Pmean较FiO_(2)对PI影响更大。

基于EIT的不同体位下肺通气、肺灌注区域分布和通气/灌注匹配研究

目的:基于电阻抗断层成像(electrical impedance tomography,EIT)比较不同体位下的肺通气、肺灌注区域分布和通气/灌注(V/Q)匹配情况。方法:选取10只健康实验猪,采集其仰卧位、俯卧位、左侧卧位、右侧卧位下的EIT肺部通气和血流灌注数据。使用MATLAB R2022b,基于EIDORS v3.9进行EIT数据分析和图像重构,以最大像素值20%作为阈值确定具有通气和灌注的有效区域,并进行V/Q匹配区域计算。比较不同体位下V/Q匹配评价指标(匹配分数%、死腔分数%、分流分数%)及通气、灌注区域在不同感兴趣区域(ROI1、ROI2、ROI3、ROI4)内的分布。结果:实验动物在不同体位下的匹配分数%、死腔分数%、分流分数%差异无统计学意义(P>0.05)。在不同体位下,通气、灌注的区域分布发生改变,通气区域在ROI1、ROI2、ROI3分布差异有统计学意义(P<0.05),灌注区域在ROI1、ROI2分布差异有统计学意义(P<0.05)。在仰卧位和俯卧位下,通气、灌注区域分布呈现出与重力依赖区分布一致的现象,而在右侧卧位和左侧卧位下,通气、灌注区域分布则呈现出与重力依赖区分布相反的现象。结论:同一实验对象在不同体位下的全局V/Q匹配参数具有较好的检验一致性;测量体位的变化将导致肺重力依赖区的变化,进而影响局部肺通气和肺灌注区域的分布;EIT能够对体位改变导致的肺通气、肺灌注改变进行测定,明确体位变化对肺通气、肺灌注和V/Q匹配的影响。

CT平扫及灌注成像评估急性缺血性卒中溶栓治疗预后的研究

目的 本研究旨在评估CT平扫及CT灌注成像在急性缺血性卒中(AIS)溶栓治疗预后中的作用。方法回顾性分析2018年9月至2023年9月在溶栓治疗前进行NCCT和灌注成像的AIS患者临床资料。采用单因素、多因素和受试者操作特征(ROC)分析评价临床危险因素、NCCT和CTP结果对预后的预测价值。结果本研究纳入75例患者,其中35例(46.7%)预后良好。多变量分析中,ASPECTS、HDVS、梗死核体积和错配率与功能结果单变量相关,而梗死核休积仍然是一个独立的预后因素。多变量模型的ROC下面积(AUC)为0.768(95%CI,0.666-0.870)。结论自动Aspects与参考CTP-Aspects评估基本一致,综合CT评估可能有助于AIS静脉溶栓后的预后。

探讨头颅CT血管造影联合CT灌注扫描在急性脑梗死溶栓后出血性转化预测中的应用价值

目的:探讨头颅CT血管造影(CTA)联合CT灌注扫描(CTP)在急性脑梗死溶栓后出血性转化(HT)预测中的应用价值。方法:选取2020年5月—2023年5月东海县人民医院收治的急性脑梗死溶栓后HT患者35例作为观察组,另外选取同期急性脑梗死溶栓后未发生HT患者70例作为对照组。患者均行CTA联合CTP检查。统计两组相关资料、脑血流动力学指标、急性脑梗死溶栓后HT的多因素Logistic回归分析、急性脑梗死溶栓后HT的预测价值。结果:两组年龄、身体质量指数比较,差异无统计学意义(P>0.05);观察组梗死面积大于对照组,美国国立卫生研究院卒中量表评分(NIHSS)低于对照组,差异有统计学意义(P<0.05);观察组脑血容量(CBV)、脑血流量(CBF)低于对照组,平均流通时间(MTT)、达峰时间(TTP)、渗透性表面乘积(PS)高于对照组,差异有统计学意义(P<0.05);梗死面积、CBV、CBF、MTT、TTP、PS、NIHSS评分是溶栓后HT的影响因素(P<0.05)。ROC曲线分析,CTA联合CTP的预测敏感性和特异性高于脑血流动力学指标(P<0.01)。结论:对急性脑梗死溶栓后HT预测使用CTA联合CTP具有较高的临床价值。

Effects of high-frequency oscillatory ventilation and conventional mechanical ventilation on oxygen metabolism and tissue perfusion in sheep models of acute respiratory distress syndrome

Background High-frequency oscillatory ventilation （HFOV） allows for small tidal volumes at mean airway pressures （mPaw） above that of conventional mechanical ventilation （CMV）,but the effect of HFOV on hemodynamics,oxygen metabolism,and tissue perfusion in acute respiratory distress syndrome （ARDS） remains unclear.We investigated the effects of HFOV and CMV in sheep models with ARDS.Methods After inducing ARDS by repeated lavage,twelve adult sheep were randomly divided into a HFOV or CMV group.After stabilization,standard lung recruitments （40 cmH2O × 40 seconds） were performed.The optimal mPaw or positive end-expiratory pressure was obtained by lung recruitment and decremental positive end-expiratory pressure titration.The animals were then ventilated for 4 hours.The hemodynamics,tissue perfusion （superior mesenteric artery blood flow,pHi,and Pg-aCO2）,oxygen metabolism and respiratory mechanics were examined at baseline before saline lavage,in the ARDS model,after model stabilization,and during hourly mechanical ventilation for up to 4 hours.A two-way repeated measures analysis of variance was applied to evaluate differences between the groups.Results The titrated mPaw was higher and the tidal volumes lower in the HFOV group than the positive end-expiratory pressure in the CMV group.There was no significant difference in hemodynamic parameters between the HFOV and CMV groups.There was no difference in the mean alveolar pressure between the two groups.After lung recruitment,both groups showed an improvement in the oxygenation,oxygen delivery,and DO2.Lactate levels increased in both groups after inducing the ARDS model.Compared with the CMV group,the superior mesenteric artery blood flow and pHi were significantly higher in the HFOV group,but the Pg-aCO2 decreased in the HFOV group.Conclusion Compared with CMV,HFOV with optimal mPaw has no significant side effect on hemodynamics or oxygen metabolism,and increases gastric tissue blood perfusion.

Pulmonary functional MRI: an animal model study of oxygen-enhanced ventilation combined with Gd-DTPA-enhanced perfusion

Background The assessment of regional pulmonary ventilation and perfusion is essential for the evaluation of a variety of lung disorders. Pulmonary ventilation MRI using inhaled oxygen as a contrast medium can be obtained with a clinical MR scanner, without additional equipment, and has been demonstrated to be a feasible means of assessing ventilation in animal models and some clinical patients. However, few studies have reported on MR ventilation-perfusion imaging. In this study, we evaluated the usefulness of oxygen-enhanced ventilation in combination with first-pass Gd-DTPA-enhanced perfusion MRI in a canine model of pulmonary embolism and airway obstruction.Methods Peripheral pulmonary embolisms were produced in eight dogs by intravenous injection of gelfoam strips at the pulmonary segmental arterial level, and airway obstructions were created in five of the dogs by inserting a self-designed balloon catheter into a secondary bronchus. Oxygen-enhanced MR ventilation images were produced by subtracting images from before and after inhalation of pure oxygen. Pulmonary perfusion MR images were acquired with a dynamic three-dimensional fast gradient-echo sequence. MR ventilation and perfusion images were read and contrasted with results from general examinations of pathological anatomy, ventilation-perfusion scintigraphy, and pulmonary angiography. Results Regions identified as having airway obstructions matched using both MR ventilation and perfusion imaging, but regions of pulmonary embolisms were mismatched. The area of airway obstruction defects was smaller using MR ventilation imagery than that using ventilation scintigraphy. Abnormal perfusion regions due to pulmonary embolisms were divided into defective regions and reduced regions based on the time course of signal intensity changes. In the diagnosis of pulmonary embolisms with the technique of ventilation and perfusion MRI, sensitivity and specificity were 75.0% and 98.1%, respectively, and the diagnostic results of this MRI technique were in agreement with the results of ventilation-perfusion scintigraphy and pulmonary angiography (K: 0.899, 0.743).Conclusions Oxygen-enhanced ventilation in combination with pulmonary perfusion MRI can be used to diagnose abnormalities of airways and blood vessels in the lungs, and can provide regional functional information with high spatial and temporal resolution. This method possesses great potential value for clinical applications. F

生理通气辅助下HRCT靶扫描与薄层CT靶重建在肺磨玻璃样小结节诊断中的价值对比

目的:探讨生理通气辅助下高分辨率CT(HRCT)靶扫描与薄层CT靶重建在肺磨玻璃样小结节(sGGN)定性诊断中的价值比较.方法:回顾性分析经手术病理证实为肺腺癌的98例孤立性sGGN患者的临床及影像资料,其中不典型腺瘤样增生(AAH)+原位腺癌(AIS)组45例、微浸润性腺癌(MIA)组38例、浸润性腺癌(IAC)组15例.对所有结节均分别按薄层CT靶重建(A方案)及生理通气辅助下HRCT靶扫描(B方案)进行处理,评价图像质量、判断结节类型及统计结节征象、评估诊断信心并给出诊断结果,对阅片结果进行统计学分析.结果:2种方案在AAH+AIS组中的sGGN检出率相仿,但生理通气辅助下HRCT靶扫描在MIA组(P<0.001)和IAC组(P=0.017)中的sGGN检出率均显著高于薄层CT靶重建.生理通气辅助下HRCT靶扫描相较于薄层CT靶重建在密度征(P<0.001)、充气支气管征(P<0.001)、空泡征(P<0.005)及微血管征(P<0.001)等征象判断上有显著差异.生理通气辅助下HRCT靶扫描相较于薄层CT靶重建在肿瘤微血管征分型及与小支气管关系分型的级别上差异具有统计学意义(P<0.005).另外,生理通气辅助下HRCT靶扫描相较于薄层CT靶重建能够显著提升诊断信心及图像质量.结论:生理通气辅助下HRCT靶扫描能提供更好的图像质量和诊断可信度,并能更准确地判断sGGN的征象.

CT灌注成像联合平均动脉压对重型脑外伤脑卒中的诊断价值

目的运用多层螺旋CT灌注成像联合平均动脉压在重型颅脑损伤脑卒中的应用效果。方法选取2020年11月—2022年9月于黑龙江省医院神经外科住院治疗的重型颅脑外伤患者63例,随机分为三组,每组21例。采用不同扫描方法分为平扫组、灌注组及联合组。平扫组复查时采用常规CT平扫,灌注组采用CT灌注扫描,联合组选用CT颅脑灌注联合平均动脉压的方法。分别对三组患者治疗后1、3个月的格拉斯哥昏迷指数评分(Glasgow coma score,GCS评分)进行比较;对灌注组及联合组治疗后1、3个月的CT灌注参数情况进行对比;比较诊断灵敏度及特异度,绘制ROC曲线,评价联合组的诊断价值。结果治疗前三组患者GCS评分差异无统计学意义(P>0.05);治疗后三组GCS评分均有上升,治疗后1个月后联合组评分最高(P<0.05),治疗后6个月比较差异无统计学意义(P>0.05);治疗1个月后,联合组脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)均低于灌注组、联合组平均通过时间(mean transit time,MTT)较灌注组长,以上差异均有统计学意义(P<0.05)。治疗后6个月两组CBF、CBV、MTT差异均无统计学意义(P>0.05);联合组诊断灵敏度高于平扫组和灌注组(P<0.05)。结论CT灌注成像联合平均动脉压相较于其他单一检查对于重型颅脑外伤患者的诊断准确性高,值得于临床中推广使用。

CT灌注成像和增强扫描在诊断胃癌淋巴结转移中的价值

目的:探讨CT灌注成像和增强扫描对胃癌淋巴结转移的诊断价值。方法:选取长治医学院附属和济医院胃癌患者65例,术前均行腹部CT平扫、CT灌注成像和增强扫描,记录淋巴结的形态学参数(长径、短径、短长径比)、增强参数(平扫和动、静脉期CT值)及灌注参数[血容量(BV)、血流量(BF)、表面通透性(PS)和平均通过时间(MTT)],绘制受试者工作特征曲线(ROC),评价各参数对淋巴结转移的诊断效能。结果:65例胃癌患者中,病理结果发现转移性淋巴结103枚,非转移性淋巴结76枚,转移性淋巴结的短径、短长径比、平扫CT值、动脉期CT值、静脉期CT值、PS和BF均显著高于非转移性淋巴结(P<0.05),二者的长径、BV和MTT比较,差异无统计学意义(P>0.05)。ROC曲线结果显示,短径、短长径比、平扫CT值、动脉期CT值、静脉期CT值、PS和BF诊断转移性淋巴结的曲线下面积(AUC)分别为0.592,0.847,0.683,0.811,0.747,0.844和0.898;与单独参数相比,短长径比+动脉期CT值+PS三项联合的诊断效能最大。结论:CT灌注成像联合增强扫描可有效加强对胃癌淋巴结转移的诊断价值。

脉搏灌注指数和脉搏灌注变异指数在机械通气患者撤机中的应用

目的观察脉搏灌注指数(PI)和脉搏灌注变异指数(PVI)在机械通气患者撤机中的应用效果。方法选取116例准备撤机的机械通气患者,通过撤机筛查后采用T-管模式进行自主呼吸试验(SBT),以患者拔管后自主呼吸时间超过48 h为撤机成功,根据撤机结果将患者分为撤机成功组(90例)和撤机失败组(26例),使用脉搏血氧仪Radical-7监测SBT前和SBT结束时患者PI、PVI,计算SBT前后PI和PVI的变化(ΔPI、ΔPVI),利用ROC评估SBT前PI、PVI及ΔPI、ΔPVI对机械通气患者撤机结果的预测价值。结果与撤机失败组比较,撤机成功组SBT前PVI、SBT后PI、SBT后PVI、ΔPI、ΔPVI增加(P均<0.05)。当SBT前PVI>14.0%时,其预测机械通气患者撤机成功的灵敏度为86.1%,特异度为79.2%,AUC为0.860,95%CI为0.766~0.953;当ΔPVI>10.5%时,其预测机械通气患者撤机成功的灵敏度为91.7%,特异度为83.3%,AUC为0.905,95%CI为0.831~0.978;当ΔPI>12.5%时,其预测机械通气患者撤机成功的灵敏度为88.9%,特异度为80.8%,AUC为0.936,95%CI为0.877~0.996。结论SBT前PI无法有效地预测机械通气患者撤机结果,但SBT前PVI及ΔPI、ΔPVI对机械通气患者撤机结果有良好的预测价值。

CT灌注成像辅助诊断单纯疱疹病毒1型脑炎一例

单纯疱疹病毒性脑炎又称急性坏死性脑炎,是由疱疹病毒感染引起的脑实质炎症。CT灌注成像(CTP)可快速显示脑部组织灌注异常及脑组织受损情况,常被用于脑卒中的诊断,而被用于辅助诊断脑炎的文献报道较少。该文报道了1例通过CTP辅助诊断单纯疱疹病毒1型脑炎的59岁男性患者。该例患者起病急,突发右侧肢体抽搐伴发热,且伴有精神症状,不能配合完成MRI,故急行头颅CTP,结果显示其左侧颞叶灌注较右侧增加,不排除病毒性脑炎的诊断,遂于入院12 h内泵注阿昔洛韦抗病毒治疗及予其他对症治疗,患者病情逐渐好转。入院后3 d脑脊液病原体二代测序结果回报,明确诊断为单纯疱疹病毒1型脑炎。

双源CT肝动脉三期扫描和增强灌注扫描诊断肝硬化背景下小原发性肝癌价值研究

目的 探讨双源CT肝动脉三期扫描和增强灌注扫描诊断肝硬化背景下小原发性肝癌(sPLC)的价值。方法 2019年2月~2021年9月我院收治的130例肝内有结节的肝硬化患者,行双源CT肝动脉三期扫描和增强灌注扫描,记录病灶血容量(BV)、肝动脉分数(HAF)、血流量(BF)和肝动脉灌注量(HAP)。取外科手术组织或肝穿刺活检组织行病理学检查。绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)分析双源CT肝动脉三期扫描和增强灌注扫描参数诊断sPLC的价值。结果 在130例存在肝内结节的肝硬化患者中,发现sPLC者85例;病灶直径为0.8~3.0 cm,平均为(1.85±0.37)cm;动脉晚期和动脉中期扫描病灶CT绝对值分别为(69.8±15.9)Hu和(65.8±15.2)Hu,显著高于动脉早期扫描【(48.4±10.3)Hu,P<0.05】,病灶强化值分别为(24.9±5.1)Hu和(23.6±4.9)Hu,显著高于动脉早期扫描【(15.2±3.9)Hu,P<0.05】,病灶检查率分别为91.3%和88.0%,显著高于动脉早期扫描的40.2%(P<0.05);sPLC病灶BV、HAF、BF和HAP分别为(17.4±5.1)mL/100 g、(0.21±0.02)、(183.8±15.4)mL/(min·100 g)和(38.4±4.9)mL/(min·100 g),显著低于45例良性结节【分别为(19.4±6.9)mL/100 g、(0.26±0.03)、(201.9±18.3)mL/(min·100 g)和(52.3±5.6)mL/(min·100 g),P<0.05】;双源CT肝动脉三期扫描与增强灌注扫描诊断肝硬化背景下sPLC的AUC值(95%CI)分别为0.842(0.768~0.899)和0.888(0.821~0.936),其灵敏度分别为83.5%和90.6%,特异度分别为84.8%和87.0%(Z值=1.012,P值=0.312)。结论 应用双源CT肝动脉三期扫描有助于发现肝硬化背景下sPLC病灶,而增强灌注扫描可有效评估病灶性质,对确定诊断有裨益。