不同剂量64排CT增强扫描结合三维重建在胃癌应用中的图像质量研究

目的:研究不同剂量64排CT增强扫描结合三维重建在胃癌应用中的图像质量。方法:90例胃癌行胃部64层螺旋CT三期增强扫描患者后根据管电压设置分成A、B、C三组:A组120KV、B组100KV、C组80KV。通过轴位图像结合三维重建(VR、MPR和MIP等)分析不同剂量下螺旋CT扫描结合三维重建图像诊断质量。结果:A、B两组的图像清晰度的差异无统计学意义(P0.05),A、B组剂量加权指数降低率的差异具有统计学意义,A、C两组间图像清晰度及剂量加权指数降低率的差异具有统计学意义(P0.05),B、C组两项差异具有统计学意义。结论:适当调整MSCT的剂量,可以获得与常规MSCT剂量完全相同的图像而且可以降低辐射。     

计算机技术在颞骨解剖和侧颅底外科中的应用

随着耳神经外科和颅底外科的开展,侧颅底特别是其颞骨的解剖研究日益显示出其重要性。颞骨内结构多、体积小、毗邻关系复杂。常规解剖及单纯切片研究仍不能满足临床需要。近年来,运用计算机三维重建技术研究颞骨解剖已取得了较大进展。在临床应用方面.三维影像技术应用于耳和侧颅底疾病诊断的进展迅速,耳科和侧颅底的计算机辅助外科研究也已开展起来。     

乳突切迹与侧颅底重要结构的解剖学观测及应用

目的:通过测量乳突切迹与侧颅底重要骨性结构的距离,为临床相关应用提供解剖学参考。方法:取成人颅骨标本50例(去颅盖标本8例,整颅42例)100侧,测量乳突切迹及其与侧颅底重要孔、裂和管的距离。结果:左右侧乳突切迹后缘距茎乳孔、颈静脉孔外侧缘、颈动脉管外口后缘、破裂孔、棘孔、卵圆孔距离分别为25.16±3.73cm和25.02±3.58cm、30.92±3.50cm和30.45±3.49cm、38.22±3.57cm和38.14±3.43cm、57.23±3.71cm和57.14±3.44cm、47.94±3.83cm和48.32±3.54cm、53.70±3.98cm和53.55±3.75cm。结论:以乳突切迹后缘做为侧颅底手术的定位标志能够为临床相关应用提供较方便、准确的定位参考。     

颧根与侧颅底重要结构的解剖学测量

目的:通过测量颧根与侧颅底各重要结构间的距离关系,为临床侧颅底外科手术治疗提供定位参考。方法:取成人颅骨标本50例(去颅盖标本8例,整颅42例)100侧,用游标卡尺、圆规和直尺测量颧根与侧颅底重要结构的距离。结果:实验测得左右侧颧根与外耳门前缘中点、乳突尖、茎突、翼突外侧板根部、舌下神经管外口、茎乳孔、颈静脉孔外缘、颈动脉管外口后缘、棘孔、卵圆孔、破裂孔的距离分别为22.30±2.84mm和22.02±3.27mm、40.37±3.21mm和40.56±3.54mm、32.53±2.78mm和32.92±2.68mm、35.13±3.14mm和35.19±2.74mm、49.29±2.88mm和48.98±2.87mm、32.92±2.44mm和33.05±2.61mm、35.15±2.86mm和34.68±3.13mm、33.17±2.78mm和33.17±2.72mm、28.83±2.62mm和28.68±2.63mm、31.15±2.76mm和31.49±2.73mm、43.67±3.32mm和44.15±3.02mm,左右侧数据无差异(P>0.05)。结论:颧根可以作为侧颅底外科手术的定位标志,为直视条件下经颞下等入路的侧颅底外科手术提供解剖学依据。     

乳突切迹与侧颅底重要结构的解剖学观测及应用

目的：通过测量乳突切迹与侧颅底重要骨性结构的距离,为临床相关应用提供解剖学参考。方法：取成人颅骨标本50例（去颅盖标本8例,整颅42例）100侧,测量乳突切迹及其与侧颅底重要孔、裂和管的距离。结果：左右侧乳突切迹后缘距茎乳孔、颈静脉孔外侧缘、颈动脉管外口后缘、破裂孔、棘孔、卵圆孔距离分别为25.16±3.73cm和25.02±3.58cm、30.92±3.50cm和30.45±3.49cm、38.22±3.57cm和38.14±3.43cm、57.23±3.71cm和57.14±3.44cm、47.94±3.83cm和48.32±3.54cm、53.70±3.98cm和53.55±3.75cm。结论：以乳突切迹后缘做为侧颅底手术的定位标志能够为临床相关应用提供较方便、准确的定位参考。     

颧根与侧颅底重要结构的解剖学测量

目的：通过测量颧根与侧颅底各重要结构间的距离关系,为临床侧颅底外科手术治疗提供定位参考。方法：取成人颅骨标本50例（去颅盖标本8例,整颅42例）100侧,用游标卡尺、圆规和直尺测量颧根与侧颅底重要结构的距离。结果：实验测得左右侧颧根与外耳门前缘中点、乳突尖、茎突、翼突外侧板根部、舌下神经管外口、茎乳孔、颈静脉孔外缘、颈动脉管外口后缘、棘孔、卵圆孔、破裂孔的距离分别为22.30±2.84mm和22.02±3.27mm、40.37±3.21mm和40.56±3.54mm、32.53±2.78mm和32.92±2.68mm、35.13±3.14mm和35.19±2.74mm、49.29±2.88mm和48.98±2.87mm、32.92±2.44mm和33.05±2.61mm、35.15±2.86mm和34.68±3.13mm、33.17±2.78mm和33.17±2.72mm、28.83±2.62mm和28.68±2.63mm、31.15±2.76mm和31.49±2.73mm、43.67±3.32mm和44.15±3.02mm,左右侧数据无差异（P〉0.05）。结论：颧根可以作为侧颅底外科手术的定位标志,为直视条件下经颞下等入路的侧颅底外科手术提供解剖学依据。     

以乳突切迹和翼钩为基点的侧颅底分区方法

目的:探讨以乳突切迹和翼钩为基点的侧颅底分区新方法.方法:在乳突切迹后缘、翼钩、枕骨大孔前缘中点和颧根四个结构间相互连线,区分侧颅底并测量连线的长度.结果:乳突切迹与侧颅底重要结构的关系密切,切迹后缘与翼钩连线和正中线将侧颅底分成内、外侧两个大的三角区,每个区再分成前后两个三角区共四个三角区,即腭和颞下三角、咽三角、关节和听三角、血管神经三角,其中血管神经三角的三边长度左右侧分别为(74.52±5.47)mm和(74.66±5.41)mm、(59.77±3.84)mm和(59.67±3.56)mm、(42.23±3.11)mm和(42.48±2.60)mm.结论:本研究提供了新的侧颅底分区方法,且血管神经三角的区域划分更为科学,为临床侧颅底手术入路和定位提供了解剖学参考.     

多层螺旋计算机断层扫描联合磁共振成像对早期中央型肺癌及术后复发的诊断价值

目的:探讨多层螺旋计算机断层扫描(MSCT)联合磁共振成像(MRI)对早期中央型肺癌及术后复发的诊断价值。方法:选取2015年8月到2017年2月我院收治的早期中央型肺癌患者98例,所有患者均经MSCT和MRI检查。分析并对比单独MSCT的诊断结果及MSCT联合MRI的诊断结果。随访1年,观察并比较疑似复发的患者单独MSCT的诊断结果及MSCT联合MRI的诊断结果,并比较其对复发诊断的灵敏度、特异度。结果:MSCT联合MRI对早期中央型肺癌诊断的准确率、误诊率、漏诊率分别为94.90%、1.02%、4.08%,与单独MSCT诊断的82.65%、9.18%、8.16%比较,MSCT联合MRI诊断的准确率明显升高,误诊率明显降低(P0.05),而两种诊断方法的漏诊率比较差异无统计学意义(P0.05)。随访1年后,98例患者共复查122例次,共有49例复发。MSCT联合MRI诊断早期中央型肺癌患者术后复发的灵敏度、特异度分别为97.96%、93.15%,均高于单独MSCT诊断的83.67%、82.19%(P0.05)。结论:MSCT联合MRI诊断早期中央型肺癌准确率较高,且在诊断术后复发中可提高灵敏度、特异度。     

以乳突切迹和翼钩为基点的侧颅底分区方法

目的：探讨以乳突切迹和翼钩为基点的侧颅底分区新方法。方法：在乳突切迹后缘、翼钩、枕骨大孔前缘中点和颧根四个结构间相互连线,区分侧颅底并测量连线的长度。结果：乳突切迹与侧颅底重要结构的关系密切,切迹后缘与翼钩连线和正中线将侧颅底分成内、外侧两个大的三角区,每个区再分成前后两个三角区共四个三角区,即腭和颞下三角、咽三角、关节和听三角、血管神经三角,其中血管神经三角的三边长度左右侧分别为（74.52±5.47）mm和（74.66±5.41）mm、（59.77±3.84）mm和（59.67±3.56）mm、（42.23±3.11）mm和（42.48±2.60）mm。结论：本研究提供了新的侧颅底分区方法,且血管神经三角的区域划分更为科学,为临床侧颅底手术入路和定位提供了解剖学参考。     

运用CT三维重建测量重度先天性脊柱侧凸Cobb角的临床应用

目的:评价在CT三维重建上测量重度先天性脊柱侧凸Cobb角度的可重复性和可靠性。方法:收集在我院诊治的重度先天性脊柱侧凸病人的CT三维重建和脊柱全长X线片,共计67例。由五名不同测量者对CT三维重建脊柱畸形冠状面主弯Cobb角测量两次,两次间隔在三周以上,并测量脊柱全长X线片脊柱畸形冠状面主弯Cobb角一次,运用组内相关系数分析测量结果之间的可重复性和可靠性。结果:同一测量者两次测量结果之间的差值平均为4.5°。同一测量者两次测量结果之间的组内相关系数为0.969,不同测量者之间测量结果的组内相关系数为0.913。取五名测量者在CT三维重建上第一次测量的Cobb角度,其平均值为(110.5±23.5)°,五名测量者在X线片上测量结果的平均值为(103.1±22.0)°,对两组数据进行Mann-Whitney非参数检验差异有统计学意义(Z=-2.86,P=0.004)。结论:在CT三维重建上测量重度先天性脊柱侧凸的Cobb角,可以减小测量的误差,提高测量的可重复性和可靠性,是一种相对准确的测量方法。     

64层螺旋CT对胸部创伤的诊断价值

目的:评价64层螺旋CT相对于CR片在胸部创伤诊断中的价值。方法:我院2006年1月～2008年3月收治81例胸部创伤,全部患者在伤后10min至5h进行了64层螺旋CT检查,其中58例在初次检查后12～38h内进行了CR或床旁CR检查,CT扫描采用GE LightSpeed 64层螺旋CT机,层厚0.625 mm,螺距为0.984:1。结果:81例中诊断肋骨骨折72例,肺挫裂伤65例,气胸36例,血胸53例,血气胸31例,锁骨骨折12例,肩胛骨骨折13例,皮下及纵隔积气18例,右横膈破裂2例。在同时进行过CR检查的患者中,非错位性及撕脱性肋骨、肋软骨骨折在CR上常显示不佳,而在64层螺旋CT多平面或三维重建图像上显示非常清晰。结论:64层螺旋CT多平面及三维重建对胸部创伤各种病变的检测明显优于x线平片,对临床急救计划的制定有重要的指导意义。     

Capacities of multidetector spiral computed tomography in the planning and postoperative examination of patients undergoing coronary artery bypass surgery

Multiple investigations show that multidetector spiral computed tomography (MSCT) bypass grafting becomes an alternative to invasive coronary angiography in detecting coronary graft stenoses and occlusions. The investigation retrospectively estimated the patency of aortocoronary and mammary coronary artery anastomoses by MSCT bypass grafting. Examinations were made in 85 (326 anastomoses) patients who had undergone aortocoronary and mammary coronary artery bypass surgery and had MSCT bypass grafting within 3 years after the surgery. In the first year following the surgery, 18 patients with graft stenotic changes, as evidenced by MSCT, underwent intervention coronary angiography, the sensitivity and specificity of which was 100%. The results of clinical and instrumental examinations were also compared with graft incompetence, as shown on MSCT that revealed that MSCT bypass grafting was the only noninvasive technique to evaluate early coronary graft closure both in the absence of clear signs of myocardial ischemia according to the data of exercise tests and in the presence of recurrent angina pectoris.     

多排螺旋CT后处理技术对不规则骨骨折的诊断价值

目的:探讨多排螺旋CT及其后处理技术在诊断不规则骨骨折中的诊断价值。方法:用16排螺旋CT对25例怀疑颅骨、脊柱或关节附近骨折的外伤患儿进行扫描并进行后处理(MPR、VR)。结果:25例病例中颅骨骨折15例,脊柱骨折5例,四肢关节骨折5例(其中3例关节内骨折伴有骺软骨损伤)。结论:对于不规则骨骨折,多排螺旋CT及其后处理重建具有很大的优越性,应横断位、MPR及VR三者相结合判断,为临床提供丰富的、科学的、准确的信息依据。     

缺血性心肌病的多模态心血管影像学方法进展

近年来,超声(ultrasound, US)、CT冠状动脉造影(CT coronary angiography, CCTA)、血管内超声(intravenous ultrasound,IVUS)、光学相干断层成像(optical coherence tomography, OCT)、多层螺旋CT成像(multi-slice computed tomography, MSCT)、单光子发射计算机断层成像(single-photon emission computed tomography, SPECT)、正电子发射计算机断层成像(positron emission computed tomography, PET)及心脏磁共振(cardiac magnetic resonance, CMR)等多种心血管成像技术能够提供与冠脉病变及心肌形态和功能相关的解剖学、血流动力学、细胞生物学及病理生理学等方面的重要信息,在缺血性心肌病的临床诊疗及预后评估中发挥着日益重要的作用。然而,如何恰当选择的多模态心血管影像技术是临床医师面临的一大难题。因此,本文在归纳总结主要心血管成像技术临床应用进展的基础上,对多模态心血管影像学在缺血性心肌病相关的冠脉解剖与斑块成像、心肌功能、心肌灌注及心肌活性显像中的临床应用价值进行综述。旨在帮助临床医师客观认识各种成像技术的优势与不足,从而制定最优化的选择方案。     

Image assessment of MSCT and CBCT scans for rapid maxillary expansion: a pilot study

Objectives: The accuracy of cone-beam technique, cone-beam computed tomography (CBCT), compared with that of the multislice spiral CT (MSCT), for image-based linear measurements of midpalatal suture was assessed.

Material and Methods: Two measurements were performed by one investigator on the dry skull by using one digital caliper and in the axial cuts by using software. A 2D object-based image registration process was applied to determine the best affine transformation that maps a 2D input image (CBCT) in a reference image (MSCT).

Results: The value of the intraclass correlation coefficient was approximately 0.9%. The results suggest that differences between two scanners did not exist (observation 1, p = 0.964 and observation 2, p = 0.795). With regard to the dry skull and the image, the significance probabilities equaled zero (observation 1, p = 0.002 and observation 2, p = 0.004), therefore, indicating significant differences.

Conclusion: Measurements acquired in the images were similar and these findings contribute to stimulate the use of CBCT for evaluation of the maxillary expansion procedure.     

MSCT评价兔VX2乳腺种植瘤抗血管生成治疗的研究

探讨多层螺旋CT（multi—slice spiral computed tomography,MSCT）灌注成像与肿瘤血管内皮生长因子（vascular endothelial growth factor,VEGF）表达的相关性以评估兔VX2乳腺种植瘤抗血管生成治疗的疗效。将69R乳腺VX：瘤兔于肿瘤生长2周后随机分为对照组（生理盐水1、恩度组（Endostar）、cEF组[环磷酰胺（Cyclophosphamide C）、表阿霉素（EpirubicinE）和5-氟尿嘧啶（5．FluorouracilF）]、联合治疗CR（Endostar和CEF）。治疗2周后对瘤兔进行MSCT灌注扫描,获得血流量（bloodflow,BF）、血容量（bloodvolume,BV）、平均通过时间（meantransittime,MTT）及表面通透性（permeabilitysurface,PS）等灌注参数均值：随后取瘤组织进行免疫组化及Westernblot检测 VEGF蛋白表达情况。结果显示,对照组、CEF组、恩度组、联合治疗组BF、BV和Ps均与VEGF表达结果呈正相关（R对照组=0．896、0．680、0．765,RCEF组=0．877、0．876、0．852,R恩度组=0．804、0．924、0．888,R联合治疗组=0．780、0．735、0．744;P〈0．05）,MTT均与VEGF表达结果呈负相关（R对照组＝-0．591,RCEF组=0．678,R恩度组=0．793,R联合治疗组=-0．687;P〈0．05）。MSCT灌注参数与VEGF蛋白表达具有相关性,MSCT灌注参数可以反映肿瘤治疗后免疫组化与分子水平VEGF表达的变化,MSCT可以在体无创评价兔VX2乳腺种植瘤抗血管生成治疗的疗效。     

Transverse relationships of the infraorbital foramina in cleft and noncleft individuals

An evaluation of the location of the infraorbital foramina in a transverse plane was undertaken by direct skull and radiographic measurements in unrepaired cleft palate and age- and sex-matched noncleft individuals. Physioprints were obtained on six dry skulls with left-sided clefts of the primary and secondary palates and on six age- and sex-matched noncleft palate skulls. The left infraorbital foramen was found to be significantly superior in a transverse plane to the right infraorbital foramen in the cleft palate skulls. No significant differences in transverse location of the infraorbital foramina were found in the cleft skull group based on differences in sex or age. Posterior-anterior cephalographs were obtained on 15 left unilateral cleft palate individuals and on age- and sex-matched noncleft palate individuals. The location of the infraorbital foramina in a transverse plane in the posterior-anterior cephalographs was found to be too variable to permit the use of parametric statistical tests. When the data on location of the infraorbital foramina were analyzed by a nonparametric statistical test it was found that the left infraorbital foramen was significantly superior to the right infraorbital foramen in the cleft palate individuals. The more superiorly placed infraorbital foramen on the cleft side was suggestive of a vertical deficiency of the maxilla on the cleft side.     

Three-dimensional reconstruction of human diaphragm with the use of spiral computed tomography

Pettiaux, Nicolas, Marie Cassart, Manuel Paiva, and MarcEstenne. Three-dimensional reconstruction of human diaphragm withthe use of spiral computed tomography. J. Appl.Physiol. 82(3): 998-1002, 1997.We developed atechnique of diaphragm imaging by using spiral computed tomography, andwe studied four normal subjects who had been previously investigatedwith magnetic resonance imaging (A. P. Gauthier, S. Verbanck,M. Estenne, C. Segebarth, P. T. Macklem, and M. Paiva.J. Appl. Physiol. 76: 495-506,1994). One acquisition of 15- to 25-s duration was performed atresidual volume, functional residual capacity, functional residualcapacity plus one-half inspiratory capacity, and total lung capacitywith the subject holding his breath and relaxing. From theseacquisitions, 20 coronal and 30 sagittal images were reconstructed ateach lung volume; on each image, diaphragm contour in the zone ofapposition and in the dome was digitized with the software Osiris, andthe digitized silhouettes were used for three-dimensionalreconstruction with Matlab. Values of length and surface area for thediaphragm, the dome, and the zone of apposition were very similar tothose obtained with magnetic resonance imaging. We conclude thatsatisfactory three-dimensional reconstruction of the in vivo diaphragmmay be obtained with spiral computed tomography, allowing accurate measurements of muscle length, surface area, and shape.

     

Multislice spiral computed tomography in the planning of transcatheter aortic valve replacement

Surgical treatment for aortic valve (AV) pathology is an urgent and important problem of modern medicine. The prevalence of valve disease is great and remains steadily high in the population. Due to a large number of patients who cannot undergo open AV surgery, alternative hybrid treatments are recently being actively improved. Multislice spiral computed tomography (MSCT) is mandatory prior to transcatheter AV replacement as the examination results determine if a hybrid treatment can be performed and the access is transfemoral or transapical. MSCT provides the data necessary to determine the sizes and types of AV prostheses. The application of the current systems of 320-640 spiral tomographs will further improve MSCT as the method of choice in examining patients before transcatheter AV replacement.