结节或肿块型不典型肺结核的CT表现及误诊原因分析

目的探讨结节或肿块型不典型肺结核的CT表现及误诊原因。方法选择2009年1月~2016年12月在我院行CT诊断被误诊为肺癌的32例结节或肿块型不典型肺结核患者以及45例肺癌患者为研究对象,观察肺结核患者病变的形态、部位、大小、密度、增强以及边缘等征象,分析误诊原因,并比较分析肺癌患者与肺结核患者的CT征象。结果误诊原因:(1)患者的临床表现不存在特征性,经细菌培养未发现结核杆菌;(2)患者的病灶部位不存在特征性,发生在各个肺段;(3)患者的病灶表现为结节状肿块,属于不典型结核的影像学表现。与肺癌患者的CT影像学分析比较,肺癌的CT影像学表现为深分叶征、短毛刺征、支气管充气征、空泡征、胸膜凹陷征、血管集束征等出现的概率均大于肺结核,差异有统计学意义(P0.05)。肺癌患者显著增强的概率大于肺结核患者,差异有统计学意义(P0.05)。肺结核的CT影像学表现为浅分叶征、长毛刺征以及轻度强化的出现概率大于肺癌患者,差异有统计学意义(P0.05)。结论在结节或肿块型不典型肺结核患者的CT表现中,浅分叶征、长毛刺征以及轻度强化等比较多见,而深分叶征、短毛刺征、支气管充气征、空泡征、胸膜凹陷征、血管集束征较少见。     

不同剂量多排螺旋CT扫描对儿童肺结核的诊断价值比较研究

目的:探讨不同剂量多排螺旋CT扫描对儿童肺结核(PTB)的诊断价值。方法:以我院于2016年5月～2018年11月收治的156例PTB患儿为研究对象,根据患儿年龄分为A组52例(0～5岁)、B组52例(6～9岁)、C组52例(10～14岁)。三组患儿均进行低剂量64排螺旋CT扫描,其中A组剂量为20 MA,B组剂量为30 MA,C组剂量为40 MA,2 d后,三组患儿均进行常规剂量64排螺旋CT扫描,其中A组剂量为100 MA,B组和C组剂量均为150 MA。分别对比A组、B组、C组患儿低剂量与常规剂量CT扫描的扫描效果、图像优良率及辐射剂量。结果:A组、B组、C组患儿低剂量与常规剂量CT扫描对病灶数量、结节、空洞、胸膜粘连、钙化灶的显像率比较差异无统计学意义(P0.05),但A组、B组、C组患儿低剂量CT扫描对毛刺、磨玻璃影的显像率明显低于常规剂量CT扫描(P0.05);A组、B组、C组患儿低剂量与常规剂量CT扫描的图像优良率比较差异无统计学意义(P0.05);与常规剂量CT扫描相比,A组、B组、C组患儿低剂量CT扫描的剂量长度乘积(DLP)、CT剂量指数(CTDIvoI)、CT加权剂量指数(CTDIw)、放射剂量明显更低(P0.05)。结论:使用常规剂量多排螺旋CT扫描对PTB儿童毛刺、磨玻璃影的显像效果较好,但是使用低剂量多排螺旋CT扫描同样能够确保图像的质量,达到诊断要求,并且能够降低对患儿的辐射剂量,在考虑人体健康的前提下,建议使用低剂量多排螺旋CT扫描。     

128层螺旋CT 低剂量扫描检查孤立性肺内结节性病灶的研究

目的:探讨多排螺旋CT(128排)低剂量扫描参数下检查孤立性肺内结节的可行性研究。方法:随机连续搜集我院低剂量(30m A)CT肺体检者,发现肺内结节病灶患者13例,对其进一步以常规剂量(350m A)CT精细扫描,比较低剂量扫描及常规剂量扫描肺结节大小差异。结果:两种剂量扫描策略均检查出46枚结节。常规剂量与低剂量测得各部位结节体积分别为:肺尖部:(431.3±92.8)mm~3,(658.4±94.4)mm~3,肺中部:(3025.8±526.7)mm~3,(2989.4±520.4)mm~3,肺底部:(1241.5±438.9)mm~3,(1266.0±447.6)mm~3,肺尖部肺结节大小差异明显,肺中部及肺底部肺结节大小均无显著性差异(P0.05)。常规剂量与低剂量测得结节体积(除外肺尖部位结节5枚)分别为,组1:(39.8±14.6)mm~3,(40.7±15.5)mm~3;组2:(202±106.3)mm~3,(204.1±103.6)mm~3;组3:(4179.7±4410.4)mm~3,(4190.5±4487.2)mm~3。三组组内测量结果均无显著性差异(P0.05)。常规剂量与低剂量测得非实性结节密度[(-68.3±24.2)HU,(-64.6±22.8)HU]及实性结节结节密度[(97.5±69.5)HU,(107.2±90)HU]均无统计学差异(P0.05)。结论:低剂量更加有利于肺内孤立结节患者扫描复查病灶,可以应用推广。     

64层螺旋CT不同剂量扫描对活动性继发性肺结核患者诊断价值、图像质量和辐射剂量的影响

目的:研究64层螺旋CT不同剂量扫描对活动性继发性肺结核患者诊断价值、图像质量和辐射剂量的影响,旨在为临床活动性继发性肺结核患者提供更为安全有效的检查方案。方法:将我院从2018年1月2020年1月收治的100例活动性继发性肺结核患者纳入研究。对所有患者分别进行低剂量(40 m A)以及常规剂量(120 m A)扫描和薄层重建。比较不同剂量扫描的诊断准确率、影像学表现、图像质量以及辐射参数、患者满意度。结果:64层螺旋CT低剂量扫描与常规剂量扫描诊断活动性继发性肺结核的准确率分别为92.00%、93.00%,两者比较差异无统计学意义(P>0.05)。低剂量扫描及常规剂量扫描在空洞、钙化灶、实变、磨玻璃密度影及树芽征发生率方面对比差异均无统计学意义(P>0.05)。低剂量扫描及常规剂量扫描在扫描图像质量、薄层重建图像质量方面对比差异均无统计学意义(P>0.05)。低剂量扫描各项扫描辐射参数均低于常规剂量扫描,差异有统计学意义(P<0.05)。低剂量扫描的患者满意度高于常规剂量扫描的患者(P<0.05)。结论:64层螺旋CT不同剂量扫描对活动性继发性肺结核患者的诊断价值及生成的图像质量相近,但低剂量扫描可有效降低辐射剂量,从而在一定程度上增加扫描的安全性,使患者满意度提升。     

低剂量和常规剂量螺旋CT动态扫描对慢性阻塞性肺疾病患者辐射剂量、成像质量及满意度的影响

摘要 目的：探讨低剂量和常规剂量螺旋CT动态扫描对慢性阻塞性肺疾病（COPD）患者辐射剂量、成像质量及满意度的影响。方法：选取我院于2019年1月~2020年1月收治的初步诊断为COPD的患者88例。将患者采用单双号分组法分为低剂量组和常规组,各44例。低剂量组采用低剂量螺旋CT动态扫描,常规组采用常规剂量螺旋CT动态扫描。比较两组的辐射剂量、成像质量以及COPD的诊断结果。比较两组满意度评分。结果：低剂量组CT剂量加权指数（CTDIw）、剂量长度乘积（DLP）以及有效辐射剂量（ED）均明显低于常规组,差异有统计学意义（P<0.05）。常规组成像质量的优秀率明显高于低剂量组（P<0.05）,但两组成像质量的优良率对比无明显差异（P>0.05）。低剂量组灵敏度、特异度与常规组比较差异无统计学意义（P>0.05）。低剂量组患者满意度评分明显高于常规组（P<0.05）。结论：低剂量螺旋CT动态扫描对于COPD的诊断价值与常规剂量CT动态扫描相当,且可以保证成像质量,同时其能明显降低辐射剂量、提高COPD患者满意度,具有一定的临床应用价值。     

高分辨率CT与常规CT检查对肺小结节及早期肺癌诊断价值的对比研究

目的:对比高分辨率电子计算机断层扫描(CT)与常规CT检查对肺小结节及早期肺癌的诊断价值。方法:将2018年6月2020年1月我院收治的肺小结节及早期肺癌患者94例纳入研究。以随机数字表法将其分为观察组及对照组,每组各47例,对照组实施常规CT检查,观察组则实施高分辨率CT检查。比较两组CT肿瘤征象情况(主要包括毛刺征、分叶征、棘突征、钙化征、空泡征、支气管征、胸膜凹陷征、血管集束征),CT扫描图像质量,诊断肺小结节及早期肺癌的效能。结果:观察组各项CT肿瘤征象人数占比均高于对照组(P<0.05)。观察组CT扫描图像质量优良率为97.87%(46/47),高于对照组的72.34%(34/47)(P<0.05)。高分辨率CT诊断早期肺癌的灵敏度及准确度、特异度分别为96.67%(29/30)、95.74%(45/47)、94.12%(16/17),高于常规CT检查的74.19%(23/31)、74.47%(35/47)、75.00%(12/16)。结论:高分辨率CT检查对肺小结节及早期肺癌诊断价值显著高于常规CT检查,可作为临床肺小结节及早期肺癌诊断的有效影像学手段,值得临床应用。     

多层螺旋CT低剂量扫描技术在胸部的应用价值

目的研究多层螺旋CT低剂量扫描技术对肺部疾病的诊断价值。方法将51例胸部CT检查者在同一时间分别行常规剂量（200mAs）与低剂量（25mAs）扫描。评定2种剂量对肺部CT常见征象的显示能力。结果在肺部CT常见征象的显示中,除病灶内结节的显示率低剂量扫描较常规剂量低外,其余征象如：钙化、毛刺、支气管征、形态和边缘等二者均无显著差异。结论胸部低剂量扫描技术能作为健康体检或肺部疾病治疗后复查的首选方法。     

多层螺旋CT低剂量扫描在小儿胸部的应用探讨

目的:评价小儿胸部多层螺旋CT低剂量与常规剂量扫描的图像质量,探讨低剂量扫描在小儿胸部应用的可行性。材料与方法:(1)随机选择肺部感染的患儿30例,先常规剂量(150mAs)扫描,再在感染灶局部加作低剂量扫描,剂量为50,35及15mAs。其他参数为:120kV,床进28.8mm/圈,0.5s/圈,16×1.5mm准直,重建层厚及间隔均为3mm。分别记录不同剂量扫描时的CT权重剂量指数(CTDIw)及剂量长度乘积(DLP)。(2)由2位高年资医师按优、良、合格及不合格的等级盲法评价不同剂量的图像质量,结果进行统计学处理。结果:(1)小儿胸部35mAs和15mAs的CTDIw与常规剂量150mAs的比值分别为23.0%及10.0%,其DLP与常规剂量比值为23.3%和10.0%。(2)图像质量评价结果:150,50,35,15mAs的可诊断图像χ2检验,肺窗P>0.05,纵膈窗P<0.05,提示上述剂量肺窗图像差异无显著性意义,纵膈窗图像差异有显著性意义。用150,50,35mAs的可诊断图像进行χ2检验,P>0.05,提示其差异亦无显著性意义。结论:多层螺旋CT低剂量扫描适用于小儿胸部检查,在保证图像质量的前提下,采用35mAs左右的扫描条件较为适宜。     

低剂量与常规剂量扫描在CT引导下经皮穿刺肺活检术中的临床应用价值对比研究

摘要 目的：比较低剂量与常规剂量扫描在CT引导下经皮穿刺肺活检术中的临床应用价值。方法：选择2018年1月至2019年12月我院行CT引导下经皮穿刺肺活检术的患者96例,采用随机数字表法分为低剂量组和常规剂量组,每组48例,两组分别在低剂量扫描、常规剂扫描下行CT引导下经皮穿刺肺活检术,比较两组扫描范围、X射线剂量、图像质量、穿刺成功率及并发症发生情况。结果：低剂量组CT吸收剂量加权指数（CTDIw）、平均剂量长度乘积（DLP）显著低于常规剂量组（P<0.05）,两组扫描范围比较无统计学差异（P>0.05）。低剂量组图像质量1级1例、2级1例、3级46例;常规剂量组1级0例、2级1例、3级47例,两组图像质量比较无统计学差异（P>0.05）。低剂量组穿刺成功率87.50%,常规剂量组穿刺成功率89.58%,两组穿刺成功率比较无统计学差异（P>0.05）。低剂量组并发症发生率为12.50%,常规剂量组并发症发生率为10.42%,两组并发症发生率比较差异无统计学意义（P>0.05）。结论：与常规剂量扫描相比,在CT引导下经皮穿刺肺活检术中应用低剂量扫描可以有效降低辐射剂量,但不影响图像质量和穿刺成功率,患者并发症发生率也未增加,具有较好的临床价值。     

双源CT低剂量适应性序列扫描技术在心律不齐患者冠状动脉CT血管造影(CTA)中的应用价值探讨

目的:探讨双源CT低剂量适应性序列扫描技术在心律不齐患者冠状动脉CT血管造影(CTA)中的应用价值,提高患者的临床治疗效果。方法:选取某院2012年5月至2014年5月收治的120例实施双源CT冠状动脉血管造影检查的心律不齐患者作为研究对象,按照收治先后分为对照组和研究组各60例。其中对照组采用常规回顾性心电门控螺旋扫描;研究组采用低剂量适应性序列扫描,收集两组患者的辐射剂量数据并绘制表格进行分析比对工作。结果:根据两组患者冠状动脉血管显像情况,研究组患者辐射剂量为(3.2±0.7)mSv,明显低于对照组(7.8±0.5)mSv,差异经过统计学处理具有统计学意义(P0.05)。结论:双源CT低剂量适应性序列扫描技术对心律不齐患者进行冠状动脉CT血管造影检查时能够有效降低辐射剂量,具有较高的应用价值,值得在实际临床治疗中推广使用。     

Radiation dose in repeated CT guided radiofrequency ablations

ObjectiveTo calculate the cumulative effective and skin doses in patients that underwent repeated CT guided radiofrequency ablations (RFA).Materials and methodsFrom all patients that had undergone RFA during a five years period those which had three or more RFAs were selected. Using the CT images DICOM data, the dose length product (DLP), effective dose (E), skin dose profiles as well as the peak skin dose (PSD) were calculated, using appropriate methods and software developed for this purpose. For each patient, cumulative DLP and E were also calculated from the sum of the respective figures of each individual procedure. To calculate PSD, the skin dose profiles of each procedure were overlaid on the same Z-axis scale using anatomical landmarks for reference and the skin doses to each point were summed up.ResultsFive patients were studied; four had undergone 3 RFAs and one 10 RFAs. Cumulative DLP, E and PSD ranges were 5.6–22.3 Gy cm, 0.08–0.36 Sv and 0.8–3.4 Gy, respectively. Median E and PSD values per RFA were 35 mSv and 0.4 Gy, respectively. For comparison purposes it must be noted that in this CT department a routine abdomen-pelvis scan results to an E of about 10 mSv.ConclusionsPatients that undergo repeated RFAs are exposed to considerably high radiation exposure levels. When these patients are in the final stage of malignant diseases, stochastic effects may not be of major concern. However, optimization of the exposure factors and monitoring of these patients to avoid skin injuries are required.     

Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures

PurposeThe feasibility of setting-up generic, hospital-independent dose alert levels to initiate vigilance on possible skin injuries in interventional procedures was studied for three high-dose procedures (chemoembolization (TACE) of the liver, neuro-embolization (NE) and percutaneous coronary intervention (PCI)) in 9 European countries.MethodsGafchromic® films and thermoluminescent dosimeters (TLD) were used to determine the Maximum Skin Dose (MSD). Correlation of the online dose indicators (fluoroscopy time, kerma- or dose-area product (KAP or DAP) and cumulative air kerma at interventional reference point (K_a,r)) with MSD was evaluated and used to establish the alert levels corresponding to a MSD of 2 Gy and 5 Gy. The uncertainties of alert levels in terms of DAP and K_a,r, and uncertainty of MSD were calculated.ResultsAbout 20–30% of all MSD values exceeded 2 Gy while only 2–6% exceeded 5 Gy. The correlations suggest that both DAP and K_a,r can be used as a dose indicator for alert levels (Pearson correlation coefficient p mostly >0.8), while fluoroscopy time is not suitable (p mostly <0.6). Generic alert levels based on DAP (Gy cm²) were suggested for MSD of both 2 Gy and 5 Gy (for 5 Gy: TACE 750, PCI 250 and NE 400). The suggested levels are close to the lowest values published in several other studies. The uncertainty of the MSD was estimated to be around 10–15% and of hospital-specific skin dose alert levels about 20–30% (with coverage factor k = 1).ConclusionsThe generic alert levels are feasible for some cases but should be used with caution, only as the first approximation, while hospital-specific alert levels are preferred as the final approach.     

Current use of the EPA uncertainty factor approach in New Jersey standards and risk assessment

The derivation of the uncertainty factors used in the construction of reference doses for 61 chemicals of regulatory concern to the state of New Jersey were evaluated. Frequency of use of uncertainty factor variables was enumerated with the aim of providing a guide to existing methodology in the analysis of critical studies by the United States Environmental Protection Agency.     

Estimates of the number of patients with high cumulative doses through recurrent CT exams in 35 OECD countries

PurposeTo estimate the number of patients in OECD (Organization for Economic Co-operation and Development) countries who receive a cumulative effective dose (CED) ≥ 100 mSv from recurrent computed tomography (CT) exams.MethodsTaking into account recently published data on the number of CTs per patient and the fraction of patients with CED ≥ 100 mSv as well as country-specific data for the number of CT exams/1,000 population from OECD publication, this paper makes estimations for 35 OECD countries.ResultsThe estimated total number of patients with CED ≥ 100 mSv for all 35 OECD countries combined in a 5-year period is around 2.5 million (2,493,685) in a population of 1.2 billion (1,176,641,900), i.e., 0.21% of the population. Expressed per 1,000 population, the range is from 0.51 for Finland to 2.94 for the US, a nearly six-fold difference. Countries with more than 2 patients with CED ≥ 100 mSv in a 5-yr period per 1,000 population are: Belgium, France, Iceland, Japan, Korea, Luxembourg, Portugal, Turkey, and US.ConclusionsThe first estimates of the number of patients likely receiving CED ≥ 100 mSv through recurrent CT exams in 35 OECD countries indicate that 2.5 million patients reach this level in a 5-year period. There is an urgent need for various stakeholders including medical physicists, referring physicians, health policy makers, manufacturers of CT equipment and epidemiologists to attend to the issue in the interest of patient radiation safety.     

Toxicity,Safety, and Efficacy Studies on Mesenchymal Stem Cells Derived from Decidua basalis in Wistar Albino Rats by Intravenous and Subcutaneous Routes

Ex vivo expanded decidua-basalis(DB)-derived mesenchymal stem cells (MSCs) obtained from single donors have demonstrated therapeutic benefits in in vitro and in vivo studies. In this report, the intravenous and subcutaneous administration of DB-MSCs obtained from five healthy donors was assessed considering clinical grade proliferation, accessibility, and toxic effects in Wistar albino rats. The ability of the obtained DB-MSCs for differentiating, as well as their expression of several cell surface markers and immunomodulatory activities, were all assessed. Clinical standard proliferated cells were administered to animals intravenously and subcutaneously in a series of preclinical models in order to assess their in vivo toxicity, general safety, and tumorigenic possibilities. We established that DB cells exhibit structural and functional traits with MSCs. At various doses supplied intravenously or subcutaneously, the research showed no fatality, abnormal response to therapy, or substantial pathological modifications in the rats. Furthermore, there was no indication of prenatal damage in the same animal species when the rats were repeatedly treated with DBMSCs. Thus, DBMSCs were demonstrated to be non-toxic, non-teratogenic, and non-tumorigenic. To determine whether they can be administrated to human patients without risk, more investigation is recommended.     

A method for assessing alternative effects functions that uses simulation with EMDEX data

A method for evaluating a variety of alternative biologically plausible effects functions through the use of simulation studies conducted on personal-monitor exposure data is described. Using magnetic field time series collected with EMDEX instruments, we demonstrate how the method can be used to explore (1) how the outputs from various effects functions simulations compare to the results obtained by assuming that effects are proportional to time average field strength; (2) how the results of epidemiological studies might be used to assess the relative likelihood that each of the alternative effects functions describes biological reality; and (3) how the results might be used to assess possible health risks. Although the available data are sufficient to demonstrate the general method, they are not yet sufficient to support actual discrimination among possible alternatives. The arguments on the use of the method are for illustrative purposes only. © 1995 Wiley-Liss, Inc.     

320排动态容积CT冠脉成像双低扫描的可行性研究

目的:通过与常规冠脉造影(Digital Signature Algorithm,DSA)对比评估双低扫描(低放射剂量,低造影剂量)方案在320排动态容积CT冠脉成像(coronary angiography with CT,CCTA)中应用的可行性。方法:选取2014年5月2015年8月完成CCTA双低扫描30例患者为双低组,双低组根据患者体重指数采取相应的管电压(BMI重指数采取相应的管电压(BMI≤25 kg/m~2:80 kv,25 kg/m~2BMI≤28 kg/m~2:100 kv,BMI〉28 kg/m~2:120 kv),造影剂浓度选用320 mg I/m L,接受0.6 m L/kg的对比剂;完成双低扫描的30例患者并在CCTA检查的前后两周内同时完成了DSA检查为对照组,另外完成CCTA常规扫描检查的30例患者为常规组,电压设置为常规使用的120 kv管电压,造影剂浓度选用370 mg I/m L,以及均接受造影剂的量为65 m L。结果:与DSA比较,CCTA对诊断冠脉狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为91%、94%、92%、93%,在诊断冠脉狭窄方面没有明显统计差异;与常规扫描比较,CCTA有效辐射剂量降低了约62%。结论:应用双低扫描的CCTA检查具有与DSA几乎同样的图像诊断质量,有效辐射剂量有了大幅度减低。     

Measurement-based model of a wide-bore CT scanner for Monte Carlo dosimetric calculations with GMCTdospp software

The aim of this work was to create a model of a wide-bore Siemens Somatom Sensation Open CT scanner for use with GMCTdospp, which is an EGSnrc-based software tool dedicated for Monte Carlo calculations of dose in CT examinations.The method was based on matching spectrum and filtration to half value layer and dose profile, and thus was similar to the method of Turner et al. (Med. Phys. 36, pp. 2154–2164). Input data on unfiltered beam spectra were taken from two sources: the TASMIP model and IPEM Report 78. Two sources of HVL data were also used, namely measurements and documentation. Dose profile along the fan-beam was measured with Gafchromic RTQA-1010 (QA+) film. Two-component model of filtration was assumed: bow-tie filter made of aluminum with 0.5 mm thickness on central axis, and flat filter made of one of four materials: aluminum, graphite, lead, or titanium.Good agreement between calculations and measurements was obtained for models based on the measured values of HVL. Doses calculated with GMCTdospp differed from the doses measured with pencil ion chamber placed in PMMA phantom by less than 5%, and root mean square difference for four tube potentials and three positions in the phantom did not exceed 2.5%. The differences for models based on HVL values from documentation exceeded 10%. Models based on TASMIP spectra and IPEM78 spectra performed equally well.