目的:探讨三维动态增强磁共振血管成像(3D CE-MRA)在双下肢动脉病变成像中对比剂最佳用量.方法:45例我院进行双下肢动脉3D CE-MRA血管成像的患者,根据就诊顺序随机分为A、B和C三组,三组钆对比剂用量分别为0.1、0.2和0.3mmol/kg,分别与盐水进行1:1配比,分别对不同对比剂用量的后处理图像进行主观及客观评分,并对小腿及足部血管进行整体静脉重叠评分,最后采用Wilcoxon检验比较3种扫描方案差异.客观评分是对3组的原始增强图像进行信号强度(SI)、信噪比(SNR)、对比噪声比(CNR)的测量及计算,比较股动脉、胭动脉及小腿动脉水平信号强度差异,进行t检验比较3种扫描方案差异.结果:对比剂用量为0.1mmol/kg时股动脉、胭动脉及小腿动脉的图像质量评分分别为(3.35±0.25)、(2.97±0.25)、(2.35±1.15);对比剂用量为0.2mmol/kg时,上述部位的评分分别为(3.75±0.35)、(3.55±0.32)、(2.97±0.70);对比剂用量为0.3mmol/kg 时,上述部位的评分分别为(3.90±0.41)、(3.83±0.52)、(3.10±0.75).A 组有33.33％图像不满足诊断需要,B组和C组图像全部满足诊断需要,A组与B组差异有统计学意义,B组与C组差异无统计学意义.B和C组的股动脉、胭动脉的SI、SNR、CNR明显高于A组,且B组和C组差异无统计学意义.B组和C组图像优于A组.结论:适当提高对比剂用量有助于提高患者双下肢动脉全程的3D CE-MRA成像质量,0.2mmol/kg的对比剂用量对血管的评估是可靠准确的,能够为临床外周动脉疾患的治疗方案提供准确可靠的影像依据.

目的 通过对煤工尘肺结核和单纯性煤工尘肺2组患者影像资料的对比分析,探讨活动性尘肺结核早期影像诊断特点,为尘肺结核早期影像诊断提供科学依据.方法 收集2018年1月-2020年1月应急总医院及3家合作医院职业病科的煤工尘肺结核患者及单纯性煤工尘肺患者各60例(分别包括壹期、贰期、叁期患者的资料各20例),对2组患者影像资料进行分析、记录,对结果进行分析及统计学处理.结果 正确识别58例煤工尘肺结核,影像诊断正确率96.67％.玫瑰花样小结节、磨玻璃影、树芽征、卫星灶、实变影、空洞、纵隔及肺门淋巴结肿大(直径＞1.5 cm)、支气管壁增厚及扩张、单/双侧胸膜肥厚并胸腔积液等影像学表现在尘肺结核组的检出率分别为100.00％、75.00％、65.00％、41.67％、26.67％、63.33％、58.33％、46.67％和26.67％;单纯性尘肺组检出率分别为3.33％、8.33％、1.67％、0.00％、11.80％、1.67％、6.67％、31.67％和0.以上影像学表现除支气管壁增厚及扩张外,差异均有统计学意义(均P＜0.05).结论 活动性煤工尘肺结核早期薄层CT影像学表现具有特征性,其有助于提高煤工尘肺结核早期诊断率,对尘肺结核早期诊断具有指导意义.

肝豆状核变性(HLD )又称威尔逊病(WD) ,是一种常染色体隐性遗传病,致病基因定位于染色体 13q14.3 的ATP7B ,该基因突变导致 P型铜转运 ATP酶功能减弱或丧失,导致血清铜蓝蛋白合成减少和胆道排铜障碍,铜离子在肝脏、脑、角膜、肾脏等部位沉积,引起进行性加重的锥体外系症状、精神症状、肝硬化、肾功能损害及角膜色素环(K-F环)[1] .妊娠期间发病患者罕见,容易延误诊断.现报道一例孕期发病伴A T P7B基因双突变的病例.

Objective To evaluate the study value of positional change multi-slices helical CT Colonography in colorectal polyps.Methods Total 189 polys in 39 cases were performed with conventional Colonoscopy and underwent multi slices helical CT Colonography between two weeks.The CT Colonography screening in both supine and prone position.Results All the 39 cases showed 203 polys in supine position and 199 polys in prone position scaned.185 polys is noted by combined evaluation when change positional screening in both supine and prone positions,4 polys size＜5mm were missing.Conclusion MS CTC screening in change positional is excellent sensitivity and specificity for colorectal polys,which can provide more accurate informations for clinical diagnosis and treatment.

目的 探讨肾素血管紧张素原(angiotensinogen,AGT) M235T基因多态性与脑白质疏松症(Leukoaraiosis,LA)的相关性.方法 采用聚合酶链反应(PCR)及聚合酶链反应-限制片段长度多态性(PCR-RFLP)及Sequenom系统检测,经头部MRI确诊的202例脑白质疏松症患者及105例经MRI排除LA的正常对照者AGTM235T基因多态性.结果 脑白质疏松症患者AGTMT基因型及T等位基因频率与对照组有明显差异,两组间TF基因型差异无统计学意义.结论 AGT基因MT基因型和T等位基因可能与脑白质疏松症的发病相关.

Objective: To explore a best does (method, standard and accurate calculation) of bone cement in PKP, based on the CT and MRI image data of thoracolumbar vertebrae with new compression fracture. Methods: 42 new compression fracture patients with thoracolumbar vertebrae injury underwent PKP and examined by CT and MRI before surgery no more than 1 week. Retrospectively analyzed the image data and compared the statistical image data followed a variety of reconstruction. Results: Of 42 cases, new compression fracture located in the T10 (n=2), T11 (n=5), T12 (n=9), L1 (n=11), L2 (n=7), L3 (n=5), L4 (n=3). The average fracture compression rate of bone cement in PKP ranged from 1.6 to 6.3ml. Conclusion: It is practicable to predict the best dose of bone cement in PKP that by reprocessing the image of preoperative CT and MRI, which can make the treatment more effective, at the same time, the interrelated complication can be avoided.

Objective To explore the characteristics of cognitive function in the patients with different locations of lesions and severity degrees of white matter lesions (WMLs). Methods A total of 179 WMLs cases and 97 normal brain magnetic resonance imaging (MRI) control cases were included prospectively and demographic information was collected. According to the locations of lesions, WMLs were classiifed into 3 subgroups: subcortical white matter lesions (SWML), periventricular lesions (PVL) group and mixed legions group. Fazekas visual ratings were administered to evaluate the severity of WMLs. Montreal Cognitive Assessment Scale (MoCA) was used to evaluate the cognitive function differences among different locations of lesions and severity degrees of WMLs. According to MoCA, WMLs group can be divided into subgroups WMLs cognitive impairment (116 cases) and the WMLs cognitively normal group (63 cases). The analysis of risk factors for cognitive impairment of patients with WMLs was performed and discussed. Results Total MoCA scores (P﹤0.001), visual space execution ability (P﹤0.001), named (P=0.019), language (P=0.005), abstract understanding (P=0.003) and delayed memory (P﹤0.001) of WMLs group was significantly lower than those of control groups, respectively. The higher Fazekas classiifcation, the signiifcantly lower MoCA scores and the scores of all items (P﹤0.05). Compared with control group, the MoCA scores (allP﹤0.001), visual space execution ability (P﹤0.001), language (P=0.006, 0.022, 0.008), abstract understanding (P=0.003, 0.011, 0.016) and delayed memory (allP﹤0.001) of PVL group, the SWML group and mixed group had signiifcant statistical differences. WMLs subgroup analysis showed that the high level of education was a protection factor for cognitive impairment WMLs. Conclusion High education is the protection factor for cognitive impairment in WMLs patients. The visual space execution ability, delayed memory are more obviously impaired in WMLs patients. The higher severity level of WMLs lesions, the more distinct decrease of the cognitive function. SWML WMLs, PVL WMLs and mixed groups have severe damage in the visual space and execution ability, language, abstract understanding, and delayed memory.

Objective To evaluate the diagnostic value of susceptibility weighted imaging in cavernous hemangioma of extremities soft tissue.Methods Both 50 cases clinical and pathological were confirmed to be Cavernous hemangioma in extremities soft tissue scaned with SWI and Conventional MRI sequences.Results Total of 62 lesions of cavernous hemangioma in extremities soft tissue were detected from the 50 patients, including 8 patients with multiple lesions. Found Ⅰ(node) type 9 patients,Ⅱ(limited mass) type 17, Ⅲ(diffuse vines) type 25 and Ⅳ(hybrid) type 11. 24 lesions are Low return type and 38 lesions are high return type be shown.Conclusion SWI is an important supplement sequence of MRI in the diagnosis of hemangioma in extremities soft tissue, can reflect internal composition and physiological change of the lesions more fully, shows more obviously advantages on the analysis of the abnormal blood vessels,identification of calcification, hemorrhage and iron deposit,and owns important application value for clinical diagnosis, making relevant treatment and estimating prognosis.

Objective To evaluate the study value of multi-slices helical CT angiography and three dimensional dynamic contrast-enhanced MRA in lower extremities arteriosclerotic occlusion disease(ASO).Methods 38 cases of ASO were performed with MS CTA and 3D CE-MRA between two weeks. The CT original axial data was reconstructed by ADW4.6 workstation of MPR, MIP and VR, compared with processed MIP images with MRI. Bilateral lower extremity arterial vascular system of each case was divided into three regions and 23 segments, each segment was evaluated for the presence and degree of vascular stenosis.Results All the 38 cases including 8 cases with mild stenosis, 14 cases with moderate syenosis, 12 cases with significant stenosis and 4 cases with occlusion. The significant disease of the lower extremities were demonstrated clearly by MS CTA and 3D CE-MRA.Conclusion MS CTA and 3D CE-MRA are excellent in patients with clinical symptoms of the arteriosclerotic occlusive disease of lower extremity, which can provide more accurate informations for clinical diagnosis and treatment.

目的 探讨和评估核磁共振PROSET序列在腕管综合征病变中的应用价值.方法 对18例腕管综合征(CTS)患者进行了常规MRI序列及PROSET序列扫描,并进行多种重建及统计的分析.结果 PROSET序列结合常规MRI序列能够更好地显示CTS的腕管解剖结构及正中神经的卡压情况.结论 PROSET序列作为一种重要的补充序列,在评估CTS患者正中神经病变中更加准确,对指导临床选择手术方式及评估预后有重要意义.

目的 探讨在椎-基底动脉系统短暂性脑缺血发作(VB-TIA)患者中,Willis环变异是否为脑白质疏松(LA)的危险因素.方法 回顾性连续选取113例VB-TIA患者,收集患者的性别、年龄、血浆高密度脂蛋白(HDL)、有无颈动脉斑块、头部MRI资料(判断有无LA)、头部MRA资料(判断有无Willis环变异及其类型).根据Willis环变异的4种类型(A型、P型、O型及N型)分为A组、P组、O组、N组,分别对各组间LA发生率进行独立样本x2检验,再以VB-TIA患者伴LA的危险因素及x2检验差异有统计学意义的配对组为自变性,以是否有LA为因变量,进行多因素Logistic回归分析.结果 相较于无Willis环变异(N型)者,A型Willis环变异及O型Willis环变异者LA发病率均较高,差异有统计学意义(P＜0.05),其他各组间LA发病率差异无统计学意义(P均＞0.05).将x2检验差异有统计学意义的配对组(A型-N型、O型-N型)纳入多因素Logistic回归分析.结果显示,A型Willis环变异(P=0.011,OR=7.768,95％ CI:1.602 ～ 37.666)及O型Willis环变异(P=0.009,OR=5.236,95％CI:1.513 ～ 18.519)为VB-TIA患者LA的危险因素.结论 本研究提示,50岁以上VB-TIA患者头部MRA显示的Willis环变异(胚胎型大脑后动脉除外)是LA的危险因素.

目的:通过对中心气道原发鳞状细胞癌(SCC)与腺样囊性癌(ACC)的CT能谱扫描及多参数定量测量,探讨CT能谱成像在二者鉴别诊断中的初步应用价值.方法:选取未经任何治疗、行宝石能谱CT检查的中心气道SCC、ACC患者26例,SCC组14例,ACC组12例.符合增强条件者于平扫及动脉期行能谱扫描,将原始数据进行能谱分析,选取肿瘤实性部分作为测量感兴趣区,测量其平扫时40 keY的CT值、钙含量和水含量;增强扫描动脉期40 keV的CT值、碘含量、水含量,并计算平扫及动脉期相应能谱曲线斜率.采用独立样本t检验分析平扫及动脉期各参数在各组间有无统计学意义.结果:平扫时,SCC组40 keY对应CT值、能谱曲线斜率、钙含量均大于ACC组,差异有统计学意义(P＜0.05),水含量在两组间的差异无统计学意义(P＞0.05).增强扫描动脉期:SCC组40 keV下CT值、能谱曲线斜率、碘含量均高于ACC组,差异有统计学意义(P＜0.05),水含量间差异无统计学意义(P＞0.05).结论:CT能谱成像可作为中心气道原发SCC与ACC鉴别诊断的一种新方法,具有一定临床应用价值.

目的 探讨椎-基底动脉系统短暂性脑缺血发作(VB-TIA)患者脑白质变性(leukoaraiosis,LA)的危险因素.方法 回顾性连续选取313例住院行头颅MRI检查的VB-TIA患者,以所收集的患者性别、年龄、心电图RV5+ SV2电压值(mV)、是否有颈动脉斑块、C-反应蛋白(CRP)、胆固醇(TC)、高密度脂蛋白(HDL)、三酰甘油(TG)、低密度脂蛋白(LDL)、尿酸(UA)、同型半胱氨酸(Hcy)、糖化血红蛋白(HbA1c)、叶酸(FA)、维生素B12水平(VB12)等临床资料为自变量,以是否并发LA为因变量,先对各自变量分别进行单因素Logistic回归分析,再对单因素分析有统计学意义自变量进行多因素Logistic回归分析.结果 并发LA的VB-TIA患者与未并发LA的VB-TIA患者间年龄、心电图RV5+ SV2电压值、CRP、HDL、Hcy、FA和颈动脉斑块发生率比较差异有统计学意义(P＜0.1);将上述单因素Logistic回归分析有统计学意义的自变量纳入多因素Logistic回归分析进行校正,结果显示年龄增长(P=0.000,OR=1.116,95％CI:1.081～1.153)、颈动脉斑块(P=0.000,OR=4.881,95％CI:2.510～9.493)和低HDL水平(P=0.017,OR=3.676,95％ CI:1.267～ 10.638)为VB-TIA患者并发LA的独立危险因素.结论 年龄增长、颈动脉斑块及低HDL水平可能为VB-TIA患者LA发生的独立危险因素.

目的 探讨阑尾穿孔具有诊断价值的CT征象.方法 回顾性分析205例经手术病理证实的穿孔性和非穿孔性阑尾炎患者的CT图像.观察12项急性阑尾炎的CT征象,采用χ2检验筛选可用于鉴别诊断穿孔性与非穿孔性阑尾炎的CT征象,评价这些征象的敏感度、特异度和准确率.采用Logistic回归分析法分析阑尾穿孔最具诊断价值的CT征象.结果 205例中,40例(40/205,19.51％)阑尾穿孔与165例(165/205,80.49％)阑尾未穿孔患者间,脓肿、阑尾壁强化缺损、蜂窝织炎、阑尾腔外积气、阑尾腔外粪石差异均有统计学意义(P均＜0.05),各征象鉴别诊断穿孔性和非穿孔性阑尾炎的敏感度、特异度和准确率依次分别为:脓肿80.00％(32/40)、97.58％(161/165)、94.15％(193/205),阑尾壁强化缺损50.00％(20/40)、98.79％(163/165)、89.27％(183/205),蜂窝织炎37.50％(15/40)、95.76％(158/165)、84.39％(173/205),阑尾腔外积气27.50％(11/40)、99.39％(164/165)、85.37％(175/205),阑尾腔外粪石5.00％(2/40)、100.00％(165/165)、81.46％(167/205),Logistic回归分析显示脓肿、阑尾壁强化缺损与阑尾穿孔相关(Wald=33.21、16.19,P均＜0.001).结论 脓肿、阑尾壁强化缺损是阑尾穿孔最有诊断价值的CT征象.

马德隆畸形是腕部少见疾病,主要指由于桡骨远端内侧骨骺发育障碍、外侧骨骺及尺骨发育正常而造成的腕部骨骼畸形.以往主要依据X线表现的桡骨干短而弯曲、桡骨远端关节面向尺侧倾斜以及腕骨呈三角形排列等特征进行诊断[1-3].随着MRI技术的研究进展,学术界对于马德隆畸形的发生、发展及诊断等方面提出了一些新的观点[4-8].本文就其病因、X线诊断及MRI表现等相关研究作一综述.

目的:探讨中心气道原发肿瘤的CT表现,提高该病的CT诊断水平.方法:回顾性分析经病理证实的189例中心气道原发肿瘤患者的基本临床资料及CT表现.分析内容包括:患者的性别、年龄,肿瘤的生长部位、大小、形态、边缘、密度、强化程度、纵隔淋巴结及肺内情况.结果:男138例,女51例;患者年龄3～84岁(平均年龄56.3岁±17.7岁);恶性肿瘤165例、良性24例;肿块直径3～67 mm,平均(25±18.6) mm;肿块位于气管73例,隆突8例,左主支气管37例,右主支气管28例,中间段支气管12例;肿块表现为管内型35例,管壁型29例,管外型6例,混合型88例;病变表面光滑40例,不光滑118例,宽基底138例,窄基底20例;37例肿瘤内有坏死,3例瘤内有钙化;47例纵隔及肺门淋巴结肿大,12例合并肺内转移,8例合并胸腔积液,75例合并肺不张及阻塞性肺炎.结论:不同类型的中心气道肿瘤在CT影像表现上具有一定特点.

[Objective]To discuss the consistence between Digital Radiography(DR) and high kilovoltage(high-kV) chest radiographs in diagnosis of coal workers' pneumoconiosis,evaluate the application value of DR chest radiograph in diagnosis of pneumoconiosis.[Methods]104 coal workers selected from a Coal Mining Group were examined by high-kV and DR chest radiographs.The patients were all men;the range of their age was from 35 to 70 years old,the average was(51.74 ± 9.30) years old;the length of exposure to dust was 9 ~ 40 years,the average was(24.74 ± 13.30) years.The shape,intensity and stages of small opacity of high-kV and DR chest radiographs of 104 coal workers were diagnosed by three diagnostic physicians.The data was checked consistency,which were evaluated by the concordance rate and Kappa(K).[Results]①The diagnosis consistency of the small opacity shape between DR and high-kV chest radiographs was 61.54%,among the concordance rate of p,q,s and t were 15.63%,79.69%,1.56% and 3.13% respectively.The inconsistent diagnostic rate was 38.46%,among the difference of p /q was larger(77.5%).②The diagnosis consistency of the intensity of pulmonary nodules between DR and high-kV chest radiographs was81.75%,among the concordance rate of the grade 0,1,2 and 3 were 11.76%,61.18%,24.71%,and 2.35%.The inconsistent diagnostic rate was 18.27%,among high diagnostic rate of DR was 52.63% and low diagnostic rate was 47.37%.③The consistency of DR and high-kV chest radiographs in diagnosing the stage of pneumoconiosis was 81.73% and the value of Kappa was0.714(P 0.05),among the observation object,stageⅠ,Ⅱ and Ⅲ accounted for 11.54%,36.54%,32.69% and 0.96% respectively.Compared to the gold standard of high-kV chest radiographs,the low diagnostic rate of DR in diagnosing the stageⅠof pneumoconiosis was 7 /51(13.72%),and the high diagnostic rate was 6 /51(11.76%).The low diagnostic rate of stage II was2 /40(5%),and the high diagnostic rate was 0%.The diagnosis consistency of observation object and stage III was 100%.[Conclusion]①There is a better consistency of DR and high-kV chest radiographs in diagnosing the shape of small opacity,but there are differences in diagnosing the shape of p or q small opacity.②There is a good consistency of DR and high-kV chest radiographs in diagnosing the overall density of pneumoconiosis,but there are differences of two methods in diagnosing the density which is 0 or 1.③There is a good consistency of DR and high-kV chest radiographs in diagnosing the stage of pneumoconiosis.④The method of DR has the better application value in diagnosing the pneumoconiosis.

目的 探讨急性阑尾炎螺旋CT征象的诊断价值.方法 回顾性分析经手术病理和随访观察证实的205例阑尾炎患者和100例阑尾正常者的CT资料.观察分析阑尾增大、阑尾壁增厚、阑尾壁强化、阑尾壁强化缺损、阑尾周围脂肪内条纹、盲肠顶局部增厚、阑尾粪石、阑尾腔外积气、阑尾腔外粪石、蜂窝织炎、阑尾腔外积液、阑尾周围脓肿、淋巴结肿大等13项指标,用卡方检验统计学方法选出急性阑尾炎的CT诊断征象,并对这些征象的敏感性和特异性进行评价.结果 13种征象的敏感性和特异性中:阑尾增大(98.5％,98％)、阑尾壁增厚(96％,99％)、阑尾壁强化(97.6％,99％)、阑尾壁强化缺损(6.3％,99％)、阑尾周围脂肪内条纹(99.5％,90％)、盲肠顶肠壁增厚(53.7％,97％)、蜂窝织炎(17.1％,92％)、脓肿(16.6％,95％)8种征象对急性阑尾炎诊断有统计学意义(x2=282.804、266.897、278.887、4.379、257.254、73.957、4.569、8.090,P＜0.05).结论 阑尾增大、阑尾壁增厚、阑尾壁强化、阑尾周围脂肪内条纹4个征象对阑尾炎诊断的敏感性和特异性较高,而阑尾壁强化缺损、盲肠顶肠壁增厚、蜂窝织炎、脓肿4个征象特异性较高,但敏感性较低.

目的:探讨64排螺旋CT对稳定性骨盆骨折的评估价值.方法:收集2009年7月～2012年8月连续44例经64排螺旋CT检查确诊为稳定性骨盆骨折的门急诊患者影像数据,并重新采用多层面重建(MPR);最大密度投影(MIP)和容积重建(VR)等多种后处理技术进行了回复性分析.结果:全部病例均为Tile A型,其中16例A1型和28例A2型,MDCT 3D可以准确评估骨盆骨折的部位、类型、程度及并发症等,符合临床诊断要求.结论:64排螺旋CT联合应用多种重建技术对稳定性骨盆骨折的评价是可靠和准确的,尤其对并发症的评估可以为临床提供更多的诊断信息,能够为临床采取及时有效的治疗提供更准确可靠的影像依据.

OBJECTIVETo analyze the relationship between the pathological features and 64-multislice spiral computed tomography (64-MSCT) findings of pulmonary nodules in autopsies from patients with coal workers' pneumoconiosis (CWP), to investigate the optimal imaging method for the distribution of pulmonary nodules, and to provide data for the establishment of CT diagnostic criteria for CWP.METHODSCadaveric lung specimens were collected from 7 CWP patients. All of them were men, aged 42∼77 years (mean, 60.00±13.00 years), and their dust exposure time was 5∼30 years (mean, 15.4±8.01 years). The cadaveric lung specimens were treated by aeration, sectioning, and immobilization and were then examined by coronary 64-MSCT. The primitive images were reconstructed into the maximumintensity projection (MIP) images (slice thickness: 3 mm, 5 mm, and 8 mm). The sensitivities of imaging methods with different slice thickness were evaluated based on the pathology and anatomy of local pulmonary nodules, and the correlation between pathological results and radiological findings was analyzed.RESULTSThere were significant differences between the stages determined by pathological examination and high-kV chest radiography (before death) (χ(2) = 4.667, P < 0.05; kappa value = 0.167, P < 0.05). A total of 271 nodules were found in all pathological sections, including peribronchovascular nodules (27, 9.9%), centrilobular nodules (67, 24.6%), interlobular nodules (65, 24.3%), nodules within 5 mm from the pleura (45, 16.5%), pleural plaque-like nodules on the lateral chest wall (45, 16.5%), and nodules on the interlobar pleura (22, 8.1%). The likelihood ratio was the highest (0.981) between 5-mm MIP images and pathological results according to the chi-square test.CONCLUSIONThe stage of pulmonary nodules determined by pathological examination is significantly different from that determined by high-kV chest radiography. The 5-mm MIP images of 64-MSCT provide a good reflection of the local pathology and anatomy of pulmonary nodules in CWP patients.