目的 探究增强CT联合癌胚抗原(CEA)检测在孤立肺结节(SPN)良恶性判断中的应用效果.方法 选择62例SPN患者为研究对象,分别对其实施增强CT检测及CEA实验室检测,以病理学检查结果为金标准,记录单独增强CT、单独CEA检测以及增强CT联合CEA检测的灵敏性、特异性和准确度,并将3组结果进行对比分析.结果 检测发现,增强CT检测SPN良恶性结果灵敏性为78.95％,特异性为41.67％,准确度为64.52％,CEA检测灵敏性为84.21％,特异性为25.00％,准确度为66.13％,联合检测灵敏性为92.11％,特异性为83.33％,准确度为88.71％;增强CT与CEA联合检测的灵敏度、特异度、准确度均高于二者单独检测.结论 增强CT联合CEA检测能够提高SPN良恶性判断的灵敏性、特异性及准确度,具有一定的临床参考价值.

目的:分析采用体表投影定位的异物钳取术在临床应用的效果.方法:体表投影定位采用CT扫描检查.我院2012年收治795例,通过体内金属异物体表投影定位异物钳取术,共取出1 008个金属异物.结果:所有病人行CT检查定位后,异物全部被取出,取出率为100％,无并发症出现.治疗效果满意.体表投影定位异物钳取术具有切口小(0.4±0.1) cm、出血量少(1.1±0.5) mL、手术时间短(4.1±2.0) min、术后疼痛轻等优点.结论:异物体表投影定位是一项精确、有效的术前定位方法.

Objective:To determine preliminarily the feasibility and a one-stop strategy of CT urography and angiography in one scanning acquisition using 4-slice MDCT. Materials and methods:Seventy-five consecutive patients (41 men and 34 women; mean age 52 years; age range, 22 to 86 years) without evident hydronephrosis who asked for CT urography (CTU) examination received the new technique of CTUA using by 4-MDCT. Twice-bolus protocol consisted of 50 mL of contrast material (300 mg per milliliter of iodine) immediately after urinating at 2~2.5 mL/sec at 0 seconds and 50 mL at 3.5~4 mL/sec at 20 minutes through the forearm vein. CT scanning (CTUA) started with one breath-hold 20 seconds after the second injection with 10 mm of slice thick, 0.75:1 of pitch and 15 mm/rot of speed. Five minutes after the second injection, CT scanning started again using the same parameters for routine CTU. After thin-slice reconstruction of 5 mm thick and 2.5 mm interval, all the images data were then transferred to an ADW 4.2 workstation to post-process by 3D VR software. Excellent rate of visualization of renal parenchyma, urinary tracts, and main arteries on CTUA and CTU images were reviewed and assessed independently first and interpreted agreeably by two experienced radiologists. Statistical analysis was performed using variance analysis (ANOVA) to evaluate the difference, and P 0.05 is considered statistically significant. Results:The technique success rate of CTUA was 100%, and excretory-corticomedullary phase source images were acquired, which the good rate of distinguishing the renal cortex from the medulla and calices was 100% (148/148), while the CTU source images were not well depicted the renal cortex, medulla and calicessimultaneously (P = 0.000). The good opacification of the renal calices, ureter, bladder, and the renal artery, the aorta and iliac artery was achieved in 95.94% (142/148), 94.59% (140/148), 95.95% (71/74), and 87.16% (129/148), 96% (72/75), 81.33% (122/150) of segments, respectively in CTUA, and 100% (148/148), 97.97% (145/148), 98.65% (73/74), 0%, 0%, 0% of segments, respectively in CTU. Urinary tracts were shown slightly better in CTU than in CTUA (P 0.05), but the arteries were shown significantly better in CTUA than in CTU (P = 0.000), and the CTUA could accurately reveal the tumor, stones, inflammation, prostatic hyperplasia, atherosclerosis and all kinds of deformities of urinary tract and vessels. Conclusion:It is technically adequate for a one-stop CTUA to achieve by using a single excretory-corticomedullary phase CT scanning after twice-bolus contrast injection with routine concentration and volume with once venepuncture. It three-dimensionally reveals renal parenchyma, urinary tract and main arteries simultaneously and the renal cortex, medulla and calices are also distinguished clearly.

Objective To compare the application value of the new compressor to traditional one using routine dose contrast media in urography.Materials and Methods76 patients with intravenous urography were divided into two groups,under the same pressure and at the same compression site,one group of patients were treated with the new compressors,the other with the traditional ones.After injection of contrast media,the gray value of contrast media in bladder and kidney pelvis and calices was investigated at 3 min,5 min,7 min,15 min on pressure and at 30 min off pressure.ResultsAs compared to patients adopting tradition compressors,the gray value of contrast media in kidney pelvis of patients adopting the new compressor at 7 min and 15 min was more intensive,whereas gray value of contrast media in bladder at 3 min、5 min and 30 min was less intensive,suggesting the effect of the new compressor was better than that of the traditional compressor in intravenous urography.ConclusionThe compressing effect of new compressor on ureter is superior to the traditional compressor and has a more valuable clinical value in the intravenous urography.

Objective To explore the clinical value of interventional removal of human soft-tissue foreign body(STFB)with double guiding of regional CT virtual anatomy and roentgenoscopy.Methods All of 1315 patients with metal STFBs were divided into 3 groups:Plain film group,plain film plus routine CT group and plain film plus regional CT virtual anatomical group.Volume rendering(VR)with dynamic variable threshold value technique was used to post-process 3-dimensional(3D)CT virtual anatomical images.The feasibility was prospectively estimated,and the specific method of interventional removal of STFBs was determined based mainly on the patients' imaging data.Regional anaesthesia was performed before C-arm fluoroscopy-guided percutaneous removal of STFBs.Results The technical success rate of regional CT virtual anatomy reconstructed by spiral thin-slice CT source imaging data with dynamic variable threshold value technique was 100%.It was more abundant in layers of virtual anatomical images reformed from enhanced CT imaging,the arteries and deep veins unreformed from unenhanced CT imaging could be clearly displayed in 3D images.CT virtual anatomical images precisely evaluated the interventional removability,risk and specific operation method.The safety,success and cure rate of interventional removal of STFBs in plain film plus regional CT virtual anatomical group were significantly higher than other two groups(P0.01).The time of operation and hospital stay was shorter(P0.01),the complication morbidity and the cooperating usage rate of special positioners were lower than other two groups(P0.05).Conclusion Interventional removal of mental STFBs has reliable clinic value and good outcome under double guiding of regional CT virtual anatomy and roentgenoscopy.

自发性胆瘘少见,胆汁漏入腹膜后间隙尤其右侧肾后平面目前鲜见文献报道.笔者诊治1例,报告如下. 患者女,81岁,因油腻饮食后右上腹持续性疼痛2天入院,不伴背部放射痛,无畏寒、发热.30年前曾接受胆囊切除术.既往有糖尿病、冠心病病史.体检:皮肤巩膜轻度黄染,腹平软,右中上腹压痛,无反跳痛,移动性浊音(-).