Objective To evaluate the value of non-gated 64 multi-slice CT in left atrium and pulmonary vein imaging. Methods The clinical data of 127 patients with atrial fibrillation who had underwent radiofrequency catheter ablation from September 2015 to December 2017 were retrospectively analyzed. Among them, non- gated technique scanning was used in 107 cases (non- gated technique group), and gated technique scanning was used in 20 cases (gated technique group). The volume rendering (VR) of post-processing technique was used to observe the anatomic structures of the left atrium and pulmonary vein. Results In non-gated technique group, there were 101 cases with good left atrial filling, 4 cases with acceptable filling and 2 cases with poor filling; in gated technique group, there were 18 cases with good left atrial filling and 2 cases with acceptable filling. There was no statistical difference in the image quality of left atrium between 2 groups (P>0.05). Among 107 patients of non- gated technique group, the standard type of 4 pulmonary veins was in 90 cases (84.1％), and the variation of pulmonary veins was in 17 cases (15.9％). Conclusions The anatomic structures of pulmonary veins and left atrium could be displayed clearly in non-gated 64 multi-slice CT with reconstruction techniques, which has important value in the guidance of radiofrequency catheter ablation for treatment of atrial fibrillation.

Objective To evaluate and recognize the molybdenum-rhodium target X-ray mammography charactistics of ductal carcinoma in situ(DCIS) of the breast. Methods All molybdenum-rhodium target X-ray mammography data of 59 patients with histologically proved DCIS were analyzed retrospectively. Imaging findings of ductal carcinoma in situ and its relationship with pathology were analyzed. Results Among the 59 patients, 49 were microcalcifications, 10 were non-calcifications. There was marked difference between the calcification and non-calcification. Conclusion The mammgraphy is a new technique using in the DCIS, and its features is helpful in identifying patients with high-risk DCIS.

随着隆乳美体术的广泛开展，乳腺假体植入后的致癌性、假体破裂、漏出及感染等不安全因素有所增加，给隆乳者带来很大的心理和经济负担[1-3]。钼铑双靶 X 线摄影是乳腺疾病筛查、诊断和预后评估较为理想的影像学方法，但是，目前有关国内隆乳术后乳腺腺体、植入假体及其并发症的钼铑双靶 X线摄影研究并不多见，针对乳腺假体的 X线摄影方法尚缺乏统一的标准。本研究使用全数字、平板钼铑双靶乳腺 X线机的假体优化模式，对18例硅凝胶假体及乳腺腺体进行影像评价，旨在探讨乳腺假体植入后的安全性及其并发症。

患者女,45岁,以双乳疼痛6年余,加重半年主诉入院.查体:右乳外上距乳头2 cm处可触及一大小2 cm×1.5 cm的肿物,质硬.活动度良好,边界不清,乳头正常,无乳头溢液,同侧腋窝淋巴结未触及肿大.乳腺CR斜位片显示右乳腺外上象限一小结节样高密影,大小约1.2 cm,病灶下缘欠规整,上缘尚清晰,密度尚均匀一致(图1).

乳腺X线摄影能检出90%以上临床不能触摸到的乳腺癌[1].乳腺CR成像系统能更清晰地显示乳腺图像的细微结构[2],大大降低了乳腺癌患者的死亡率,但该方法的效果和成功率取决于乳腺摄影质量的恒定性(如高分辨力、高对比度、低剂量).为了在低剂量辐射水平下获得高质量影像,成像过程的每一个步骤都必须保持高标准.

Objective To investigate the effect of nasal continuous positive airway pressure (NCPAP) on cardiac function in children with pneumonia complicated with heart failure.Methods Twenty-two children with pneumonia complicated with heart failure were selected in emergency room of Beijing Children′s Hospital Affiliated to Capital Medical University from Oct.2008 to Mar.2009,aged 1 month and 15 days to 2 years and 8 months,prospective clinical study.Cardiac function[including cardiac index(CI),heart rate(HR) and stroke volume index(SVI)] before and after NCPAP 0.04-0.05 kPa for 30 minutes were monitored by ultrasonic cardiac output monitoring(USCOM).Results After the application of 0.04-0.05 kPa NCPAP for 30 minutes,the heart rate decreased signi-ficantly [(173±10) beats/min vs (151±13) beats/min P0.05 ];the respiratory rate decreased significantly[(69±10) beats/min vs (491±12) beats/min P0.05]. The stroke volume index elevated significantly [(31.818±4.521) mL/m2 vs (35.909±7.177) mL/m2 P0.05 ].However,there was no significant difference in cardiac index [(5.486±0.976) L/(min/m2) vs (5.386±1.134) L/(min/m2 ) P 0.05].Conclusions NCPAP might improve cardiac function by increasing stroke volume index and decreasing heart rate and respiratory rate in children with pneumonia complicated with heart failure.

心搏出量(CO)的监测对于掌握病情,早期发现循环功能异常,指导针对性用药有重要意义。目前监测心搏出量的方法很多,但由于其存在种种缺陷,限制了在儿科的广泛应用。近年来超声多普勒技术的广泛应用,给小儿心搏出量的无创监测提供了新的选择。本文将应用超声多普勒技术测量小儿CO的几种方法作一综述。

Objective To assess differential diagnostic value of MSCT with multi-planar reconstructions(MPR)in the rare intra-trachea and main bronchial tumor.Methods MPR images of 23 patients including intra-tracheobronchial benign tumor(n=16),and intra-tracheobronchial malignant tumor(n=7)were retrospectively analyzed.All the final diagnosis was proved by pathology.The chest images were viewed by two separate radiologists.Thickness of tumor involved trachea and main bronchial adjacent wall was measured.Results Sixteen patients with benign intra-tracheobronchial tumor revealed without the thickening wall of main bronchus,among them,the margin of 13 tumors were smooth and of the rest 3 were rough,the mean tracheobronchial wall thickness was 2.45 mm.Seven patients with malignant intra-tracheobronchial tumor revealed the thickening wall of bronchus,and their margins were rough with the mean tracheobronchial wall thickness 5.83 mm.Conclusion MSCT with MPR can display the size,morphology,range of intra-tracheobronchial tumor and its relation with tracheobronchial wall and is helpful to the differential diagnosis of intra-tracheobronchial tumor.

Objective To assess the mammographic features of early breast carcinoma on CR and the correlation between the mammographic and pathologic findings.Methods CR mammograms in 43 patients with breast carcinoma confirmed pathologically,including ductal carcinoma in situ(DCIS)and DCIS associated with small invasive foci(n=30),infiltrating ductal carcinoma(n=12),invasive lobular carcinoma(n=1)were analysed retrospectively.The correlation between the mammographic features and pathologic findings was also evaluated.Results(1)In the 43 cases of early breast cancer,micro-calcifications(n=21),nodular(n=15),and asymmetric increasing density with disorder structure(n=7)were seen on CR mammograms.(2)mini-mammary structure of early breast carcinoma could be seen on CR mammography.Conclusion CR mammography is of significant value in diagnosis of early breast carcinoma.

1 临床资料 患儿,男,7岁,9个月前无明显诱因出现皮疹,散在分布于四肢,为鳞屑性红斑丘疹,予中药外洗及抗过敏治疗,皮疹时重时轻,近2个月反复发热,流涕,咳嗽,元咳痰,喘息,发热时皮疹未加重,经抗感染治疗3～5 d可好转,1周左右再次出现呼吸道感染症状.

经颅多普勒超声(TCD)作为一种常规检查手段在临床上的应用越来越广泛,但各个医院的检查程序和诊断标准并不统一.因此,国际专家组织结合基础理论研究及临床经验,开始规范TCD的操作方法,统一诊断标准,确定使用范围.第一部分介绍脑血管疾病的频谱TCD检查.颞窗常用于观察大脑中动脉(MCA),大脑前动脉(ACA)、大脑后动脉(PCA)、颈内动脉C1段(ICA)及前交通动脉(AComA)、后交通动脉(PComA)的侧支循环;眼窗用于观察眼动脉(OA)和ICA虹吸部;枕窗用于观察椎动脉(VA)和基底动脉(BA).尽管Willis环的构成存在显著的个体差异,但完整的诊断性TCD检查还是应该评价双侧的脑动脉,包括:大脑中动脉M2段(深度范围30～40 mm),M1段(深度范围40～65 mm)[大脑中动脉M1段中点的深度位于50 mm处(范围45～55 mm),平均长度约16 mm(范围5～24 mm)],大脑前动脉A1段(深度范围60～75 mm),颈内动脉C1段(60～70 mm),大脑后动脉P1～P2段(平均深度63 mm,范围55～75 mm),前交通动脉(70～80 mm),后交通动脉(58～65 mm),眼动脉(40～50 mm),颈内动脉虹吸部(55～65 mm),椎动脉(40～75 mm),以及基底动脉近端(75～80 mm)、中段(80～90 mm)、远段(90～110 mm).经下颌下窗检测颈段ICA远端(40～60 mm)可以计算VMCR/VICA比值或Lindegaard指数,用于评价蛛网膜下腔出血后血管痉挛的程度.诊断性TCD检查的目的是探查上述动脉节段的特征性频谱,确定动脉血液流动方向,计算脑动脉血流速度和搏动指数.对于频谱多普勒和具有M-模的超声装置来说,建立标准化的检查程序,诸如选择探头的位置、角度和深度及血管的区分等,将有助于该项检查的临床应用和推广.

计算机X线摄影(computed radiography,CB)系统与增感屏/胶片组合比较其曝光剂量较小,而且是数字化信息,能进行计算机处理、可存储和传输,且成像后信息可以进行再处理等.是最早发展起来的数字成像装置,实现了平片的数字化.与传统的屏/胶系统比较,CR系统在骨骼肌肉系统的应用中具有以下优越性[1]:(1)线性检测响应;(2)提高检测效率;(3)数字化成像及成像后处理能力.由于CR系统的这些特性,使得它在骨骼肌肉系统的显像优于传统的屏/胶技术,我们就照射剂量对27例股骨头缺血性坏死(avascular necrosis of femoral head,ANFH)的病人进行了CR检查,并与同期常规的屏/胶平片进行对比.

Objective To assess the diagnostic value of multi-slice spiral CT virtual bronchoscopy (CTVB)in tracheal and bronchial disease.Methods Forty-two patients including central lung cancer (n=35),endobronchial tuberculosis(n=3),intrabronchial benign tumor(n=3),and intrabronchial foreign body(n=1)were examined by using multi-slice spiral CT examinations.All the final diagnosis were proved by pathology except 1 patient with endoluminal foreign body was proved by clinic.All patients were scanned on GE Lightspeed 99 scanner,using 10 mm collimation,pitch of 1.35,and reconstructed at 1 mm intervals and 1.25 mm thickness.The chest images of transverse CT and virtual bronchoscopy were viewed by two separate radiologists who were familiar with the tracheal and bronchial anatomy.Results Among the 42 patients,the tumor of trachea and bronchial lumen appeared as masses in 22 of 35 patients with central lung cancer and bronchial stenosis was found in 13 of 35 patients with central lung cancer,and bronchial wall thickening was revealed on transverse CT in all 35 cases.3 patients of endobronchial tuberculosis showed bronchial lumen narrowing on CTVB,the bronchial wall thickening was revealed on transverse CT, and the length of the wall thickening was long.3 patients with intrabronchial benign tumor showed nodules in trachea and bronchial lumen on CTVB,and without wall thickening on transverse CT.CTVB could detect the occlusion of bronchial lumen in 1 patient with intrabronchial foreign body and CTVB was able to visualize the areas beyond stenosis,and the bronchial wall was without thickening on transverse CT.Conclusion Multi- slice spiral CTVB could reflect the morphology of tracheal and bronchial disease.Combined with transverse CT,it could provide diagnostic reference value for bronchial disease.

传统CT影像能清晰显示气道的轴位像,但不能显示气管、支气管树的整体形态.多层螺旋CT可对气道进行多平面、三维立体和仿真支气管内镜重组,从任意角度观察气管、支气管树的轮廓,弥补了传统CT的不足.就多层螺旋CT气管、支气管树的重组技术、临床应用及其限度等方面的内容进行综述.

Objective To evaluate wall sign in the diagnosis and differentiation of central lung cancer.Materials and Methods Bronchial wall thickness (T) and the length of the thickened bronchial wall (L) in 57 patients with central pulmonary cancer, in 28 patients with endobronchial tuberculosis and in 10 patients with intrabronchial tumor were measured, T/L ratios were calculated, and the results were compared between each other.Results Of 57 patients with central pulmonary cancer, thickened bronchial wall was seen in 45 (79%) with T/L ratio of 0.64. In 28 cases with endobronchial tuberculosis, thickened bronchial wall was seen in 6 (21.4%) with T/L ratio of 0.22. Significant difference in the detecting rate of thickened bronchial wall existed between central pulmonary cancer group and endobronchial tuberculosis group (P0.01). Marked difference in bronchial wall thickness was also found between 45 patients of lung cancer and 6 patients of endobronchial tuberculosis, who showed wall sign (P0.05), with significant difference in L value and T/L ratio (P0.01). Of 10 patients with intrabronchial tumor, malignancy was seen in 4, presenting as endobronchial nodule and thickened bronchial wall. Benign tumor was seen in 5 and bronchial metastasis in one, displaying as intrabronchial nodule without wall thickening.Conclusion Bronchial wall thickening is an important sign for the diagnosis of central pulmonary cancer and for the differentiation of benign with malignant endobronchial tumors. T/L ratio is of help in the differentiation of central pulmonary cancer.

中央型肺癌是指发生在肺段以上支气管黏膜上皮的恶性肿瘤,近年发病率有明显上升趋势.早期诊断对病人的预后尤为重要.螺旋CT的局部薄层扫描、三维重建及高分辨率CT(HRCT)在早期发现病灶、鉴别诊断和肿瘤分期上有重要价值.就支气管的CT显示、中央型肺癌的CT表现和中央型肺癌CT鉴别诊断等方面的内容进行了论述.

目的评价计算机X线成像技术(CR)系统在乳腺成像中的应用价值。方法我们对42位女性患者双侧84例乳腺进行CR检查，并与传统X线检查结果对照。结果 CR检查检出乳腺正常者30例，乳腺增生者48例，良性占位者1例，检出率与传统X线平片无差异；但在5例乳腺癌中有3例在传统X线片未能确诊；CR在显示乳腺层次及微小病变及降低X线照射剂量方面优于传统X线片。结论乳腺CR成像技术是一种值得进一步推广使用的X线检查新技术。