目的 研究肝脏MRI特异性对比剂Gd-EOB-DTPA在肝脏肿瘤诊断及鉴别诊断中的价值.方法回顾性分析2011年1月～2018年10月我院收治的肝脏肿瘤患者80例,且均经手术治疗或穿刺及病理检查并已明确诊断.比较使用特异性对比剂Gd-EOB-DTPA行MRI检查结果与病理结果的符合率及Kappa值.分析Gd-EOB-DTPA MRI及增强CT对肝肿瘤病灶的检出率. 结果原发性肿瘤符合率为95.7％,Kappa值>0.8,具有高度一致性;继发性肿瘤符合率为96.4％,Kappa值>0.8,具有高度一致性;肝脏局灶性结节增生符合率80.0％,Kappa值>0.8,具有高度一致性.Gd-EOB-DTPA MRI对于<1cm肝肿瘤病灶的检出率相比增强CT明显提高(P<0.05).结论临床上对肝脏肿瘤患者行MRI检查时,采用特异性对比剂Gd-EOB-DTPA,具有较高的准确性,可为临床诊断及鉴别提供重要依据,值得在临床推广.

Objective To discuss the value of multi-slice spiral CT(MSCT) and MRI scanning in the diagnosis of Castleman disease(CD).Methods A retrospective analysis was made in the MSCT and MRI manifestations of 8 patients who were pathologically diagnosed as CD.Results Locations of lesions were as follows: chest in 3 case,cervical part in 2 cases,retroperitoneal part in 1 case,lesions in both retroperitoneal and pelvic parts in 1 case,and in cervical part,chest,and armpit in 1 case.The clinical classifications included localized focuses in 4 cases in which satellite focuses were observed in one and multicentric type in 4 ones.The pathological types included hyaline-vascular type in 7 cases and plasma cell type in one case.The MSCT or MRI manifestations included hyaline-vascular type CT plain scanning in 4 cases with punctiform,dash form,and arborizing calcification,homogeneous attenuation on CT plain scans in the other ones.Moreover,fascial thickening could be observed around the mass in 1 case,and the enhancement scanning showed obvious continuous strengthening,the way of which was similar to that of the great vessel;in another one,stripe hypodense was observed.The MRI examination showed medium signal intensity of T1WI and high signal intensity of T2WI in one case,in which stripe low signal intensity and stripe blood shadow around the mass could be observed,and the features of the enhancement scanning was similar to that of CT.Plasma cell CT plain scanning showed homogeneous attenuation,and the enhancement showed mild-medium strengthening.Conclusion MSCT and MRI manifestations of CD are closely correlated with the clinical and pathological types.MSCT and MRI have a higher accuracy and great value in the diagnosis of hyaline-vascular type CD.The plasma cell type lacks characteristics,so its final diagnosis must be combined with pathologic examination.

Objective To find out an effective method of improving the successful rate of once puncture in CT guided needle biopsy of chest lesion.Methods By looking into 60 cases with definite diagnostic conclusions,the relationship between the distance that the lesion is away from the thoracic cavity wall and the success rate of once puncture in the CT guided biopsy of chest lesion as well as diagnostic accuracy,complication rate and influential factors were analyzed.Results The accuracy rate of diagnosing lung cancer was 89.25% and successful rate of once puncture was 81.9%,which were far higher than the statistics the medical documents put forward.Conclusion Combining CT position techniques and the puncture techniques can improve the successful rate of once puncture without increasing the complications rate.

急性胸部闭合伤后导致肺挫伤并不少见.收集本院200例肺挫伤胸部平片,经反复阅片分析,结合文献复习,报告如下,以期提高对肺挫伤X线诊断的认识.

目的通过对60例CT导向下经皮肺内结节性病灶的活检分析,寻找提高肺内结节性病灶经皮肺活检的一次性穿刺成功率和诊断准确性的方法。方法回顾性分析60例有明确结果的经皮肺活检病例,分析其病灶离胸壁距离远近与肺内结节性病灶经皮肺活检一次性穿刺成功率的关系,及诊断准确性、并发症率及其影响因素。结果对肺癌的准确率为89.2%,一次性穿刺成功率81.9%,较文献资料报道有所提高。结论将CT定位技术与穿刺技术有效结合,可望在不增加并发症发生率的前提下,提高一次性穿刺成功率。

目的:通过对肺内结节性病变的影像表现的总结,分析其在CT引导下经皮肺穿刺活检结果及手术病理结果,提高对肺内结节性病变诊断的准确性.方法:收集肺内结节性病变共66例.应用CT机薄层扫描定位,经皮肺穿刺行病理学检查,其中14例进一步手术治疗,对其穿刺结果及手术结果进行回顾性分析.结果:影像诊断:恶性51例,良性14例;穿刺病理诊断:恶性45例,良性18例,不定性:3例.手术14例,恶性10例,良性4例;其中6例穿刺与手术结果一致,8例穿刺提示见核异质细胞或炎性细胞,手术进一步证实其为恶性或炎变.影像诊断与穿刺结果的符合率恶性为88%,良性82%,CT引导下经皮肺穿刺活检的敏感度90%,特异度100%.结论:CT引导下经皮肺穿刺活检是一种安全有效的诊断方法,可以为影像诊断及手术治疗提供重要的信息.

Objective To introduce QCT and its significance, accuracy and precision in bone marrow density(BMD)measurement.Methods The BMD of the QCT bone phantom made by the West-China Osteoporosis Study Center of Sichuan University (Sichuan phantom) was tested using the bone phantom and software coming with a Toshiba CT machine.The Sichuan phantom was put 15 cm under the water simulating human vertebrae and the Toshiba phantom between the water container and the scanning table.Measurement was conducted once daily for 25 days under the same condition as that for human being.SD and CV were calculated and Shewhart chart was plotted.Results The accuracy errors of the three sections measured from large to small in the Sichuan phantom were -60.4%,-39.1% and -13.6%,their correction coefficients were 2.69,1.64,1.15,and the relative coefficient were 0.9966;the regression equation was Y=35.6+0.958X.Precision error of the 25 times/one day and 25times/25days in bone densitometry by this QCT was 1.25%-5.54% and 1.98%-7.87% respectively.Thus the variation of precision error was small in one day,but increased with the time.Polt baseline of shewhart chart of 25times/25days is better than that of the 25times/one day.Conclusions Quality control is necessary in all BMD measurement by QCT.The accuracy errors must be corrected followed by precision experiment to ensure a true,scientific and reliable result.

Objective The correction of accuracy errors in bone desitometry by QCT has not been carried out yet at present in China This article introduces the methods of QCT accuracy test and the reasons of accuracy error correction Methods A referential bone phantom (named Toshiba phantom) with software contained in a Toshiba CT machine was used as measuring tools to measure the BMD of the QCT bone phantom made by West China Osteoporosis Study Center of Sichuan University(named Sichuan phantom) The Sichuan phantom(mimicking human vertebrae) was put in a water bath 15cm deep while the Toshiba phantom was placed between the water bath and the scan table as a referential criterion Then the machine was operated according to the measuring conditions of scanning human lumbar vertebrae2,3,4 and the methods of Toshiba QCT densitometry until it measured out BMD values and obtaihed QCT images Because the real densities of the three sections of hydroxyapatite in Sichuan QCT phantom are 50mg/cm 3,100mg/cm 3,and 200mg/cm 3,respectively, the measured value of each section's deviating from its real value can be calculated, and the accuracy error in precentage is acquired The measured value larger than the real one is positive, aad the contrary is negative Also because the BMD of the three sections in the Sichuan phantom are distributed linearly from large to small, a regression equation can be calculated Then the regression equation was used to correct the accuracy errors Results The accuracy errors of the three sections measured from large to small in the Sichuan phantom were 13 0%, 5 26% and +3 85%,respectively; their correction coefficients were 1 149, 1 055 and 0 963,respectively, and the relative coefficient R was 0 998; the regression equation was Y=12 075+0 907X (X is the measured BMD, and Y the corrected one) During the test, one X ray tube of the CT machine was replaced After the replacement, the errors of Sichuan phantom from large to small changed to 30 54%, 9 97% and 0 01%,and the regression equation changed to Y=18 43+0 910X Conclusion In view of the Characteristic of the accuracy error distribution, errors at the lower density ends are larger than those of the higher ones( the error at the lowest end reaches as high as 30%) Most patients' bone densities are concentrated at the lower ends In consideration of both the higher and lower density ends, using the regression equation for correction is superior to using the correction coefficient Therefore, we should take the quality control of QCT seriously, otherwise the data will have poor comparability and conformity, leading to excessive false positive and false negative resuets Recently, Sichuan University has researched and produced Chinese QCT phantoms, which can be used as referential phantoms to meet the needs of measuring BMD and quality controls

鼻咽癌多发生于咽隐窝,早期易于粘膜下浸润,突破咽基底筋膜后可侵犯咽旁间隙,CT为鼻咽癌分期的可靠方法.本文分析了1996～1998年经我院诊治的48例鼻咽癌CT表现特点,探讨咽旁间隙侵犯对T分期的影响.