目的:探讨青年人MSCT胸部健康体检肺尖帽(PAC)影像学表现及其相关因素.方法:选择375例40岁以下胸部健康体检者MSCT资料,依据PAC形态分为Ⅰ～Ⅲ级,测量其最大胸膜厚度及气管分叉平面胸廓横径与前后径比值(R),依据冠状位胸膜顶形态分为凹陷型、中间型和膨隆型.分析PAC分级与性别、R值、胸膜顶类型及其厚度关系.结果:375例(750侧)中Ⅰ～Ⅲ级PAC占比分别为50.1％、35.3％和14.5％(P<0.05),其中女性Ⅲ级占比10.4％,显著高于男性4.1％(P<0.05).Ⅰ～Ⅲ级PAC胸膜厚度分别为2.76±1.25 mm、3.46±1.74 mm和5.12±2.08 mm(P<0.05),Ⅲ级厚度显著大于Ⅰ级(P<0.05);R值分别为2.12±1.08、2.32±1.41、2.51±1.64(P<0.05),Ⅲ级显著大于Ⅰ级(P<0.05).胸膜顶膨隆型主要见于Ⅱ级PAC,中间型主要见于Ⅰ级PAC,凹陷型主要见于Ⅲ级PAC(P<0.05).PAC分级与其厚度呈正相关(r=0.651,P<0.01).结论:PAC分级比较客观评估肺尖肺胸膜肥厚程度,部分Ⅲ级PAC伴胸廓扁平者可能为肺胸膜纤维弹性组织增生前期状态或早期轻度PPFE.

目的 采用MRI技术研究马尾神经冗余(RNRs)与腰椎滑脱(LS)关系及其意义.方法 收集253例MRI诊断为LS患者资料,在T2 WI矢状位观察马尾神经根形态,分为RNRs(+)和RNRs(-),测量其长度及最小硬膜囊面积(DSCA)并计算RNRs长度相对值.组间计量资料采用t检验,计数资料采用χ2检验,等级资料采用单因素方差分析,进行Kappa一致性检验.结果253例中发现RNRs 42例(16.6％),其中真性LS 3例(4.47％),假性LS 39例(20.97％)(χ2=11.59,P<0.01).Ⅰ～Ⅲ度真假性LS伴RNRs依次分别为0例、0例和3例及8例、27例和4例(F=10.26,P<0.05).假性LS L3～S1各层面伴RNRs分别为13例、24例和2例(F=15.34,P<0.05).Ⅰ、Ⅱ度假性LS伴/不伴RNRs各节段最小DSCA均有显著性差异(P<0.05).RNRs形态大致分"藤索"、"葡萄串珠"和"蛇纹石"3型,长度相对值分别为2.69±1.47、3.75±1.72和4.61±2.23(F=7.52,P<0.05).伴/不伴RNRs手术治疗率分别为40.48％(17/42)和21.33％(45/211)(χ2=6.89,P<0.05).结论 RNRs 与 LS 类别、层面及滑脱程度相关,其形态和相对长度一定程度上反映 LS 伴腰椎管狭窄严重程度,可能是采取手术干预措施的重要征象.

目的 分析比较不同方法判断神经根沉降征(NRSS)与椎间隙层面关系.方法 随机收集68例腰椎管狭窄(LSS)患者MRI检查资料,选择L3～L4椎间隙3个连续横断面(头→足侧依次记为层1、层2和层3),以关节间隙顶点连线(方法1)及腰椎管有效矢状径等分线(方法2)作为参考线判断NRSS.神经根位于参考线腹侧判为NRSS阳性,背侧为阴性.测量3个层面硬膜囊面积(DCSA,按大→小记为层L、层M和层S),综合DCSA<100 mm2和临床症状判断LSS.LSS诊断率两两比较采用单因素方差分析,NRSS判断配对比较采用χ2检验.结果 68例L3～L4椎间隙层1～3神经根均可辨认,NRSS判断方法1:57例3个层面完全一致(χ2=8.22,P<0.01);方法 2:62例3个层面完全一致(χ2=9.47,P<0.01).NRSS阴阳性例数比方法1为0.38,方法2为1.3(χ2=8.44,P<0.01).依据NRSS判断阳性的层L、层M和层S,LSS诊断率方法1分别为49.5％、70.7％和90.4％(F=7.62,P<0.05);方法 2分别为82.3％、88.6％和95.3％(F=2.49,P>0.05).NRSS阳性层面中层S LSS诊断率最高,其中方法1为90.4％,方法2为95.3％(χ2=2.16,P>0.05);层L最低,其中方法1为49.5％,方法2为82.3％(χ2=4.63,P<0.05).另外7例中有4例3个层面神经根均显示不清,DCSA<80 mm2,硬膜囊几乎全部位于关节突连线腹侧;3例2个层面神经根显示不清,另一层面NRSS均阳性.结论 NRSS判断与椎间隙扫描层面无关,层S为NRSS判断和LSS评估的最佳层面,方法2优于方法1.

目的 探讨马尾神经根冗余(RNRs) MRI特征、机制及意义.方法 搜集MRI诊断为腰椎管狭窄(LSS)患者247例,观察矢状位马尾神经形态,分为RNRs(+)和(-),并测量LSS节段最小硬膜囊面积(DCSA).LSS平面分腰2～4范围内外单平面和多平面三类;LSS平面椎管前壁突出物形状分圆钝和尖锐两种,其后缘“硬度”分Ⅰ、Ⅱ两级.组间计量资料采用x2检验,计数资料采用t检验,等级资料采用单因素方差分析,结果行Kappa一致性检验.结果 247例中发现RNRs 49例(19.8％),形态大致分“藤索”型、“葡萄串珠”型和“蛇纹石”型三种.LSS伴与不伴RNRs患者平均年龄分别为(62.72±24.50)岁和(53.70±21.87)岁(t=6.35,P＜0.05);最小DCSA分别为(61.70±21.53)mm2和(86.72±29.50) mm2(t=9.48,P＜0.01).LSS腰2～4单平面87例、非腰2～4单平面69例和多平面91例,伴RNRs分别为36、9和4例(F=13.89,P＜0.01).LSS平面椎管前壁突出物圆钝和尖锐分别为185例和62例,伴RNRs分别为18例和31例(x2=11.84,P＜0.01);“硬度”Ⅰ级167例、Ⅱ级80例,伴RNRs分别为20例和29例(x2=13.17,P＜0.01).椎体滑脱56例,伴RNRs 23例(x2=17.69,P＜0.01);真假滑脱分别为18例和38例,伴RNRs分别为4例和19例(x2=12.04,P＜0.01).结论 马尾神经根“藤索”、“葡萄串珠”及“蛇纹石”样改变是RNRs特征性表现;高龄、中间段单平面重度LSS、假性滑脱和突出物尖“硬”压迫是RNRs主要形成因素;RNRs为诊断症状性LSS重要依据,是LSS手术治疗的指征之一.

目的 评估不同神经根沉降征(NRSS)判定方法预估腰椎椎管狭窄(LSS)的准确性,探索合理的NRSS判断方法.方法 回顾性分析136例临床诊断为LSS和非特异性腰腿痛(LBP)患者MRI图像资料,由两位经验丰富的医师分别采用上关节突顶点连线(A方法)、椎小关节顶点连线(B方法)和硬膜囊横断面正中矢状径垂直平分线(C方法)判断NRSS,筛选NRSS阳性(+)、阴性(-)病例,并测量狭窄节段硬膜囊横断面面积(DSCA).同种方法组内对比资料采用独立样本t检验、配对卡方检验,A、B、C三种方法判断结果相互比较采用方差分析法(ANOVA);再利用受试者工作特征曲线(ROC)分析A、B、C三种方法NRSS定性后与DSCA的关系.结果 A、B、C三者LSS组NRSS+例数分别为11、53、55;LBP组NRSS-例数分别为59、50、65.LSS、LBP组DSCA为(74.29±15.41)mm2、(146.13±26.82)mm2,差异有统计学意义(t=-13.48,P＜0.05),各方法中LSS、LBP组DSCA差异均有统计学意义.A、B、C方法中NRSS+组DSCA分别为(110.02±43.28) mm2、(91.95±32.59)mm2、(77.79±23.83)mm2,NRSS-组为(110.68±42.11)mm2、(131.6±44.53) mm2、(139.79±31.83)mm2.B、C方法NRSS+ DSCA小于NRSS-,差异有统计学意义(t=4.30、9.14,P＜0.01);A方法差异无统计学意义.A、B、C方法总NRSS+、-DSCA比较差异均有统计学意义(NRSS+组F=5.01,P＜0.01;NRSS-组F=6.65,P＜0.01);LSS组中A、B方法NRSS+、-DSCA差异无统计学意义,C方法差异统有统计学意义(t=3.54,P＜0.01).LSS组A、B、C三者NRSS+ DSCA差异无统计学意义,而NRSS-差异有统计学意义(F=6.75,P＜0.01).ROC曲线下面积(AUC)分别为0.55(P ＞0.05)、0.74(P ＜0.01)、0.92(P ＜0.01).结论 不同方法判定NRSS+间接诊断LSS准确率关系:C＞B＞A,依据NRSS+判断LSS时宜采用C方法.

Objective To analyze the value of perfusion weighted imaging, diffusion tensor magnetic resonance imaging hydrogen proton magnetic resonance spectroscopy in the diagnosis of glioma. Methods The clinical data of 68 patients with glioma treated in hospital were analyzed retrospectively, PWI, DTI and 1H-MRS were performed before operation for all patients, and the related indexes were analyzed. Results The results of PWI and DTI showed that the CBV, CBF in the solid area and the edema area around the tumor was significantly higher than that in the healthy white matter area, and the FA value was lower than that in the healthy white matter area ( P<0. 05 ) . There was also a significant difference between the solid area of the tumor and the edema area around the tumor ( P <0. 05 ) , and there was also a significant difference between the high grade patients and the edema area around the tumor (P<0. 05). The Cho/NAA, Cho/Cr of the affected side was higher than that of the lower order side, and the value of NAA/CR was lower than that of the lower order side ( P<0. 05 ) , and there was also significant difference between the affected side and the healthy side of the high grade and lower order patients (P <0. 05). Conclusions The three techniques of PWI,DTI,1H- MRS are valuable in the diagnosis of glioma. The three techniques can be combined to judge the grade of glioma accurately.

目的 分析脑胶质瘤患者脑中不同区域的代谢物浓度及FA值相关性.方法 前瞻性纳入临床疑似脑胶质瘤患者110例,MR检查后,经开颅手术或穿刺获得病理诊断结果,将71例确诊为脑胶质瘤患者作为研究对象,对所有患者脑中瘤体区、周围水肿区及周围正常脑白质区进行1 H-MRS和DTI扫描,以Spectroscopy软件于各区域取1～7个体素,检测各体素内N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)浓度,计算NAA/Cr、Cho/Cr比值,以Viewing软件选取与各1H-MRS体素相对应位置的ROI,测量各ROI内FA均值.观察比较患者脑内不同区域NAA、Cho、Cr水平,NAA/Cr、Cho/Cr比值及FA值差异,并对各区域NAA、Cho、Cr、NAA/Cr、Cho/Cr与FA值相关性进行研究.结果 瘤体区和水肿区NAA、Cho、NAA/Cr、Cho/Cr及FA值与正常区域相比均有显著差异(P＜0.05),与水肿区相比,瘤体区NAA、NAA/Cr显著降低,Cho、Cho/Cr显著升高(P＜0.05),Cr和FA值无差异(P＞0.05);患者瘤体区NAA、NAA/Cr与FA值呈显著正相关,水肿区NAA、Cho和Cho/Cr与FA值呈显著正相关,正常区域NAA、NAA/Cr与FA呈显著正相关(P＜0.05).结论 瘤体内NAA、NAA/Cr与FA值呈显著正相关,水肿区NAA、Cho和Cho/Cr与FA值呈显著正相关,1H-MRS和DTI可联合用于脑胶质瘤的检测,为无创性研究脑胶质瘤代谢特点及微观结构提供一定的基础.

目的:探讨应用CT肺动脉血管成像观察肺栓塞抗凝治疗后主干及分支不同类型血栓的溶解情况.方法:对急性发病的肺栓塞患者132例进行抗凝治疗1月,复查CT肺动脉血管成像(CTPA),比较位于主干及分支的4种不同类型的血栓溶解情况.结果:主干血栓、 分支血栓完全溶解率分别为61.6%、66.9%,大部分溶解率分别为21.2%、18.7%,部分溶解率分别为12.3%、11.5%,未溶解率分别为4.8%、2.9%.中心型血栓、锐角附壁型血栓、钝角附壁血栓、 完全闭塞型血栓完全溶解率分别为66.2%、74.4%、36.4%、52.9%,大部分溶解率分别为20.7%、18.6%、27.3%、7.4%,部分溶解率分别为11.7%、3.8%、25%、22.1%,未溶解率分别为1.4%、3.2%、11.4%、17.6%.主干与分支之间溶解情况,差异无统计学意义(χ2=3.537,P=0.316),4种不同类型血栓的溶解情况差异有统计学意义(χ2=90.766,P=0.000),且中心型、锐角附壁型的溶解率明显高于钝角附壁型和完全闭塞型.结论:CTPA显示的血栓类型对抗凝治疗效果有预示意义,临床可以据此进行早期、有效的病情预评估.

目的 探索血浆D-二聚休水平能否作为反映急性肺血栓栓塞症(APTE)长程抗凝治疗后血栓变化情况的有效监测指标.方法 采用前瞻性观察性研究方法,选择2010年7月至2014年4月南通大学附属医院经D-二聚体水平及同步CT血管造影(CTPA)确诊的62例APTE患者.所有患者均进行长程抗凝治疗,观察血浆D-二聚体变化,随访终点时患者肺动脉血栓变化以CTPA复查结果作为最终依据,并将其分为血栓复发组(5例)与未复发组(57例).将随访终点的D-二聚体检测结果与CTPA结果进行Kappa分析,以判断两种方法确诊APTE的一致性.结果 经规范抗凝治疗后,APTE患者血浆D-二聚体均逐渐下降;随访终点时,复发组血浆D-二聚体显著高于未复发组,差异有统计学意义(μg/L:958.4± 213.1比209.9±122.0,P＜0.05);对症状无反复、D-二聚体持续阴性者,复查CTPA也提示肺动脉血栓消失或趋于慢性机化;而症状反复、D-二聚体水平波动增高者,复查CTPA则证实肺动脉血栓活动复发;Kappa分析提示两种检测方法有高度一致性,差异有统计学意义(Kappa=0.621,P=0.000).结论 动态监测血浆D-二聚体可替代CTPA作为APTE抗凝治疗效果的随访指标,具有良好的医疗经济学效益,值得推广.

目的:探讨多层螺旋CT增强扫描对肾嫌色细胞癌的诊断价值.方法:回顾性分析14例经手术病理证实的肾嫌色细胞癌的CT平扫及三期动态增强扫描图像,并以55例肾透明细胞癌图像作为对照,比较两者在肿瘤性质,平扫CT值及皮质期、实质期、排泄期相对强化CT值,以及肿瘤强化方式等方面的差异.结果:肾嫌色细胞癌以实性为主12例(85.7％),透明细胞癌以囊实性为主32例(58.2％),差异具有统计学意义(P＜0.001).肾嫌色细胞癌与肾透明细胞癌皮质期、实质期及排泄期相对强化CT值比较,差异均具有统计学意义(P＜0.001),肾嫌色细胞癌相对强化程度明显低于肾透明细胞癌.肾嫌色细胞癌主要表现为均匀强化(8/14),而肾透明细胞癌主要表现为不均匀强化(49/55),两者强化方式差异具有统计学意义(P＜0.001).结论:肾嫌色细胞癌大部分为均匀实性肿块,少有囊变,且呈中等度均匀强化,大部分与肾透明细胞癌容易鉴别.

Objective To investigate the evaluation significance of plasma D-dimer level for the prognosis in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) excluding pulmonary embolism(PE).Methods The patients with AECOPD were collected from the respiration department and emergency internal medicine department of the Affiliated Hospital of Nantong University during 2007-2011.Thirty-five AECOPD cases of D-dimer positive and excluding PE and lower extremity deep venous thrombus(DVT)by CT angiography served as the experimental group and 35 cases of D-dimer negative as the control group.The differences in the first time hospitalization duration,GOLD grade,mortality rate,re-hospitalization times within 4 years,times of admission to ICU,times of intracheal intubation,rehospitalization and outside-hospital mortality rate were compared between the two groups.The receiver operatingcharacteristic(ROC)curve was applied to evaluate the short-term and long-term prognostic capacity of D-dimer.The t test at the follow up end point was used to analyze the D-dimer level in the death group and the survival group.Results The D-dimer level,length of hospital stay,death number of first time hospitalization,times of re-hospitalization,times of admission to ICU,times of intubation,re-hospitalization and outside-hospitalization mortality rate and total mortality rate had statistical differences between the experimental group and the control group(P＜0.05);but the differences in the age,gender and GOLD grade between the two groups had no statistical significance(P＞0.05).The sensitivity of D-dimer＞1 165 μg/L for predicting the death number of the first time hospitalization was 87.5 ％,and the specificity was 80.6 ％.The sensitivity of D-dimer＞ 865μg/L for predicting the mortality rate of re-hospitalization and outerside-hospital was 78.9 ％,and the specificity was 74.5 ％.The survival curve graph during the follow up period in the two groups revealed that the survival time and survival rate had statistical difference between the two groups.The D-dimer level in the death group was significantly higher than that in the survival group with statistical difference(P＜0.05).Conclusion The D-dimer level is an independent risk factor affecting the short-term and longterm prognosis of AECOPD.

鼻咽癌是头颈部常见肿瘤之一，放射性治疗在其治疗中起着重要的作用。然而放射性治疗在有效杀灭肿瘤组织的同时，具有较多并发症，如放射性脑损伤和放射性血管损伤［1，2］。随着肿瘤患者放疗后生存期的延长，放射性血管损伤这一严重并发症日益受到重视。

PurposeTo explore the multislice CT (MSCT) and clinical manifestations of diaphragmatic hiatus hernia with hernial sac effusion, in order to improve its diagnostic rate.Materials and MethodsMSCT data were retrospectively analyzed for morphologies and clinical manifestations in 32 patients with diaphragmatic hiatus hernia and hernial sac effusion.Results32 patients included 21 males and 11 females (χ2=0.64,P>0.05). 25 patients were older than 60 years and 7 cases younger than 60 years (χ2=13.58,P<0.01). There were 27 cases with non-viscera hiatus hernia including 23 cases of combined fat-water hernia and 4 cases of simple effusion. 5 cases were of viscera type hiatus hernia (χ2=5.47,P<0.05). 28 cases showed ascites including 23 cases with non-viscera hiatus hernia and 1 case with viscera type hiatus hernia (χ2=9.56,P<0.01). The axial images from different levels of non-viscera hiatus hernia with liquid hernial sac demonstrated "quasi-circular", "meniscus", ringlike and "teardrop" shapes.Viscera type hiatus hernia and liquid hernial sac were found to be irregular shape . All patient sufferered from dysphagia, chest distress and epigastric discomfort.ConclusionThe increased pressure gradient between thorax and abdomen driving ascites into supradiaphragmatic hernial sac and clamping by hiatus may be the main mechanism. "Quasi-circular", "meniscus", "ringlike" and"teardrop" were the characteristic signs of diaphragmatic hiatus hernia with hernial sac effusion.

目的：探讨软组织肉瘤的MR T2WI特征可否用于高、低级别软组织肉瘤鉴别。方法：分析新辅助化疗与术前行MR T2WI检查的软组织肉瘤患者41例。通过组织学标本记录每例软组织肉瘤的病理分级。在MR T2WI上分析瘤体的深度、尺寸、信号强度、信号异质性、瘤体边缘和病灶周围信号特征。结果：软组织肉瘤低级别与高级别的MR T2加权像特征分析10项指标中，其中5项指标差异有统计学意义：瘤体尺寸（5cm，P=0.047）、T2信号异质性（P=0.022）、瘤体边缘（P=0.001）、瘤周包膜（P=0.003）、瘤周高信号（P=0.049）。结论：MR T2WI形态特征有助于诊断高级别低级别软组织肉瘤的病理学分级。

Objective: To explore CT manifestations and pathologic fe atures of pulmonary carcinoid tumours and carcinoid tumourlets. Methods: Retrospective analysis was conducted of the CT imagings and the pathologic features of pulmonary carcinoid tumours(5 cases) and carcinoid tumourlets(3 cases), which were all diagnosed by pathologic manifestations. Results: There were 2 peripheral atypical carcinoid cases in which necrosis and costal metastatic carcinoma were found in 1 case. There were 3 typical carcinoid cases including 2 central types and 1 peripheral type, all of which manifested smooth shape and clear boundary with lung tissue in CT imagings and 1 of which showed the ice-berg sign and vascular notch symptom. 3 carcinoid tumorlet cases had no characteristics to show definite tumor lesions, pulmonary fibrosis background and tumor cell nests around small airways under the microscope. All 8 cases expressed CK18, CgA and Syn positively and 4 of them had an index lower than 5% by Ki-67 examination. Conclusions: Pulmonary carcinoid tumours and carcinoid tumourlets have their own characteristics relatively in CT and pathologic features.

目的:分析总结类风湿性关节炎(RA)的影像特征,以提高对其的早期准确诊断。方法:分析临床确诊的45例类风湿关节炎(RA)患者的X线和MRI资料,对其影像学表现进行总结。结果:RA患者45例162个关节,X线平片检出阳性36例,病变关节132个(81%),其中Ⅱ期5例,Ⅲ期26例,四期5例。45例中23例X线平片阴性或早期RA的36个关节MRI检查,检出病变关节32个(88%),Ⅰ期4例,Ⅱ期6例,Ⅲ期13例。结论:MRI对骨侵蚀病灶的检出及软组织滑膜病变的显示明显早于X线平片,X线平片适用于中晚期患者观察和随访检查,应用MRI平扫加增强可明显提高RA的早期诊断的准确性。

目的对健康体检中发现老年肺癌的影像特征进行综合分析,评价健康体检对诊断早期肺癌的重要性和提高老年人生存质量的重要意义。方法选取2012至2013年5月间健康体检中发现结节或球形病灶患者50例,通过CT进一步检查或胸部穿刺活检确诊38例,在此对以上病例影像进行讨论分析比较。结果早期周围型肺癌具有分叶征、边缘毛刺征、血管集束征、空泡征、胸膜凹陷征等影像特征,X线胸片较易检出,而早期中央型肺癌X线表现隐匿,结合CT薄层检查明显提高老年早期中央型肺癌的检出率。结论由于DR及CR在社区医院的普及,X线胸片结合CT薄层增强检查,大大增加了老年人健康体检中肺癌的检出率。早期诊断早期治疗对改善老年人的生存质量,具有着非常重要的意义。