目的 探讨CT炎性值及分级评估COVID-19肺炎严重程度的诊断价值及与临床分型的相关性.方法 回顾性分析55例确诊COVID-19患者的实验室检查指标、肺炎的分布、大小、密度、CT炎性值在临床分型中的差异和诊断价值以及CT炎性值分级与临床分型的相关性.结果 重型组的年龄,肺炎的分布、大小、密度、CT炎性值均高于普通组(t=-2.138,-5.055,-6.775,-4.863,-6.064,P<0.05).CT炎性值分级在普通型与重型两组患者间存在显著性差异(χ2=28.212,P<0.05).CT炎性值分级与临床分型相关性:Cramer's V 0.759(P<0.05).CT炎性值的ROC曲线下面积为0.867(P<0.05).结论 CT炎性值与分级对COVID-19肺炎严重程度的评估具有较高的诊断价值和相关性.

为探讨IDose4迭代重建技术在低剂量CT肾动脉血管造影中的应用价值,选取205例拟行肾动脉CT血管造影患者,随机将其分为4组,A组(51例)采用管电压100 kV、管电流100mA,碘海醇370 mg I/mL及IDose4迭代重建技术,B组(51例)采用管电压100 kV、管电流150mA,碘海醇270 mg I/mL及IDose4迭代重建技术,C组(51例)采用管电压80 kV、管电流180mA,碘海醇270 mg I/mL及IDose4迭代重建技术,D组(52例)管电压120 kV、管电流120 mA,碘海醇370 mg I/mL及滤波反投影(FBP)重建技术.分析各组图像肾主动脉干CT值、噪声(SD)、信噪比(SNR)和噪声比(CNR),受检者接受CT有效剂量(ED)、容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP)、碘摄入量以及重建图像评分差异和诊断效能.结果 显示,A、B、C组重建图像评分优于D组,肾动脉主干CT值、SD、SNR、CNR均高于D组,B、C组肾动脉主干CT值、SD略低于A组.A、B、C组CTDIvol、DLP、ED均低于D组,B组CTDIvol、DLP、ED高于A组.A、B、C、D组诊断肾主动脉狭窄准确率分别为92.68％、86.49％、84.62％、82.86％.证实IDose4迭代重建技术能降低受试者受辐射和造影剂剂量,提高成像质量,在低剂量CT肾动脉血管造影中具有较高可行性和实用性.

目的:探究新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)胸部CT半定量评分及分级与临床分型的相关性.方法:回顾性分析2020年1至2月重庆医科大学附属永川医院收治的71例COVID-19患者的临床和影像资料,将患者依据《新型冠状病毒肺炎诊疗方案(试行第六版)》分为轻型(8例)、普通型(53例)、重型(8例)、危重型(2例),比较不同临床分型患者的实验室检查结果,并分析其胸部CT影像表现,根据病变的部位、范围、密度进行半定量评分,计算肺部炎症指数并将其分为5级,分析肺部炎症指数分级与临床分型的相关性.结果:COVID-19的主要临床症状为发热(49例)、咳嗽(43例)等.不同临床分型间淋巴细胞计数、C反应蛋白、红细胞沉降率及降钙素原差异具有统计学意义(P＜0.05).CT表现中,PII 0级中轻型患者8例(100％);PII Ⅰ级中普通型患者34例(97.1％),重型患者1例(2.9％);PII Ⅱ级中普通型患者17例(94.4％),重型患者1例(5.6％);PII Ⅲ级中普通型患者2例(28.6％),重型患者5例(71.4％);PII Ⅳ级中重型患者1例(33.3％),危重型患者2例(66.7％),其差异具有统计学意义(P＜0.05).CT肺部炎症指数分级与临床分型呈正相关,相关系数r=0.75.结论:COVID-19患者的胸部CT半定量评分及分级与临床分型间具有较好的相关性,对临床诊治具有指导意义.

Objective:To observe the size and density of adrenal gland, and the dynamic changes in patients with COVID-19.Methods:Study sample consisted of 67 patients diagnosed as COVID-19 (COVID-19 group) and 70 normal controls. COVID-19 group were divided into two groups: ordinary cases and severe cases. The CT value and thickness of adrenal gland in the control group (uni-temporal) and the COVID-19 group (multi-temporal) were measured, the CT value of adreal/erector spinae were calculated.Results:Compared with the control group, the COVID-19 group had bigger body, medial and lateral branches of bilateral adrenal gland ( P<0.05) . There was no significant difference between the CT value of adrenal/erector spinae for the two groups. Receiver operating characteristic curve analysis showed the thickness of right medial adrenal limb in detecting diffuse adrenal hyperplasia was the best (0.881) . And there was no significant difference in the CT value of adrenal/erector spinae, thickness of bilateral adrenal body, medial and lateral branches in COVID-19 group at different times. Conclusion:The bilateral adrenal glands of COVID-19 patients were slightly swollen, adrenal body, medial and lateral branches were slightly bigger than the normal adrenal glands, but the density was normal, and there were no dynamic changes during the course of the disease.

目的 运用多层螺旋CT研究脾静脉(SpV)和肠系膜上静脉(SMV)血流在门静脉内和肝内的分布规律,为临床提供相应的影像解剖学数据.方法 回顾性分析在重庆医科大学附属第一医院行上腹部CT平扫及增强检查,动脉期SpV强化而SMV未强化的165例患者的CT资料,观察门静脉主干内SpV与SMV血流的分布情况.分别测量平扫和增强动脉期门静脉左支(LPV)与门静脉右支(RPV)、肝脏左叶与右叶CT值;分析SpV和SMV的血流在门静脉内和肝脏内的分布区域及规律.结果 (1)SpV和SMV血流在门静脉主干内分布情况:分层分布(A组)占61.81％ (102/165);螺旋形分布(B组)占24.85％ (41/165);紊乱分布(C组)占13.33％ (22/165).(2)动脉期LPV的CT值＞RPV占84.24％(139/165),＜RPV占15.76％ (26/165),肝脏左叶CT值＞右叶占85.45％(141/165),＜右叶占14.55％ (24/165);动脉期门静脉左右支、肝脏左右叶CT值差异有显著统计学意义(P＜0.01),平扫无统计学差异(P＞0.05).A、B、C三组组内动脉期门静脉左右支、肝脏左右叶CT值差异有统计学意义(P＜0.05),平扫差异均无统计学意义.结论 SpV和SMV血流在肝门静脉内存在分层分布、螺旋形分布、紊乱分布.84.24％的患者SpV血液主要流入LPV进入肝左叶,SMV血液主要流入RPV进入肝右叶.

Objective Using MSCT to display the normal anatomic structure and variation of the adrenal vein accurately and to provide image anatomy data for clinical application. Methods 108 patients with abdominal examination of CTA were retrospectively analyzed. A thin layer of MIP and MPR technique was applied to evaluate and measure the adrenal vein diameter, length and line path. Results ① Display rate and variation rate in the right side was 64.81% (70/108) and 5.71% (4/70). The adrenal vein drained directly into the inferior vena cava in 7 o'clock to 8 o'clock direction, accounting for a majority of 42.42%(28/66). The diameter of adrenal vein was (2.19±0.56) mm, the length of vein outside the gland was (15.02± 1.82) mm, the distance between the sites where the right and left the adrenal veins joint the inferior vena cava was (240.69 ± 12.96) mm; the inferiorly-oriented angel of adrenal vein into the inferior vena cava was (60.25 ± 17.85)° . ② Display rate and variation rate on the left side was 97.22% (105/108) and 14.29% (15/105);adrenal vein was (2.39±0.56) mm, the length of vein outside the gland was (17.28±4.01) mm, the shared trunk between the diaphragmatic-adrenal veins was (3.65 ± 0.93) mm, the distance from the point of diaphragmatic-adrenal vein draining into the left renal vein was (14.07 ± 6.77) mm, the distance from the point of the diaphragmatic-adrenal vein draining into the left renal vein to the left side of the inferior vena cava was (32.89 ± 4.85) mm, the inward angel of the diaphragmatic-adrenal vein drainging into the left renal vein was (118.06±18.49)°,the inferiorly-oriented angel of the adrenal vein draining into the diaphragmatic-adrenal vein (156.15 ± 13.81)° . Conclusion MSCT can display most of the right adrenal vein and the vast majority of the left adrenal vein in normal and abnormal passageway. Measurement of relevant imaging anatomy data can provide the imaging data for operation scheme such as AVS.

<正>基于问题的教学模式(problem-based learning,PBL)是60年代美国神经病学Barrows教授创立的自主学习模式,目的是让学习者通过合作来解决问题,学习隐含于问题背后的科学知识,培养学生独立解决问题的技能以及自主学习的能力。病例导入式教学法(case based study,CBS),则是以病例为导向的教学法,是PBL教学法的延伸,主要通过临床病例来引导学生

<正>患者女,62岁,左上腹阵发性隐痛1个月。查体:左上腹及中上腹压痛。实验室检查:肝功异常,乙肝标志物(+),甲胎蛋白(AFP)>1210 U/ml。B超:脾脏体积增大,实质内见约8.1cm×6.3cm偏低回声,CDFI于周围探及少许血流信号,考虑脾脏实性占位病变。CT:脾脏体积增大,脾脏上极类圆形肿块约85mm×66mm,分叶状,边缘较清,周围有包膜;增强后动脉期肿块不均匀强化,CT值约30～73 HU,低密度区无强化(图1),脾动脉包绕肿块下部,静脉期肿块强化程度与动脉期相