目的 评价CT肺动脉造影(CTPA)在血液恶性肿瘤患者肺部侵袭性霉菌感染(IMD)诊断中的应用价值.方法 依据《侵袭性肺部真菌感染的诊断标准与治疗原则》,于2018年3月至2019年4月共纳入40例厦门大学附属中山医院血液科的血液系统恶性肿瘤患者,并进一步将其分为确诊、临床诊断和拟诊.对所有患者行CTPA检查,观察影像与临床/微生物之间的关系以及能否利用CTPA协助发现拟诊分类中的IMD患者.结果 所有确诊的6例患者均出现肺血管栓塞改变的阳性结果;9例临床诊断患者中,8例CTPA阳性,1例CTPA阴性;25例拟诊患者中,12例CTPA阳性,13例CTPA阴性.结论 CTPA可直接发现可疑肺IMD患者肺血管闭塞,其在血液恶性肿瘤患者肺IMD的早期诊断价值值得进一步探讨.

目的 应用DSA和CTA技术探讨中晚期肝癌的血供特点及血流灌注动态变化情况.方法 选取我院于201 3年1月至2015年1月间收治的28例中晚期肝癌患者为研究对象,对其肝动脉及门静脉等进行DSA及CT血管造影检查,检测患者的血供及血流灌注动态变化情况.结果 DSA和CT血管造影显示所有患者的病灶数目、大小及位置一致.肝动脉造影表现为动脉期多血供,且CTHA例数显著高于DSA肝动脉造影(27VS23) (P=0.000);间接门静脉造影表现为门静脉期乏血供,在DSA门脉造影和CTAP上均未发现门脉血供.肝癌组织在CTHA单层动态扫描上呈明显强化,且肝动脉期具有丰富动脉血流灌注,而在CTAP单层动态扫描上呈无明显强化,且肝门静脉期无门脉血流灌注,差异具有统计学意义(P=0.000).中晚期肝癌患者的DSA和CT血管造影结果显示:弥漫型、结节型及巨块型肝癌病理类型的动脉血供比较,差异无统计学意义(P＞0.05),且均未发现门脉血供.结论 中晚期肝癌患者以肝动脉供血为主,侧枝动脉供血为辅,门静脉供血较低或无;应用DSA和CT血管造影技术综合评价肝癌的血供特点和血流灌注动态变化,可为介入治疗提供参考依据.

目的:评价低剂量CT(low-dose CT,LDCT)在孤立性亚实性肺腺癌结节影像分期中的价值.方法:搜集LDCT筛查发现并经病理学检查证实的亚实性肺腺癌结节53例,其中男性19例,女性34例,平均年龄55岁.采用Kappa检验回顾性分析影像与病理分期的一致性,以及不同胸部影像科医师之间影像分期的一致性.结果:LDCT对亚实性肺腺癌结节影像T和N分期的准确率分别为88.7％(47/53)和94.3％(50/53).影像与病理分期及不同胸部影像科医师之间影像分期的一致性良好(Kappa=0.803,0.733;P＜0.05).结论:亚实性肺腺癌结节多为早期肺癌,淋巴结或远处转移发生率低,LDCT适用于其术前影像分期.

Objective To observe and evaluate MSCT multi﹣phase dynamic contrast enhancement features of primary ureteral carcinoma. Methods Thirteen cases with primary ureteral carcinoma with operative and pathologic identification were studied by MSCT multi﹣phase dynamic contrast enhancement. There were 11 males and 2 females. Results The peak enhancement of 8 primary ureteral carcinomas by MSCT multi﹣phase dynamic contrast enhance﹣ment were in the nephrogram phase;3 cases in the corticomedullary phase, 2 cases in the pyelogram phase. Conclu﹣sion MSCT dynamic contrast enhancement features of primary ureteral carcinoma have some characteristics. It is easy to diagnose with other image signs. The main differential diagnosis of few primary ureteral carcinoma with con﹣tinuing enhancement pattern was primary non﹣specificity ureteritis.

后颅窝实质性血管母细胞瘤血供极其丰富,手术难度大,致残率和病死率均较高.近年来我们应用术中超声技术,对后颅窝实质性血管母细胞瘤进行实时的定位和相关的血流监测,提高了手术治疗效果,现将结果报告如下.

Aim: To investigate the value of intraoperative real-time ultrasound during surgery of cerebral arteriovenous malformations(AVMs).Methods: 15 patients with cerebral AVMs underwent microsurgical treatment. Intraoperative ultrasound was performed before the starting of resection in order to localize and delineate the AVM ; definiting the hematoma and AVM relationship and identifying the feeding arteries and draining veins.After removing of the lesion,sonographic examination was repeated to detect the residual AVM tissue and the findings were compared with post-operative angiographic finding. Results: Total resection was achieved in all 15 patients under real-time ultrasonographic examination.The AVM were localized and defined precisely.The hematoma exhibited hyperechogenicity without blood signals.The feeding vessels were distinguished from normal ones hemodynamically.Complete removal of the AVM determined sonographically was then confirmed by angiography. Conclusion: Intraoperative real-time ultrasound allows accurate localization of the cerebral AVMs and helps to determine the degree of removal of the cerebral AVM.It provides valuable supplement information for pro- operative MRI and DSA during surgery,