Objective To explore the feasibility of use of virtual non-contrast images in te place of conventional noncontrast images of dual-energy computed tomography(DECT) in evaluating pancreatic carcinoma.Methods Thirty-three patients with pancreatic carcinoma proved by pathological diagnosis underwent abdominal DECT using a triphasic protocol consisting of true non-contrast(TNC),arterial-phase(AP) and venous-phase (VP) acquisitions.The virtual non-contrast CT images and iodine images were reconstructed based on the enhanced imaging data.The average CT value,image noise (SD),signal-noise ratio(SNR) of pancreatic carcinoma tissue,score of subjective diagnosis and the detection sensitivity of pancreatic carcinoma were compared among TNC,AVNCand VVNC.Results The CT value of AVNC and VVNC in pancreatic carcinoma tissue was positively correlated with that of TNC(AVNC r =0.793,VVNC r =0.555).The average CT value of pancreatic carcinoma tissue from large to small was TNC ＞ AVNC ＞ VVNC,the SD of lesion obtained from AVNC,VVNC and TNC was TNC ＞ VVNC ＞ AVNC,and the SNR was AVNC ＞ VVNC ＞ TNC.By respective pairwise comparison of the CT value,SD and SNR of the lesion among three groups,there were significant difference between TNC and AVNC,TNC and VVNC(P ＜0.05),and there was no significant difference between AVNC and VVNC(P ＞0.05).All three groups of image quality could meet the clinical diagnostic requirements.There was no significant difference in subjective quality scores among the three groups(P ＞ 0.05).The detection sensitivities of pancreatic carcinoma were not significantly different among the three groups(P ＞ 0.05).Conclusion Image quality of VNCT derived from dual-energy CT can meet the diagnostic requirements.VNCT could be obtained with similar image quality as TNCT.Iodine images can provide additional diagnosticvalue.

Objective To investigate the application of dual- source four- dimensional CT angiography (4D- CTA) com-bined with CT perfusion imaging (CTPI) in diagnosis of acute cerebral ischemic diseases. Methods Thirty patients with clinical y suspected acute cerebral ischemic disease underwent head plain CT scan and whole brain CTPI examination 2~16h after onset, the images of CBF, CBV, MTT, TTP and 4D- CTA were obtained. Patients also underwent MRI examination in 1~3 d. The findings of plain CT scan, CTPI, 4D- CTA and MRI were analyzed. Results Plain CT scan found 16 ischemic lesions in 12 cases, CTPI found 32 ischemic lesions in 26 cases, MRI found 28 ischemic lesions in 25 cases, and 4D- CTA demonstrated various degree of stenosis or occlusion in supplying vessels in 20 cases. Conclusion Dual- source 4D- CTA combined with CT perfusion imaging provides comprehensive and detailed imaging information, so that has important value for early diagnosis and treatment in pa-tients with acute cerebral ischemia.

OBJECTIVE To analyze and discuss the potential causes and preventive measures for nosocomial infections induced by computed tomography guided non-vascular intervention.METHODS The features of non-vascular intervention guided by computed tomography were investigated and the risk of possible hospital infections was evaluated,and then the discussion of possible solutions for the problems discovered was followed.RESULTS Feasible measures for the infections due to intervention operations have been established,which deepened the understanding of hospital infections of medical staff in CT rooms.Furthermore,with the discovery and correction of weak points in the prevention of hospital infections,the incidence of the infection has been decreased.CONCLUSION In the prevention of computed tomography guided non-vascular intervention induced infections,it is vital to establish measures for the prevention of nosocomial infections in CT rooms,the prevention measures for possible hospital infections should be carried out to reduce the incidence of hospital infections.

应用多层螺旋CT(MSCT)三维重组技术研究冠状动脉病变的价值已得到临床广泛认可,尤其是16层以上螺旋CT,为临床提供了一种精确的评价冠状动脉病变的方法[1].而应用MSCT进行心脏静脉系统的研究刚刚起步.冠状静脉窦(CS)系统是心脏静脉系统的重要组成部分.

Objective To evaluate the effects of the interventional treatment combined with Tetrastigma hemsleyanum Diels et.Gilg(SYQ) extract on rabbit VX2 liver tumor.Methods Totally 33 tumor-bearing rabbits were randomly divided into 3 groups:control group,simple intervention group and intervention combined with SYQ extracts group.After 14 days,a comparative study of imaging changes of the multi-slice CT(MSCT) and liver function changes was carried out.Results After 14 days,imaging changes in the multi-slice CT(MSCT) showed that there was a significant effect in the tumor size,tumor growth rate,and necrosis rate by intervention combined with SYQ extracts group as compared with other two groups(P<0.05).In intervention combined with SYQ extracts group,the positive rates of liver GPT,GOT were significantly lower than other two groups(P<0.05).Conclusion Interventional treatment combined with SYQ extracts has a certain effect in inhibiting the VX2 rabbit liver tumor and maintaining a protective change in liver function.

Objective To investigate the clinical value of magnetic resonance angiography(MRA) of vertebral artery in etiological diagnosis of patients with vertigo.Methods A total of 52 blackout patients with vertebrobasilar insufficiency vertigo were diagnosed clinically.All the patients were examined by MRA to investigate the tracks,diameters,and stenosis locations of vertebral arteries.Results MRA positive of vertebral artery were in 38 patients,and negative in 14 patients.Among MRA positive patients,there were obstruction of vertebral artery in 3 cases,narrow lumen in 13 cases,localized stenosis in 15 cases,and circuity in 7 cases.Furthermore,some patients were also examined by digital subtraction angiography(DSA).The full accordance of both methods in the diagnosis of thin veterbral artery was 70.59%.Conclusions As a noninvasive method,MRA was a useful tool in diagnosing vertebral artery stenosis and obstruction,and especially available for diagnosis and treatment of patients with vertebrobasilar insufficiency.

Objective To investigate interventional treatment method of lower limb arteriosclerosis in diabetic foot and its clinical value.Materials and Methods Through the femoral artery puncture antegrade or retrograde intubation by Seldinger technique methods,the limb arteriography in 12 patients with diabetic foot were undertaken by digital subtraction angiography(DSA).Arteriosclerosis was found in 15 lower limbs,angioplasty combined eluting stent were implemented,and the curative effect at 2 weeks,4 weeks was compared.Results Limb blood flow after operations was improved in all patients.4 weeks after treatment,the clinical symptoms of numbness,pain,skin temperature,purple had significantly improved(χ2=6.85,χ2=6.95,χ2=7.02,χ=7.33,all P<0.01),ABI index(0.80±0.13)were higher(0.62±0.10)(t=3.412,P<0.01).Ultrasound showed blood vessel diameter increased after treatment(t=3.412,P<0.05).Conclu-sion Interventional treatment of diabetic foot is minimally invasive,safe and effective,and can significantly improve the limb blood supply.

Objective To explore the features of intracranial collateral circulation in patients with symptomatic cerebral artery stenosis.Method Ninety-four patients with ischemic cerebrovascular disease admitted from Apr.2004 to Jun.2009 were involved in present study.All the patients were examined with cerebral multi-slice CT angiography,and the features of cerebral artery stenosis and intracranial collateral circulation were evaluated using maximum intensity projection(MIP) and volume rendering(VR) images of CT angiography.Result Of the 94 patients involved,48 were diagnosed as cerebral artery stenosis,including 29 cases of cerebral infarction,18 of transient ischemic attack(TIA) and 1 of moyamoya disease(MMD).Among the 14 cases of severe cerebral artery stenosis or occlusion,cerebral infarction was found in 6 cases with lesser intracranial collateral vessels(including massive cerebral infarction in 4 cases and watershed infarction in 2 cases),and focal infarction of central semi-ovale in 1 case and TIA in 7 cases were found with abundant intracranial collateral vessels.Multiple lacunar infarction was found in 22 cases of mild or moderate cerebral artery stenosis,but there was no significant correlation between the stenosed arteries and infarction sites.Abundant intracranial collateral vessels were found in one patient with Moyamoya disease but no infarction was observed.Conclusions Intracranial collateral circulation plays an important role of compensation in patients with severe cerebral artery stenosis or occlusion.Cerebral angiography with multi-slice CT is of great significance in evaluation of cerebral artery stenosis and intracranial collateral circulation.

患者男,58岁.因心律失常心脏起搏器植入术前X线胸片发现肺部肿块,于2009年10月19日就诊,主诉反复头晕10余年,眩晕2年.既往无咳嗽、咯痰、气急、胸痛等呼吸系统症状.体检示两肺呼吸音清,心率60次/min,律不齐,未闻及病理性杂音.动态心电图示阵发性房颤伴部分心室长间歇。

Objective To explore the value of spiral CT multi-planar reconstruction(MPR) in diagnosing diaphragmatic hernia.Materials and Methods Spiral CT MPR was performed in patients suspected with diaphragmatic hernia.The diameters of diaphragmic hiatus measured by different reconstruction methods were compared and statistic analyzed.Resu-lts Fifteen cases of esophageal hiatus hernia,3 cases of traumatic diaphragmatic hernia,2 cases of diaphragmatic eventration,2 cases of triangle hernia between vertebral lumbar and rib and 1 case of diaphragmatic hernia occurred after operation were collected.CT axial and MPR imagings in revealing diaphragmatic hernia were compared.There was significant difference between CT axial and MPR imagings in displaying diaphragmatic hiatus.There was significant difference between CT axial and MPR imagings in measuring the diameter of diaphragmatic hiatus.Conclusion Spiral CT MPR can clearly show the diaphragmatic hiatus and also can precisely measure the diameter of diaphragmatic hernia.It plays an important role in diagnosing various types of diaphragmatic hernia and can guide to therapy.

目的 探讨计算机辅助检测系统(CAD)在检测肺结节中的应用价值.方法 随机选取有胸部CT检查且在前后10 d内行胸部后前位片检查的200例患者,由3位不同临床经验的放射科医师分别记录应用CAD前和应用CAD后直径在3～20 mm的结节个数,并以CT检查为金标准,对其检出敏感性进行统计学分析.结果 CT发现45例80个结节符合直径在3～20 mm,CAD准确率51.25%,放射科医师甲、乙、丙在使用CAD前准确率分别为40%、37.5%及26.25%,使用CAD后准确率分别为46.25%、46.25%及30.0%.在直径3～10 mm的结节中,CAD发现30个,放射科医师甲、乙、丙在使用CAD前分别发现12、13、7个,各位医师的准确率与CAD间有显著差异(P<0.05);使用CAD后,放射科医师对3～20 mm结节的准确率无明显提高(P>0.05).结论放射科医师应重视CAD提示的小结节,尤其是低年资医师和对直径3～10 mm的结节.

动脉瘤样骨囊肿临床较少见,它几乎可累及人体所有骨骼,其影像学表现差异较大,易与其他囊样改变的骨肿瘤相混淆[1-3],并且该病常与其他骨病伴发,增加了诊断的难度.笔者整理分析了16例经手术、病理确诊的继发性动脉瘤样骨囊肿患者的影像资料,现总结报告如下.

We describe a case of superoinferior ventricles with an unusual superior location of the left ventricle and inferior location of the right ventricle. The patient was a 17-year-old boy who had been admitted for paroxysmal supraventricular tachycardia with pre-excitation syndrome. The cardiac anomaly was first recognized after admission, and the pre-excitation syndrome, eventually, was treated successfully by radiofrequency catheter ablation. This case featured a segmental set notation {S, D, S} with concordant atrioventricular and ventriculoarterial alignments. Persistent left superior vena cava was the only associated defect. To the best of our knowledge, there has been only 1 other reported case of superoinferior ventricles in which the left ventricle was in the superior position. In our case, the patient's hemodynamics were sufficiently normal that he had reached adolescence with only minor adverse events.

Objective To analyze the computed tomography (CT) imaging findings of invasive pulmonary aspergillosis (IPA) and estimated the diagnosis value of CT.Methods CT images of 11 cases with IPA were retrospectively analyzed.The lung abnormal lesions were dynamically observed.Results The early CT findings included nodules surrounded by halo sign or consolidation.From 10th to 20th d after onset,at CT,lesions were characterized typically by nodules or mass-like consolidation in 8 cases (4 mixed with cavities),halo sign in 5,low density in 1,and air crescent sign in 1. Moreover,3 cases were only presented patchy consolidation.Conclusions Lung CT should be taken and dynamically followed up when respiratory infection occurred in immunocompromised patients.Familiarity with CT imaging findings in IPA may suggest or improve the diagnosis.

心脏是一个特殊的器官,不但自身在不断地快速运动,病理状态下也在进行不规则运动,同时还随呼吸上下移动.因此,在心脏影像检查中不仅要有一般脏器检查所需的较高的密度(灰度)分辨力和空间分辨力外,还要有较高的时间分辨力.既往心脏影像检查中,心血管造影一直是诊断和评价心脏疾病的"金标准".

目的 探讨肺隐球菌病的CT表现及其诊断价值.方法 回顾分析7例经病理证实的PC临床及多层螺旋CT资料.结果 病变好发于肺外围,呈单发或多发结节块影3例;单发或多发斑片影3例;斑片影与结节影混合病灶1例;邻近胸膜增厚、粘连6例,胸水1例,晕征3例,空洞2例.结论 肺隐球菌病的影像表现缺乏特异性,诊断依赖病理学检查,但CT上仍有一定的特点,结合临床资料有助于本病的诊断和鉴别诊断.

支气管黏液表皮样癌是一种源于支气管黏膜腺体及其导管的肺部少见恶性肿瘤.本病既可发生在成人,也可发生在儿童.最近我院收治年仅8岁的儿童1例,并复习国内文献,对中国儿童支气管黏液表皮样癌临床和影像表现作一讨论。

患者 女,71岁.无明显诱因的情况下出现右后背部疼痛1月余入院.查体:患者一般情况良好,全身浅表淋巴结无肿大,血压145 mmHg/85 mmHg(1 mmHg=0.133 kPa).

患者女,27岁.无明显诱因出现反复心前区隐痛2年余,再发伴持续头痛20 d入院.无胸闷、气急、晕厥、黑矇,无畏寒、发热.心前区隐痛,经休息后可缓解.入院体检:体温正常,心率72次/min,血压107/56 mm Hg(1 mm Hg=0.133 kPa),胸骨左缘2～3肋间可闻及Ⅲ级连续性杂音.

Objective To study the CT appearances of primary pulmonary histoplasmosis (PPHP)and evaluate the diagnostic values of CT for PPHP.Methods The clinical materials and multi-slice spiral CT appearances in 8 patients with PPHP proved pathologically were reviewed retrospectively.Results Single or multiple pneumonia-like lesions were seen in 3 esses,single or multiple nodules or masses were in 4 cases,and both pneumonia-like lesions and nodules or mflsses in 1 case.Calcification and halo sign were common,and only slight enhancement was demonstrated after intravenous contrast administration on CT.Conclusion CT is helpful imaging method in the diagnosis and differential diagnosis of PPHP combining with clinical materials although the CT appearances are not specific.