多原发肺癌(multiple primary lung cancer,MPLC)是指在同一患者肺内同时或先后发生2个或2个以上原发性肺癌。根据癌灶发现时间可将 MPLC 分为发生时间间隔<6个月的同时性 MPLC(synchronous MPLC,sMPLC)和间隔在6个月或以上的异时性 MPLC(metachronous MPLC,mMPLC)[1]。随着检查技术快速发展,近年来 MPLC 的检出也越来越多。笔者通过总结 MPLC 的 MSCT 征象、临床诊断及治疗,评价 MSCT诊断 MPLC 的临床应用价值。

Objective To investigate the value of regular test system in further education of radiology, and to compare the teaching efficiency. Methods The doctors who worked in PLA general hospital for one-year further education were enrolled. Compare the teaching effciency of doctors with and without regular test system. Their teaching efficiency included diagnostic reports, written exam score, and published articles. Results In regular test system group, the diagnostic reports were 4 865 reports per person, the mean of written exam score was (86.2±4.7), and there were 20 published articles, while in control group, there were 3 772 reports per person, mean score of (78.6±5.3), and 8 published articles. It was statistical improvement in teaching efficiency (P<0.05). Conclusion The regular test system may improve the teaching efficiency in further education of radiology, and may be helpful to deifnite the qualiifcations.

目的 探讨肺朗格汉斯细胞组织细胞增生症(PLCH)的CT表现.方法 回顾性分析10例经病理证实PLCH患者的临床资料及CT影像资料,分析病变的分布、大小和形态等CT特征.结果 单系统(SS)朗格汉斯细胞组织细胞增生症(LCH)7例,其中早期1例,中晚期6例;多系统(MS) LCH 3例,其中早期1例,中晚期2例.10例病变均呈弥漫、对称性分布,并以中上肺野分布为主.2例早期PLCH患者CT表现以多发小叶中央性结节为主,并见厚壁或薄壁空洞结节;8例中晚期患者,CT表现以囊腔为主,为圆形或类圆形囊腔、形态多样的融合囊腔合并/不合并少量结节、空洞结节,其中2例融合性囊腔形成肺大疱,并破裂产生气胸.结论 双侧中上肺野多发小叶中心性分布结节、空洞结节,合并囊腔,特别是形态多样的囊腔为PLCH的CT特征表现.

Objective To investigate the clinical diagnose value on the new CTA scanning program of lower limbs.Method 50 patients(average age:55year) were performed with spiral CTA scan,they were randomly divided into two groups;one was subjected with traditional injection project(adopt single-phase contrast inject,flow rate was4.0ml/s,volume 100ml),and the other group was injected with the new project(between the first and the end phase of contrast agent injection intervened with saline injection,the flow rate of contrast agent on first phase is3.5ml/s,the dosage is 70 ml,the flow rate of saline is 2.5ml/s,the dosage is 20 ml,and at the last phase the contrast agent injected was 30 ml with a speed of 2.5ml/s,three phases injection were not discontinuous).Scanning parameters were as following:tube voltage and current were 120 kV and 220 mAs;both slice thickness and gap were1.25 mm,pitch factor was 0.8mm.The image quality were evaluated with blind method by two experienced radiologists.Result After comparing the images of distal lower extremity vascular acquired with two scanning solutions,we found that the vascular images with new program were more excellent than that produced with traditional project.The improvement program achieved the quality requirements of medical diagnostic imaging,it has the significant value of increasing the discovery rate of stenosis in lower limb artery.Conclusion As well as new project image mass to satisfy the needs or requirements of clinic diagnoses,Boost lower limbs pathological changes diagnosis worth.

Objective To describe CT features and tumor cell differentiation in pathology in adenocarcinoma of lung in young patients. Methods The clinical data and CT findings of lung adenocarcinoma proved pathologically in 57 young patients were reviewed. Results The average duration from symptom onset to diagnosis was (3.6±0.4) months. 16 cases were misdiagnosed. There were 4 patients with central bronchogenic carcinoma, 52 with peripheral bronchogenic carcinoma, 1 with diffuse bronchial carcinoma (DBC) and 2 with multiple primary bronchial carcinomas (MPBC), 46 cases presented as masses and nodules and 39 with lobulation, 29 with speculation and 27 with pleural indentation. There were 51 patients with discernible degree of cancer differentiation, 1 case with AIS, 1 with minimally invasive adenocarcinoma, among invasive adenocarcinoma, 4 with high differentiation, 2 with high-moderate differentiation, 14 with moderate differentiation, 9 with low-moderate differentiation and 20 with low differentiation. Most of the cases were advanced stage when diagnosed, 44 presented with metastasis, 38 patients with chest metastasis, pleural effusion occurred in 14 patients. Conclusion Peripheral mass and nodule are the predominant CT features of lung adenocarcinoma in young patients. Poor-differentiated tumor with metastasis is common when diagnosed.

目的:探讨冠状动脉CT造影(CCTA)指标对老年中高危险度非心脏手术计划的影响.方法:回顾性分析我院2012年1月到2013年12月,连续入组的非心脏手术术前怀疑冠心病而行CCTA的患者冠状动脉粥样硬化特征资料,包括冠状动脉狭窄的严重程度(MSS)、冠状动脉粥样硬化病变累及支数(N)、节段累及积分(SIS)、节段狭窄积分(SSS);记录推迟或放弃手术的原因、分析CCTA结果对非心脏手术计划的影响.应用Logistic回归分析患者冠状动脉MSS、N、SIS及SSS与非心脏手术计划改变之间的关系,计算优势比(OR),作受试者工作特征曲线(ROC)并计算曲线下面积.结果:本研究共398例患者,其中76例(19.1％)冠状动脉无异常表现;220例(55.3％)表现为轻度冠状动脉粥样硬化征象;102例(25.6％)显示重度冠状动脉粥样硬化征象;参考CCTA结果,340例(85.4％)患者如期进行了手术,26例(6.5％)患者干预后择期进行手术,32例(9.2％)放弃手术;Logistic回归分析表明:个体冠心病的MSS、N、SIS及SSS是老年非心脏手术计划改变的危险因素,OR值分别为:2.07,2.89,1.17及1.16(均P＜0.05).个体冠心病的MSS、N、SIS及SSS的ROC曲线下面积依次为:0.613,0.615及0.624,0.648,SIS及SSS的最佳截断点分别为3.50和3.50.结论:应用CCTA评价术前怀疑冠心病的老年中高危险度非心脏手术患者,冠状动脉粥样硬化指标均会影响手术计划.

目的：分析总结肺硬化性血管瘤（PSH）的临床表现和CT表现，提高诊断正确率。方法回顾性分析经手术病理证实的33例PSH的临床资料和胸部CT表现，其中15例接受CT平扫，18例接受CT平扫和增强扫描。结果大部分患者为中青年女性，无临床症状，CT表现为边缘清晰、圆形或类圆形单发软组织结节或肿块影，以肺周边多见，密度多均匀，钙化偶见，可有浅分叶，无明显毛刺，增强扫描大部分强化明显。结论胸部CT扫描是PSH重要的诊断、鉴别诊断依据。

Objective To improve the understanding of gastrointestinal wall diffuse hemangioma(GWDH)by summarizing its CT features.Methods Clinical data and imaging features of 4 GWDH patients admitted to our hospital from April to November 2012 were retrospectively analyzed.Of the 4 patients,3 underwent routine abdominal plain and enhanced CT scanning,1 underwent pelvis plain and enhanced CT scanning due to bleeding in the lower digestive tract.Results The average age of the 4 patient was 16,30,42 and 33 years old,respectively.The 3 male patients had presented with repeated painless bloody stools since their childhood and the female patient had bloody stools for more than 1 month.CT showed that the lesions involving gastric wall and several segments of intestinal wall were manifested as circularly and irregularly thickened long segment wall with local lumen stricture and multiple punctuate and nodular calcification shadows.Enhanced CT showed no significant change in the lesions at conventional arterial and venous phases but at the delayed 90-120 s phase.The lesions showed progressive enhancement with their CT value increased to 2030 HU.Moderate homogenous enhancement of the lesions was observed in 1 patient 50 min after delayed scanning with the CT value of about 60 HU.A portal venin drainage tube was placed in 3 patients and a tortuous subcutaneous vein drainage tube was placed in 1 patient.No normal structure of the portal vein was observed in 2 patients,indicating that sponge-like degeneration occurs in the portal vein.Conclusion Attention should be paid to GWGH in those who have presented with bloody stools or repeated bloody stools since their childhood.Specific CT features in combination with clinical history contribute to the correct diagnosis of bloody stools.

【Objective】 We aimed to discuss the clinical value of multi-slice spiral CT angiography (CTA) in the diagnosis of carotid artery stenosis. 【Methods】 Both CTA and DSA image data of 164 cases of carotid artery were analyzed retrospectively. The differences of stenosis evaluated by the two methods were also analyzed. 【Results】 150 cases patients suffered different degrees of carotid artery stenosis in 164 patients, and 341 lesions were analyzed. There was statistical differences in evaluation the stenosis between two methods in slight stenosis group, but no obvious statistical differences are found in middle and serious stenosis groups. 【Conclusion】 Multi-slice spiral CTA of carotid artery may replace DSA and be regarded as a routine examination for screening of suspected carotid stenosis.

Objective To discuss the diagnostic value and clinical application value of multi-slice spiral computed tomography about gastrointestinal stromal tumor.Methods We analyze 38 cases with stomach stromal tumor which are confirmed by pathology and immunohistochemistry retrospectively,observe the size,shape,density,reinforcement of lesion or focus and other organ invaded and secondary changes,and decide that it is benign tumor or malignant tumor.Results The maximum diameter of tumor is smaller than 5cm(4 cases),the maximum diameter of tumor is from 5cm to 10cm(22 cases),the maximum diameter of tumor is bigger than 10cm(12 cases).There is necrosis and cystic change(13 cases)and hemorrhage(8 cases)in the lesion.The normal membrana mucosa is not existed in the gastral cavity(10 cases).The focus is communicated with gastral cavity because of ulcer formation(8 cases)but there is not any ulcer of stomach although air is in gastral cavity(2 cases).It is asymmetry reinforcement of the tumor and the center of the focus is without any reinforcement sometime.The tumor has adhesion to tissue or organ around it(28 cases).The preoperative diagnoses are benign tumor(5 cases),anaplastic tumor or borderline tumors(23 cases),malignant tumor(10 cases)according to size,density and contiguity.Conclusion It is possible to display stomach stromal tumor focus by multi-slice spiral computed tomography definitely and to supply effective information about diagnosis and grading.Image of multi-slice spiral computed tomography is effective measure about preoperative evaluation and postoperative follow-up and curative effect assessment to stomach stromal tumor.It is effective supplement of endoscopy.

目的 探讨多层螺旋CT(MSCT)对胰腺实性假乳头状瘤的诊断价值,以提高对该病的认识.方法 回顾性分析了16例经手术病理证实的胰腺实性假乳头状瘤患者的CT资料,16例中12例为年轻女性,男性4例.均行GE Discovery Ultra 16层螺旋CT平扫及增强,增强扫描包括动脉期、静脉期及平衡期,然后利用后处理软件对图像进行多平面重组(MPR).结果 位于胰头6例,胰体2例,胰尾3例,胰体尾均累及4例,胰头、胰尾多发1例.CT平扫均为混合性肿块,增强后动脉期实性部分不同程度强化,以后逐渐强化明显,部分与增强后正常胰腺一致,可见包膜强化,囊性部分无强化.2例见斑点状钙化,1例伴肝内外胆管扩张,4例囊内自发性出血.结论 结合临床特点MSCT增强扫描对胰腺实性假乳头状瘤具有较高的诊断价值.

目的:分析总结肺淋巴管肌瘤病(PLAM)的临床表现和CT表现,提高诊断正确率。方法:回顾性分析经临床确诊的13例PLAM的临床和胸部CT表现。结果:患者均为女性,主要症状为进行性劳力性呼吸困难。CT表现为肺内弥漫或散在分布的薄壁囊腔,分布无特异性,其中6例合并气胸,4例合并乳糜性胸腔积液。结论:肺部CT是PLAM的重要诊断依据。

目的:提高淋巴管肌瘤病(LAM)肺部CT表现的认识。方法:回顾性分析经临床确诊的10例LAM的临床和胸部CT表现。结果:临床表现主要为渐进性劳力性胸闷和呼吸困难,其中1例合并结节硬化。CT表现10例均表现为弥漫或散在分布的薄壁囊腔,分布区域无差别。其中,3例合并乳糜性胸腔积液,3例合并气胸,1例见胸膜下多发肺大疱,2例见磨玻璃密度,1例见网格影。结论:LAM的肺部CT表现具有特征性,结合其临床特点,是诊断的重要依据。

<正>内脏性肥胖与原发性高血压、糖尿病、血脂代谢异常等多种心血管疾病的危险因素密切相关。与非肥胖个体比较,内脏肥胖者心肌梗死发病率更高,冠状动脉粥样硬化进展更快,即使在具有相同脂肪总量的人群中,由于人体的脂肪分布不同,其发生心血管疾病的危险性并不相同,内脏型肥胖

冠状动脉节段走行于浅层心肌纤维下,称为壁冠状动脉,表面心肌称为心肌桥.虽然壁冠状动脉是一种先天性的解剖变异,但由此引发心绞痛、心肌梗死甚至猝死的临床报道有所增加[1].因此对其诊断具有重要的临床意义.

目的 评价冠状动脉钙化与颈动脉钙化的关系及其危险因素.方法 2周内先后完成冠状动脉和颈动脉CT平扫检查的162例患者,采用相同的重建条件,分别进行钙化积分的测量,用Spearman相关分析进行两者的比较.同时记录患者的性别、年龄、血压、总胆固醇、甘油三脂、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、糖尿病、吸烟史、冠心病早发病史等,用Logistic回归分析冠状动脉及颈动脉钙化积分与多个临床危险因素之间的关系.结果 在162例患者中,冠状动脉钙化积分(CACS)与颈动脉钙化积分之间存在线性正相关关系,r值为0.690,P<0.01.CACS的危险因素包括年龄、糖尿病、总胆固醇、LDL,颈动脉钙化的危险因素为年龄和糖尿病.结论 冠状动脉钙化与颈动脉钙化呈线性正相关,但冠状动脉与颈动脉钙化的危险因素不完全相同.

OBJECTIVE:To investigate the feasibility of proton magnetic resonance spectroscopy ((1)H-MRS) of the myocardium in vivo.METHODS:A total of 100 volunteers were examined with 1H-MRS scan using a 1.5T MR scanner, and the magnetic resonance spectra were analyzed.RESULTS:All the volunteers completed the examinations, and the spectral peaks were identified with the chemical shifts of water (4.7 ppm), choline (3.2 ppm), creatine (3.0 ppm), and triglyceride (0.9-1.6 ppm), whose presentation ratios were 100%, 86%, 90%, and 98%, respectively. In 86 cases the spectra showed all the chemical shifts. The myocardial metabolite contents were expressed as the ratio of metabolites to water (%), and the contents of choline, creatine, and triglyceride were 1.94%, 1.95%, and 9.41%, respectively.CONCLUSION:(1)H-MRS can be used in detecting the metabolic products of myocardium in vivo.

目的 探讨细支气管肺泡癌(BAC)的CT表现及临床特点,提高BAC的认识水平.方法 回顾性分析经手术病理证实细支气管肺泡癌52例,总结BAC的CT表现.评价指标包括:病灶部位、数目、大小、形态、边缘、密度、有无含气空腔(或囊状影)、充气支气管征、血管集束征、胸膜凹陷、有无淋巴结肿大等.结果 共收集52个病例,71.2%为查体发现,肿瘤标记物CEA和CA125的阳性率分别为6.5%和3.2%.病变平均直径＜2.5 cm,80.4% CT表现为单纯的磨玻璃(GGO)结节,96.4%边界清晰,分叶征、充气支气管征、血管集束征及胸膜凹陷的发生率分别为69.6%、60.7%、62.5%、58.9%,均无肺门纵隔淋巴结转移.结论 BAC在CT上的形态学特点较具诊断价值.

Objective To analyze the CT findings in pulmonary sclerosing hemangioma(PSH)for improving its imaging diagnosis.Methods CT data and pathological reports of 42 patients admitted to our hospital in September 2004-June 2009 were retrospectively analyzed.Results The median age of the 42 patients(38 females and 4 or median males)included in this study was 46.6 years(range from 19 to 66 years).Of the lesions in the lung,39(92.86%)were located in the medial or median zone.Nodular foci were found in 30 cases(71.43%)and tumor mass 12 cases.Smooth tumor margin was shown in 31 cases,lobulated tumor margin in 9,and speculated change in 2 cases.Calcification was observed in 11 cases with a prevalence of up to 66.67%when the diameter of lesion was 30mm larger.Of the 31 enhanced cases,8(25.81%)and 18(66.67%)showed a heterogeneous density of lesion before and after contrast administration.The mean enhancement value was(31.16±11.93)HU(range 1-64 HU).The seemingly characteristic peritumor ground-glass opacity and air-crescent sign were found in 11 and 6 cases,respectively.Conclusion PSH usually occurs in the medial or median lung zone of middle-aged and old females,which is characterized by obvious or heterogeneous enhancement,peritumor ground-glass opacity,and air-crescent sign.

Objective:To develop the diagnostic level of bronchioloalveolar carcinoma(BAC) by analyzing the clinical fea-tures and CT presentations of BAC.Materials and Methods:All the cases of BAC comfirmed by operation and pathology were retrospectively analyzed from June 2002 to June 2007.These cases were review using the 2004 revised WHO classifica-tion of BAC and separated them into two groups,pure BAC and mixed subtype adenocarcinoma with BAC components.The CT presentations of pure BAC were analyzed.Evaluated findings included the number(solitary or multiple),size,morphous,contours,density and gas-containing space of lesions.Other CT findings such as air bronchogram,vascular converging and lymphadenopathy were also assessed.Results:145 surgically resected cases with thin-section CT images were histologically diagnosed as BAC from 2002 to 2007.Of these,32(22.1%) proved to be pure BAC using the 2004 revised WHO classifica-tion.There were 20 men(62.5%) and 12 women(37.5%).The positive rate of tumor markers CEA and CA125 was 10% and 5%,respectively.The mean diameter of BAC was less than 3cm and all of the cases presented pure ground glass opacity.82.9% of them showed inhomogeneous density,97.1% well-defined margin.The rate of lobulated shape,air bronchogram and gas-containing space were 62.9%,60%,57.1%,respectively and lymphadenopathy in none of these BAC.Conclusion:In the di-agnosis of early stage of BAC,some morphologic features of lesions on thin slice CT may be more important.