目的 应用三维CT重建图像测量肩关节前向不稳患者的盂肱关节骨性数据.方法 回顾性分析有肩关节前脱位史的患者48例(病例组)和正常肩关节50例(对照组)的CT图像,测量其肩胛盂高宽比、盂窝深度、肱骨头包含角度及喙肱距离.结果 对照组和病例组的肩胛盂高宽比为1.52±0.03和1.64±0.05,肱骨头包含角度为(68.54±2.07)°和(62.55±2.43)°,2组间有统计学差异;对照组和病例组的盂窝深度为(2.12±0.29)mm和(2.09±0.28)mm,喙肱距离为(11.55±0.41)mm和(11.44±0.38)mm,2组间无统计学差异.结论 肩胛盂高宽比的增大和肱骨头包含角度的缩小,与肩关节前向不稳相关.

目的 观察磁共振成像(Magnetic Resonance Imaging,MRI)诊断透明细胞软骨肉瘤(clear cell chondrosarcoma,CCCs)的准确性及影像特点.方法 选取上海市第八人民医院及上海市第六人民医院收治的65例疑似CCCS患者,予以MRI检查,以病理诊断为“金标准”,观察MRI检查准确性、灵敏度及特异度,并分析其MRI影像特点.结果 手术病理诊断显示,65例患者中,56为CCCS,MRI诊断灵敏度92.86％ (52/56),特异度77.78％(7/9),准确性90.77％(59/65),Kappa值0.65;MRI确诊的CCCS中,溶骨性破坏与侵蚀性破坏分别占78.85％、21.15％;点状钙化占100.00％,不均匀分隔状强化占100.00％,混杂信号占80.77％.结论 MRI诊断CCCS具有较高准确性,其MRI影像特点以溶骨性破坏、不均匀分隔状强化、点状钙化以及混杂信号(主要是高强度T1、T2)为主.

目的 探究增强CT联合癌胚抗原(CEA)检测在孤立肺结节(SPN)良恶性判断中的应用效果.方法 选择62例SPN患者为研究对象,分别对其实施增强CT检测及CEA实验室检测,以病理学检查结果为金标准,记录单独增强CT、单独CEA检测以及增强CT联合CEA检测的灵敏性、特异性和准确度,并将3组结果进行对比分析.结果 检测发现,增强CT检测SPN良恶性结果灵敏性为78.95％,特异性为41.67％,准确度为64.52％,CEA检测灵敏性为84.21％,特异性为25.00％,准确度为66.13％,联合检测灵敏性为92.11％,特异性为83.33％,准确度为88.71％;增强CT与CEA联合检测的灵敏度、特异度、准确度均高于二者单独检测.结论 增强CT联合CEA检测能够提高SPN良恶性判断的灵敏性、特异性及准确度,具有一定的临床参考价值.

法国的EOS X线影像采集系统作为一种全新的X线骨科影像诊断设备已经在国内外医疗机构投入研究和临床使用.其最大的特点是负重位下一次性快速全身正侧位同时扫描,精准的1:1影像可以通过sterEOS后处理工作站进行3D建模和定量评估分析.本文从传统影像设备对于骨骼成像的限制,基于EOS的骨骼成像解决方案介绍,EOS全身姿态评估的基本操作流程以及国外EOS矢状面平衡技术的临床应用现状等4方面来阐述.基于EOS系统的全身矢状面平衡分析或将成为一种新的评价体系.

Objective To investigate the feasibility,methods and value of establishment of 3D digitized wrist model in vivo based on helical CT thin-slice axial images.Methods Fifty-two patients with one wrist injuries by foreign object underwent helical CT(arterial and venous phases contrast-enhanced CT scanning in 21 cases) with scan slice thickness and interval of 5 mm and reconstruction of 1.25 mm.Post-processing on a ADW 4.2 workstation by using VR Opacity software to generate the wrist 3D images of dorsal side,palmar side and cross-section views respectively through sliding mouse slowly to adjust the minimum threshold value from-600 Hu to 120 Hu(the maximum threshold was always set up as 600 Hu).Results The rate of 3D display layer by layer of from skin surface to bone was 100% in the wrist 3D images of dorsal and palmar side views.The best 3D depiction of skin,subcutaneous vein,muscle tendons,joint and bone was on the VAI with-300,-200,-100,0,100 Hu of the minimum threshold value respectively.And the 3D demonstration rate of the wrist extensor and flexsor tendons,subcutaneous vein,and bone was 100%.All arteries or deep veins were hundred percent depicted distinctly only in the 3D images reconstructed from enhanced arterial or venous phase CT,and the anatomic relationship among these vessels,bones and foreign objects was observed more excellently with from 80 Hu to 110 Hu of the minimum threshold.The wrist retinaculi and carpal tunnel structures were three-dimensionally shown clearly only on the 3D images of cross-section view in particular based on enhanced source data,which the more appropriate threshold was 0 Hu.The size,length,depth,distance of the structures shown on the 3D images were all measured accurately.Conclusion CT volume rendering visualization based on the sequential threshold carry out noninvasively the 3D to show and observation in vivo of the wrist anatomy and disorders and the 3D digital modeling of human wrist based on CT axial images.It may be considered as an effective means of anatomy teaching,operation simulation,pre-operation assessment,operation guidance and following up.

研究发现,髋关节牵引可导致旋股内、外动脉尤其股骨头供养血管闭塞与血运障碍[1-3],为了观察持续牵引、闭塞这些血管对股骨头血循环的影响尤其会否发生股骨头坏死(osteonecrosis of the femoral head,ONFH),笔者进行了经皮经腔犬旋股内动脉内结扎术(percutaneous transluminal medial femoral circumfflex arterial ligation,PTMFCAL)的研究,结果报告如下。

Objective To investigate the value of CTA on blood supply of femur head in dog.Methods CTA and DSA of bilateral hips were performed in 18 dogs.CTA was obtained after single-bolus injection of contrast media from the peripheral vein using 4-slice spiral CT.The blood supply of femur head and femur head cyclic process(FHCP) were observed.The sensitivity and the specificity of the medial and lateral circumflex femoral artery(MCFA and LCFA),the retinaculum artery(RA) and the artery of the ligamentum teres femoris(LTA) of CTA were compared with those of DSA.Results Blood supply to the femoral head was mainly from MCFA and LCFA,especially from RA originated from MCFA in dogs.CTA accurately displayed the common iliac arteries,internal and external iliac arteries,femoral arteries,deep femoral arteries,median sacral arteries and their 3 bifurcations.The sensitivity of CTA for MCFA,LCFA and RA was 94.44%(34/36),88.89%(32/36) and 3.03%(5/165),respectively;and the specificities were all 100%.LTA and FHCP were not shown by CTA.The assessment ability of CTA for RA,LTA and FHCP was significant lower than DSA(P0.001).Conclusion The value of 4-slice spiral CTA in evaluation on blood supply of dog's femoral head is very limited.

Objective To evaluate the past 5 years' clinic experience of diagnosis and treatment of the pediatric soft-tissue foreign body(STFB),and to probe new strategies for its clinical management.Methods Totally 165 consecutive children with small radiopaque STFB were involved.All the children were diagnosed with X-rays.CT(enhanced CT in 9 children) and virtual anatomy imaging(VAI) were performed in 40 children.Percutaneous foreign body forceps removal guided with C-arm video-fluoroscopy was performed and the effect was evaluated.Results The longest dimension of STFB ranged from 1 mm to 40 mm,and the shortest dimension ranged from 1 mm to 5 mm,including scrap-iron,broken iron nails and needles,and glass pieces embedded in soft tissues under surface of the limbs,neck,chest,abdomen and pelvis.Seventy-six(76/165,46.06%) children received interventional therapy,and 73 were completely cured(73/76,96.05%),2 were partially cured(2/76,2.63%),and 1 was failed(1/76,1.32%).VAI accurately depicted STFB closely to large vessels even associated vascular complication with local large hematomas or pseudoaneurysms,helped to select the treatment methods and the forceps removal roads.Hematoma,infection,neural damages and other serious complications did not occur during and after operation.Conclusion Video-fluoroscopy-guided percutaneous foreign body forceps removal is minimally invasive,safe and effective for small radiopaque STFBs,but may not suitable for the one very close to large blood vessels with or without vascular injuries complications.Preoperative CT VAI is helpful to locate STFB within complicated anatomic structures,selecting optimal intervention pathway and assessing the risk of intervention.

Objective： To determine preliminary the values and limits of computed tomographic angiography （CTA） in assessment of arterial supplying to the femur head. Methods： Two thousand and one sets of femoral head thin slice CT axial images in arterial phase were retrospectively 3D reconstructed on AW 4.2 workstation. CTA was obtained by using the 4-detector row CT scanning after single-bolus injection of 95 mL contrast media at 4 mL/s from the peripheral vein. Tile supply arteries was observed. Results： The CTA sensitivity of MCFA, LCFA and RA were 100%, 100% and 28.57% respectively. What were depicted clearly on CTA were their origin, main trunk and proximal portion, and their distal portions were not shown clearly. The method of3D VR rotation view, using small FOV and minimal value of 75 - 80 Hu and maximal value of 250 - 300 Hu, gave good visualization of these vascular structures. Conclusion： It was limited for 4-detector CTA to evaluate the arterial supply of femoral head,