目的 分析脑梗死后遗症期合并社区获得性肺炎(CAP)患者影像学特征,构建和验证预后风险评分模型.方法 选取 2018 年 1 月至 2022 年 3 月湖州学院附属南太湖医院和 2012 年 1 月至 2021 年 12 月陆军第 72 集团军医院诊治的 216 例脑梗死后遗症期合并CAP患者,采用随机数字表法,将 216 例患者按照 7∶3 的比例分为建模组(151例)和验证组(65例).追踪住院期间患者是否死亡,将其分为死亡组和存活组.基于建模组数据,采用单因素和多因素logistic回归模型分析脑梗死后遗症期合并CAP患者预后的影响因素;根据多因素回归方程中各指标对应的回归系数,建立风险评分模型;使用受试者操作特征曲线评价模型效能,利用验证组数据对模型进行验证.结果 216 例脑梗死后遗症期合并CAP患者病死率为 20.37%,建模组、验证组患者病死率分别为19.21%、23.08%.CT检查显示,脑梗死后遗症期合并CAP患者肺部感染累及单肺占 72.69%,累及双肺占 27.31%;CT检出肺实变占12.96%,检出胸腔积液占21.30%.死亡组和存活组年龄、发病至就诊时间、脑梗死病程、糖尿病、合并多重耐药革兰氏阴性菌(MDR-GNB)感染、中量及大量胸腔积液、中性粒细胞/淋巴细胞比值(NLR)、乳酸比较,差异有统计学意义(P＜0.05).脑梗死病程≥5 年(OR=5.284)、糖尿病(OR=3.515)、合并MDR-GNB感染(OR=13.821)、中量及大量胸腔积液(OR=6.618)、NLR＞5.85(OR=8.186)、乳酸＞2.66 mmol/L(OR=4.699)是脑梗死后遗症期合并CAP患者预后的影响因素(P＜0.05).构建的风险评分模型在建模组和验证组中的曲线下面积分别为 0.804(95%CI:0.731～0.864)、0.821(95%CI:0.706～0.905).≥5分为死亡高风险人群.结论 本研究构建的风险评分模型对于评估脑梗死后遗症期合并CAP患者预后具有良好的预测能力.

Objective To investigate the pathogen distribution,imaging characteristics,and risk factors of pulmonary infection with multi-drug resistant organism (MDRO) in patients with severe craniocerebral injury,and establish and verify the risk prediction model. Methods A total of 230 patients with severe craniocerebral injury complicated with pulmonary infection were collected retrospectively.According to the 7∶3 ratio,they were randomly assigned into a modeling group (161 patients) and a validation group (69 patients).The risk factors of MDRO pulmonary infection were predicted with the data of the modeling group for the establishment of the risk prediction model.The data of the validation group was used to validate the performance of the model. Results Among the 230 patients,68 patients developed MDRO pulmonary infection.The isolated drug-resistant bacteria mainly included multi-drug resistant Acinetobacter baumannii,multi-drug resistant Klebsiella pneumoniae,multi-drug resistant Pseudomonas aeruginosa,and methicillin-resistant Staphylococcus aureus,which accounted for 45.21%,23.29%,16.44%,and 15.07%,respectively.The imaging characteristics included pleural effusion,lung consolidation,and ground-glass shadow,which accounted for 72.06%,63.24%,and 45.59%,respectively.Multivariate Logistic regression analysis showed that the independent risk factors for MDRO pulmonary infection included age ≥60 years (P=0.003),history of diabetes (P=0.021),history of chronic obstructive pulmonary disease (P=0.038),mechanical ventilation ≥7 d (P=0.001),transfer from other hospitals (P=0.008),and coma (P=0.002).A risk scoring model was established with the β value (rounded to the nearest integer) corresponding to each index in the regression equation.Specifically,the β values of age ≥60 years,history of diabetes,history of chronic obstructive pulmonary disease,mechanical ventilation ≥7 d,transfer from other hospitals,and coma were 1,1,1,2,2,and 1,respectively (value ≥4 indicated a high-risk population).The areas under the receiver operating characteristic curve of the modeling group and validation group were 0.845 and 0.809,respectively. Conclusions Multi-drug resistant Acinetobacter baumannii is the most common pathogen of MDRO pulmonary infection in patients with severe craniocerebral injury.Pleural effusion,lung consolidation,and ground-glass shadow were the most common imaging characteristics.The established risk model has high discriminant validity in both the modeling group and the validation group.

目的 探讨多模态磁共振成像在急性缺血性脑卒中(AIS)的诊断价值及溶栓、取栓中的风险评估.方法 回顾性分析经临床证实的47例AIS患者的临床及影像资料,磁共振成像采用常规序列,部分使用三维动脉自旋标记成像(3D-ASL)、扩散加权成像(DWI)、磁敏感加权成像(SWAN)等多模态成像,分析其诊断价值及治疗风险评估.结果 所有患者磁共振影像显示不同大小范围脑梗死;3D-ASL显示均有低灌注区,有31例患者存在缺血半暗带,复查后有6例出现高灌注,后发生出血转化(HT);有2例患者不同灌注延迟时间均为低灌注区,但在PLD 1.5s时,病变周围扭曲血管影(ATA),提示侧支循环代偿良好,调整治疗方案,未发生HT等并发症.有4例患者经过SWAN扫描发现点状、片状低信号,后期复查已证实出血转化.结论 多模态磁共振成像在AIS的诊断及溶栓、取栓治疗中具有重要应用价值.DWI及ADC可精准诊断AIS,SWAN及3D-ASL预估出血转化,对调整诊疗方案有指导意义.

目的 探讨基于ASIR平台宝石CT低千伏CTV成像技术在下肢静脉造影中的应用.方法 选取本院52例(59侧患肢)疑似下肢静脉疾病行宝石CT直接法低剂量下肢静脉CT造影(CT venography,CTV)检查患者回顾性分析.59侧患肢中静脉血栓11侧、静脉曲张32侧、静脉血管瘤2侧、静脉血管瘤合并曲张1侧、外伤静脉损伤3侧、静脉血管无异常10侧.结果 11例静脉血栓患者经介入手术溶栓、取栓治疗,32例静脉曲张患者、2例静脉血管瘤患者及1例静脉血管瘤合并曲张患者行外科手术治疗,术中发现CTV成像定位准确,直视血管病变与CTV显示影像相符;3例外伤静脉损伤患者留院保守治疗.结论 基于ASIR平台宝石CT低千伏CTV成像技术可以获得满足下肢静脉疾病诊断用图像,能为下肢静脉疾病诊断提供可靠的影像学信息,并且大幅降低放射剂量.

目的 目前临床早期鉴别诊断冠心痛比较困难,冠心病已成为中老年猝死的主要原因之一.本研究探讨宝石能谱计算机断层扫描(computed tomography,CT)双低技术在冠脉狭窄中的诊断价值,并分析冠脉斑块性质与狭窄程度的分布情况.方法 选取2015-05-01-2017-05-31中国人民解放军第九八医院收治的50例疑似冠心痛患者为研究对象,均行宝石能谱CT双低技术检查和冠脉造影(computed tomography,CAG).以冠脉造影作为金标准,评价宝石能谱CT双低技术诊断冠脉狭窄程度的应用价值,同时分析冠脉斑块性质与冠脉狭窄程度的分布特点.结果 以冠脉造影作为金标准,宝石能谱CT双低技术诊断冠脉狭窄的准确率、灵敏度、特异度、阳性预测值和阴性预测值分别为94.67％、81.63％、98.30％、93.02％和95.05％;两种方法诊断结果一致性的Kappa值为0.836;两种方法冠脉狭窄检出率差异无统计学意义,x2=0.984,P=0.321.不同冠脉斑块性质与冠脉狭窄程度分布差异有统计学意义,x2=22.862,P＜0.001;其中冠脉轻度狭窄主要与钙化斑块相关,中度狭窄主要与混合斑块相关,而重度狭窄与非钙化性斑块相关.结论 宝石能谱CT双低技术不仅在冠脉狭窄中的诊断价值较高,而且可以无创性评价冠脉斑块性质,值得临床上进一步推广应用.

Objective To?investigate?the?functional?disorder?of?arteriovenous?internal?fistula?in?patients?with?maintenance?hemodialysis?by?using?dynamic?500?row?with?adaptive?statistical?iterative?platform.?Methods A?retrospective?review?of?all?patients?with?functional?disorder?of?arteriovenous?internal?fistula?diagnosed?by?CT?from?January?2016?to?June?2018?in?the?98th?Hospital?of?People's?Liberation?Army?of?China?was?performed.?Twenty-one?patients?were?recruited?in?this?study.?All?patients?underwent?a?routine?VHS?scanning?mode?on?a?GE?Discovery?HD?750?scanner?with?thinner?thickness?of?0.625?mm?after?the?scanning?of?8?shuttle?sequence?image,75%?ASiR?reconstruction,volume?rendering,maximum?density?projection, and?curved?surface?reconstruction?for?image?analysis.?Results Of?21?patients?with?arteriovenous?internal?fistula?dysfunction,the?prevalence?of?stenosis?in?anastomotic,outflow?tract,and?inflow?tract?were?3/10%,6/10%,and?1/10%?in?10?patients?with?artificial?AVG,respectively.?Comparing?to?artificial?AVG,the?instance?of?stenosis?in?anastomotic,outflow?tract,and?inflow?tract?were?1/11%,8/11%,and?2/11%,respectively.?Conclusion Dynamic?500?rows?based?on?ASiR?platform?is?capable?of?characterizing?the?diseased?vessels?by?reducing?the?conical?beam?artifacts?and?improving?the?signal-to-noise?ratio.?The?findings?suggest?a?more?effective?method?for?evaluating?arteriovenous?internal?fistula?dysfunction.

目的 探讨宝石能谱CT血管造影对冠状动脉瘤的诊断价值.方法 回顾性分析我院16例确诊为冠状动脉瘤的宝石能谱CT血管造影影像资料,对所有图像进行VR、MIP、CPR等后重建处理,观察动脉瘤形态、位置、瘤颈形状、载瘤动脉狭窄程度及对斑块成份分析.结果 16例均清楚显示瘤体的大小,形态,血栓形成情况及载瘤动脉狭窄程度;6例位于右冠状动脉近段(RCA),1例位于右冠状动脉圆锥支(RCB)、3例位于右副冠状动脉,3例位于左冠状动脉主干(LM),1例位于左冠状动脉第1对角支近段(D1),2例为左冠状动脉瘤,伴发冠状动脉-肺动脉瘘形成.结论 宝石能谱CT血管造影在评价冠状动脉瘤中具有明显优势,对于动脉瘤的病因、病理形态、临床手术指导及支架术后复查均具有重要意义.

Objective To investigate the value for MRV in the preoperative evaluation of the location,degree that the meningiomas beside sinus which invaded venous sinus and the compensatory situation of draining veins. Methods 27 patients of meningiomas beside venous sinus were examined preoperatively with conventional MRI scan,enhanced MRI scan and MRV,the location,degree that the tumor invaded venous sinus and the compensatory situation of draining veins were observed and the diagnoses of MRV with the findings of operation were compared one by one. Results All of the 27 MRV images were clearly displayed:11 cases were classified in type I,MRV showed that venous sinus were light pressed or normal,the lumen were clear 9 cases were classified in type II,MRV showed that venous sinus were deformed,filling defect were found in sinus cavity,the lumen were partially clear 7 cases were classified in type III,MRV showed that venous sinus were disrupted,the signal of venous sinus were completely disappeared,the lumen were occluded,compensatory expanded draining veins were showed beside all of the tumors. Conclusion The relationship between meningiomas and venous sinus can be evaluated by MRV,it has an important guiding significance to choose operative approach for meningiomas beside the venous sinus and deal with the relationship intraoperatively between tumors and blood vessels,increase the complete resection rate of tumors and decrease the postoperative complications.

Objective To investigate the cerebral blood flow in migraine without aura with three-dimensional arterial spin labeling technology .Methods From January 2013 to February 2016, magnetic resonance perfusion imaging was operated in 20 migraine patients without aura and 20 healthy controls by using arterial spin labeling, to determine their regional cerebral blood flow (rCBF) during migraine attacks and attack-free period.The significant difference was analyzed in rCBF between the two groups .Results The rCBF was significantly lower at the headache side during migraine period ( ( 52.77 ±5.97 ) ml? 100 g-1? min-1 ) than symmetrical side in the migraine patients without aura ((62.72 ±6.65) ml? 100 g-1?min-1 , t=3.780,P<0.01).The rCBF of temporosphenoid lobe in headache side in the migraine patients without aura ((53.97 ±5.87) ml? 100 g-1? min-1) was significantly lower than corresponding region in the control group ((59.21 ±2.35) ml? 100 g-1? min-1, t=4.449, P=0.001).And no significant difference in rCBF was found in migraine patients without aura under attack-free period. Conclusions Three-dimensional arterial spin labeling could quantitatively analyze the cerebral blood flow .Monitoring the perfusion difference in migraine patients could provide some references in the pathogenesis research and therapy.

目的：探讨能谱CT单能量成像对下消化道血管畸形的诊断价值。方法对14例临床诊断下消化道出血患者行能谱CT增强检查，采用能谱成像（GSI）扫描模式，分别进行动脉期、门静脉期扫描，分别进行普通模式及GSI模式重建，得到混合能量图像及60 keV单能量图像，进行血管成像（CTA），并采用多平面重建（MPR）、曲面重建（CPR）、容积再现（VR）及最大密度投影（MIP）技术对能谱单能量图像进行分析；10例病变与血管造影（DSA）进行对照分析，3例病变于手术证实，1例病变被肠镜证实。结果14例临床诊断下消化道出血患者中，普通模式混合能量图像明确诊断11例病变（11/14），能谱CT 60 keV单能量成像均能明确诊断出血部位（14/14）。14例病变在60 keV单能量成像均表现为增粗、迂曲的供血动脉，5例病变可见粗大引流静脉，6例病变见肠腔内片状造影溢出影，病灶的对比噪声比（CNR）明显高于普通模式重建图像；所有病灶于碘基图均显示。其中11例行DSA检查，9例得到证实（9/11），表现为增粗扭曲血管影，并见畸形血管团，其中6例显示活动性出血灶，另2例未被DSA检出，而60 keV单能量成像及碘基图图像均显示，由外科手术证实；2例行肠镜证实为结肠出血；另1例直接行外科手术证实。结论能谱CT单能量成像诊断下消化道血管畸形的价值高于普通MSCT及DSA，具有较高的临床诊断价值。

Objective To apply 3 .0T MRI in diagnosing injuries of anterior bundle of medial collateral ligament after elbow dislo‐cation .Methods The MRI features of the injuries of medial collateral ligament anterior bundle were analyzed retrospectively in 20 patients with elbow dislocation .The coronal ,sagittal ,axial and lamina oblique coronal were scanned routinely with SE T1WI ,T2WI‐FS sequences .Results Varying degrees of anterior bundle injuries of medial collateral ligament were observed in all the 20 patients ,in‐cluding the mild injury(n=8) ,part avnlsion(n=5) ,completely rupture(n=7) .Furthermore ,concomitant injuries including lateral collateral ligament(n=11) ,ringlike ligament(n=5) ,flex/stretch muscle tendon(n=9) ,and the fracture(n=7) were also observed . Conclusion The injuries of medial collateral ligament anterior bundle after elbow dislocation could be diagnosed accurately with 3 .0T MRI and the degree of injuries could also be defined on image .The 3 .0T MRI could be recommended as regular examination to pa‐tients with elbow dislocation .

ObjectiveTo discuss the diagnosis value of 3D-MT-TOF MRA in atherosclerotic aneurysm.Methonds To 45 patients doubt suffer from intracranial atherosclerotic were examined 3D-MT-TOF MRA,using MT technology.according to blood vessels by maximum density projection and volumetric reconstruction.Results In 45 cases imaging of MRA,32cases diagnosis atherosclerotic,9 cases with aneurysm,among them,7 cystic aneurysm,4 spindle aneurysm(2 cases both the aneurysm);4 cases aneurysm occur in the internal carotid artery,2 cases aneurysm occur in the middle cerebral artery,3 cases aneurysm occur in the posterior cerebral artery,1 case aneurysm occur in the vertebral artery. Conclusion 3D-MT-TOF MRA to reconstruction the intracranial arterial satisfied,can clearly rendering the atherosclerotic narrow and aneurysm .provided reliable basis to the clinical,also can be used as a preferred method of screening.

病例 女,25岁,1周前无明显诱因出现头痛、头晕症状,无恶心、无胸闷气急,无呼吸困难,无四肢抽搐.外院就诊检查头颅CT示颅内占位病变,为进一步诊治来我院门诊复查.颅脑MRI检查示右额叶巨大肿块,呈T1FLAIR像等低信号、T2FLAIR等高信号及DWI像高信号影,内见畸形血管流空信号影,边界欠清,周围脑实质水肿,增强后显著不均匀强化,部分坏死灶,邻近脑膜增厚、强化,脑膜尾征可见,提示血管瘤型脑膜瘤可能(图1,2).入院后行颅脑CT增强示右额叶片状高低不均密度影,边界欠清,增强后病灶显著不均匀强化,CTA示混杂血管团,提示“颅内动静脉畸形”可能(图3).术前行DSA检查,并行脑膜中动脉栓塞术(图4).术中见肿瘤质地软,呈现鱼肉状,血供极其丰富,出血量约600 mL;术后病理结果为胶质肉瘤(WHOⅣ级).

患儿 女，8岁。1年前出现左下肢跛行呈进行性加重而来我院就诊。体检：患儿腹壁、胸壁、右上臂、后背、左臀部及左下肢多发散在大小不等咖啡牛奶斑，以左臀部为甚（图1），色斑沉着随年龄增长渐加重；近1年出现左下肢渐进性跛行，且左侧大腿较对侧稍增粗。实验室检查及胸部平片均未见明显异常，患儿家属否认家族中类似病例及相关遗传病史。

目的 评价3.0T MR在肩袖损伤中的诊断价值,对肌腱断裂的定性、定量诊断价值.方法 回顾性分析35例经手术及关节镜证实的肩袖损伤患者,3.0T MR对肌腱断裂的定性、定量诊断与手术及关节镜进行对比.结果 35例均有不同程度的肩袖损伤,部分患者为复合伤:冈上肌肌腱损伤29例,包括19例肌腱部分断裂,10例完全断裂;冈下肌肌腱损伤7例,5例肌腱部分断裂,2例为完全断裂;肩胛下肌肌腱损伤3例,2例肌腱部分断裂,1例为完全断裂.结论 3.0TMR对肩袖损伤有非常重要的应用价值,肌腱撕裂的定性与定量诊断对术前有明确的指导意义.

Objective To evaluate the application of 3.0T magnetic resonance angiography (MRA) in diagnosis of in-tracranial artery fenestration deformity (FIA). Methods Seventy eight patients with FIA underwent MRA examination from April 2012 to December 2014. The imaging features, deformity sites and type, and other intracranial vascular lesions were retrospec-tively reviewed. The original vascular images were reconstructed and processed with AW4.5 workstation by minimum intensity projection(MIP) and volume rendering(VR) methods. Results Among 78 FIA patients, 61 cases had single lesions, 17 cases mul-tiple lesion with a total sites of 95. In 61 patients with single lesions, 15 were located in basilar artery, 13 in anterior communicating artery, 26 in anterior cerebral artery, 5 in middle cerebral artery and 2 in posterior cerebral artery. In 17 patients with multiple le-sions, 6 were located in basilar artery and left anterior cerebral artery, 7 in left vertebral artery intracranial segment and left anterior cerebral artery, 4 in basilar artery and anterior communicating artery. 65 out 78 cases (83.3%) were complicated with other vascu-lar lesions, with bilateral artery predominant in 36 cases, with arteriovenous malformation (AVM) in 1 case, trigeminal artery in 3 cases, A1 segment of anterior cerebral artery deletion in 16 cases and vascular stenosis in 9 cases. Conclusion 3.0T MRA as a non- invasive imaging method can effectively diagnose intracranial arteries fenestration and other intracranial vascular lesions.

目的：探讨3.0T磁共振M RA诊断颅内动脉成窗畸形的临床价值，了解颅内动脉成窗畸形的M RA表现、好发部位。方法回顾性分析2012-04-2013-02我院22例颅内动脉成窗畸形患者的影像学特点、畸形好发部位、类型及合并其他颅内血管性病变。22例均行颅脑磁共振血管成像（magnetic resonance angiography ，MRA）扫描，再将原始图像经 AW4.5工作站采用M IP及V R两种方法进行血管重组，并对血管图像进行后处理。结果22例颅内动脉成窗畸形患者中，单发19例，多发3例，共25处。其中19例单发病例中位于基底动脉6例，位于前交通动脉区3例，位于大脑前动脉10例；3例多发病例中，位于基底动脉及左大脑前动脉1例，位于左椎动脉颅内段及左大脑前动脉1例，位于基底动脉及前交通动脉1例。22例中合并其他颅内血管性病变者20例（90.9％），双侧动脉对比一侧优势者16例，伴AVM1例，永存三叉动脉1例，大脑前动脉A1段缺失8例，血管狭窄2例。结论3.0T磁共振M RA能清楚显示颅内动脉成窗畸形的位置、形态及合并颅内其他血管病变，是诊断颅内动脉成窗畸形首选、有效、无创的影像检查方法。

Objective: Explore 3.0 T MRA diagnosis of intracranial artery into the window deformity clinical value, understanding of intracranial artery into window deformity the MRA performance, the predilection sites, as wel as the value of clinical application. Methods:A retrospective analysis of the April 2012 to February 2013, a total of 22 cases of intracranial arteries into window deformity in patients with the imaging features, deformity predilection sites, type its combined with other intracranial vascular lesions. 22 cases underwent brain MRA scan, then the original image AW4.5 workstation using two methods of MIP and VR vascular reorganization, and vascular image processing. Results:22 cases of intracranial arteries window deformity patients, single 19 cases, multiple three cases, a total of 25. 19 patients with single cases in the basilar artery in six cases, three cases located in the anterior communicating artery, located in the anterior cerebral artery 10 cases. Three cases frequently occurring example, in the basilar artery and left anterior cerebral artery in 1 case, in the left vertebral artery intracranial segment of the left anterior cerebral artery in 1 case, in the basilar artery and the anterior communicating artery in 1 case. 20 patients with other vascular lesions in 22 cases, 90.9%, contrast side of the advantages of bilateral artery in 16 patients, with AVM 1 case, trigeminal artery in 1 case, A1 segment of anterior cerebral artery deletion in 8 cases,vascular stenosis in 2 patients. Concluson:3.0 T MRA can clearly show the intracranial arteries window demformity position, morphology and other intracranial vascular lesions, the diagnosis of intracranial into windows deformity preferred, effective, non-invasive imaging method.

Objective To compare the application value between MT technology and 3D-TOF in MRA. Methods Eighty-two patients accepted MRA scanning by both MT technique and conventional 3D-TOF method ,the original images of the both kinds were done with three-dimensional reconstruction and analyzed.Results MT MRA vascular background was completely inhibited ,branches of small vessels were clearly displayed ,and the vascular background suppression of conventional 3D-TOF MRA was not complete ,peripheral branches of small vessels were not clear or not shown.Conclusion The MT method is su-perior to the conventional 3D-TOF method MRA to obtain high clear vascular images.

<正>脐尿管囊肿为少见的先天性泌尿系统发育畸形,是成人脐尿管病变中最常见的发病类型,占所有畸形的约30%。男女发病率无明显差异,30岁以下患者发病以脐部表现为主,而30岁以上者以膀胱表现为著[1]。囊肿大小不等,一般无明显症状,多在囊肿变大或者体检时发现。先天性脐尿管疾病一旦确诊,在感染控制后应早切除[2]。本文回顾性分析脐尿管囊肿的MSCT表现,以提高对本病诊断水平。