Objective To compare and analyze the clinical application of third generation dual source CT prospective ECG gating coronary angiography(CTCA)in patients with high heart rate. Methods 147 patients who had examined with coronary angiography by the third generation dual source force in our hospital were collected during December 2016,the patients were divided into 4 groups,according to the heart rate,group A (n=40):heart rate<70/min,group B(n=42):70≤heart rate<80/min,group C(n=50):80≤heart rate<100/min,group D(n=15):heart rate more than 100/min. All acquired images were processed by the prospective ECG gated technique,and the quality of all segments of coronary artery images were analyzed and compared. Results The evaluation rates of coronary artery segments in the 4 groups were 99.8％,96.7％,98.9％,and 94.8％,respectively. The excellent rate of coronary artery images in the 4 groups were respectively 90.2％,84.2％,83.1％,and 69.3％. Between the 4 groups of coronary artery evaluation rate had difference(χ2=30.48,P<0.05),the difference of image quality also had difference(χ2=50.64,P<0.05). Conclusion The application of the third generation dual source CTCA in patients with high heart rate can obtain stable high quality images,which can be widely used in clinical practice.

OBJECTIVE To explore the clinical value of spectral CT iodine-based material imaging in diagnosis of the elderly pneumonia patients complicated with pulmonary embolism so as to perform the diagnosis and treatment in early stage .METHODS The elderly pneumonia patients complicated with pulmonary embolism underwent the con-ventional CT scanning and spectral enhanced scanning ,then the iodine contents of perfusion defects ,pneumonia lesions ,and normal lung parenchyma were observed and measured ,and the two groups were compared by using the Chi-square test for categorical data .RESULTS The iodine content in the lung perfusion defects was (0 .32 ± 0 .21)g/L ,the pneumonia lung segment (0 .461 ± 0 .31)g/L ,the contralateral or adjacent normal lung paren-chyma (1 .93 ± 0 .45)g/L ,and there was significant difference in the iodine content between the lung perfusion de-fects and the contralateral or adjacent normal lung parenchyma (Z= -5 .63 ,P<0 .01) ,but there was no significant difference in the iodine content between the lung perfusion defects and the pneumonia lung segment .The accord-ance rate of the iodine-based materials imaging and pulmonary artery CT imaging was 93 .1% in diagnosis of com-plete embolism lesions ,91 .1% in diagnosis of partial embolism lesions .CONCLUSION The spectral CT iodine-based materials imaging provides a new imaging method for the diagnosis of the elderly pneumonia patients compli-cated with pulmonary embolism .

Objective To evaluate the application of dual source CT (DSCT) in laparoscopic nephron- sparing surgery (LNSS) for patients with T1a renal tumor. Methods Sixty patients with T1a renal tumors underwent DSCT scan before LNSS. Multiplanar reformation,volume- rendered and maximum intensity projection images were created for measuring the anatomic structure of artery and vein, tumor size, location and the spatial relationship between the tumors and surrounding tissue, and the contralateral renal.The images were compared with those observed in LNSS and pathological results. Results There were no differences in the anatomic structure of artery and vein, tumor size and location between DSCT images and those observed in LNSS(P>0.05);and the concordances between DSCT images and pathological results in the invasion depths, spatial relationship between the tumors and the surrounding blood vessel, renal col ecting system were satisfactory (Kappa value=0.949, 0.872 and 0.936, respectively;P<0.05). Conclusion DSCT is an effective preoperative assessment tool in LNSS for T1a renal tumors.

Objective We wanted to evaluate the image quality and diagnostic value of 64-slice dual-source computed tomography (DSCT) coronary angiography in patients with atrial fibrillation (Afib). Materials and Methods The coronary arteries of 22 Afib patients seen on DSCT were classified into 15 segments and the imaging quality (excellent, good, moderate and poor) and significant stenoses (≥ 50%) were evaluated by two radiologists who were blinded to the conventional coronary angiography (CAG) results. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting important coronary artery stenosis were calculated. McNemar test was used to determine any significant difference between DSCT and CAG, and Cohen's Kappa statistics were calculated for the intermodality and interobserver agreement. Results The mean heart rate was 89 ± 8.3 bpm (range: 80-118 bpm). A range from 250 msec to 300 msec within the RR interval was the optimal reconstruction interval for the patients with Afib. The respective overall sensitivity, specificity, PPV and NPV values were 74%, 97%, 81% and 96% for reader 1 and 72%, 98%, 85% and 96% for reader 2. No significant difference between DSCT and CAG was found for detecting a significant stenosis (reader 1, p = 1.0; reader 2, p = 0.727). Cohen's Kappa statistics demonstrated good intermodality and interobserver agreement. Conclusion 64-slice DSCT coronary angiography provides good image quality in patients with atrial fibrillation without the need for controlling the heart rate. DSCT can be used for ruling out significant stenosis in patients with atrial fibrillation with its high NPV for detecting in important stenosis.

目的:探讨3.OT MR心肌灌注成像(MR myocardial perfusion imaging MRMPI)检查技术应用及方法.方法 对25例冠脉CTA确诊的冠心病患者行MR首过心肌灌注、延迟增强成像,经两位高年资医师以双盲法对图像质量进行评价分析.结果:21例图像质量达到诊断要求,21例受检者狭窄度≥50%的冠脉共34支中,29支显示首过灌注减低,9支显示延迟增强,其中心肌透壁增强4例,非透壁增强5例.4例图像质量不能达到诊断要求.结论在控制好受检者心率及呼吸,掌控好技术要点的情况下,MR心肌灌注成像完全可以得到符合诊断要求的图像,有效评价心肌缺血情况及程度,为冠心病的临床诊断及合理治疗提供可靠的依据.

目的 比较双源CT前瞻性心电门控扫描与应用不同管电压回顾性心电门控扫描的冠脉成像质量和患者的辐射剂量.方法 对23例心率＜70次/min且心率波动＜5次/min的患者采用前瞻性心电门控,55例心率不齐或＞70次/min的患者采用按体重指数 (BMI)不同而改变管电压的回顾性心电门控.并随机抽取30例采用常规回顾性心电门控CT冠脉成像(不变动管电压)的患者作为对照组.由两位放射科医师对图像独立进行质量评价,同时对患者的辐射剂量进行统计.结果 前瞻性心电门控冠脉成像与按患者的BMI指数应用不同管电压的回顾性心电门控冠脉成像的质量均能满足临床诊断要求.前瞻性心电门控冠脉成像的辐射剂量较回顾性心电门控下降了约60%～70%,降低管电压也可使辐射剂量明显下降,差异有统计学意义 (P＜0.05).结论 在保证冠脉成像质量的前提下,根据患者的自身情况制定最合适的检查方案,能够切实降低患者的辐射剂量.

<正>数字乳腺钼靶X线摄影(简称乳腺X线摄影)是诊断乳腺肿瘤的主要方法[1],而近年来MRI技术在乳腺疾病诊断中的应用日益广泛。本研究将两项技术单独或联合应用于乳腺肿瘤的诊断,现报告如下。

目的探讨双源CT应用钆喷酸二葡甲胺对不适用碘对比剂患者冠状动脉成像的可能性。方法分析了30例怀疑冠状动脉病变患者行钆喷酸二葡甲胺双源CT冠状动脉成像的图像质量和冠状动脉病变。结果 30例患者均可见冠状动脉主干及其分支的强化,增强效果优秀7例,增强效果好21例,增强效果欠佳2例。5例可见非钙化斑块或者钙化,并可见冠状动脉管腔狭窄征象,冠状动脉起源异常1例,冠状动脉-肺动脉瘘1例,肌桥18例。结论对于不适用碘对比造影剂的患者,怀疑冠状动脉病变时,在肾功能情况良好的前提下,可以利用钆喷酸二葡甲胺进行双源CT冠状动脉成像。

Objective:To investigate the clinical value of 3.0T susceptibility weighted imaging (SWI) in the diagnosis of post-infarct cerebral hemorrhage.Methods:50 patients with suspected cerebral hemorrhage after acute cerebral infarct underwent CT examination and conventional MR sequence (T2WI,T1WI,DWI) as well as SWI simultaneously,the results were statistically analyzed.Results:Of the 34 patients had post-infarct cerebral hemorrhage proved by CT,cerebral hemorrhage was diagnosed by SWI (34 patients),T2WI (19 patients ),T1WI (21 patients) and DWI (25 patients).The sensitivity of diagnosing cerebral post-infarct hemorrhage by SWI,T2WI,T1WI and DWI was 100%,59%,61.4% and 73% respectively;the specificity was 100%,65.2%,68% and 65.3% respectively;the positive predictive value was 100%,68.1%,71%,75.4% respectively;the negative predictive value was 100%,60.3%,57.2%,78.3% respectively.The Youden index (correct index) was 1.0,0.24,0.29,0.38 respectively.Diagnostic tests RSR analysis showed the RSR value of SWI,T2WI,T1WI and DWI was 1.0,0.3,0.5,0.7 respectively.Conclusion:SWI was superior to conventional MRI sequences in the diagnosis of cerebral post-infarct hemorrhage,and can be used as the routine examination for patients with acute cerebral infarction and follow-up after thrombolytic therapy.

目的探讨钆喷酸葡胺替代碘对比剂作双源CT冠状动脉血管造影增强效果和可行性。方法对30例患者进行双源CT检查。对比剂剂量:0.6mmol/kg例。结果本组钆喷酸葡胺剂量26.1～58.8ml,平均(48±9.6)ml。所有患者均可见冠状动脉主干及其分支的强化,左主干内CT值为55～187Hu,平均(130.73±26.95)Hu。增强效果优7例,增强效果良21例,增强效果欠佳2例。结论钆喷酸葡胺用于双源CT冠脉血管造影能获得高质量的图像,所用剂量对患者的肾功能无明显影响。

CT的辐射剂量和图像质量一直是生产厂家、放射学工作者关注的重点问题之一~([1]).随着临床CT检查的普及,CT的辐射剂量在所有放射成像影像设备中所占的比重越来越大,这就要求尽量降低受检者的辐射剂量。

目的 探讨快室率房颤(平均心室率≥80次/min)双源螺旋CT冠状动脉造影(CTCA)的成像质量及诊断价值.方法 对36例快室率房颤患者进行双源螺旋CTCA检查,根据美国心脏病协会冠状动脉分段标准对冠状动脉进行分段.以4级图像质量(优、好、中、差)评价标准对冠状动脉各节段进行评价.其中17例患者进行了冠状动脉造影(CAG),对管腔狭窄≥50%节段与双源螺旋CTCA对照,评价诊断敏感性、特异性、阳性预测值和阴性预测值.比较两种检查方法的准确性,并对比其诊断的一致性.结果 所有快室率房颤患者均采用绝对值时间间隔重建,其中影像诊断医师A、B分别有14、13个节段图像质量无法评估.影像诊断医师A对≥50%狭窄节段评价的诊断敏感性、特异性、阳性预测值、阴性预测值分别为78%、98%、90%、96%,影像诊断医师B的评价分别为75%、98%、87%、95%.双源螺旋CTCA与CAG对诊断≥50%狭窄病变并无明显差异(P>0.05),两种检查方法及两位诊断医师的诊断结果一致性较好.结论 双源螺旋CTCA在快室率房颤冠状动脉造影中可获得较好的图像质量,具有较高的阴性预测值,可作为房颤患者冠状动脉造影前的首选筛查方法.

Objective:To discuss the feasibility of gadolinium-enhanced CT coronary angiography in patients with contraindication to iodinated contrast medium. Methods:Thirty patients with contraindication to iodine underwent CT coronary angiography with Gadolinium. Each patient received a dose of 0.3 mmol Gd/kg of body weight at a flow rate of 4～5 ml/s. Total volume of Gadolinium was 25～52 ml. All CT examinations were performed with a dual-source CT scanner,with total scan time ranging from 7 to 10 seconds. Results:Enhancement of trunks and branches of coronary artery could be seen in all thirty patients. The attenuation within trunks was 130.73±26.95 HU (range,55～187 HU). In total,there were 402 segments. Not-evaluative image quality was found in segment 8,segment 10,segment 14 and segment 15. Serum creatinine levels of all cases were normal before and after CT exam. Conclusion:Gadolinium-enhanced CT coronary angiography is technically feasible and is valuable in coronary heart disease patients with contraindications to iodinated contrast material. Renal function should be identified normal before injection of Gadolinium to prevent nephrogenic systemic fibrosis (NSF).

目的探讨双源CT血管减影成像技术显示头部血管的优势。方法对45例患者进行头部血管双源CT减影成像检查。将增强前后图像进行减影,去除骨结构干扰,利用减影图像进行头部血管三维重建。结果45例均能显示颈内动脉,椎动脉及其主要分支,其中41例无骨质干扰,余4例因头部轻微运动,颅底及颈椎骨质未能完全减去,但不影响诊断。结论双源CT头部血管减影成像技术,重建时间短,能清晰显示头部血管及与周围组织的关系,是一种安全、便捷的检查方法,值得在临床中推广应用。

Objective To assess the image quality of dual-source CT in patients with high heart-rate.Methods 48 patients with high heart-rate were divided into 3 groups and coronary CT angiography was applied.Enhanced scan,fore-lyinged electrocardiograph(ECG) gating data collection、 curved planar reconstruction(CPR)were carried out.Maximum intensity projections(MIP)was used to evaluate the coronary artery lumens、volume Rendering(VR)was used to evaluate the image quality.Results All the patients had the image of coronary CT angiography successfully,the main branches of coronary showed fine image quality.Some branches showed constructed defect in slight or middle degree,which didn't affect to make a diagnosis.There was significant difference between those in group C and those in group A and B(p<0.05).Conclusions Dual-source CT can make coronary CT angiography for patients with high heart-rate successfully and the images are satisfactory.As a none-invasive method,it can be widely applied in clinic。

[目的]探讨磁共振背景抑制弥散加权成像(DWIBS)在体部淋巴结成像的技术探讨.[方法]使用Philips Intera Achiva 3.OT超导型双梯度MR扫描仪,采用背景抑制弥散加权成像技术对32例恶性肿瘤患者进行体部扫描,所得图像进行最人密俊投影(MlP)重建并黑白翻转.[结果]全部32例均成功得到DWIBS图像,DWIBS图像卜组织背景被抑制呈低信号,淋巴结呈高信号,达到类似PET的效果.[结论]磁共振DWIBS技术能清楚显爪体部淋巴结的分布,直观立体地显示淋巴结的数量与大小.

[目的]探讨磁共振背景抑制弥散加权成像(DWIBS)在体部淋巴结成像的技术探讨。[方法]使用Philips Intera Achiva 3.0T超导型双梯度MR扫描仪,采用背景抑制弥散加权成像技术对32例恶性肿瘤患者进行体部扫描,所得图像进行最大密度投影(MIP)重建并黑白翻转。[结果]全部32例均成功得到DWIBS图像,DWIBS图像上组织背景被抑制呈低信号,淋巴结呈高信号,达到类似PET的效果。[结论]磁共振DWIBS技术能清楚显示体部淋巴结的分布,直观立体地显示淋巴结的数量与大小。

下肢血管疾病的影像学检查,DSA被认为是金标准,但是其具有创伤性、辐射性、碘剂过敏等诸多缺点而致应用受到限制.磁共振血管成像(Magnetic Resonance Angiography,MRA)作为无创性影像学检查方法,在头颈部血管疾病的应用已较成熟.近年来,随着MobiTrak,自动移床、造影剂团注跟踪等技术的开发,为3D-CE MRA在腹盆及下肢血管病变的检查提供了新的检查手段.本文通过行下肢血管3D-CE MRA检查的18例患者,阐述该成像技术的要点.

Objective:To discuss the value of optimized pulse sequences of magnetic resonance imaging (MRI) in the diagnosis of super-acute and acute intra-cerebral hematoma (ICH) by experimental study with 1.5T MR scanner. Methods:32 rabbits were randomly divided into 2 groups,including experiment group (n=24) and control group (n=8).For experiment group,autogenous blood was injected to create ICH.Different stages (3、6、12、24 and 48h after operation) of ICH were imaged with 1.5T MR scanner.T1WI,T2WI,T2*WI and diffusion weighted imaging (DWI) were acquired and analyzed.MRI findings were correlated with histology.Results:Well-defined hypointense lesion was showed on T2*WI in every stage of ICH.The average volume of blood injected was (250±20)μl.Using volumetric measurement software,the average volume of intra-cerebral hematoma measured on T2*WI was (310±19)μl.There was no significant statistic difference between the two (t=0.003,P<0.05).On DWI,hypointensity in central area of the lesion with a hyperintense rim were assessed on different stages of hematoma.There was no characteristic finding of the ill-defined intra-cerebral hematoma on T2WI and T1WI.After 6 hours of the autogenous blood injection,polymorphonuclear leucocytes and small amount of micro-glial cell infiltration around the hematoma were revealed on histology.At 12h,mild erythrocyte lysis could be found in the center of the lesion.There was no intra-cerebral hematoma in the control group on MRI and histology.Conclusion:T2*WI and DWI showed high sensitivity in the diagnosis of super-acute and acute ICH.Super-acute or acute ICH could be diagnosed on MRI using conventional pulse sequences combined with DWI and T2*WI .

近年老年人脊柱结核的发病增多,且易与各种退行性变混淆,早期诊断不易.我们搜集了13例老年性脊柱结核的病例,回顾研究其低场磁共振(MRI)表现特点,提高对其认识.