Objective:To study the multi-detector CT(MDCT)appearances of infection and air collection at cervicothoracic junction,and correlated with anatomic findings on cross-section of cadavers.Methods:11adult cadavers were used to study the structure and morphology characteristics of cervico-thoracic junction,with axial section(n=5),sagittal section(n=4)and coronal section(n=2).84 patients with infection or air collection(pneumatosis)at cervico-thoracic junction underwent MDCT were also studied and correlation with patho-anatomy was performed.Results:The main findings of 11 cadavers were as follows:anatomic communication was revealed between retropharyngeal space and prevertebral space with retroesophageal space of superior mediastinum;prevertebral space extended laterally and inferiorly,communicating with axillary fossa via axillary sheath;carotid sheath was continuous with perivascular space of superior mediastinum;pretracheal space of neck communicated with superior mediastinum.The MDCT findings of 84 cases showed infection of retropharyngeal space extended downward to posterior mediastinum;infection of prevertebral space extended downward to posterior mediastinum and laterally to axillary fossa;infection of carotid sheath could spread downward to superior mediastinum.Air collection in mediastinum in cases of pneumatosis could simultaneously spread to neck and axillary fossa.Conclusion:The detail information of distribution of infection or air collection in cervico-thoracic junction could be revealed clearly on MDCT.The distribution of disease depends on the specific anatomy characteristics which were showed on cross section study of cadavers.

OBJECTIVE. The objective of our study was to clarify the anatomic and radiologic features of the extraperitoneal fasciae and fascial spaces associated with the rectum.MATERIALS AND METHODS. Fourteen embalmed cadavers were studied: two for gross anatomy; six for sectional anatomy, of which two underwent histologic study; and six for space perfusion study. These examinations were followed by CT and cross dissection to observe the pelvic extraperitoneal fasciae and the role of the fasciae in the anatomic subdivision and communication of the fascial spaces. Eighty healthy subjects underwent CT or MRI to identify the imaging characteristics of the pelvic fasciae.RESULTS. Cadaver dissection and histologic study revealed a distinct sheath consisting of dense connective tissue encasing the rectum and surrounding adipose tissue like a sleeve that divided the rectal extraperitoneal space into the perirectal space and pararectal space. Perfusion studies showed communication between the pararectal spaces and the vesical extraperitoneal space anteriorly and the anterior pararenal space superiorly, but not with the perirectal space. In healthy subjects, both CT (95.0%) and MRI (97.5%) showed a circular or linear structure representing the rectal fascia outside the rectum encasing the rectum and its surrounding adipose tissue.CONCLUSION. The extraperitoneal segment of the rectum and its surrounding adipose tissue are encased by a fascia, like a sleeve, that can be seen on CT and MRI in healthy populations. The fascia divides the rectal extraperitoneal space into the perirectal space and pararectal space, and it may prevent lesions of the rectum from spreading to other pelvic extraperitoneal spaces.

Objective To evaluate the CT features and implications of the pericardial sinuses and recesses effusion by combining the sectional cadavers and 16 mttlti-slice CT(MSCT)reformation.Methods The anatomy and communication of the pericardial sinuses and recesses on the axial,coronal and saggital sectional cadavers(respectively 1 case),and the morphologic features on MSCT reformatted images in 104 patients were observed,The detection rate of effusion was analyzed.Results The sectional cadavers and CT images showed that the pericardia] sinuses and recesses were formed by the reflections of the pericardium on the root of the great vessels.The detection rate of the sinuses and recesses was lower in small effusion than in moderate and large effusion(P0.05).The superior aortic recess was the most common recess for pericardial effusion.Conclusion The MSCT reformatted images can show the morphologie features of pericardial sinuses and recesses effusion and communications with the pericardia1 cavity,help differentiate pericardial effusion from other mediastinal or pericardial lesions.

PURPOSE:To investigate the utility of multidetector CT (MDCT) in the diagnosis of gastric bare area (GBA) invasion by proximal gastric carcinoma (PGC).METHODS:Sixty-eight consecutive patients with biopsy-proven PGC underwent MDCT scan prior to gastrectomy. We evaluated the CT images separately for the site, size, depth, lymph node, and enhancement characteristic of each case. Each postsurgical stomach specimen was axially sectioned and comparison was made to determine the correlation between the CT findings and the pathological examination of each tumor bearing slice.RESULTS:The sensitivity for detecting GBA involvement in patients with PGC was 84%. MDCT correctly identified 32 of 38 patients with GBA invasion and 10/13 (77%) tumors with metastatic lymph node greater than 5 mm in GBA or subphrenic retroperitoneal space. 33/36 (92%) patients with tumor extension within the edge of the gastric wall and 28/32 (88%) patients with tumor infiltration into subphrenic fat were correctly identified. MDCT correctly predicted the infiltration of tumor into the diaphragm in all 14 patients and identified 6/11 (55%) patients with gastrophrenic ligament invasion.CONCLUSION:MDCT may be of value in assessing the important radiological characteristics of GBA invasion in patients with PGC.

Objective:To explore the innervating nerves and supplying vessels of the transposed flaps below gluteus maximus muscle(GMM) in children and provide evidences for clinical procedure of the external anal sphincter reconstruction.Methods:The nerves as well as vessels in the pedicled flaps and their relevant data were observed and measured on buttocks of 29 children's cadavers.Results:The nerves and vessels in 36 pedicled flaps below their GMM could be assured,and one or another could be found in 7 flaps;neither was found in 5 flaps.Both nerve and vessel were damaged in 10 flaps.We could not infer that there was obviously different distributions of nerves and vessels in the pedicled flaps(P>0.05).Conclusion:The pedicled flaps below the GMM could be transposed to reconstruct the external anal sphincter.

支气管树的解剖结构较复杂,分支多且有一定变异,传统影像检查方法对其显示存在一定限度.近年来CT广泛应用于临床,尤其是高分辨率CT(HRCT)和多层螺旋CT(MSCT)的出现,使得对气管的显示和疾病的诊断准确性明显提高.支气管树的分支逐级变细且走行各异,变异较多,因此熟练掌握支气管树的解剖结构,同时合理、有效地选择CT检查方法及成像参数显得至关重要,将有利于作出正确的影像诊断,并为临床医师提供准确的影像学证据[1,2].关于支气管树CT成像方法及其应用的研究,近年来国内外取得了许多新的进展,本文力图结合断层解剖基础,对其作以下综述.

腹膜后间隙与盆部腹膜外间隙的解剖通连关系是目前放射解剖学研究的热点和难点.综述了肾筋膜向下的延伸、附着情况及腹膜后诸间隙向下与盆部腹膜外各间隙通连关系的研究进展.

Objective To determine how the pulmonary ligament affects the helical CT appearances of the lower thoracic disease on the basis of the anatomic findings. Methods Four cadavers were cut transversely, with the section thickness of 11.3-13.4 mm. 57 patients with the lower thoracic disease were scanned using Somatom Plus 4, with administration of intravenous contrast material. The correlation of the anatomic findings of the pulmonary ligament and the helical CT appearances of the lower thoracic disease was evaluated. Results On cadaver sections, the right pulmonary ligament attached the lower lobe of the right lung to the esophagus, while the left ligament attached the lower lobe of the left lung to the esophagus or the descending aorta. In 40 pleural effusion and 7 pneumothorax cases, the pulmonary ligament tethered the medial aspect of the collapsed lower lobe and limited the shift of the lower lobe. In 40 pleural effusions, the ligament divided the medial pleural space into an anterior and a posterior compartment. The ligament showed thickness due to the invasion of the lesions of lower lobe including 7 tumors and 3 inflammatory diseases. Conclusion The pulmonary ligament can affect the helical CT appearances of the lower thoracic disease, such as lobe collapse, pleural effusion and pneumothorax; while the intraparenchymal and mediastinal abnormality can extend into the pulmonary ligament.

目的:研究正常健康人腕管内部结构组织高频超声回声表现,建立正常人腕管相关结构超声测量的参考值范围.方法:对118例正常健康人(236个)腕管行高频超声检查,观察正中神经和屈肌腱的形态、大小、解剖关系及回声表现;且在桡骨远端、豌豆骨、钩状骨横切面及桡腕纵断面分别测量正中神经的前后、左右径及截面积,腕管内容物的截面积和腕横韧带的膨隆率及掌腕桡韧带和腕横韧带的厚度;并计算正中神经的扁平率和肿胀率,分析测量指标与性别、年龄、身高、体重和腕粗的相关性.结果:高频超声能显示正中神经和屈肌腱.横断面上正中神经呈圆形或类圆形低回声区,周围包绕以稍强回声,屈肌腱呈圆形或椭圆形稍强回声,周围包绕以低回声;纵断面上,正中神经呈条带状弱回声,屈肌腱呈条带状增强回声.本研究中正中神经的前后、左右径及截面积分别为:桡骨远端平面4.3±0.5mm、1.9±0.2mm、6.0±1.0mm2;豌豆骨平面5.0±0.6mm、1.9±0.2mm、7.2±1.2mm2;钩骨平面5.7±0.5mm、1.6±0.2mm、6.6±1.2mm2.正中神经平均扁平率和腕横韧带的膨隆率分别为:桡骨远端平面2.2±0.4;豌豆骨平面2.7±0.5、1.9±0.8mm;钩骨平面3.1±0.5、1.8±0.6mm.正中神经平均肿胀率和腕横韧带膨隆率分别为:1.2±0.2.腕管内容物(正中神经、屈肌腱和腱鞘)截面积分别为:豌豆骨平面142.7±21.1mm2,钩骨平面111.8±15.5mm2.腕管内容物截面积与年龄、体重、身高、性别及腕粗相关;桡腕韧带与体重、身高、性别及腕粗相关;腕管内径与体重、腕粗相关.结论:高频超声能清楚显示腕管内正中神经、深浅屈肌腱的形态、大小及其关系,并能测量正中神经、腕管内容物截面积及桡腕韧带厚度,有一定临床应用价值.

横窦是心包窦中位置最深的一个窦,是指位于升主动脉、肺动脉干的后方与上腔静脉、左、右心房及左、右上肺静脉之间,由壁层心包与脏层心包返折形成.

本文所述胰周淋巴结主要位于胰周围、肠系膜根部、门腔间隙和脾门.常见的淋巴结病变包括结核、淋巴瘤及转移性肿瘤.淋巴结结核CT强化表现为淋巴结增大,呈周边强化,易形成多房样征象.87.5%霍奇金病和70%非霍奇金淋巴瘤淋巴结增大呈均匀强化,少数呈均匀强化合并坏死,解剖上优势地累及腹主动脉周围上、下部淋巴结.转移性肿瘤淋巴结增大强化特征与原发灶的细胞类型以及有无化疗等相关,其优势解剖分布取决于原发肿瘤的淋巴引流途径.

Objective To study the manifestations of the pericardial sinuses on axial spiral CT scans in comparison with sectional anatomy, and to evaluate its imaging significance.Materials and Methods Axial spiral CT findings of the mediastinum in 52 patients with pericardial effusion (effusion group) and 146 subjects without pericardial effusion (control group) were reviewed. Comparing with the sectional anatomy in two cadavers, the display rate of the sinuses and recesses on 5 main axial CT slices was analyzed statistically.Results The display rate of the sinuses and recesses was over 40% and no significant difference was found between small, moderate and large effusion group (P0.05). No significant difference in the display rate of PCR, RPR and pSAP existed between effusion group and control group (P0.05), except for the others (P0.05).Conclusion Pericardial sinuses and recesses can be easily detected on spiral CT scans. The localizing diagnosis is depended on the relative sectional anatomic knowledge. The pericardial sinuses and recesses should be differentiated from the adjacent normal structures as well as diseases.

Objective To study whether the left subphrenic fat infiltration (LSFI) is a sign of acute pancreatitis (AP) on CT images, and to observe its morphology and incidence. Methods CT images of 188 consecutive AP cases were retrospectively studied, and the morphology, density, and thickness of the edematous band in the left subphrenic region were observed. CT images of the left subphrenic region of 50 normal individual, 30 cases with pleural effusion, and 30 cases with ascites were also observed as control groups. Results LSFI appeared as a diffusive or focal crescent edematous band of soft tissue density superior to the left adrenal gland, laying just anterior to the inferior surface of left diaphragm, with or without a layer of normal fat tissue anteriorly. The incidence of the LSFI in AP was about 40.96%. Thickness of LSFI ranges from 3mm to 50 mm, with the mean value of 8 mm. In the 110 cases of the control group, only 1 case demonstrated a sign that was somewhat similar to LSFI, though it was still easily distinguished from it. Conclusion LSFI is a sign of CT manifestations of AP, it changes while AP develops, and disappears after recovery in most cases, or remains as fibrotic change in some cases.

目的:研究正常健康人腕管内正中神经的超声回声表现.方法:对118例正常健康人腕管行高频超声检查,观察正中神经的形态、大小、解剖关系及回声表现;且在桡骨远端、豌豆骨及钩状骨切面测量正中神经的前后、左右径及截面积,并计算正中神经的扁平率和肿胀率.结果:高频超声能纵、横向显示正中神经.横断面上正中神经呈圆形或类圆形低回声区,周围包绕以稍强回声;纵断面上,正中神经呈条带状弱回声.本组正中神经的前后、左右径及截面积分别为:桡骨远端平面4.25±0.50mm、1.92±0.20mm、6.04±1.00mm2;豌豆骨平面5.08±0.46mm、1.88±0.20mm、7.19±1.23mm2;钩骨平面5.68±0.62mm、1.58±0.20mm、6.3±1.17mm2.正中神经平均扁平率和腕横韧带的膨隆率分别为:桡骨远端平面2.24±0.41;豌豆骨平面2.73±0.45、1.91±0.77mm;钩骨平面3.05±0.47、1.82±0.59mm.正中神经平均肿胀率:1620±0.17.结论:高频超声能清楚显示腕管内正中神经的形态、大小及其关系,并能测量正中神经截面积等指标,有一定临床应用价值.

Objective To study the correlation between the manifestations of the left subphrenic fat infiltration (LSFI) and the severity of acute pancreatitis (AP) Methods One hundred and forty four cases and 188 cases of AP scored by Ranson′s scoring system and graded by Balthazar′s staging system were retrospectively studied respectively The thickness of the LSFI in each case was respectively and individually observed and measured, and the thickness under 3 mm was graded as 0 of which the sign of LSFI was considered as negative Rank correlation analysis of the thickness of LSFI with Ranson′s scoring and Balthazar′s staging was used respectively Results The incidence of LSFI in Ranson′s rank 1-3 was 30 86%, 54 90%, and 75 00%, respectively, and rank correlation coefficient of LSFI and Ranson′s score was 0 417 9( P 0 0 1) Incidence in Balthazar′s grade A-E was 0, 0, 31 52%, 71 05%,and 80 76%,respectively, and rank correlation coefficient was 0 630 1( P 0 01) Conclusion The thickness of LSFI has a strong positive correlation with both the Ranson′s scoring and the Balthazar′s staging, and it could reflect the severity of AP

Objective To evaluate IVC hepatic segment displacement (IVCHSD) sign on CT scan in determining the origin of huge mass in hepatorenal recess.Materials and Methods Enhanced CT scan was performed in 97 cases with pathologically proved mass (diameter≥4cm) located in hepatorenal recess. The mass was originated from the liver in 43 cases (study group), from extra hepatic structure in 54 cases (control group). The CT findings were analyzed, focusing on the IVCHSD sign.Results The incidence of IVCHSD sign in study and control group was 86.0% (37/43) and 7.4% (4/54), respectively. No significant difference in displacement direction between two groups was found (χ 2=0.03, P0.05). The sensitivity, specificity and accuracy of IVCHSD sign for establishing the hepatic origin of the mass was 86.0%, 92.6% and 89.7%, respectively. Conclusion IVCHSD sign is a valuable CT sign in identifying the hepatic origin of huge mass located in hepatorenal recess.

目的:阐明肝胃韧带分隔网膜囊上隐窝(SRL5)的意义及内侧胃膈韧带的存在.方法:①观察肝的韧带的附着和相互移行情况及肝胃韧带、SRLS与左肝上后间隙、左肝上前间隙的通连关系.②观察腹部连续断层标本(横断层和矢状断层).③腹部螺旋CT扫描.结果:①通常教科书和文献所述的肝胃韧带实际上由肝膈韧带、肝食管韧带和肝胃韧带构成.②肝胃韧带位于静脉韧带裂内,后层在近胃小弯处反折至膈形成内侧胃膈韧带,并与内侧胃膈韧带分别作成SRLS的前界和左侧界.③肝胃隐窝与SRLS之间因隔以肝胃韧带而不相通.结论:肝胃韧带和内侧胃膈韧带分别构成SRLS的前界和左侧界分隔SRLS:一些教材所用的图,表达SRL5与左肝上后间隙相通的概念值得商榷.

Objective:To investigate the CT features of masses originating from parenchymal organs in upper part of right perirenal space (UPRPS).Methods:The CT features of 76 cases with mass of more than 4 cm in diameter originating from parenchymal organs in UPRPS were analysed.All cases underwent CT scanning before operations and were confirmed by surgery,pathology and clinical data.Results:There were 22 cases with mass diameter less than 8cm,of which 3 cases with mass dominant plane above the level of hepatic portal originated from the liver (3/3,100%),and 18 of 19 cases with dominant plane below the level of hepatic portal from the right adrenal gland or kidney (18/19,94.7%).The cases with the left anterior displacement of both segment Ⅰ (from second to first hepatic portal) and segment Ⅱ (from first hepatic portal to renal hilus) of inferior vena cava resulted from liver masses (24/27,88.9%),and all the 7 cases with anterior displacement of the only segment Ⅱ resulted from right adrenal masses.In the 33 cases with renal fascia visualization,masses out of the renal capsule (n=11) and within the renal capsule (n=22) were from the liver and the right adrenal or kidney,respectively.In 13 cases with invasion of right diaphragmatic crus,9 (69.2%) originated from the right adrenal gland.Conclusion:CT findings such as the location of mass dominant plane,the involvement of adjacent vessels and organs,invasion of right diaphragmatic crus,and the correlation with renal capsule may be helpful for differentiating the organ originations of masses in UPRPS.

目的:研究Oddi括约肌(sphincter of Oddi,SO)形态结构特点,为SO切开术及其病理生理意义提供形态学基础.方法:对53例正常Vater区标本进行巨微解剖,免疫组化,Masson染色和体视学技术综合性观测.结果:①SO可分为固有肌和十二指肠延续肌纤维两类,前者有内纵、外环两层;②SO与十二指肠环肌间有肌束联系;③自十二指肠大乳头尖至胆总管(common bile duct,CBD)括约肌上界距离(15.92±4.97)mm;SO长(13.99±3.84)mm;从大乳头尖至CBD穿十二指肠肌层处间距(11.34±3.07)mm;SO最厚处(0.83±0.18)mm.结论:SO形态特点可支持SO生理活动特征;为临床操作ERCP、SO压力检测和Oddi括约肌切开术等,提供解剖学资料.