OBJECTIVE:To analyze radiological characteristics of Muller-Weiss disease, evaluate the clinical value of the imaging examination in diagnosis of Muller-Weiss disease.METHODS:The imaging data of 26 patients with Muller-Weiss disease were collected from September 2015 to August 2020, including 7 males and 19 females, aged 43 to 68 years old with an average of (52.7±4.6) years old. In the X-ray examination observed the shape and position of the navicular bone. The talar-first metatarsal angle(TFM) was measured on the weight-bearing anteroposterior radiograph. The arch angle and angle between mid-axis of talus and mid-axis of the first metatarsal(Meary angle) were measured on the weight-bearing lateral radiographs. The morphology, density, adjacent joint space and position of the navicular bone were evaluated by computed tomography(CT), and magnetic resonance imaging(MRI) was used to observe the shape, signal, cartilage and surrounding soft tissue changes of the navicular bone.RESULTS:Among 26 patients, 21 cases were unilateral and 5 cases were bilateral;X-ray examination showed that the lateral part of navicular bone of foot was compressed and flattened, showing"comma like"or"drop like", navicular moved to the medial side, partial fragmentation of bone, peripheral articular hyperplasia, uneven density and narrowing of relationship gap. According to Meary angle and deformity degree of the affected foot on the lateral X-ray of the load-bearing foot, Maceira staging was performed. There were 0 cases in stageⅠ, 2 cases in stage Ⅱ, 11 cases in stage Ⅲ, 9 cases in stage Ⅳand 4 cases in stage Ⅴ. CT examination showed bone fragmentation, medial displacement of navicular bone and formation of the talocalcaneal joint. MRI examination showed the irregular shape and uneven signal of navicular bone, narrowing of joint space, talocalcaneal joint surface hyperplasia and cartilage destruction, tarsal joint effusion and swelling of surrounding soft tissue.CONCLUSION:Muller-Weiss disease has specific imaging manifestation, and an accurate diagnosis can be made based on the patient's age, gender, and clinincal history. Preoperative imaging examination can stage the disease, help clinicians to formulate better surgical plans, and postoperative imaging examination can better evaluate the surgical effect.

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:探讨膝关节炎患者下肢全长负重位X线片对膝内、 外翻畸形诊断的临床价值.方法:选取32例临床诊断为膝关节炎51膝分别拍摄下肢全长负重X线片,测量下肢力线和机械轴偏距(mechanical axis offset distance,MAD),解剖学股胫骨角(anatomical femor-tibial angle,aFTA),股骨远端力学外侧角(mechanical lateral distal femoral angle,mLDFA),胫骨近端力学内侧角(mechanical medial proximal tibial angle,mMPTA),对图像数据进行分析,对膝关节炎进行X线K/L分级,通过SPSS 17.0统计对下肢力线各参数与关节炎的相关性进行分析.结果:①膝关节下肢全长负重位X线片显示,关节有不同程度骨质增生,关节间隙变窄.②51膝骨关节炎中确诊膝内翻畸形38膝(74.51.％)和膝外翻畸形8膝(10.42％),5膝均无内外翻畸形.③膝关节炎X线K/L分级显示,0级:5膝(9.8％),I级:12膝(23.5％),II级:22膝(43.1％);III级:9膝(17.6％);IV级:3膝(59％).④膝内翻组中股骨内翻7膝(18.42％),胫骨内翻18膝(47.36％),股骨、胫骨均内翻13膝(34.21％);膝外翻组中股骨外翻6膝,股骨、胫骨均外翻2膝.⑤在膝内翻组中,aFTA与骨关节炎X线K/L分级呈正相关(B值=0.132,t=2.648,P=0.012,P<0.05).结论:下肢全长负重X线显示下肢结构清晰、完整,通过测量下肢力线参数评估,可全面诊断膝关节炎的内翻畸形或外翻畸形,膝内翻中以胫骨内翻显著,膝外翻中则以股骨外翻显著.因此,膝关节骨性关节炎的下肢全长负重X线检查具有较高的临床价值.

目的:探究急性一氧化碳(CO)中毒患者并发肺部感染的危险因素及其防治对策.方法:选取2016年11月-2019年12月期间收治的急性CO中毒患者180例资料,统计其一般临床资料和临床检查指标,依据是否合并肺部感染,将患者分为感染组和未感染组;比较两组患者一般临床资料和临床检查指标差异,采用多因素Logistic回归分析法探究急性CO中毒患者并发肺部感染的危险因素和防治对策.结果:180例CO中毒患者中,并发肺部感染41例;肺部感染患者经治疗后康复或好转31例,治疗后的总有效率为75.61％;与未感染组患者比较,感染组患者的平均年龄大、CO接触时间长、有迟发性脑病、有基础疾病、脑部苍白球异常比例升高、入院时血液中CRP、LDH、Lac以及FIB含量升高与肺部感染之间具有相关性(P＜0.05);血液LDH、CRP、苍白球异常、CO接触时间是影响急性CO中毒并发肺部感染的独立危险因素(P＜0.05).结论:探究急性CO中毒患者并发肺部感染的危险因素与防治方法,有助于采用有效措施预防急性CO中毒患者并发肺部感染发生的风险,以改善患者预后提高其生存率.

分析52例急性一氧化碳中毒迟发性脑病(DEACMP)病例资料,记录患者性别、年龄、CO接触时间、既往病史、入院时头颅MRI检查结果、格拉斯哥昏迷(GCS)评分、血清C反应蛋白(CRP)水平、神经元特异性烯醇化酶(NSE)水平、病程3个月时的统一帕金森病评定量表(UPDRS)评分,以患者预后好坏情况为因变量,影响因素为自变量,行非条件Logistic回归分析.结果发现,DEACMP患者预后中等及以上患者占比与基础疾病有无、入院时GCS评分、CO接触时间长短、血清CRP和NSE含量高低有关(P＜0.05),血清NSE水平、CRP水平、CO接触时间长短是影响DEACMP患者预后的独立危险因素,这为DEACMP患者预后评估提供了指导依据.

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.

目的 探讨能谱CT在膀胱癌术前分期中的应用价值.方法 收集经手术病理证实的58例膀胱癌患者,术前均行盆腔平扫及动态增强扫描,独立分析混合能量和单能量图像并进行术前分期,以术后病理分期为标准,比较二者在膀胱癌术前分期中的准确率.结果 混合能量图像对＜T3b期的分期准确率为66.4％,单能量图像对＜T3b期的分期准确率为82.5％,两者差异有统计学意义(P＜0.01);混合能量图像总的分期准确率为69.3％,单能量图像总的分期准确率为84.1％,两者差异有统计学意义(P＜0.05).结论 与传统的混合能量成像相比,CT能谱成像可获得最佳keV单能量图像,能明显提高膀胱癌术前分期的准确率,具有较大的临床应用价值.

目的:分析踝关节骨折合并下胫腓前韧带(anterior-inferior tibiofibular ligament,ATIFL)损伤的X、CT、MRI影像学特点.方法:选择2017年6月至2018年6月共48例踝关节骨折合并ATIFL患者作为研究对象进行回顾性分析.X线测量下胫腓间隙(tibiofibular clear space,TFCS)、下胫腓重叠(tibiofibular overlap,TFO);CT检查踝关节骨折类型;MRI评估ATIFL损伤程度.结果:对48例患者进行分析,X线表明16例TFCS＞6mm,21例TFO＜ 6mm;CT提示踝关节骨折旋后-内收型6例,旋后-外旋型20例,旋前-外旋型16例;MRI提示ATIFL损伤中24例Ⅰ级,16例Ⅱ级,8例Ⅲ级.结论:X线平片和CT对踝关节骨折的结构改变、骨折类型及下胫用联合分离有诊断价值;MRI诊断踝关节骨折合并ATIFL损伤有更高的准确性和临床参考价值.

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.

病例1 女,49岁,发现双侧甲状腺肿块3月,收住入院。胸部 X 线片示：奇静脉结增大,边缘光滑(图1A)；肺纹理增多；肺门影规则,膈面光滑,膈角锐利；气管、心脏居中。胸部增强CT 示：奇静脉扩张,最宽径约2.54 cm,下腔静脉肝段静脉期未见显示(图1B)；脾区多发大小不一类圆形软组织密度影,边缘光整,增强后强化方式与脾脏一致。上腹部 MR 增强示：下腔静脉肝段未显示,左肾静脉向前绕腹主动脉,双肾静脉入奇静脉,奇静脉增粗,直径约2.30 cm,经上腔静脉注入右心房(图1C,D)。

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.

目的 探讨CO2-DSA在骨盆骨折大出血介入栓塞治疗中的可行性及其优势.方法 对28例骨盆骨折大出血伴失血性休克患者,分别采用纯CO2及碘剂为对比剂行髂总动脉造影及介入栓塞,对比两种对比剂的造影效果.结果 28例患者均有不同程度的血管断裂及远端渗血,其中髂内动脉及分支断裂9例,远端局部外溢19例;CO2-DSA均清晰显示血管断裂及远端出血点,其中3例碘剂-DSA造影无明显出血点或仅分支血管粗细不均,CO2-DSA造影示多处出血点;CO2-DSA均无明显并发症.结论 CO2-DSA在骨盆骨折大出血介入栓塞治疗中安全、有效,对细小出血点显示优于碘剂-DSA.

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.

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.

<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。

Objective To determine the feasibility of multislice spiral CT(MSCT) and magnetic resonance imaging(MRI) for diagnosing the fine and occult fractures.Methods Sixty-nine patients with communication accident trauma initially were negative findings on conventional radiographs and CT images and then underwent MSCT and MRI examinations for suspected fractures.Results Among 69 patients with suspected fracture,MSCT detected out 52 cases fine fractures whose locations included 8 nose,9 cranial bases,6 spines,10 ribs,and 19 bone joints,while other 17 cases without fracture signs on MSCT images further underwent MRI examinations,simultaneously,the occult fractures were found in 5 cases of spine and 12 bone joint,respectively.Conclusion MSCT was able to detect fine and occult fractures which could not be found by either plain radiography or conventional CT,especially it has significant advantage in detecting the fractures in some uncommon locations such as cranial basis and rib and in identifying the type of fractures and the extent of fracture lines,while MRI could show the bone contusions and occult fractures which could not be found by MSCT.The combination of MSCT and MRI can provide the reliable evidence for guiding the clinical treatment and identifying the traffic accident.

Objective:To evaluate the value of multi-slice computed tomography in diagnosis of tendon or ligament injury.Methods:Analysis retrospectively the CT diagnosis of tendon or ligament,some compare with diagnosis of MRI or operation results.Results:In the 24 injures of knee ligaement,11 cases of anterior cruciate ligament injures,8 cases of posterior cruciate ligament injures,6 cases of outside assistant ligament injures;4 Achilles tendon injures were found,in addition,3 cases un-whole laceration,1 cases fracture.Conclusion:The limition of displaying by MSCT in the slice ligament,but very good in the tendon or rough ligament,the diagnosis was accurate,provide an effective consultation to diagnosis or medicat treatment.

患者 女性,44岁.因右侧胸痛半年,加重1周来院就诊,既往胸部有外伤史;查体:一般情况可,局部无隆起,右侧胸壁皮肤无红肿,局部轻度压痛;外院X线片示:右侧胸膜增厚,胸膜炎首先考虑.