Objective To discuss the radiation quality control in county based on regional medical imaging platform. Methods Based on regional medical imaging platform with the combination of PACS technology and telecommunication broadband network, we established the database, unified the radiological image quality standards and the regional medical imaging platform templates of the radiological examination report, built the evaluation standards, objectives, methods and processes of radiological quality, and observed the good rate of image quality and diagnostic report quality, in order to build a county-based radiation quality control system based on regional medical imaging platform. Results The good rate of the image quality and the diagnostic report quality increased and reached the target of examination(≥ 90％). Conclusion Through the regional medical imaging platform, changing the quality control mode of traditional radiation can improve the quality of radiation examination in the region and increase management efficiency and time efficiency.

Objective To review the CT and MRI manifestations of sarcomatoid malignant mesothelioma.Methods The CT and MRI manifestations of 6 cases of pathologically proved sarcomatoid malignant mesothelioma were retrospectively analyzed.The tumors of 5 cases occurred in the pleural,and one case occurred in the peritoneum.All cases received plain CT scan and contrast-enhanced scan,and one case received MRI plain scan and contrast-enhanced scan additionally.Results Five patients developed pleural sarcomatoid malignant mesothelioma in the left chest,with extensive irregular pleural thickening and pleural effusion.Among them,three cases developed large soft tissue masses,showing inhomogeneous density in plain scan,and obvious inhomogeneous after contrast-enhanced scan;One case developed multiple mediastinal lymphadenectasis.One case of peritoneal sarcomatoid malignant mesothelioma developed massive seroperitoneum,irregular thickening of the peritoneum,and large soft tissue mass.For this patient,plain CT scan showed inhomogeneous density,and contrast-enhanced scan showed uneven enhancement.The patient also developed multiple lymphadenectasis in the abdominal cavity and retroperitoneal region.MRI scan suggested irregular soft tissue mass,with equal and low signal in T1 weighted imaging (T1WI),high signal in T2-fat suppression image,high signal in diffusion weighted imaging (DWI),and obvious inhomogeneous enhancement in contrast-enhanced scan.Conclusion CT and MRI scans can accurately demonstrate the characteristics of sarcomatoid malignant mesothelioma,and are helpful for qualitative diagnosis.

Objective To investigate the MRI features of malignant mesothelioma(MM).Methods MRI data of 18 cases of MM confirmed by pathology were analyzed retrospectively.1 5 cases were malignant pleural mesothelioma,and 3 cases malignant peritone-um mesothelioma.MRI scans were performed in all cases,including MRI plain scan,MRI enhancement and diffusion weighted ima-ging(DWI).We evaluated the location,shape,size,signal,enhancement mode,dispersion characteristics,invasions of surrounding tissues and concomitant changes of MM.Results Among the 15 cases of malignant pleural mesothelioma,14 cases were diffuse type, 1 case was localized type,and 3 cases of malignant peritoneum mesothelioma were all diffuse types.10 of 14 diffuse malignant pleural mesothelioma had a thickening pleural of more than 3 cm,the average thickness was (5.3±3.8)cm,in which soft tissue mass was showed in 6 cases.2 of 3 diffuse malignant peritoneum mesotheliom had a thickening peritoneal of more than 3 cm with soft tissue mass.On T1 WI images,slightly low signal were showed in 7 cases,and equal signal in 1 1 cases.On T2 fat suppression sequence,low signal were showed in 4 cases,slightly high signal in 10 cases and high signal in 4 cases.On DWI,18 cases of MM lesions all showed high signal.On enhanced scan,continuous enhancement were showed in 1 8 cases of MM and the enhancement was the most obvious at 180 s.8 cases with lymph node enlargement (8/18).The diseased lateral thoracic profile was significantly narrowed in 11 cases with malignant pleural mesothelioma,of which 7 cases with chest wall invasion.Conclusion The MRI features of MM have certain char-acteristics,and MRI examination will help to make accurate diagnosis before treatment.

目的 探讨基于MRI定量对恶性胸腹膜间皮瘤的早期诊断价值.方法 选择2012年7月~2016年2月在我院就诊的疑似恶性胸腹膜间皮瘤患者27例作为研究对象,均接受MRI检查,以病理检查结果 为金标准.结果27例疑似恶性胸腹膜间皮瘤患者经病理诊断证实18例为恶性胸腹膜间皮瘤.恶性胸腹膜间皮瘤患者MRI初始峰值、增强峰强度及平扫信号强度均显著高于肿瘤胸腹膜转移患者(P<0.05).恶性胸腹膜间皮瘤患者ADC值显著低于肿瘤胸腹膜转移患者(P<0.05).MRI对恶性胸腹膜间皮瘤的灵敏度、特异性、阳性及阴性预测值分别为88.9%、66.7%、84.2%和75.0%.结论 基于MRI定量评估的恶性胸腹膜间皮瘤早期诊断具有较高的临床实用价值,可在临床推广使用.

目的 探讨多排螺旋CT动态增强扫描对侵犯肾实质而肾盂占位不明显的肾小管逆行浸润型肾盂癌的诊断和鉴别诊断价值,以期提高临床诊断准确性.方法 对经手术病理学检查确诊的9例浸润型肾盂癌患者的术前多排螺旋CT平扫、皮髓交界期和实质期动态增强扫描结果进行分析,并与病理学检查结果作对比.结果 本组患者的患肾位于右侧6例,左侧3例;8例患肾形态无明显改变,另1例患肾隐约隆起;浸润型肾盂癌病灶形态均不规则,肾盂壁与肾实质分界不清,肾窦脂肪均消失.CT平扫病灶呈等高密度5例,等或稍低密度4例;有钙化或结石3例,出血2例,肾盂内均无明显肿块;CT值17.6～31.5Hu,平均24.6 Hu.CT动态增强扫描皮髓交界期呈相对较低密度,CT值29.4～55.2Hu,平均39.8Hu;实质期呈相对低密度,CT值38.2～73.2Hu,平均51.0 Hu.结论 浸润型肾盂癌从肾盂壁向肾实质浸润生长,患肾肾盂、肿瘤和肾实质分界不清,占位效应不明显,病灶呈轻中度进行性持续强化.多排螺旋CT动态增强扫描对该病诊断和鉴别诊断有重要价值.

OBJECTIVEOur study analyzed the clinical symptoms and computed tomography (CT) manifestations of massive localized malignant pleural mesothelioma (LMPM) patients to improve the knowledge and diagnosis of this disease.METHODSOur study collected 6 massive LMPM patients pathologically confirmed by CT in the department of Radiology of the People's Hospital of Yuyao, Zhejiang Province, from January, 2007 to June, 2013; data of patients were also collected. The clinical symptoms, clinicopathological characteristics, CT manifestations, treatments and prognosis of enrolled patients were analyzed.RESULTSOur study enrolled 6 LMPM patients (2 males; 4 females) classified to epitheliated type (n = 4) and sarcomatous type (n = 2) with mean age of 62.7 ± 7.4, and 5 of them had a history of asbestos exposure. CT manifestations revealed that large soft-tissue mass close to pleura, which was smooth and lobulated, was discovered in all patients with maximum diameter of 10~15 cm and mean diameter of 13.67 ± 1.15 cm; The mean value of CT was 36.29 ± 2.62 HU; after enhancement, the mean value was increased to 76.36 ± 7.73 HU; patients showed zones of small patchy necrosis and large patchy necrosis. The following presentations were founded: enlargement of tumor vessel which showed arborization (2 patients), mass wrap around the descending aorta in left lower chest (1 patient), strips of fat density in mediastinum superior (1 patient), pleural tail sign (3 patients). Among 6 patients, pleural effusion (n = 4), mediastinal lymph node enlargement (n = 3), invasion and destruction of local ribs (n = 2). Median survival time of patients were 20 months (2 cases conducted operation), 24 (2 cases chose combined radiotherapy and chemotherapy) and less than 6 months (2 cases underwent chemotherapy).CONCLUSIONTo sum up, CT showed important diagnostic values on massive LMPM patients; patients with a history of asbestos exposure, large soft-tissue mass of pleura with an abundant blood supply and wrap around large vessels might increase the risk of massive LMPM.

Objective To explore the function of the regional medical image network consultation system in propelling the quality control of regional medical image.Methods Based on the regional medical image network con-sultation system,the unified standard of quality control was implemented to reach the integrated management of the imaging quality control in region.The imaging specialists checked the quality of image and report in real time.In addi-tion,the specialists and inspectors monthly examined the quality of image and report.Subsequently,the unqualified causes were analyzed and the improvement measures were used.Finally,the quality of image and report were continu-ously improved.Results After the homogeneity management was applied for one year,the rates of remaking photos and returning the report were significantly decreased from 10% to 2%,and 12% to 4% respectively.Additionally,the rates of good image and report were significantly increased from 83% to 98%,and 89% to 100% respectively.The objective of good rate ≥90% was excellently achieved.Conclusion Based on the regional medical image network consultation system,the management in quality control of the networking hospitals has been uniform,and the technique of examination and the report format have been consistent.The standardability and accuracy of image examination have been realized.

患者女，75岁。发现左乳腺结节50年，逐渐增大2年就诊。体检：左乳内上象限可触及约6.0 cm×7.0 cm的肿块，质硬，形态不规则，边界尚清，无压痛，活动度差，双侧腋下未触及肿大淋巴结。<br>　　B超检查：左乳内上象限可见6.5 cm×4.5 cm×7.1 cm的低回声肿块，边界清楚，形态欠规则，后缘达肌层，内部血流信号较丰富（图1）。胸部CT：平扫示左乳腺团块状软组织密度肿块，CT值为37 HU，呈分叶状，边界清，未见钙化及坏死、囊变（图2）。MRI：左乳腺软组织肿块，T1WI以低信号为主，其内可见多发云雾状稍高信号（图3）；T1WI抑脂序列上仍呈稍高信号（图4）；T2WI抑脂序列上呈不均匀高信号，其内有多发条状低信号分隔（图5）；DWI呈高信号（图6）；动态增强扫描肿块不均匀明显强化，呈平台型强化模式（图7）。按乳腺影像报告与数据系统报告分类为4B类。

目的 探讨餐巾环征(NRS)和未来急性冠脉综合征(ACS)之间的关系.方法 回顾性地分析2008-01-01-2013-05-31在我院行冠脉CT血管造影(CCTA)的患者499例.记录冠脉节段斑块特点包括非钙化斑块、钙化斑块和混合斑块,非阻塞性斑块和阻塞性斑块,低密度斑块,正性重塑斑块和餐巾环征斑块(PNRS).随访以电话随访为主,辅以门诊随访、住院随访等,终点事件为ACS,随访截止时间为2013-06-30.生存率估算应用Kaplan-Meier法,两条生存曲线之间的比较采用log-rank检验.Cox比例风险模型评估PNRS与ACS之间的关系.结果 7 119个节段、749个斑块纳入分析.26个(3.5%)斑块为PNRS,分别有11个(42.3%)、16个(61.5%)PNRS为正性重塑斑块和低密度斑块,20个(76.9%)PNRS为正性重塑斑块或低密度斑块,7个(26.9%)PNRS既是正性重塑斑块又是低密度斑块.随访结束时16例发生ACS,其罪犯节段的阻塞性斑块、正性重塑斑块、低密度斑块、PNRS均高于非罪犯节段,差异有统计学意义(P＜0.05).Cox比例风险模型证实,低密度斑块、正性重塑斑块和PNRS是预测罪犯节段即ACS事件的独立因素.NRS阳性组与阴性组无ACS生存曲线间差异有统计学意义(P＜0.05).结论 CCTA NRS与未来ACS事件密切相关,独立于正性重塑斑块和低密度斑块,NRS的检测有助于识别未来ACS事件的高危患者.

[目的]分析恶性胸膜间皮瘤的CT征象,评价CT平扫及多期增强扫描对该病的诊断价值.[方法]回顾分析39例经组织学及免疫组织化学证实的恶性胸膜间皮瘤的CT征象,全部病例均行多层螺旋CT平扫,其中27例加多期增强扫描.[结果]39例恶性胸膜间皮瘤患者中,35例为弥漫型,其中12例为环状胸膜增厚,17例为弥漫结节型胸膜增厚,6例为弥漫肿块型胸膜增厚:胸廓缩小25例:4例为巨块型,最大直径15cm;胸水32例,肋骨破坏4例,淋巴结肿大13例,增强后病灶呈中度持续强化.36例有石棉接触史,27例同时发现胸膜斑.[结论]恶性胸膜间皮瘤在CT平扫及多期增强扫描中有一定的特征性,CT是恶性胸膜间皮瘤诊断、随访最主要的影像诊断手段.

Objective To investigate the CT and MRI appearances of the uterine fatty leiomyoma.Methods CT and MRI findings of 5 patients with uterine fatty leiomyoma proved by pathology were analysed retrospectively.Results There were solitary lesion in 5 patients in the present study,all masses with clear boundaries,one case with envelope.Three CT examinations were located in the uterine muscle wall.By fat density and soft tissue density with different proportion of interphase distribution,including 1 case of both a considerable proportion,2 cases with soft tissue density mainly.Soft tissue portion of its density than the normal womb muscle density is slightly low,relatively uniform.Two lesions by MRI examination were mainly in fat composition,one located in the uterine cervix,another located in the left broad ligament.On MR imaging,there was hyper-intense on T1WI and T2WI in most of the region.On fat-suppression T1WI the most region showed marked hypointense.On dynamic enhancement imaging,there was mild to moderate enhancement in the soft tissue area.Conclusion The appearance of the uterine fatty leiomyoma on CT and MRI were relatively characteristic,CT and MRI can be a valuable tool for the diagnosis of the uterine fatty leiomyoma.

Objective To compare diagnostic performance of CT and MRI for cystic renal masses using the Bosniak classification system.Methods CT and MRI data of 30 cases(42 cystic renal masses) with pathologically or clinically follow-up confirmed were retrospectively reviewed.Diagnostic performance of both modalities was compared using receiver operating characteristic curve.Results Six,twenty four,nine,and three lesions were classified as Bosniak I,II,IIF,III and IV respectively under CT.And false positive number was zero while false negative number was 14 with pathological correlation.Eight,eighteen,ten and six lesions were classified as Bosniak I,II,IIF,III and IV respectively under MRI.And false positive number was zero while false negative number was 11 with pathological correlation.The area under the receiver operating characteristic curve for MRI was larger than CT.Both specificity and sensitivity of the former were higher than those of the latter.Conclusion Diagnostic performance of Bosniak classification with MRI is higher than that of Bosniak classification with CT.Bosniak classification with MRI is recommended as soon as condition permits.

目的观察在CT增强检查静脉注射非离子型碘帕醇对比剂和碘克沙醇对比剂后对患者肾功能的影响。方法回顾性分析在我院行CT增强检查并符合条件485病例,其中碘帕醇组236例,碘克沙醇组257例,两组患者在增强前12h及增强后72h内测定血肌酐值(Scr),计算Scr绝对值及CIN的发生率。结果碘帕醇组及碘克沙醇组血肌酐绝对值无明显差异,分别为3.57μmol·L-1和3.21μmol·L-1P>0.05,两组对比剂肾病发生率亦无显著性差异.分别为2.54%和2.72%P>0.05。结论碘帕醇和碘克沙醇对患者肾功能的影响无显著性差异。

目的 探讨MRI对乳腺错构瘤诊断的价值.方法 收集经手术病理证实的乳腺错构瘤8例,回顾性分析其临床及MRI表现,并复习相关文献.结果 发病年龄42~52岁,平均48岁,病程2 d~15年不等,均为无痛性肿块,其中1例15年来逐渐增大,挤压双乳后有乳汁分泌.8例中椭圆形5例,圆形3例,直径4~10 cm不等.混合型5例,脂肪型2例,致密型1例.MRI表现为T1WI、T2W SPIR高低混杂信号影,即肿块内混杂的成熟脂肪组织和纤维腺体组织,2种成分按不同比例相间分布,边界清,均可见完整的包膜.动态增强后纤维腺体成分呈渐进性强化,强化曲线呈缓慢上升型.结论 明确的脂肪成分与纤维腺体组织不同比例混合的混杂信号及完整的包膜是乳腺错构瘤MRI特征性表现,最后确诊有赖于病理.

目的 探讨CT对恶性腹膜间皮瘤的诊断价值.方法 回顾性分析12例经组织学证实的恶性腹膜间皮瘤的CT征象,并讨论其CT特点.结果 12例恶性腹膜间皮瘤中,1例为局限型腹膜间皮瘤,11例为弥漫型腹膜间皮瘤.主要CT表现:1例局限型腹膜间皮瘤表现为孤立性的巨大囊实性肿块,以囊性为主,实性区显著强化;11例弥漫型腹膜间皮瘤均表现为腹腔积液及腹膜、大网膜、肠系膜不规则增厚,其中8例见广泛的明显强化的腹膜结节、肿块,6例形成网膜饼,腹膜后淋巴结肿大2例,合并胸膜病变2例.结论 显著的腹腔积液伴不规则腹膜增厚及广泛腹膜强化结节、肿块是弥漫型恶性腹膜间皮瘤的主要表现.

肾上腺神经源性肿瘤包括神经母细胞瘤、嗜铬细胞瘤、节细胞神经瘤和神经鞘瘤,均来源于肾上腺髓质,起源于肾上腺神经母细胞.其中,肾上腺神经鞘瘤极为少见,其发病率远低于肾上腺其他神经源性肿瘤.现笔者对近年来收治的肾上腺神经鞘瘤患者的CT和MR表现作一回顾性分析,以期为本病的诊断和鉴别诊断提供帮助.

Objective:To investigate the manifestations of non-hodgkin's lymphoma involving deep lymph nodes and large vessels on contrast-enhanced multi-slice spiral CT.Methods:We retrospectively reviewed the CT imagings of 62 cases of pathologically proved non-hodgkin's lymphoma(NHL) with deep lymph nodes and large vessels involved,including 38 cases of diffuse large B-cell lymphoma,13 peripheral T-Cell Lymphoma,3 follicular lymphoma,3 mantle cell lymphoma,3 small B-cell lymphoma and 2 small lymphocytic lymphoma.Results:① Distribution site: all pathological types of non hodgkin lymphoma mainly involved retroperitoneal and abdominal lymph node,as well as mediastinal and pelvic lymph nodes in some cases;② Discreteness and coalesce: lymph nodes especially retroperitoneal involved by Diffuse large B cell lymphoma,mantle cell lymphoma and small B cell lymphoma tends to be coalesce,but lymph nodes involved by peripheral T-Cell Lymphoma and small lymphocytic lymphoma are all discrete;③ "vascular embedding" sign: when large vessels embedded by discrete lymph nodes,"vascular embedding" sign was formed,all embedded vascular had no sign of luminal irregularity,stenosis and rough wall.Conclusion:Non-hodgkin's lymphoma with deep lymph node involvement mainly involved retroperitoneal lymph node,followed by abdominal lymph nodes."Vascular embedding" sign,which indicates no luminal irregularity,stenosis and rough wall,is helpful for the differentiation from other malignant tumors.

目的:通过余姚市基层远程医学影像会诊中心对乡镇、街道等基层卫生院放射科的影像质量进行分析,并制定相应的改进措施,提高其影像质量。方法:随机抽取2010年7月到12月基层远程医学影像会诊中心成立初期及2011年1月到6月的乡镇及街道卫生院的影像会诊片各2 000例,每片记录影像质量及报告修改与否。结果:2010年7月到12月2 000例会诊片中,甲级片790例,乙级片1 050例,丙级片(影响诊断)160例;诊断报告未修改1 292例,修改报告610例,严重错误(漏诊或误诊)98例。2010年底,基层远程医学影像会诊中心针对存在的问题,对会诊医院的放射科医生进行了一系例的教育与培训措施,2011年1月到6月2 000例会诊片中,甲级片1 262例,乙级片661例,丙级片(影响诊断)77例;诊断报告未修改1 758例,修改报告205例,严重错误(漏诊或误诊)37例。结论:通过基层远程医学影像会诊中心的运作,明显提高了乡镇、街道卫生院的摄片质量及报告质量,提高了基层卫生院放射科医生的业务水平,避免了较多的漏、误诊病例,明显减少了医疗纠纷的发生,提高了乡镇、街道卫生院的总体素质与实力。