1 病例资料 患者,男性,43 岁,因"发现左侧腹股沟区包块2 年"入院.两年前患者无意间发现左侧腹股沟区约一鸡蛋大小包块,无压痛,未予重视,近半年来包块进行性增大,呈类圆形,约拳头大小,活动度差,局部皮肤完整,包块处轻度压痛,活动时伴牵扯痛,伴尿频尿急等不适,为求进一步诊治就诊于我院.入院查体:体温 36. 6℃,心率 70 次/分,呼吸 20 次/分,血 压 111/71 mmHg(1 mmHg≈0. 133 k P a),慢性病容,步入病房,神志清楚,查体合作,头颅五官无畸形,心肺查体无特殊,腹软,无压痛、反跳痛及肌紧张,肝脾未触及,肾区无叩痛,左侧腹股沟区触及一大小约 12 cm × 14 cm 类圆形包块,无搏动感,类圆形,局部皮肤完整,无红肿、皮肤破溃及分泌物流出,包块质韧,轻压痛并活动度差,边界尚清;双侧睾丸存在,透光实验阴性,余查体无特殊,生理反射存在,病理征未引出.

Objective:To analyze the correlation of multi-slice spiral computed tomography (MSCT) perfusion parameters with the degree of differentiation and clinicopathological classification of rectal cancer.Methods:Sixty-five patients with rectal cancer treated in Nanyang First People’s Hospital from February 2020 to January 2022 were selected as the research subjects. All patients underwent MSCT examination. MSCT perfusion parameters, including blood volume (BV), blood flow (BF), mean transit time (MTT), permeability surface (PS) and time to peak (TTP), of rectal cancer tissue and normal rectal tissues in rectal cancer patients were compared. The MSCT perfusion parameters of rectal cancer patients with different degrees of differentiation and different clinicopathological classifications were compared. The correlation of MSCT perfusion parameters with differentiation degree and clinicopathological classification was analyzed.Results:The parameters, including BV, BF, PS and TTP, in rectal cancer tissues were higher than those in normal rectal tissues, while MTT in rectal cancer tissues was lower than that in normal rectal tissues ( P<0.05). The BV, BF, PS and TTP in the poorly differentiated patients were higher than those in the moderately and well differentiated patients, and the MTT was lower than that in the moderately and well differentiated patients ( P<0.05). The BV, BF, PS and TTP in patients at stage III-IV were higher than those in patients at stage I-II, and the MTT was lower than that in patients at stage I-II ( P<0.05). Results of Pearson analysis showed that BV ( r=-0.50), BF ( r=-0.51), PS ( r=-0.62) and TTP ( r=-0.44) were negatively correlated with the degree of differentiation, while MTT ( r=0.61) was positively correlated with the degree of differentiation ( P<0.05); BV ( r=0.51), BF ( r=0.61), PS ( r=0.69) and TTP ( r=0.65) were positively correlated with clinicopathological classification, while MTT ( r=-0.54) was negatively correlated with clinicopathological classification ( P<0.05). Conclusions:MSCT perfusion parameters are closely related to the degree of differentiation and clinicopathological classification of rectal cancer, which can provide a scientific basis for clinical diagnosis.

患儿 男,4 月 29 d,因发现腹胀 4 月余入院.体格检查:腹部膨隆,腹部触及一大小约 25 cm×20 cm×20 cm明显质韧肿物,活动度差,边界欠清晰. 实验室检查:甲胎蛋白(alpha fetoprotein ,AFP )增高(48.09 ng/mL,正常范围为0～9 ng/mL),糖类抗原CA-125 增高(162.80 U/mL,正常范围为 0～35 U/ml);CT 平扫+增强:中下腹、盆腔内可见一巨大混杂密度肿块影,大小约 12.3 cm× 10.2 cm×16.0 cm,其内可见散在结节状高密度钙化灶及大片状脂肪密度影、液体密度影(图 1),增强扫描实性部分呈明显不均匀强化,液体密度及脂肪密度影强化不明显,其内可见较多迂曲小血管影,团块边界欠清,胰腺受压推挤向前移位,双侧肾脏密度正常,增强扫描未见异常强化(图 2,3).行腹膜后肿瘤切除术,肿瘤 HE 染色显示:其内可见骨细胞、平滑肌细胞、黏液上皮成分及肾小球、肾小管结构(图 4,5).免疫组化:CK Pan (+),WT-1(+)(图6),病理诊断:畸胎瘤样肾母细胞瘤(teratoid wilms tumor,TWT).

目的 采用心脏磁共振(CMR)评估二尖瓣结构对肥厚型心肌病(HCM)左室流出道梗阻(LVOTO)的影响,为早期识别存在LVOTO风险的HCM患者提供可靠的疾病监测指标.方法 回顾性分析行CMR检查并确诊为HCM患者40例、正常对照组(NCG) 30例,测量及观察因素有二尖瓣前叶长径(AMVLL)、二尖瓣后叶长径(PMVLL)、左室流出道直径(LVOTD)、二尖瓣收缩期前向运动(SAM)征,使用超声心动图检测HCM患者左室流出道(LVOT)压力阶差,根据有无LVOTO将其分为肥厚型梗阻性心肌病(HOCM)及肥厚型非梗阻性心肌病(HNCM)2组,比较3组的系列参数.结果 3组间PMVLL、LVOTD、AMVLL、AMVLL/LVOTD、SAM征比较有统计学意义,Logistic回归分析提示AMVLL、LVOTD、AMVLL/LVOTD、SAM征等均与LVOTO相关并是其影响因素,ROC曲线分析得出AMVLL/LVOTD对LVOTO诊断的准确性较高,AMVLL对LVOTO诊断有一定的准确性,而LVOTD无明显诊断价值.结论 二尖瓣叶长径增加是HOCM一个表现特征;AMVLLL、LVOTD、AMVLL/LVOTD、SAM征等均与LVOTO相关并是其影响因素,其中AMVLL、AMVLL/LVOTD对HCM出现LVOTO具有一定诊断预测价值,可作为诊断预测HCM患者存在LVOTO的一个监测指标.

目的:探究经颅彩色多普勒超声诊断脑动脉狭窄及闭塞的准确性分析.方法:设置本次实验的起止时间为2018年3月-2019年2月,研究对象为中枢神经系统疾病的患者60例,全部患者均行CT检查和磁共振波谱成像技术检查,对比两种诊断方式的诊断结果.结果:磁共振波谱成像技术在诊断中枢神经系统疾病中的总检出率显著高于CT诊断,差异具有统计学意义(P＜0.05);采用磁共振波谱成像技术检查时正常区和病灶区域各数值对比,差异具有统计学意义(P＜0.05).结论:磁共振波谱成像技术在中枢神经系统疾病诊断中具有较高的应用价值,可对中枢神经系统疾病进行有效确诊,并且准确率极高.