目的 探讨钛夹标记联合CT图像后处理技术在早期胃癌腹腔镜术前定位中的应用.方法 30例早期胃癌患者经消化道内窥镜检查发现病灶并常规活检后,于瘤体旁放置钛夹,术前12～24 h分别行腹部卧位X线摄影及腹部CT平扫,通过CT图像后处理技术及腹部X线摄影来了解钛夹的位置,以便术前确定病灶部位及范围,并与术中所见病灶位置进行比较,评判两种方法对早期胃癌腹腔镜手术的术前定位准确率,并通过CT对胃周围淋巴结转移进行初步评判.结果 本组30例患者术前行钛夹标记联合CT图像后处理技术对胃癌的定位与手术结果符合率为100％(30/30),其定位准确率优于钛夹标记联合腹部X线摄影对胃癌的定位方法.所有患者均顺利完成腹腔镜手术.结论 对于早期胃癌患者,利用钛夹标记联合CT图像后处理技术是术前准确可靠的病灶定位方法,亦可大体了解胃周围淋巴结的情况,对早期胃癌腹腔镜手术顺利完成有重要的临床意义.

Primary hepatic carcinoma has ranked as the sixth most commonly diagnosed cancer and the third leading cause of cancer death. China shares about 50% of new liver cancer cases, including 80% of hepatic carcinoma. Non-surgical therapy continues to make breakthroughs. The authors report a case of hepatic carcinoma with intrahepatic metastasis and tumor thrombus in the left portal vein, which has achieved continious partial response after the treatment of atezoli-zumab combined with bevacizumab, without adverse reactions such as liver and kidney function damage. The life quality of the patient was improved, showing safety and efficacy of the treatment.

Objective:To assess the interobserver and inter-modalities agreement with two non-invasive diagnostic modalities of hepatocellular carcinoma in high-risk patients: contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) and magnetic resonance imaging liver imaging reporting and data system (MRI LI-RADS).Methods:From August 2017 to August 2019, the CEUS and MRI data of patients at high risk for HCC from the Second Affiliated Hospital of Zhejiang University School of Medicine were analyzed retrospectively. A total of 217 lesions in 173 patients were classified according to CEUS LI-RADS v. 2017 or MRI LI-RADS v. 2018, by 4 blinded independent observers with more than 10 years of experience of CEUS or MRI. Interobserver and inter-modalities agreement was assessed with Cohen′s kappa.Results:The interobserver agreement was moderate and comparable for CEUS/MRI LI-RADS category (κ=0.606/0.603), the inter-modalities agreement was moderate for CEUS and MRI LI-RADS category (κ=0.564), LI-RADS 3, M, 4 and 5 by two imaging methods showed that the Kappa values were 0.739, 0.551, 0.734 and 0.592, respectively.Conclusions:The total inter-modalities agreement between CEUS and MRI LI-RADS categories is moderate, while the agreements of LI-RADS 3, 4 are strong, and LI-RADS M, 5 are moderate.

目的 探讨CT纹理分析对局部晚期胰腺癌(LAPC)患者化疗疗效的预测价值.方法 收集2015年8月至2019年5月在浙江省人民医院肝胆胰外科行新辅助化疗治疗的LAPC患者104例.所有患者均行3次CT检查(化疗开始前1周、化疗开始第3周、化疗结束后4周).根据化疗结果,将化疗后完全缓解、部分缓解、好转和稳定的35例患者纳入有效组(EG组),将化疗后病变进展的69例患者纳入进展组(PG组).同时将所有患者按照7:3比例分为训练组和测试组,通过Anolysis Kit软件对训练组中确定的肿瘤区域CT的纹理特征进行提取和分析,采用logistic回归分析选择化疗前纹理特征作为结果的潜在预测因子,最后采用ROC曲线分别评判训练组和测试组的诊断准确性.结果 经过计算及降维后最终得到10个特征参数.logistic回归模型评价指标的准确性、AUC、特异度、灵敏度、阳性预测值、阴性预测值分别为0.69、0.86、0.78、0.85、0.68、072.结论 基于胰腺癌CT图像所得的纹理特征可预测LAPC的化疗疗效,可为临床实践中肿瘤生物学反应提供新的生物学标志.

Objective To explore the validity of the size-specific dose estimate (SSDE) derived from the water-equivalent diameter (Dw)value of the slice located in the middle of the scan range in the head CT examination. Methods A total of 197 patients underwent head CT nonenhanced scan were enrolled in this retrospective study. The Dw, size-dependent conversion factor (f), normalized volume CT dose index (CTDIvol) and SSDE values of all slices were calculated. Two sets of SSDE, SSDEgroand SSDEcenbased on the Dwvalues slice by slice (Dw-gro) and the Dwvalues of the slices in the middle of the scan range (Dw-cen), were obtained across all patients. Pearson correlation analysis and linear regression analysis were performed for Dw-grovs Dw-cen, Spearman correlation analysis and linear regression analysis for SSDEgrovs SSDEcen, SSDE vs Dw, CTDIvolvs Dw. With the reference of SSDEgrovalue, mean absolute relative difference (MARD) of SSDEcen values were calculated to assess its accuracy and the correlated factors of MARD was analyzed with multivariate linear stepwise regression analysis. Results The minimal Dwvalue close to the roof of the skull corresponded to the maximal value of f and SSDE, which was the minimal value of CTDIvol. The significant positive correlation was showed between Dw-grovs Dw-cen, SSDEgrovs SSDEcen, SSDE vs Dw, CTDIvolvs Dw(r=0.947, 0.931, 0.416, 0.626;P＜0.05). The values of Dw,groand Dw-cenwere (16.94±0.69) and (18.50±0.62) cm respectively. The values of SSDEgroand SSDEcenwere [54.10 (52.29, 56.39)] mGy and [53.77 (51.85, 55.25)] mGy respectively. An approximation of SSDEcenvalues with an average of 1.62% of the gross MARD was found to match the reference value. Multivariate linear stepwise regression analysis indicated that MARD had negative correlation with Dw(β=–1.319,P＜0.05), positive correlation with CTDIvol(β=0.202,P＜0.05), and f was not included in the multivariate regression equation. Conclusion SSDEcenbased on the Dwvalue of the slice located at the center of the scan range yields small MARD value and can represent a reliable SSDE estimation in the head CT examination.

Objective To investigate the value of CT and magnetic resonance(MR)imaging in the evaluation of cystic renal cell carcinoma by using the Bosniak classification system and to increase the understanding of the CT and MR features of cystic renal cell carcinoma.Methods The present study retrospectively analyzed 21 cystic renal cell carcinoma in 21 patients(6 women,15 men;mean age,45.9 years;range,23-66 years),who had undergone both computed tomography(CT)and MR examinations within 6 months,and ultimately received surgical treatment. For each lesion,size of both cyst and solid component,appearing of calcification,number of septa,thickness of wall and septa,and presence of enhancement were analyzed. Each lesion was categorized(Bosniak classification)on CT and MR respectively. The MR findings were compared with CT and pathological results.ResultsOn MR,there were 6 category Ⅲ and 15 category IV lesions. On CT,there were 1 category IIF,8 category Ⅲ and 12 category IV lesions. Findings on CT and MR images were different in 4(19%)lesions. Among them,1 category IIF lesions on CT were upgraded to category Ⅲ on MR images,and the other 3 category Ⅲ lesions on CT were classified as category IV on MR. In these lesions, MRI depicted increased wall/septa thickness(n=4)and enhanced mural nodule or soft-tissue components(n=3)compared with CT,resulted in a classification upgrade. Based on the pathological results,1 of category IIF(4.8%),8 of category Ⅲ(38.1%) and 12 category IV(57.1%) lesions on CT images were malignant. On MR,6 of category Ⅲ(28.6%)and 15 category IV(71.4%)lesions were malignant.ConclusionCT and MR imaging findings are similar in the majority of cystic renal cell carcinoma .It is necessary to combine MR features with CT findings in evaluation and management of these cases with renal cystic masses.

目的 评价320排CT前瞻性心电门控心肺血管一站式成像在急性胸痛检查中的应用.方法 对170例心率≤70次/min的心肺血管一站式成像影像资料进行分析,病例分为前瞻性心电门控的前瞻组(P组)和回顾性心电门控的回顾组(R).重建所有病例冠状动脉、肺动脉、胸主动脉图像,评价图像质量并完成诊断,同时比较分析2组图像质量和辐射剂量.结果 2组满足管腔评价的血管段比例差异无统计学意义(P ＞0.597).前瞻组和回顾组肺动脉[分别为(383.00±53.64)、(366.48±60.96) HU]、冠状动脉[分别为(426.31±79.75)、(407.49±91.00) HU]、胸主动脉[分别为(416.53±63.44)、(413.58±58.62) HU]、图像噪声(分别为20.46±5.84、18.55 ±4.67)、信噪比(分别为22.06±6.47、23.13 ±5.76)、对比噪声比(分别为15.12±5.43、15.92 ±4.77)差异均无统计学意义,2组有效剂量分别为(11.85±3.90)、(20.06±3.27) mSv,其差异有统计学意义(P＜0.01).结论 前瞻性心电门控心肺血管一站式扫描能有效降低辐射剂量并保证诊断图像质量.

Objective To evaluate the safety and effectiveness of percutaneous microwave/radiofrequency ablation liver partition and portal vein embolization for planned hepatectomy (PAPEP) for hepatocelluar carcinoma(HCC) and perihilar cholangiocarcinoma with insufficient future liver remnant. Methods B ultrasound guided percutaneous microwave ablation liver partition (PMA) was applied on the future transection plane, the tumor in the left lobe was synchronal treated by dehydrated alcohol injection. one to three days after PMA, portal vein embolization (PVE) was performed. Ten to thirteen days after PVE, right trisectionectomy extended right hepatectomy surgery procedure was performe. Results The standard liver volume (SLV)was 1231.2mL、1202.9mL and 1217.1mL respectively, and the remnant liver volume was 355.6mL、383.4mL and 385.0mL, which was 28.9%、31.9% and 31.6% of the SLV before PMA. The time for PMA and PVE was 118~132min and 158~180min respectively. The FLR was increased by 41.2%, 37.6%, 23.7%to 502.1mL, 527.4mL, 476.3mL after PMA+ PVE. The operation time was 230~440min, the intraoperative blood loss was 120-1800mL. One of HCC patients complicated ascites and jaundice was cured by expectant treatment;the PHCC patient suffered subphrenic abscess which was cured by percutaneous drainage. The patients were discharged 15~40d postoperatively. Conclusion PAPEP maybe a revolutionary strategy in place of ALPPS to treat HCC and PHCC with insufficient FLR.

Objective To evaluatge percutaneous microwave ablation liver partition and portal vein embolization for planned hepatectomy (PAPEP) in treatment of hilar cholangiocarcinoma with insufficient future liver remnant.Methods The clinical data of an advanced hilar cholangiocarcinoma case with small FLR treated by PAPEP was retrospective analyzed.Preoperative assessment showed a type Ⅳ (Bismuth) and staged Ⅳa (AJCC) carcinoma patient with fight hepatic artery and right portal vein branch involvement.T-bil level decreased after PTCD,B ultrasound guided percutaneous microwave ablation liver partition (PMA) was performed,portal vein embolization (PVE) was done 1 day after PMA.Results The FLR increased by 37.55％ to 527.44 ml 13 days after PMA + PVE.A right trisegmentectomy combined with caudate lobectomy was performed,left portal vein was resected and reconstructed.Postoperative subphrenic abscess and upper gastrointestinal bleeding caused by duodenal ulcer was successfully managed.No recurrence was found during 7 months follow-up.Conclusions PAPEP is effective for the radical resection of advanced hilar cholangiocarcinoma with insufficient future liver remnant.

目的 探讨320排动态容积CT全脑成像在评估单侧大脑中动脉(MCA)闭塞患者侧支循环中的应用价值及其对预后的评价作用.方法 纳入2011年3月至2015年9月在浙江省人民医院住院治疗的37例单侧症状性MCA闭塞患者.采用320排CT进行多参数全脑灌注扫描,获取常规CTA和4D-CTA图像,分析常规CTA、4D-CTA所示侧支循环状况和金标准DSA图像并作一致性检验,同时计算4D-CTA侧支循环评分与预后的相关性.结果 4D-CTA、常规CTA所示侧支循环良好患者分别为22例(59.4％)、14例(37.8％).以DSA为金标准,常规CTA、4D-CTA侧支循环评分Kappa值分别为0.58、0.78.4D-CTA所示侧支循环不良患者和侧支循环良好患者间治疗时间窗差异有统计学意义(t=2.27,P=0.029),两者侧支循环评分与随访90d改良Rankin量表评分呈负相关(r=-0.68,P＜0.001).结论 320排动态容积CT成像是评价单侧症状性MCA闭塞患者侧支循环建立情况的有效方法.4D-CTA比常规CTA能更好地评估侧支血流和预测预后,有助于血管内介入治疗决策.

目的探讨320排CT在单侧大脑中动脉(MCA)闭塞患者血流动力学改变及侧支循环评估中的应用价值,以及对预后的评价作用.方法对63例单侧MCA闭塞患者行320排CT头颈联合多参数扫描,获取常规CT血管造影(CTA)、4D-CTA及脑灌注图像,分析常规CTA和4D-CTA图像的侧支状况,计算侧支循环评分与预后的相关性,并比较侧支循环良好组和侧支循环不良组的脑灌注差异.结果在4D-CTA上侧支循环良好者40例(63.5％),而在常规CTA上仅25例(397％).基于4D-CTA的侧支循环评分与90d改良Rankin量表评分呈负相关(r=-0.616,P＜0.01).侧支循环良好组患侧的相对脑血流量及相对脑血容量均高于侧支循环不良组(均P＜0.01).两组患侧的相对平均通过时间及相对平均达峰时间差异均无统计学意义(均P＞0.05).结论320排CT是评价单侧MCA闭塞患者脑血流动力学改变和侧支循环建立情况的有效方法,4D-CTA成像评估侧支血流和预测预后较常规CTA更好.

目的 探讨CT检查在胰腺癌术后发生腹腔感染中的诊断价值及效果,为腹腔感染患者的诊断提供合理的方法.方法 选取2013年11月-2015年10月医院收治的86例胰腺癌术后腹腔感染患者,随机分为对照组和观察组各43例,对照组则采取常规的超声检查,观察组采取CT检查,对比两组患者腹腔病变的影像学表现及诊断的准确率;采集患者5ml静脉血及腹腔引流液进行细菌学检验;采用SPSS10.0软件进行数据处理和统计分析.结果 共检出病原菌67株,其中革兰阴性菌40株占59.7％;腹腔脓肿患者CT影像学阳性表现分布中,肠袢间脓肿占50.0％,膈下脓肿占12.5％,盆腔脓肿占37.5％,有分隔占25.0％,含气征象占12.5％;肠梗阻病变及CT 影像学表现分布中肠管扩张占44.4％、肠壁增厚占22.2％、异常增强占11.1％、密度异常占11.1％、肠系膜积液占11.1％;化脓性腹膜炎CT影像学表现分布中腹膜增厚占50.0％、腹腔积液占33.3％、腹腔游离气体占50.0％、肠壁水肿占16.7％、肠系膜水肿占33.3％;对照组患者经检查后的准确率为69.8％,而观察组患者经CT检查后诊断准确率为88.4％,两种检查方法检查结果比较,差异有统计学意义(P＜0.05).结论 胰腺癌术后CT检查对腹腔感染的诊断有一定价值,可为患者的早期治疗提供理论基础.

Objective To investigate the impact of anatomical variation of the Circle of Willis on the incidence of intracranial aneurysms at various locations. Methods 1013 patients who underwent cerebral computed tomography angiography (CTA) were retrospectively divided into aneurysm group with (361) and control group without (652) aneurysms according to the CTA results. The 450 aneurysms in 361 patients were located in the anterior communicating (AcoA,72), posterior communicating artery (PcoA, 168), internal carotid artery, 100), middle cerebral artery (MCA, 58), other sites of the anterior (18) and posterior (34) circle of Willis. Patients'gender, age, locations of aneurysms, balanced or partial integral types of Circle of Willis were compared between the aneurysm and control groups. Results The average age of patients with AcoA (50.35 years) and MCA aneurysms (52.49 years) was significantly lower (P<0.05) than that of PcoA aneurysms (56.65 years)...The incidence of partial integral anterior circle of Willis was significantly (P=0) higher in the patients with AcoA aneurysm (44.4%) than that of control group (12.5%). There was also significant difference in the ratios of partial integral types of circle of Willis between MCA aneurysm and the control group (P=0.005). Conclusion Patients with partial integral circle of Willis are more likely to develop ipsilateral AcoA and MCA aneurysms.

目的：探讨多层螺旋 CT（Multi－slice CT）横断位结合多平面重建（multi planar reconstruction， MPR）对早期胃癌的检出价值。方法对确诊的62例胃癌患者进行 MSCT 横断位结合 MPR 处理，并对不同时期胃癌检出结果与超声内镜的检出结果进行比较。结果 MSCT 横断位结合 MPR 对早期胃癌的检出率显著高于超声内镜，两者差异具有统计学意义（P ＜0．05）；MSCT 横断位结合 MPR 和超声内镜对进展期胃癌的检出结果一致。结论 MSCT 横断位结合 MPR 能提高早期胃癌的检出率，对临床诊断具有重要的指导价值。

目的 初步探讨320排CT全脑动态容积成像联合颈部CTA检查对于评估慢性缺血性脑血管病的临床应用价值.方法 54例慢性缺血性脑血管病患者行320排CT头颈联合多参数扫描,对头颈动脉狭窄程度及脑灌注各参数进行分析,参数包括脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP).结果 ①发现脑灌注异常41例,共58处脑缺血灶,其中Ⅰ1期9处、Ⅰ2期24处、Ⅱ1期17处、Ⅱ2期8处.灌注参数患侧TTP、MTT和CBF与对侧镜像比较差异有统计学意义;②血管狭窄或闭塞者50例(前循环43例,后循环7例),仅累及头部者19例,仅累及颈部23例,头颈血管不同程度狭窄/闭塞8例(4例责任血管是头部;4例责任血管是颈部);50例中轻度狭窄7例,中度狭窄9例,重度狭窄19例,闭塞15例;相应供血血管重度狭窄或闭塞导致脑灌注异常明显高于轻中度狭窄者(P＜0.01).结论 320排CT全脑动态容积成像联合颈部CTA检查能全面显示脑血流灌注参数的变化及相应头颈部供血动脉狭窄程度,为临床早期治疗慢性缺血性脑血管病提供影像学依据.

Objective Using whole brain CT perfusion imaging and neck CT angiography with 320-row-detector dynamic volume CT to investigate the cerebral hemodynamic changes and the relationship between the hemodynamics and cerebral artery stenosis in patients with chronic cerebral ischemia.Methods The data of the dynamic CT angiography(4DCTA),CT brain perfusion and the CTA images of carotid artery were acquired in 88 patients with unilateral MCA and ICA stenosis or occlusion.The narrow rate of the neck and intracranial lesions of vascular and CT perfusion(CTP)parameters,including rCBF,rCBV,rTTP,rMTT,were calculated.Configuration of the CoW was described.The interrelation between the degree of artery stenosis,collateral circulation via the CoW and CTP parameters was analyzed.Results 1)The 88 patients of different intracranial artery and neck vascular stenosis or occlusion included mild stenosis in 12 cases,moderate stenosis in 25,severe stenosis in 24,occlusion in 27.There were 48 cases of unilateral ICA stenosis or occlusion and 40 cases of unilateral MCA stenosis or occlusion(M1-M2);2)There were statistical significances in rCBV,rMTT and rTTP of the middle cerebral region,anterior watershed region,posterior watershed region(P 0.05 for all).No statistically significant difference in rCBF was found among the four stenotic groups(P 0.05 for all);3)There was a weak negative correlation between the stenosis rate and rCBF of the middle cerebral region(r=-0.254,P =0.017),but the stenosis rate and rCBF of anterior watershed and posterior watershed regions was with no correlation(r=-0.131,P =0.13;r=-0.2,P =0.062,respectively).The degree of stenosis and rCBV(r=0.497,r=0.316,r=0.29,respectively;P 0.01 for all),rTTP(r=0.691,r=0.619,r=0.593,respectively;P =0.000 for all),rMTT(r=0.695,r=0.514,r=0.508;P =0.000 for all)was with positive correlation in three regions;4)NO relation was found between the configuration of the CoW and cerebral perfusion parameters.Conclusion The whole brain CT perfusion imaging and neck CT angiography with 320-row-detector dynamic volume CT can fully show position of cerebral ischemia,changes of cerebral blood flow parameters and the degree of stenosis of the corresponding the feeding artery of the head and neck.The narrower of the feeding artery,the bigger the CBV,TTP,MTT are,the ratio of stenosis was highly correlated with the rTTP.

目的：探讨C T引导下经皮肺穿刺活检诊断肺外周病灶的应用价值。方法72例肺外周病灶患者C T引导下经皮肺穿刺活检分成2组，即研究组（接受C T引导下经皮肺穿刺活检）40例、对照组（接受透视C T引导下经皮肺穿刺活检）32例，比较分析两组的敏感性和特异性。结果研究组准确率、敏感性和特异性均显著高于对照组（礸＝6．105、6.098、8．654，P值均＜0．05）。结论 CT引导下经皮肺穿刺活检诊断肺外周病灶有较高的敏感性和特异性，值得临床上推广应用。

Objective To evaluate triple rule-out 320-detector-row CT angiography in patients with acute atypical chest pain. Methods 79 consecutive patients with acute atypical chest pain underwent triple rule-out 320-detector-row CT angiography.Volume data were acquired in 3 phases after dual flow-rate contrast injection in the cranial-to-caudal direction.The pulmonary and coronary arterial and thoracic aortic attenuation values were measured.Image quality and streak artifacts from the right heart were evaluated. The sensitivity,specificity,positive predictive value,negative predictive value,and agreement rate for demonstrating 50%or greater coronary artery stenosis were calculated in comparison with conventional coronary angiography.Results The mean attenuation values of pulmonary arteries(370.35±101.34 HU),coronary arteries(396.37±83.54 HU)and thoracic aorta(383.56±68.76 HU)were above the diagnostic threshold of 250 HU.Of 1069 coronary segments,801(95.69%)were evaluable with severe streak artifacts in 2.53%(2/79).Findings included pulmonary embolism(13),aortic dissection(9),aortic intramural hematoma(2),penetrating aortic ulcer (3),thoracic aneurysm(2),and coronary artery atherosclerosis(17)including 7 patients with significant lumen stenosis≥50%.There was high agreement(96.88%)of coronary artery assessment compared to conventional coronary angiography with 90.91%sensitivity, 97.65% specificity,83.33% positive predictive value,and 98.81% negative predictive value.Conclusion Triple rule-out CT angiography with 320-detector-row CT can rapidly exclude fatal causes of acute atypical chest pain in combined evaluation of pulmonary artery,thoracic aorta,and coronary artery.

Objective:To investigate the clinical guidance of dynamic CT for acute subdural hematoma with conservative treatment, and the outcome of hematoma disease be analyzed in this study. Methods:120 cases patients with acute subdural hematoma were the objects for the study, which were treated in our hosptial during 2012.07-2013.07, been treated with conservative program and received a dynamic CT scan. Count and analyzed the outcomes of hematoma while monitored by dynamic CT, and investigate the factors related the outcomes of hematoma.Results:17 cases turned to rapid dissipation of subdural hematoma within 48h, 54 cases received a outcomes with hematoma slowly dissipated. 20 cases patients were deterioration after 2~3 weeks, and received a treatment with drilling brain drain. 21 cases patients were deterioration within 24h, received a craniotomy hematoma. The results of an investigation about the factors related with the outcomes showed that, the combined traumatic brain injury was the mian incentives for the failure of conservative treatment.Conclusions After the patients hospitalized with acute subdural hematoma, should be monitored by dynamic CT within 1week. For the patients combined with traumatic brain injury, should pay more attention to the deterioration of its hematoma lesions within 24h.