目的 探讨静脉注射大剂量甲氨蝶呤引起骨肉瘤患者脑白质病的MRI影像学表现.方法 选取在本院行大剂量甲氨蝶呤静脉化疗诱发急性脑白质病的4例骨肉瘤患者,出现临床症状时均行颅脑MRI平扫+DWI检查,其中2例行颅脑MRI增强检查.结合患者出现的临床症状,并分析其影像学表现.结果 4例脑白质病患者颅脑MRI DWI序列观察到半卵圆中心、侧脑室旁呈高信号,1例患者T2FLAIR图像呈稍高信号,其中2例行颅脑MRI增强检查,病灶未见强化.1～2周后复查颅脑MRI,结果显示DWI的高信号区域缩小、消失.结论 颅脑MRI检查对于甲氨蝶呤诱发脑白质病的早期识别具有较大医学价值,有助于准确诊断和及时进行适当治疗,预后良好.

胃肠道异物损伤是非外伤性胃肠道损伤的少见原因之一,按异物来源可分为外源性异物(鱼刺、枣核、刀片等)和内源性异物(胆石、粪石等).鱼刺、枣核、刀片等外源性异物因其边缘锋利,易戳破胃肠壁导致局部穿孔、局限性/弥漫性腹膜炎、腹盆腔积液[1-5].胆石等较大的内源性异物阻塞肠道可导致肠壁水肿、肠梗阻、腹膜炎等不良后果[6-7].极少数异物长期滞留在胃肠道可伴有脑脓肿、难治性肺部感染、胸腔积液等并发症,值得影像科医生和临床医生注意.本研究回顾性分析2011年3月至2021年1月期间杭州市第三人民医院普外科收治的25例胃肠道异物导致损伤患者的临床资料,对其影像表现、诊断与治疗方案进行总结与分析.

OBJECTIVE To explore the value of CT imaging in clinical diagnosis and treatment of pulmonary fungal infections so as to provide theoretical basis for clinical diagnosis and treatment of the pulmonary fungal infections . METHODS A total of 96 patients with pulmonary fungal infections who were treated in the hospital from May 2011 to Apr 2015 were recruited as the study objects .The results of the CT imaging and constituent ratios of pathogens isolated from the patients with fungal infections were retrospectively analyzed and were compared with the results of X-ray examination .RESULTS The CT imaging of the 96 patients with pulmonary fungal infections showed that 31 (32 .29% ) had A spergilloma type infection ,17 (17 .71% ) had real variant infection ,8 (8 .33% ) had nodular type infection ,and 40 (41 .67% ) had diffuse type infection .Totally 81 patients showed positive for the CT imaging examination ,with the positive rate 84 .38% ;totally 56 patients showed positive for the X-ray examination ,with the positive rate 58 .33% ,and there was significant difference between the two examination methods (P< 0 .05) . Of the 96 patients with pulmonary fungal infections ,96 showed positive for the fungal culture ,with the positive rate 100 .00% ;there were 39 (40 .62% ) strains of Aspergillus ,34 (35 .42% ) strains of Candida albicans ,12 (12 .50% ) strains of Candida glabrata ,8 (8 .33% ) strains of Candida tropicalis ,and 3 (3 .13% ) strains of oth-er species .CONCLUSION The CT imaging combined with illness condition and clinical symptoms has great value in early diagnosis of the pulmonary fungal infections and improvement of the cure rate .

Objective To evaluate the CT and MR features of renal oncocytoma in order to improve the ability for recognition and ima-gingdiagnosis.Methods The CT and MR findings of renal oncocytoma in 12 patients proved by pathology were retrospectively analyzed.Results CT scans were performed in 12 patients,one of which was accompanied with the contralateral renal angiomyoliptoma.In all lesions, seven were in the right kidney and five in the left.The lesions were round or oval in shape with the diameter 1.5 cm-12.3 cm.On pre-contrast scan,the homogeneous density was found in 3,calcification in 2,and central scar tissue in 5.On post-contrast images,the parenchyma of tumor was obviously enhanced in the cortical phase.However,the enhancement was attenuated in the parenchymal phase.Seven patients underwent MRI at the same time,exhibiting iso-or hypointensity on T1 WI in 4 and heterogenous hyperintensity on T2 WI in 5.Dynamic contrast enhanced MRI demonstrated homogenous enhancement in 1 and heterogenous enhancement in others with delayed enhancement of the central scar.Conclusion Most renal oncocytomas show certain characteristics on CT or MRI, which are helpful for preoperative diagnosis and surgical therapy.

Objective To explore the diagnostic value of magnetic resonance imaging of prostate cancer. Methods Collect 27 cases confirmed by surgery for patients with prostate cancer, were performed preoperative MRI, including 18 routine enhancement scanning, scanning sequence including axial t1-weighted imaging, axial and sagittal and coronal fat suppression T2 weighted imaging, shaft a DWI imaging, can strengthen the axial and sagittal and coronal a fat suppression T1 weighted imaging. The MRI diagnosis compared with surgical results.Results In the enhanced MRI lesions are found, with 80% of the lesions occur in the outside weeks.Conclusions Magnetic resonance imaging examination has important diagnostic value of prostate cancer.

肾癌又称肾细胞癌, 是肾脏最常见的恶性肿瘤,肾癌的临床诊断主要依靠影像学检查[1]. 然而临床工作中,影像学检查将不典型肾脏良性占位误诊为肾癌的情况时有发生. 本次研究回顾性分析肾脏良性占位误诊为肾癌患者的影像学表现及误诊原因,并结合文献讨论肾良性占位的影像学特点以及与肾癌的鉴别诊断,旨在提高对肾肿瘤的术前诊断水平.

Objective To explore the value of MRI to the diagnosis of anal fistulas.Methods 27 patients with anal fistulas operative verified were performed MRI before operation.The MR pulse sequences were performed on 18 cases.MR scan sequence included axial T1WI,T2WI with fat suppression at axial,sagittal and coronal planes,axial DWI,T1WI with fat suppression and dynamic contrast enhancement at axial,sagittal and coronal planes.MRI findings were analyzed by comparing with the surgical results.Results 27 patients were found to have 30 fistulas,8 branch fistulas,29 external openings,25 internal openings,and 2 perianal abscesses by MRI before surgery.The precision for detecting fistulas,branch fistulas,external openings,internal openings and perianal abscesses were 96.8%(30/31),88.9%(8/9),96.7%(29/30),92.6%(25/27) and 100%(2/2) respectively.Conclusion MRI can accurately present the number and the track of fistula,the location of internal opening and the relation between fistula and its surrounding composition,perianal abscesses.It provides great vale for surgical planning and operation.

目的探讨计算机辅助检测(CAD)在数字化胸片诊断中的应用价值。方法随机分析200例10天内行胸部后前位片检查患者,三位不同年资的放射科医师分别在应用CAD前、后对胸片进行诊断,以CT检查进行检验,检出其诊断的准确率。结果放射科医师甲乙丙在使用CAD前准确率分别为45.5%、39.4%及26.3%,使用CAD后准确率分别为50.7%、49.3%及27.2%。医师乙使用CAD后准确率有显著提高(P<0.05)。结论 CAD可以明显提高中年资放射科医师对数字化胸片诊断的准确性。

目的 探讨肺隐球菌病的CT表现及其诊断价值.方法 回顾分析7例经病理证实的PC临床及多层螺旋CT资料.结果 病变好发于肺外围,呈单发或多发结节块影3例;单发或多发斑片影3例;斑片影与结节影混合病灶1例;邻近胸膜增厚、粘连6例,胸水1例,晕征3例,空洞2例.结论 肺隐球菌病的影像表现缺乏特异性,诊断依赖病理学检查,但CT上仍有一定的特点,结合临床资料有助于本病的诊断和鉴别诊断.

Objective To study the CT appearances of primary pulmonary histoplasmosis (PPHP)and evaluate the diagnostic values of CT for PPHP.Methods The clinical materials and multi-slice spiral CT appearances in 8 patients with PPHP proved pathologically were reviewed retrospectively.Results Single or multiple pneumonia-like lesions were seen in 3 esses,single or multiple nodules or masses were in 4 cases,and both pneumonia-like lesions and nodules or mflsses in 1 case.Calcification and halo sign were common,and only slight enhancement was demonstrated after intravenous contrast administration on CT.Conclusion CT is helpful imaging method in the diagnosis and differential diagnosis of PPHP combining with clinical materials although the CT appearances are not specific.

目的:探讨低张结肠水灌肠CT检查对结肠癌的CT表现及诊断价值.材料和方法:肌注654-2 20mg后,结肠灌注微温生理盐水进行CT扫描.分析经手术病理证实的38例结肠癌资料.结果:CT显示肿瘤部位准确率为100%,CT分期与手术分期符合率为92%,低张结肠水灌肠CT可见病变肠壁增厚、突出腔内的肿块、肠腔狭窄及其浆膜面毛糙;可见结肠癌侵犯邻近器官、淋巴结肿大及远处转移.结论:低张结肠水灌肠CT检查对结肠癌的术前诊断有很大的价值.

Objective:To study the CT findings of mediastinal teratoma and their clinicopathological basis.Methods:Fifty six cases of mediastinal teratoma proved by clinicopathologically were collected,and their radiographic and clinicopathological findings were analyzed retrospectively.Results:There were 31 cystic teratoma,20 benign teratoma and five malignant teratoma.CT findings were consistent with operation and pathology.Conclusion:The CT appearances of mediastinal teratoma can reflect the clinicopathological characteristics,and have high clinical values in diagnosing and differentiating this kind of disease.