目的 探讨后胡桃夹综合征和后胡桃夹现象多层螺旋CT诊断价值.方法 搜集9例后胡桃夹综合征和5例后胡桃夹现象患者的CT资料进行回顾性分析,观察左肾静脉(LRV)的走行及形态,测量LRV扩张段内径、狭窄段内径和扩张段与狭窄内径比值.结果 14例患者中,LRV经腹主动脉后方单支注入下腔静脉11例,经腹主动脉前后方注入下腔静脉2例,于腰4椎体下缘水平单支注入下腔静脉1例.9例后胡桃夹综合征患者狭窄段LRV内径1.18 ～3.97 mm,平均(2.70±0.84) mm;扩张段LRV内径9.65 ～14.40 mm,平均(11.39±1.76) mm;狭窄段与扩张段内径比值1∶3.17～1∶8.05,平均为1∶(4.80±1.98),内径比值＞3,符合胡桃夹综合征的诊断标准.5例后胡桃夹现象患者(包括2例环主动脉型)狭窄段LRV内径为4.62 ～7.60 mm,平均(6.30±1.09) mm;扩张段LRV内径为7.90～11.58 mm,平均(10.23±1.39) mm;狭窄段与扩张段内径比值1∶1.18～1∶2.35,平均为1:(1.68±0.46),内径比值＜3,不符合胡桃夹综合征的诊断标准.结论 MSCT可准确显示变异的LRV走行及形态,并可明确诊断后胡桃夹综合征和后胡桃夹现象,为临床选择治疗方案提供重要依据.

Objective To investigate the CT features of primary mediastinal neuroendocrine carcinoma and improve the diagnostic accuracy. Methods CT findings of 12 patients with primary mediastinal neuroen-docrine carcinoma diagnosed by clinic and pathology were retrospectively analyzed. The location, size, growth pat-tern, density, degree of enhancement, invasion of surrounding tissues and metastasis of the tumor were observed, a control analysis was performed. Results Among the 12 cases, 4 cases were located in the anterior superior medi-astinum, 4 cases in the middle superior mediastinum and 4 cases in the middle mediastinum. There were 5 cases on the left side, 4 cases on the right side and 3 cases in the middle. The maximum diameter of the tumor ranged from 1.5 cm to 12.0 cm, with an average of(6.74±3.65) cm. The tumors were round or quasi-round in 6 cases, ir-regular in 6 cases, clear boundary in 9 cases and unclear in 3 cases. Uniform density was found in 6 cases. The density was heterogeneous in 6 cases, including necrosis and cystic degeneration in 4 cases, and fine-grained cal-cification in 1 case. The average CT value of plain scan was (38±4.8) HU. There was 1 case of perivascular growth, 2 cases of adjacent vascular compression, 3 cases of adjacent pleural invasion, and 6 cases of infiltrating the sur-rounding fat space. After contrast enhancement, all cases showed mild and moderate enhancement, including 4 cases with homogeneous enhancement and 8 cases with heterogeneous enhancement. After contrast enhancement, the mean CT value was (55±7.7) HU. There were 9 cases with mild enhancement and 3 cases with moderate enhance-ment. There were 3 cases with small linear abnormally enhanced vascular shadow in the tumor, and 4 cases with no enhancement both in the central necrosis and the cystic areas. There were 7 cases of typical carcinoid, 2 cases of atypical carcinoid, 2 cases of small cell carcinoma and 1 case of large cell neuroendocrine carcinoma. Conclu-sion Primary mediastinal neuroendocrine carcinoma is mainly located in the anterior-mediastinum. When the tumor is large, necrosis, cystic degeneration and invasive growth are easy to occur. The enhanced scan shows mild and moderate enhancement. Combined with clinical history, it can improve the accuracy of diagnosis.

目的 探讨绝经后妇女激素治疗不同方案对乳腺密度的影响. 方法 选择我院门诊就诊、具有激素治疗指征的绝经后妇女96例,随机分为:A组32例,给予戊酸雌二醇+地屈孕酮连续联合治疗;B组30例,给予戊酸雌二醇+醋酸甲羟孕酮连续联合治疗;C组34例,给予替勃龙治疗.分别于用药前及用药6个月时进行乳腺钼靶摄片检查、Kupperman绝经症状评分. 结果 治疗后与治疗前相比,各组绝经症状评分均显著下降(P＜0.01),治疗后各组间比较,差异无统计学意义(P＞0.05).钼靶摄片乳腺密度检查的结果显示,治疗后B组乳腺密度评分均值升高,与A组、C组比较,差异有统计学意义(P＜0.05). 结论 戊酸雌二醇+地屈孕酮方案及替勃龙方案相对戊酸雌二醇+醋酸甲羟孕酮方案,对绝经后妇女乳腺密度的变化影响较小.

目的分析磁共振背景抑制弥散加权成像（DWIBS）对甲状腺癌淋巴结转移的评估运用价值,为甲状腺癌淋巴结转移的早期诊断提供依据。方法选取我院2011年1月~2013年7月经手术病理证实的40例甲状腺癌病例,对比、分析高分辨率MRI平扫、DWIBS及增强检查在判断甲状腺癌淋巴结转移中的效果。结果 40例病例经病理证实共发现29例淋巴结转移,其中10例单分区转移,19例多分区转移;平扫T2WI、增强T1WI、DWIBS转移灶总检出率分别为65.22%、75.36%和82.61%,DWIBS检出率显著高于平扫T2WI、增强T1WI（P＜0.05）;以正常甲状腺作为对照,肿瘤实质、转移淋巴结ADC值显著低于正常甲状腺,瘤内坏死区域ADC值显著高于后者（P＜0.05）;以淋巴结区域作为鉴别诊断的阈值时,DWIBS灵敏度为96.8%,其特异度为91.0%,曲线下面积Az=0.915（P＜0.05）,诊断效果较好。结论 DWIBS同时结合高分辨率MRI技术,能敏感地发现淋巴结,有助于提高甲状腺癌T分期和N分期的准确性,值得临床推广运用。

Objective To study the CT findings of traumatic bone cyst and to improve the knowledge of that disease.Methods CT features of 8 cases of traumatic bone cyst confirmed by clinical and pathology were reviewed retrospectively.There were 4 females and 4 males,from 26 to 76 years (the median age was 53 years old)of age.Three patients had traffic accidents,2 patients had trauma unrelated,1 patient had boulder crushing,1 had patient stick wounded and 1 patient had high jump wounding.The bone cyst occurred from 18 to 36 months after trauma(2 at 18 months,4 at 24 months,1 at 30 months and 1 case at 36 months).Results There were 6 fractures,1 joint dislocation and 1 frontal soft tissue hematoma in trauma.The cyst located in the ilium of 3 cases,in the calcaneus of 2 cases,in the frontal bone of 1 case,in the hooked bone of 1 case,in the lunate bone of 1 case.The cyst size was 2.0 cm × 2.6 cm to 3.0 cm × 6.0 cm (average 2.7 cm × 4.0 cm).8 cases all single capsule change,all clear boundaries.6 cystic destruction and 2 cystic expansion destruction of bone.Two see separated and 6 no divider of the cyst region.Five bone sclerosis and 3 no hardening of the cyst edge.Three sclerosis and Five no sclerosis of the adjacent bone.Four osteoporosis decalcification and 4 no osteoporosis decalcification of he adjacent bone.Conclusion The traumatic bone cyst is closely related to trauma,CT manifestations with certain characteristics,combined with a history of trauma can make a definite diagnosis.

目的 分析背景抑制扩散加权成像(DWIBS)在甲状腺癌的诊断与分期中的价值,为甲状腺的诊断和治疗提供理论依据. 方法选取我院2011年1月~2013年9月收治的95例甲状腺肿瘤患者,分析术前DWIBS与术后病理诊断的结果,探讨DWIBS的诊断效果. 结果 DWIBS共检出良性甲状腺肿瘤57例,符合44例,符合率84.6%(44/52),恶性甲状腺肿瘤41例,符合35例,符合率81.4%(35/43),DWIBS对良、恶性肿瘤诊断的准确率均较高,且无明显统计学差异;DWIBS结果显示,甲状腺恶性肿瘤患者分期:T1 15例,T2 13例,T3 8例,T4 5例,病理检查确认甲状腺恶性肿瘤患者分期:T1 19例,T2 11例,T3 7例,T4 6例,DWIBS检查符合34例,符合率79.1%(34/43),符合率较高. 结论 DWIBS能够有效诊断和鉴别甲状腺良恶性肿瘤,在甲状腺癌的分期中也有十分优秀的表现,可敏感、直观地显示甲状腺各类病变,有利于甲状腺癌的早期诊断、治疗,从而保证了患者的生存质量,值得临床广泛推广应用.

<正>腰骶部移行椎是脊椎较常见的先天发育异常,其诊断主要依靠全脊椎X线片。近年来随着MRI检查的普及,使脊柱病变,尤其是下部腰椎间盘病变的诊断更加方便,但由于MRI扫描观察的局限性,对腰骶部有移行椎的患者容易误诊,造成定位错误。我们通过分析2005—2010年在我院行腰椎MRI检查的329

目的 探讨自制乳腺托架联合磁共振体线圈对乳腺疾病的检查效果.方法 采用自制乳腺托架在1.5T超导型磁共振机上联合相控阵体线圈对34例乳腺病变患者进行俯卧位全乳腺扫描,完成横断面快速自旋回波(FSE)T1WI、抑脂T2WI和三维快速梯度回波(3D THRIVE)动态增强扫描,并与钼靶X线进行对照分析,所有病例均经手术或活检病理证实.结果 所有乳腺MRI图像都具有良好的诊断质量,在此基础上的MRI诊断敏感性100%,准确率为76.5%,优于钼靶(敏感性82.3%,准确率58.8%).结论 自制乳腺托架联合磁共振体线圈检查乳腺是可行的,是乳腺专用线圈的一种简易而有效的替代手段.

目的探讨肝脓肿的螺旋GT表现特征,着重讨论动态增强扫描表现.方法回顾性分析32例已证实的肝脓肿的CT平扫,动态增强扫描资料.结果增强扫描表现为:(1)高灌注异常:非病变肝组织一过性不均匀强化.(2)边缘强化:肝脓肿灶周环状或不规则强化.(3)分隔状强化:肝脓肿整个病灶呈蜂窝状,簇状,分隔状持续强化.结论螺旋CT平扫和动态增强扫描对肝脓肿的定性诊断和鉴别诊断有很大帮助.