目的 探索能谱CT在低放射剂量下,通过肺碘基图成像技术,检测肺动脉栓塞(pulmonary embolism,PE)患者肺亚段及以下低灌注区的能力.方法 本研究利用CT能谱成像物质分离技术得到32例肺动脉栓塞病人的碘基图,在后处理工作站上计算碘基图上的肺亚段及以下动脉的低密度碘沉积区和对侧正常区的面积和碘含量,以及单能量CT肺动脉造影(CTPA)中对应区域的CT值,然后使用配对Wilcoxon检验比较病变区和正常区之间面积、碘含量及CT值的差异;最后检测低密度碘沉积区与CTPA图中肺亚段以上栓塞栓子的面积,并使用Pearson相关分析栓子面积和碘低密度区面积的关系.结果 分别检测到23例PE患者肺碘基物质图上发现亚段及以下区存在35处碘低密度区,发现肺碘低密度区的碘含量较对侧正常肺组织碘含量明显降低,两者差异有统汁学意义[(0.28±0.13) g/L vs.(2.54 ±0.59) g/L,Z=-6.3,P＜0.01].而在CTPA肺动脉造影图发现,对应碘基图低密度区的CT值比对侧正常区略降低,但差异无统计学意义[碘基图低密度区:(-817.70±93.46)Hu vs.对侧正常区:(-802.81 ±140.11)Hu,Z=-0.43,P＞0.05].结论 能谱CT碘基图技术可为肺栓塞患者的肺亚段下梗死区的准确诊断提供可靠数据,将为临床肺栓塞早期诊断和治疗提供有效手段.

OBJECTIVE To explore the clinical value of spectral CT iodine-based material imaging in diagnosis of the elderly pneumonia patients complicated with pulmonary embolism so as to perform the diagnosis and treatment in early stage .METHODS The elderly pneumonia patients complicated with pulmonary embolism underwent the con-ventional CT scanning and spectral enhanced scanning ,then the iodine contents of perfusion defects ,pneumonia lesions ,and normal lung parenchyma were observed and measured ,and the two groups were compared by using the Chi-square test for categorical data .RESULTS The iodine content in the lung perfusion defects was (0 .32 ± 0 .21)g/L ,the pneumonia lung segment (0 .461 ± 0 .31)g/L ,the contralateral or adjacent normal lung paren-chyma (1 .93 ± 0 .45)g/L ,and there was significant difference in the iodine content between the lung perfusion de-fects and the contralateral or adjacent normal lung parenchyma (Z= -5 .63 ,P<0 .01) ,but there was no significant difference in the iodine content between the lung perfusion defects and the pneumonia lung segment .The accord-ance rate of the iodine-based materials imaging and pulmonary artery CT imaging was 93 .1% in diagnosis of com-plete embolism lesions ,91 .1% in diagnosis of partial embolism lesions .CONCLUSION The spectral CT iodine-based materials imaging provides a new imaging method for the diagnosis of the elderly pneumonia patients compli-cated with pulmonary embolism .

OBJECTIVE To explore the clinical diagnostic value of CT pulmonary angiogram (CTPA ) in septic pulmonary embolism (SPE) induced by right-sided infective endocarditis (RIE) .METHODS Totally 10 suspected patients with SPE induced by RIE during Jun .2012 to Jun .2013 in our hospital were selected and underwent con-ventional CT plain scan and CTPA .After reconstruction along the main pulmonary artery ,five areas (regions of interest ,ROI) on each pulmonary trunk were selected ,the presence of emboli was observed ,and the emboli loca-tion ,number ,degree and iodine content in the pulmonary artery were recorded and analyzed with SPSS 17 .0 . RESULTS The 10 patients were present with a total of 39 emboli ,including 13 emboli in the lung lobe ,20 in the pulmonary segment ,and 6 in the secondary segment .Twenty-five emboli were obliterative and 14 were non-obli-terative .All obliterative embolism showed decreased perfusion ,as well as 3 cases of non-obliterative embolism . For the pulmonary artery containing SPE , there was statistically difference in ROI contents ( P < 0 .01 ) . CONCLUSION CTPA can detect small emboli in the pulmonary artery and pulmonary embolism in concealed parts , which has important implications for SPE induced by RIE .

冠状动脉CT血管造影(computed tomography angiog原raphy,CTA)作为一项微创检查,其临床应用范围一直较局限,主要受限于多层螺旋CT较低的时间分辨率[1].对于心率＜70 次/min 的患者,冠状动脉CTA 检查可通过16层以上螺旋CT完成;心率过快患者则必须依赖于茁受体阻止剂控制心率后才能进行检查.由于房颤患者心律极不规则,因此单源螺旋CT机不易采集到合适的数据样本,重建图像会产生严重伪影[2].双源螺旋CT凭借其较高的时间分辨率,大大提高了冠状动脉CTA检查的成功率[3-5].本文旨在比较不同心室率房颤患者冠状动脉双源螺旋CTA的成像质量,现将结果报道如下.

<正>随着人口老龄化社会的到来,心脏病变在老年中发病率所占比例也越来越高,而冠心病是动脉粥硬化导致脏器损害的最常见类型,是严重危害人类康的常见病[1]。双源CT是一项最新技术,其极高图像时间空间分辨率,使其成为心脏冠状动脉检查好的无创影像方法。目前被认为是可准确评价冠动脉的无创手段[2,3]。其快速、清晰的扫描特点在用于老年冠心病患者的临床检查时,可以明显减少心率、心律不齐或呼吸伪影造成的冠状动脉伪影,

目的 比较双源CT前瞻性心电门控扫描与应用不同管电压回顾性心电门控扫描的冠脉成像质量和患者的辐射剂量.方法 对23例心率＜70次/min且心率波动＜5次/min的患者采用前瞻性心电门控,55例心率不齐或＞70次/min的患者采用按体重指数 (BMI)不同而改变管电压的回顾性心电门控.并随机抽取30例采用常规回顾性心电门控CT冠脉成像(不变动管电压)的患者作为对照组.由两位放射科医师对图像独立进行质量评价,同时对患者的辐射剂量进行统计.结果 前瞻性心电门控冠脉成像与按患者的BMI指数应用不同管电压的回顾性心电门控冠脉成像的质量均能满足临床诊断要求.前瞻性心电门控冠脉成像的辐射剂量较回顾性心电门控下降了约60%～70%,降低管电压也可使辐射剂量明显下降,差异有统计学意义 (P＜0.05).结论 在保证冠脉成像质量的前提下,根据患者的自身情况制定最合适的检查方案,能够切实降低患者的辐射剂量.

Objective To investigate the value of ECG editing in dual-source CT coronary angiography in patients with atrial fibrillation(Af).Methods 38 patients with Af underwent dual-source CT coronary angiography.The ECG editing technique was applied to get the processing and reconstruction of image.The coronary imaging before and after ECG-editing was evaluated with four-score method and the significant difference was compared.Results In 38 patients of Af,a total of 494 coronary artery segments were evaluated after ECG-editing.Among of them,179(36.22%) segments were evaluated score 4,161(32.63%) segments were evaluated score 3,107(21.71%) segments were evaluated score 2 and 47(10%) segments were evaluated score 1.The average score of before ECG-editing was(2.49±0.57),and the average score of after ECG-editing group was(3.34±0.47).The difference between two groups was significant(P0.01).Conclusions ECG editing technique can effectively improve the image quality of dual-source CT coronary angiography in patients with Af.

Objective To investigate the clinical detecting efficiency of Magnetic Susceptibility Weighted Imaging in Intracerebrale Cavernoma. Methods The findings on SE sequence in 15 patients with suspect of cavernoms performed with magnetic susceptibility weighted imaging were analyzed retrospectively.Results Fifteen lesions on SE sequence were depicted iso,hyper,hypo or hetergeneous sigal intensity.No apparent hoop sign could be found.On the SWI sequence,9 lesions were depicted absolutely hypointensity and 6 lesions were depicted spot,strip or mulberry hyperintense in hypointense area with obvious hoop sign.Conclusions SWI sequence plays an important role in the diagnosis of Intracerebrale Cavernoma.

目的探讨双源CT(DSCT)冠状动脉成像在冠状动脉支架术后随访中的应用价值。方法 81例患者在放置冠状动脉支架后行DSCT冠状动脉成像检查,其中10例与选择性冠状动脉造影进行了对照。结果 81例的124枚冠状动脉支架中能满足影像学评价的有122枚,占98%,不能满足评价的有2枚,占2%;10例同时作导管法冠状动脉造影者两种检测方法结果相同。结论 DSCT冠状动脉成像是一种简便易行,安全有效的无创性检查方法 ,可作为冠状动脉支架术后随访的初步评价方法 。