BACKGROUND Tuberous sclerosis complex (TSC) and primary lymphedema (PLE) are both rare diseases, and it is even rarer for both to occur in the same patient. In this work, we have provided a detailed description of a patient's clinical presentation, imaging findings, and treatment. And a retrospective analysis was conducted on 14 published relevant case reports. CASE SUMMARY A 16-year-old male came to our hospital for treatment due to right lower limb swelling. This swelling is already present from birth. The patient’s memory had been progressively declining. Seizures had occurred 1 year prior at an unknown frequency. The patient was diagnosed with TSC combined with PLE through multimodal imaging examination: Computed tomography, magnetic resonance imaging, and lymphoscintigraphy. The patient underwent liposuction. The swelling of the patient's right lower limb significantly improved after surgery. Epilepsy did not occur.after taking antiepileptic drugs and sirolimus. CONCLUSION TSC with PLE is a rare and systemic disease. Imaging can detect lesions of this disease, which are important for diagnosis and treatment.

目的:探讨早期新型冠状病毒肺炎(COVID-19)的胸部薄层平扫CT表现特征.材料与方法:收集2022年11月至12月我院感染科确诊COVID-19且胸部CT表现阳性的患者153例,所有患者自发病后1～14天行胸部薄层平扫CT检查和有较完整的临床资料.根据患者年龄(≤60岁和＞60岁)和发病与CT检查的时间间隔(≤7天和＞7天)将患者各分为两组,比较两组患者的CT表现特征的差异性.结果:153例COVID-19患者中,累及肺部(100％)、血管(93.5％)、气道(73.4％)和胸膜(70.1％),其中年龄组间的对比显示病变数量、部位、大小、容积和束带影的差异有统计学意义;发病与CT检查时间间隔分组患者之间,病变的形态、密度、机化和纤维化以及胸膜受累等差异有统计学意义.结论:胸部薄层平扫CT可明确早期COVID-19的病变位置和范围,对COVID-19的定性诊断和鉴别有一定的特征,即以形态的多样化、胸膜内和血管周分布、肺泡为单元的间质性病变、早期混合性磨玻璃影常伴明显的机化和纤维化、胸膜局限性增厚而胸水极少等有助于COVID-19的诊断和鉴别.

目的:探讨不同扫描方式在头颈联合CT血管造影(CT angiography,CTA)检查中的应用价值,以提高图像质量.方法:选取2015年3月至2016年7月疑有脑血管疾病进行头颈部CTA检查的86例患者作为研究对象,采用随机数字表法将患者随机分为A、B 2组,每组43例.其中A组CTA扫描方向为头部至足部,B组CTA扫描方向为足部至头部,对比2组颈动、静脉各段及锁骨下动、静脉CT强化值,图像伪影分级,头颈部CTA图像质量.采用SPSS 21.0统计学软件对所得数据进行分析.结果:2组颈动脉各段CT强化值无显著性差异(P>0.05),颈静脉及锁骨下静脉CT强化值存在显著性差异(P<0.05);A组患者图像伪影分级中Ⅰ、Ⅱ级均明显多于B组,Ⅲ、Ⅳ级明显少于B组,存在显著性差异(P<0.05);A组头颈部容积重建(volume rendering,VR)、静脉最大密度投影(maximum intensity projection,MIP)图像质量评分均明显高于B组,存在显著性差异(P<0.05).结论:头颈联合CTA检查时,采用自头部向足部方向扫描能够减少静脉伪影,提高图像质量.

目的:探讨CT灌注成像在脑部肿瘤患者中的诊断效果.方法:取2015年5月至2016年9月首都医科大学附属北京世纪坛医院收治脑部肿瘤患者43例,均行常规CT扫描、CT灌注成像及增强扫描,将获得的数据、图像采用CT工作站Perfusion3软件进行处理,获得患者脑血流量(CBF)、血容量(CBV)、对比剂平均通过时间(MTT).结果:43例患者最终经CT灌注成像检查得到确诊,患者中,28例胶质瘤(占65.12％)、11例脑膜瘤(占25.58％)、2例转移瘤(占4.65％)、2例其他(占4.65％);脑部CT灌注成像中转移瘤病灶处、健侧CBF值,高于胶质瘤、脑膜瘤及其他(P<0.05);脑膜瘤病灶处、健侧CBF值,高于胶质瘤(P<0.05);脑部肿瘤中转移瘤病灶处、健侧血容量、对比剂平均通过时间,高于胶质瘤、脑膜瘤(P<0.05);脑膜瘤病灶处、健侧血容量、对比剂平均通过时间,高于胶质瘤(P<0.05).结论:脑部肿瘤患者采用CT灌注成像诊断能了解脑肿瘤部位血流状态、肿瘤血管功能,指导临床治疗,值得推广应用.

目的 探讨肺内多发结节影为主要表现患者的CT表现特点.方法 回顾性分析北京世纪坛医院影像资料库胸部CT出现肺内多发结节影的53例患者资料,其中肺结核19例、肺转移瘤23例、肺慢性炎症5例、弥漫性淋巴管瘤病6例,总结比较4种疾病的CT表现特征.结果 13例(68.4％,13/19)肺结核及18例(78.3％,18/23)肺转移瘤的结节最大径达10～20mm,3例(3/5)肺慢性炎症与3例(3/6)弥漫性淋巴管瘤病的肺内结节最大径范围为3～8 mm.肺慢性炎症的CT表现为结节以无分叶且边缘光滑为主共69个(79.3％;69/87)、病灶邻近胸膜增厚粘连36个(41.4％;36/87),结节无钙化及空洞;肺结核的CT表现为结节以无分叶且边缘光滑为主共128个(82.1％;128/156)、钙化86个(55.1％;86/156)、空洞43个(27.6％;43/156)、病灶邻近胸膜增厚粘连71个(45.5％;71/156);肺转移瘤的CT表现为结节以边缘见分叶及毛刺为主共369个(60.0％;369/615)、钙化23个(3.7％;23/615)、空洞111个(18.0％;111/615)、病灶邻近胸膜增厚粘连114个(18.5％;114/615).肺慢性炎症、肺结核出现结节边缘无分叶且边缘光滑的比率分别与肺转移瘤组比较,差异有统计学意义(x2=47.613,P=0.000;x2=88.095,P=0.000),肺结核与肺转移瘤出现钙化的比率两者差异有统计学意义(x2=270.707,P=0.000),肺结核与肺转移瘤出现空洞的比率差异有统计学意义(x2=7.048,P=0.008),肺慢性炎症与肺转移瘤、肺结核与肺转移瘤出现病灶邻近胸膜增厚粘连的比率差异有统计学意义(x2=23.670,P=0.000;x2=49.650,P=0.000).肺转移瘤空洞类型:空泡样空洞发生率(34.2％,38/111)＞囊样空洞发生率(26.2％,29/111)＞小环形空洞发生率(22.5％,25/111)＞不规则空洞发生率(17.1％,19/111);所有的空泡样空洞仅出现在腺癌肺转移中、78.9％(30/38)的空泡样空洞结节边缘均见分叶、毛刺.5例肺慢性炎症患者均见边缘模糊的结节,边缘见局限的片状浸润影及索条状影.弥漫性淋巴管瘤病的结节常呈弥漫或多灶性分布,累及多个部位并呈多发的大小不等的囊性病变,肺内结节均边缘光滑、密度均匀.结论 肺结核、肺转移瘤、肺慢性炎症和弥漫性淋巴管瘤病出现肺内多发结节时,其病灶大小、分布、形态、边缘、密度及与邻近结构的关系等各自具有一定特点,CT扫描对4种疾病进行鉴别诊断时具有重要价值.

目的 探讨适当低浓度对比剂在冠状动脉CTA成像中的应用价值.方法 对136例拟行冠状动脉CTA检查的患者行前瞻性研究,按所用对比剂浓度不同分为三组,所用对比剂浓度分别为320 mgI/ml、350 mgI/ml、370 mgI/ml,将扫描所得原始数据进行后处理重组,然后对重组后的冠状动脉图像质量进行主观评价,并对主动脉起始部及同层面降部的CT值进行测量,对其结果分别进行统计学分析.结果 三组冠状动脉图像质量的主观评价差异无统计学意义(x2 =0.785,P=0.675).采用前瞻性心电门控扫描的三组患者主动脉起始部CT值的分析结果为:F值=0.992、P值=0.376;主动脉降部CT值的分析结果为:F值=1.527、P值=0.224,采用回顾性心电门控扫描的三组患者主动脉起始部CT值的分析结果为:F值=1.206、P值=0.307;主动脉降部CT值的分析结果为:F值=1.703、P值=0.191,各组CT值的差异无统计学意义.结论 适当低浓度对比剂(320 mgI/ml)能够满足冠状动脉CTA的诊断要求,在行冠状动脉CTA检查时推荐使用.

Object: To investigate the statistic relationship between 5 clock positions of CTDI100 and stabilization of radiation. Method: Radiation meter and phantom are used to 12 time repeating tests on the radiation dose of a spiral CT at 5 Clock positions and then one-way ANOVA method is used to character the their difference significance of those 5 clock positions. Result: The relevant standard difference of measurements at 5 test clock positions are 0.33%(center), 0.73%(3 clock), 0.32%(6 clock), 1.00%(9 clock), 0.32%(12 clock) respectively; meanwhile the average of measurements at 3 clock is much close to that at 9 clock and no significant difference is found in one-way ANOVA test;Moreover the relative deviation between mean value of 12 Clock plus 6 Clock and 3 Clock is 0.5%. Conclusion: The tested spiral CT shows good radiation stability and 3 Clock position have equal effect with 9 clock's in CTDI100 measuring, moreover, peripheral CTDI of that can be simplified except for non-acceptance test or operational condition test.

目的:探讨256层螺旋CT大范围心电门控扫描胸腹部血管联合成像对冠状动脉成像质量的评价.方法:对34例因胸痛就诊的患者用256层螺旋CT行大范围心电门控扫描检查,检查完成后,进行冠状动脉图像重建,并与常规CT冠脉扫描的图像进行比较.结果:行大范围心电门控扫描检查组的冠状动脉图像质量优良率为89.7％ (456/508),能够满足诊断要求的为95.5％(485/508),常规冠状动脉扫描组中,图像质量优良率为89.8％(460/512),能够满足诊断要求的为96.3％ (489/512).两组的图像优良率无明显差异(X2=1.072,P=-0.192).结论:256层螺旋CT大范围心电门控扫描能够满足冠状动脉成像的要求,具有较高的临床应用价值.

Objective To investigate MSCT lymphangiography features of diffuse lymphangiomatosis.Methods MSCT images of 32 patients with diffuse lymphangiomatosis confirmed with clinical comprehensive diagnosis,surgery and pathology were retrospectively reviewed.Thoracic and abdominal MSCT examinations were performed after direct lymphangiography in all patients.Among them,13 patients underwent enhanced MSCT examination.The site and extent of the lesions were recorded,and the ratio of descriptive statistics was used according to categorical variable data.Results MSCT lymphangiography showed various degree of abnormal lymphatic vessels in all 32 patients:Obstructed thoracic duct was seen in 15 cases(46.9％),obstructed right lymphatic vessel in 3 cases(9.4％),unilateral (bilateral) cervical lymphatic stem reflux in 5 cases(15.6％),unilateral(bilateral) bronchial-mediastinal lymphatic stem reflux in 4 cases(12.5％).Lumbar trunk and iliac lymphatic vessel were dilated on the lymphangiography side in 32 cases(100.0％),while 28 cases(87.5％) reflux to contralateral lumbar trunk and iliac lymphatic vessel,reflux to bilateral renal sinus in 2 cases(6.2％),the contrast materials leak into unilateral(bilateral) thoracic cavity in 9 cases(28.1％),abdominal cavity in 6 cases(18.8％) and intestinal cavity in 2 cases(6.2％).The contrast materials were found in bone in 8 cases(25.0％),mediastinum in 5 cases (15.6％),pericardium in 3 cases(9.4％),spatium intermusculare in 3 cases(9.4％),pathological fractures were found in 5 cases(15.6％).Conventional MSCT images showed different locations,multiple and various sizes cystic lesions.Conclusion MSCT lymphangiography can display the features of diffuse lymphangiomatosis.Thus,it provides an important basis for diagnosis and differential diagnosis of diffuse lymphangiomatosis.

Objective：d ionization chamber and X-ray beam plane on relevant deviation（RD）,on behalf of the accuracy of CTDIw measurement,while The influence of offset distance（OD）between the center of pencile conducting axial scanning with multi-detector CT.Method：A head phantom（in compliance with ICE standard） and penciled ionization chamber are utilized to measure the CTDIw at variant OD with Philip Brilliance iCT256 using axial scanning,meanwhile,impact factors on RD were analyzed.Result：when offset distance（OD）equal to ±1 cm,the relevant deviation（RD）within the range of±5%;when OD equal to±3 cm,RD within the range of -5%~15%,and when OD equal to±5 cm,RD within the range of 40%~70%.Conclusion：OD is considered as a main impact factor to RD,while the milliampere time second（mAs）and tube voltage have little relevance on RD. However,mAs and tube voltage might affect the value range of RD at a certain OD.More importantly,dose distribution along Z axial exhibits asymmetry.

Objective To explore the collateral shunt pathways of cirrhotic portal hypertension and analyse the clinical significances in CTPV with 16-MDCT.Methods 145 patients with cirrhotic portal hypertension were analysed who underwent CTPV in 16-MDCT.Routine plain scans and post-triphase enhancement CT scans were performed.Post-processing including MIP,VR,MPR were done.Results The collateral shunt pathways were forty-five superior vena cava(31%) purely,eleven inferior vena cava(7.7%) purely,eighty-nine(61.3%) superior vena cava and inferior vena cava bidirectionally.Conclusion CTPV could clearly reveal all kinds of the porto-caval collateral shunt for cirrhotic portal hypertension,which is helpful to the treatment and following up for the complications of cirrhotic portal hypertension such as upper gastrointestinal bleeding.

Objective:To assess the clinical value of 256i CT angiography in the arteriosclerotic occlusive disease(ASO) of lower extremity.Methods:A total of 119 patients with symptomatic arteriosclerotic occlusive disease of lower extremity underwent 256i CT angiography.The scan ranged from the celiac to thenar artery.Original axial images were transferred to EBW workstation and 3D reconstruction images were performed.75 patients underwent digital subtraction angiography(DSA) between 0 and 14 days after CT angiography.The manifestations of 256i CT angiography were compared with those of DSA.Results:Of 1575 segments of arteries,1505 were displayed on both DSA and CTA.DSA images as the gold standard,the sensitivity,specificity and accuracy of 256i CTA were 100.0%,98.8%,99.7% in displaying the segments occluded and 99.3%,97.8%,98.2% in detecting the segments that had more than moderate stenosis.Therefore,there was excellent agreement between 256i CT angiographic and DSA findings in the assessment of ASO(k = 0.945).Of 975 segments,905 were found atherosclerotic plaques,12 were simple mural thrombus.Conclusion:The diagnostic performance of 256i CT angiography is excellent in patients with clinical symptoms of the arteriosclerotic occlusive disease of lower extremity.The results can be used to effectively guide therapeutic decision making in these patients.

Objective To explore the influence law of offset distance(Do) between ionization chamber center scale and X-ray beam plane of multi-slices CT to the CTDI100 measurement result.Methods Head body mold(T6M164) and long pole ionization chamber,which meet IEC standards,are used to measure the CTDI100 value of Philips Brilliance iCT 256 on axial scanning condition of different offset distance.Results when Do is 1cm,relevant deviation(Dr) is 0%～5%,when Do is 3cm,Dr is 5%～15%,and when Do is 5cm,Dr is 25%～75%.Conclusion The measurement result of CTDI100 has greater sensitivity for Do,which means the operator should make sure no deviation exist between X-ray beam and ionization chamber center,besides,more attention should be paid to radiation dose in penumbra area.Scattering beam causes the measurement of CTDI100 at 4 points around more discrete,effect of bed to measurement result shows that symmetry of CTDI100 at 4 points outside the center reduces.

Objective To analyze MSCT findings in patients with diffuse lymphangioma(LA) involved the spleen.Methods Eleven patients with LA proved with clinical comprehensive diagnosis,surgery and pathology were collected,and the MSCT findings of spleen were analyzed retrospectively.MSCT was performed including plain scan for all 11 cases and enhanced scan in 5 cases.The images of splenic lesions were analyzed combined with clinical comprehensive diagnosis,surgery and pathology in all patients.Results MSCT showed single or multiple thin-walled cystic mass with clear borders in all 11 cases,while separations of capsules were detected in 2 cases.Enhanced scan in 5 cases displayed that the wall of capsule and the separation mildly enhanced in arterial phase,and the enhancement remained on portal venous phase and delayed phase,but no enhancement of capsule contents.All patients accompanied with similar lesions on at least one parts.Conclusion The splenic lesions of diffuse LA can be identified clearly by MSCT.Combining with clinical data and results of other imaging examinations is helpful to the diagnosis of these lesions.

Objective To observe the specificity of mean corpuscular hemoglobin concentration(MCHC) in children with hereditary spherocytosis(HS).Methods MCHC was measured in 50 children with newly diagnosed HS(HS group),50 children with autoimmune hemolytic anemia(AHA group),50 children with iron deficiency anemia(IDA group),50 children with megaloblastic anemia(MA group) and 50 healthy controls(control group) using a Sysmex SE-9000 automatic blood cells analyser.Results The MCHC was significantly higher in HS group than in AHA,IDA,MA and healthy control groups(P<0.05).The cut-off value of MCHC was 355g/L.The sensitivity and specificity of MCHC in diagnosis of HS were 87.76% and 98.00%,respectively.No difference was found in MCHC among different groups(P>0.05).Conclusion Increased specificity of MCHC is of a significant value for the diagnosis of HS in children.

1 病例资料 患儿,女,9岁.人院2周前,因跳舞后发现双下肢散在出血点,量少,不伴发热,家长未予重视.入院前2d,患儿在当地医院拔牙后,局部牙龈渗血不止,并伴有眼周出血点,为进一步诊治于2010年2月2日就诊我院.患儿发病以来精神尚可,食欲好,无发热、盗汗,自觉轻度乏力,两便正常.