目的 探讨多层螺旋CT（MSCT）在肠道Crohn病（CD）诊断中的应用价值。 方法 回顾性分析2009年2月－2012年2月经综合方法确诊为CD的41例患者的MSCT表现，分析病变肠管的部位、肠壁的厚度和增强后病变肠壁的强化程度及并发症。 结果 41例中，患病肠段多节段性受累36例（87.8%），单独小肠受累16例（39.0%），小肠和结肠同时受累23例（56.2%），单独结肠受累2例（4.8%），回肠末段受累36例（87.8%），盲肠或升结肠受累22例（53.7%）。41例肠壁均见不同程度的强化及环形增厚；28例（68.3%）表现肠壁分层；23例（56.1%）表现为系膜纤维脂肪增生、蜂窝织炎，16例（39.0%）系膜血管增多，呈“梳样征”，20例（48.8%）伴有系膜及腹膜后淋巴结肿大；6例（14.6%）并发不全肠梗阻，并发瘘管穿孔1例（2.4%）。 结论 MSCT可同时显示CD的小肠和结肠病变，对肠壁病变及肠腔外并发症的显示以及在判断病变活动性方面有独特的优越性，对指导临床治疗具有重要意义。
ObjectiveTo improve the diagnosis and treatment of multiple systemic sarcoidosis (MSS) and avoid misdiagnosis. MethodsTo analyze the diagnosis and treatment of a MSS patient misdiagnosed as lymphoma. Related literatures were also reviewed. ResultsThe patients' clinical manifestations were not specific including cough and stethocatharsis. Lung and thoracic lymph nodes were most commonly involved in MSS. MSS was characterized by symmetrical lymph nodes enlargement in the bilateral lung hilus and/or mediastinum. The enlarged lymph nodes had a clear boundary and showed homogeneous enhancement. Symmetrical fluorodeoxyglucose (FDG) uptake in the hilar and/or mediastinal node was a typical finding of sarcoidosis on FDG PET/CT. Mucosal inflammation and mucosal nodules could be seen in the bronchoscope. Sarcoidosis was characterized by the presence of noncaseating groanulomas histologically. Hormonal therapy was effective for MSS. ConclusionSarcoidosis is a kind of disease involving multiple systems and organs with unknown etiology. The clinical manifestation of sarcoidosis is nonspecific,so it's likely to be misdiagnosed. Imaging examination and laboratory examination are helpful to the diagnosis of MSS. The definitive diagnosis depends on the pathologic biopsy.
【摘要】 目的 利用首过时间技术进行全胰腺CT灌注扫描，了解正常胰腺CT灌注的特点。 方法 2006年6月-2007年3月， 64例正常胰腺患者行64排螺旋CT灌注扫描，测量胰头、胰体及胰尾的灌注值、强化峰值、达峰时间和血容量。分别按患者的性别、年龄及胰腺测量的部位分组，将灌注参数进行统计分析。 结果 ①男性胰腺的血容量高于女性（Plt;0.05），其余灌注参数在两性间差异无统计学意义（Pgt;0.05）。②41~60岁组的灌注值低于lt;40岁组和gt;60岁组；gt;60岁组的强化峰值高于41~60岁组；41~60岁组的达峰时间长于lt;40岁组；gt;60岁组的血容量高于41~60岁组（Plt;0.05）。③胰体和胰尾的灌注值高于胰头（Plt;0.05），其余灌注参数在胰腺不同部位差异无统计学意义。 结论 正常胰腺血流状况在不同性别、不同年龄段及不同部位存在差异，首过时间技术应用于正常胰腺能反映这些特征。【Abstract】 Objective To investigate the CT perfusion features of normal pancreas with first-pass technique with 64-MDCT. Methods Perfusion CT was performed on 64 patients with normal pancreas from June 2006 to March 2007. Four perfusion parameters, including perfusion, peak enhancement, time to peak, and blood volume, were obtained at the head, body and tail of the pancreas. Perfusion parameters were compared between different sexes, among different age groups and among different sites. Results ① Blood volume of male was significantly higher than that of female (Plt;0.05). ② The perfusion value in the age group of 41-60 was significantly lower than that in the age group of lt;40 and gt;60 (Plt;0.05). The peak enhancement in the age group of gt;60 was significantly higher than that in the age group of 41-60 (Plt;0.05). The time to peak in the age group of 41-60 was significantly longer than that in the age group of lt;40 (Plt;0.05). The blood volume in the age group of gt;60 was significantly higher than that in the age group of 41-60 (Plt;0.05). ③The perfusion values of the body and the tail were significantly higher than that of the head (Plt;0.05). Conclusion There are significant differences in the perfusion parameters between different sexes and among several age groups and sites. The first-pass technique of perfusion applied in normal pancreas can reflect these features.
【摘要】 目的 探讨闭孔疝的CT表现，以提高对其疾病的诊断水平。 方法 回顾性分析2009年10月-2010年9月收治的经手术或临床资料证实的3例闭孔疝患者的CT影像学表现，观察闭孔疝发生的位置、密度、形态、强化特征及继发征象。 结果 3例闭孔疝均为老年消瘦患者，CT检查发现疝囊位于闭孔外肌与耻骨肌间疝出1例，闭孔外肌上、中束间疝出2例，所有疝出物均为肠管，表现为疝出部位囊性密度影，1例肠壁可见增厚、水肿，诊断为肠壁血运障碍，及时行手术治疗后预后良好。 结论 CT检查是闭孔疝有效的检测手段，特别是对于不明原因腹痛合并肠梗阻的老年消瘦患者，CT检查将有助于临床确诊。【Abstract】 Objective To observe the manifestations of CT images of obturator hernia to improve the diagnosis of obturator hernia. Methods The CT images of three patients with obturator hernia confirmed by surgery or clinical data from October 2009 to September 2010 were retrospectively analyzed. The location, density, morphology, enhancement patterns and secondary signs were observed. Results Three patients with obturator hernia were elder and emaciated. The hernia sac located between the pectineus and obturator externus muscles in two patients, between the superior and medial fasciculi of the obturator externus muscle in one patient. All contents were small intestine, performed as a low-density mass in the location. One patient with thick and hydropic intestinal wall diagnosed as strangulated obturator hernia had a good prognosis after immediately laparotomy. Conclusion CT examine is an effective measure for obturator hernia, especially for elder and emaciated patients with intestine obstruction due to unknown reason. CT examine is helpful for the diagnosis.
目的:分析不典型阑尾炎的CT表现特点,以提高对其诊断和鉴别诊断。方法:临床表现不典型的阑尾炎17例,对CT表现进行重建及分析。结果:单纯阑尾增粗有8例,增粗并结石2例,阑尾周围脓肿5例,阑尾合并肠套叠肠梗阻1例,阑尾周围脓肿并广泛盆腔炎1例。结论: 16 MSCT对不典型阑尾炎的诊断有较高的临床应用价值。
目的:探讨MSCT对结肠癌诊断价值。方法:收集我院手术病理证实且经MSCT检查的结肠癌患者,对其CT表现进行分析,并与纤维结肠镜(FC),钡灌肠对比研究。结果:所有收集的结肠癌患者,MSCT均能多角度,多方法显示病变。结论: MSCT检查对结肠癌具有较高的诊断价值且对临床治疗有重大指导意义。
目的:通过对64排螺旋CT(MSCT)冠状动脉造影与选择性冠状动脉造影检测冠状动脉病变(冠状动脉狭窄≥50%)的对比分析,探讨64层螺旋CT评估冠状动脉病变诊断的准确性。方法:回顾性收集2007年12月~2008年10月于我院同期接受64层螺旋CT冠状动脉成像和常规经皮冠脉造影的112位冠心病患者的影像资料,以常规冠脉造影为参考标准,对2种检查方法的结果进行对比分析,评估64层螺旋CT冠脉造影对冠状动脉病变诊断的准确性。结果:按常规冠脉造影计算,112例患者共发现374处病变用于评价,MSCT造影检测冠脉病变总的准确性为906％,假阳性率和假阴性率分别为43％和51％;其中MSCT检测为假阴性均发生在左回旋支和右冠远段,假阳性均为冠状动脉伴有钙化。结论:64排螺CT冠状动脉造影检测冠状动脉病变诊断的准确性较高,但血管解剖和冠状动脉钙化可能会影响其对冠状动脉病变的评价和检测。
目的：探讨胆囊癌肝侵犯的CT诊断及临床价值。方法：回顾性分析经手术、病理证实的17例胆囊癌肝侵犯CT资料。结果：肿块型11例，腔内型2例，厚壁型4例。侵犯肝左内叶5例，肝右叶前段3例，同时侵犯肝左内叶及右叶前段9例。5例侵犯深度＜2 cm，12例侵犯深度＞2 cm。CT表现为胆囊窝脂肪间隙消失，邻近胆囊窝的肝脏组织内出现不规则形低密度影，边界模糊，胆囊癌肿与肝脏组织分界不清，增强后肝内病灶不规则强化。结论：CT对胆囊癌肝侵犯的诊断及临床分期、治疗方案的选择具有重要价值。
Objective To investigate the value of CT grading diagnosis in clinical therapy of acute pancreatitis. Methods CT scanning was carried out in patients with acute pancreatitis between 2003 and 2009, and Enhancement CT scanning was carried out in patients without contraindications of contrast medium. Two radiologists analyzed the images and made CT grading diagnose. Contrast study was made between CT grading diagnose and clinical scale as well as prognosis. Results In 518 cases, the CT grading was as the following: grade A 9 cases, grade B 66 cases, grade C 105 cases, grade D 147 cases, and grade E 191 cases. Patients with grade A and B were fully recovered after conservation and supportive treatment. In cases of grade C, only 2 patients had recurred pancreatitis after conservation treatment, and others were fully healing. Ninety-four patients who needed operation and 23 patients who died were all occurred in grade D and E. Conclusion CT grading diagnosis of acute pancreatitis can reflect the range, extent, and course of disease, and it has good dependablity with clinical grading.
ObjectiveTo analyze the CT features of solid pseudopapillary tumor of pancreas (SPTP). MethodsEight patients with SPTP received triple phasic contrast-enhanced CT, and its consistency with pathological findings was analyzed. ResultsSPTP manifested as a solitary and exogenous mass, with a heterogeneous pattern composed of solid and polycystic parts. The shape of SPTP was spherical in four patients, oval in two patients, and shallow lobulation in another two patients. In contrast-enhanced phase images, the solid parts showed mild to moderate enhancement in both arterial and portal phases. Complete capsule was showed in seven patients, and nodules were found in the wall of mass in five patients. Hemorrhage was seen in two patients and calcification was showed in five patients. The dilation of pancreatic duct was found in one patient, liver metastases was showed in one patient, and the invasion of tumor to posterior gastric wall was found in one patient. Pseudopapillary structure, hemorrhage, necrosis, and cystic degeneration were showed in all patients by histological study. ConclusionSPTP has certain characteristic CT imaging manifestations consistent with histological features, which is helpful for the diagnosis and differential diagnosis of SPTP.