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The Diagnosis of Lumbar Slippage with Spondylolysis Using MSCT

目的:探讨腰椎峡部裂性滑脱的多层螺旋CT特征及其价值。方法 收集经临床诊治的腰椎峡部裂性滑脱30例CT资料进行回顾性分析。结果 多层螺旋CT能清晰显示腰椎峡部裂性滑脱的椎弓峡部裂、椎体滑脱程度、椎间盘及椎管等CT特征。结论 多层螺旋CT是腰椎峡部裂性滑脱的优良影像学检查方法。

CT and MRI Manifestations of Primary Central Nervous System Lymphomas

【摘要】 目的 探讨原发性中枢神经系统淋巴瘤(PCNSL)的CT及MRI表现特征,以提高术前对该病的影像诊断能力。方法 分析2008年1月—2009年8月华西医院16例经病理证实PCNSL患者的CT、MRI资料及病理资料。结果 病理检查均为B细胞来源的弥漫性大B细胞性淋巴瘤。16例PCNSL 29个病灶,单发11例(69%)，多发5例(31%)18个病灶。病灶好发部位依次是大脑半球临近蛛网膜下腔12个(41.4%)、脑室周围深部白质7个(24.1%)、胼胝体3个(10.3%)。有5例病变CT平扫表现为等或略高于脑实质密度影,无出血和钙化；MRI平扫75.9%(19/25)的病灶T1WI呈等低信号,T2WI等稍低信号,类似“脑膜瘤”样信号,均未见血管流空；增强后病灶大都均匀实质团块状或结节状强化,典型的可出现“尖角征”、“握拳征”,3例可见小囊变,呈“硬环征”。结论 CT对PCNSL的定性诊断作用有限,MRI具有一定特征性表现者,多可作出正确的诊断,但确诊有赖于病理。

Clinical Value of Dual-source CT Cerebral Perfusion Imaging in Assessing Cerebral Hemodynamic Changes in Patients with Internal Carotid Atherosclerosis

ObjectiveTo explore the clinical value of dual-source CT perfusion imaging (CTPI) in the assessment of cerebral hemodynamic changes in patients with internal carotid atherosclerosis. MethodsThirty patients diagnosed to have internal carotid atherosclerosis by CT angiography examination with various degrees of stenosis or occlusion were treated between January 2012 and May 2013. Whole brain perfusion imaging was performed on all the patients. We rebuilt the CTPI figure parameters respectively, including cerebral blood volume (CBV), blood flow (CBF), mean transit time (MTT) and time to peak (TTP) to assess brain tissue perfusion. ResultsIn the 30 patients with internal carotid atherosclerosis, 8 had mild stenosis lumen, 12 moderate stenosis, 7 severe stenosis and 3 had occlusion. In mild stenosis cases, TTP of stenosis-side vessels was higher than those of coutralateral side (P<0.05), and there were no significant differences in other perfusion parameters between bilateral vessels among mild stenosis cases (P>0.05). MTT and TTP of stenosis-side vessels were higher than those of contralateral side in moderate stenosis cases (P<0.05). In severe stenosis or obstruction cases, MTT and TTP of stenosis-side vessels were higher than those of contralateral side, while CBF and CBV of stenosis-side vessels were lower than contralateral side (P<0.05). Twenty-two in the 30 cases had perfusion abnormalities, and there was a significant difference between the stenosis side cerebral perfusion and the healthy side mirror area (P<0.05). ConclusionCTPI can reflect brain tissue perfusion early and comprehensively, and fully reflect internal carotid atherosclerosis caused by severe stenosis or occlusion of cerebral hemodynamic changes, which provides important information for clinical treatment and helps clinicians to formulate individualized treatment plan.

Differentiation of Miliary Nodules on HRCT: Miliary Pulmonary Tuberculosis versusPneumonoconiosis and Metastatic Tumor in Lung

目的:探讨粟粒性肺结核、尘肺和粟粒性肺转移瘤的HRCT表现及鉴别特征。方法:回顾性分析经本院临床证实的38例粟粒性肺结核,33例尘肺和41例粟粒性肺转移瘤的常规CT及HRCT资料,观察结节的大小、分布特点,统计分析三者的差异。结果:38例粟粒性肺结核中,结节全肺野和内、中、外带分布均匀者分别为32例(84.2%)和29例(76.3%),33例(86.8%)以全小叶分布为主。33例尘肺中,结节以中、上肺野和内中带分布为主者分别为30例(90.9%)和31例(93.9%),28例(84.8%)以小叶中心分布为主。41例粟粒性肺转移瘤中,结节以中下肺野和中、外带分布为主者分别为37例(90.2%)、34例(82.9%),36例(87.8%)以小叶实质分布为主。结核、尘肺及肿瘤结节大小均匀分别为31例(81.5%)、9例(27.3%)、6例(14.6%);边界清晰者分别为36例(94.7%)、31例(93.9%)、39例(95.1%);合并有磨玻璃征者分别为34例(89.4%)、7例(21.2%)、21例(51.2%)。结论:HRCT能够很好地显示粟粒性肺结核、尘肺及粟粒性肺转移瘤结节的分布特点,在诊断和鉴别诊断这三种粟粒性疾病中具有重要价值。

CT features of immune checkpoint inhibitor-related pneumonia

ObjectiveTo analyze the CT features of immune checkpoint inhibitor-related pneumonia (CIP) and improve the diagnostic accuracy of CIP. MethodsAmong patients with malignant tumor treated with immune checkpoint inhibitors, those who developed pneumonia and rule out other causes of disease were identified. Chest CT Imaging were reviewed to assess special signs, distribution characteristics, severity of pneumonia and radiographic patterns of CIP. ResultsA total of 28 patients were enrolled, including 26 males and 2 females. CT features include ground-glass opacity, centrilobular nodularity, reticular opacity, consolidation, traction bronchiectasis, honeycomb, etc. The lesions predominant involved peripheral lung zone (17/28), lower lung zone (18/28) and posterior lung zone (18/28), with a diffuse distribution (23/28). In most cases the disease involved both lungs (23/28), and a few involved unilateral or single lobe. The most common affected lobes were the lower lobe of the right lung (25/28) and the lower lobe of the left lung (20/28), followed by the upper lobe of the right lung (18/28). Mean pneumonia severity score was 5.5, standard deviation was 3.8, and range was 1 - 15. The most common radiographic patterns of CIP were nonspecific interstitial pneumonia (11/28) and hypersensitivity pneumonia (10/28). The second was organizing pneumonia (6/28). ConclusionsThe CT manifestations of CIP have certain specificity. Combined with the history of drug treatment and clinical symptoms of patients, the early and correct diagnosis can be obtained.

Diagnosis of Gastrointestinal Invasion by Carcinoma of Gallbladder on Spiral CT(Report of 8 Cases )

【Abstract】ObjectiveTo study the spiral CT features of gastrointestinal invasion by carcinoma of gallbladder. MethodsEight patients with surgical-pathologically documented gastrointestinal invasion by carcinoma of gallbladder were analyzed retrospectively. All patients underwent plain and contrast-enhanced dual-phase scanning of the abdomen. Oral contrast medium (1.2% Angiografin) was used to fill the gastrointestinal tract before CT scanning. ResultsThere were 2 cases of gastric antrum invasion, 6 duodenal invasion and 3 colonic invasion according to the surgical and pathological findings. Spiral CT correctly diagnosed 2 gastric invasion and 4 duodenal invasion based on several imaging features, like blurring of fat plane, focal wall thickening and luminal narrowing of involved gastrointestinal segments, and mass formation. However CT was unable to diagnose the 3 cases of hepatic flexure of colon invasion. ConclusionCT is valuable for diagnosing upper gastrointestinal tract invasion by carcinoma of gallbladder, yet the diagnosis of hepatic flexure of colon invasion is still difficult.

CT Diagnosis and its Clinical Value of Gallbladder Carcinoma Hepatic Involvement

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。

Research Progress in Multidetector-row Computed Tomographic Presentations and Their Anatomic-pathologic Features of Aortic Dissection after Endovascular Graft Exclusion or Combined Surgical and Endovascular Treatment

With the development of radiologic intervention, the treatments of aortic dissection are getting more and more diversified. In recent years, Debakey Ⅲ and DebakeyⅠaortic dissection has been usually treated with endovascular graft exclusion, or combined surgical and endovascular treatment. It is therefore more important to evaluate the aorta and its complications after interventional treatments. Because multidetector-row computed tomography (MDCT) has advantages, such as short examination time, high spatial resolution, and simple operation, this modality has become a first choice of non-invasive methods for the follow-up of aortic diseases after the intervention. Now the MDCT presentations and their anatomic-pathologic features of aortic dissection after endovascular graft exclusion or combined surgical and endovascular treatment are reviewed in this article.

食管壁间血肿一例诊疗体会并文献复习

不同病理分级胰腺神经内分泌肿瘤的影像特征分析

目的初步探讨不同病理分级的胰腺神经内分泌肿瘤的CT和MRI表现特点。 方法回顾性分析2013年1月至2015年12月期间于笔者所在医院经穿刺及手术病理学检查证实的15例胰腺神经内分泌肿瘤患者的临床及影像资料，根据2010年WHO第4版“神经内分泌肿瘤病理分类标准”分为G1、G2及G3级后进行分析。 结果15例患者中，8例有神经内分泌症状，5例主要症状为腹痛，2例无任何症状；G1、G2及G3级各5例。15例患者共检出17个病灶（G1级5个，G2级5个，G3级7个），肿瘤主要位于胰体尾部（9个，其中G1级1个，G2级和G3级均为4个），其次为胰头（7个，其中G1级3个，G2级1个，G3级3个）；1个病灶内有钙化点（G2级），9个病灶内可见坏死（G1级2个，G2级4个，G3级3个）；10个病灶形态为类圆形（G1级3个，G2级3个，G3级4个），7个为不规则形（G1级2个，G2级2个，G3级3个）；10个病灶位于胰腺轮廓内（G1级4个，G2级3个，G3级3个），7个位于胰腺轮廓外（G1级1个，G2级2个，G3级4个）。CT平扫示17个病灶均为等或低密度，有坏死者密度不均。MRI检查示：5个病灶T1WI为低信号，T2WI为高信号（G1级1个，G2级1个，G3级3个）；2个病灶T1WI为低信号，T2WI为等信号（G1级1个，G2级1个）；1个病灶T1WI及T2WI均为等信号（G1级）。病灶强化方式：1个病灶表现为动脉期明显强化，门静脉期强化密度降低（G1级）；8个病灶表现为动脉期和门静脉期均明显强化（G1级3个，G2级4个，G3级1个），8个病灶表现为动脉期轻度-较明显强化，门静脉期进一步明显强化（G1级1个，G2级1个，G3级6个）。1例G1级及1例G2级病例发生肝脏转移，1例G3级病例发生肝脏多发转移及L2椎体骨转移，另1例G3级病例有门腔间隙淋巴结肿大。 结论各级别胰腺神经内分泌肿瘤的影像表现不具有特异性，尚需进一步大样本研究。