读片窗附视频

洪杨

扩散张量成像在颅内占位性病变中的应用研究附视频

史瑞华, 漆剑频, 王承缘

目的:评价MRI扩散张量成像在颅内占位性病变中的应用价值。材料与方法:经手术及病理证实的星形细胞瘤、脑膜瘤、垂体瘤、转移瘤及脑脓肿共46例。行常规MRI扫描、扩散张量成像(DTI)检查。构建各向异性分数(FA)图,并测量病变及周围白质的FA值。结果:正常白质纤维在FA图上表现为高信号。肿瘤多呈低信号。在肿瘤存在时,周围白质纤维可表现为受推压移位或浸润破坏,破坏后FA值降低,表现为低信号。脓肿多呈低信号,其内部若有尚未破坏的白质纤维存在,可呈高信号。这些表现在常规MRI图像上均未清楚显示。结论:DTI可清楚显示占位性病变与周围白质纤维的解剖关系,指导临床制定手术方案。

99Tcm-TRODAT-1SPECTDAT显像与帕金森病UPDRS评分关系的研究

邓怀福, 胡平, 陈萍

Objective To discuss the relationship between the specific radioactivity uptake of the bilateral striatum with 99Tcm-TRODAT-1 and UPDRS and evaluate the severity of Parkinson diseasePD from the point of imaging. Methods Fifty one patients with PD and a control group of 15 healthy subjects were applied dopamine transporterDAT imaging by SPECT with 99Tcm-TRODAT-1. The radioactive ratio between bilateral striatum and cerebellum(STCB) and the asymmetry indexAI of bilateral striatum were computed by using region of interestROI technology. Meanwhile the PD patients were classified by the improved Hoehn-Yahr disability score and then evaluated by UPDRS. Results There was a negative correlation between the bilateral STCB mean of the PD and the Hoehn-Yahr grading the UPDRS score the patients' self caring ability the ability to move. As for the asymmetry index there was also a negative correlation with the severity of PD. Conclusion There was a significant correlation between the specific radioactivity uptake of the bilateral striatum with 99Tcm-TRODAT-1 and UPDRS and it could monitor the state of PD and showed the symptom severity of PD evaluate the severity of PD.

实验性脑缺血模型脑组织微血管P-选择素表达的研究

董伟, 周怀琪, 郭顺林, 王文辉

目的:研究不同缺血时间兔脑组织微血管P-选择素表达的变化,探讨其临床价值。方法:新西兰白兔34只随机分实验组、对照组。实验组股动脉穿刺插管至颈内动脉后造影,经导管注入自体血栓选择性栓塞大脑中动脉建立急性脑梗死模型。按缺血时间不同分为1小时、3小时、6小时、12小时、24小时5个亚组,确认兔急性脑梗死模型建立成功后对缺血脑组织进行免疫组织化学检查,观察P-选择素表达的动态变化。对照组手术步骤同上,仅予以造影观察血管是否通畅。结果:对照组兔脑组织微血管未见P-选择素的表达。缺血1小时组缺血侧脑组织微血管P-选择素开始表达犤阳性血管数(55±18)条犦,1小时、3小时及6小时组缺血侧脑组织微血管P-选择素逐渐升高,各组间阳性血管数有显著性差异(P<0.01),6小时组缺血侧脑组织微血管P-选择素表达到高峰犤阳性血管数(417±28)条犦并持续到24小时犤阳性血管数(428±62)条犦,6小时、12小时及24小时组微血管P-选择素表达无显著性差异(P>0.05)。缺血1小时、3小时及6小时组各组间缺血侧皮质P-选择素表达明显高于髓质(P<0.05),而12小时、24小时组皮质与髓质P-选择素表达无显著性差异(P>0.05)。对侧大脑半球(非缺血侧)缺血1小时、3小时均未见P-选择素表达,而6小时、12小时、24小时可见有少量P-选择素表达

乳腺癌的钼靶X线征象与病理表现(附56例分析)

赵雪梅, 耿进朝, 崔斌, 周玉荣, 马民

目的:讨论乳腺癌X线征象与其病理类型的关系,进而推测其生物学行为及预后。方法:分析56例经钼靶摄影及术后病理证实为乳腺癌的临床资料,并记录各病例的影像表现及病理类型。结果:发病部位在外上象限较多见,占50.0%。56例乳腺癌X线片显示肿块占76.78%,簇样钙化占51.78%,片状致密影及结构紊乱占21.43%。浸润性导管癌发病率最高,占62.5%,其次为浸润性小叶癌,占10.71%。结论:不同病理类型乳腺癌X线表现从一定程度上反映了癌细胞的生物学行为和预后,对早期诊断和临床治疗方法的选择有一定意义。

X线、CT对胶原性疾病致弥漫性肺间质病变的诊断及意义(附13例分析)

杨丽萍

目的:探讨胶原病致弥漫性肺间质病变的病理演变、影像特点及影像诊断的作用和价值。方法:本组胶原性疾病共13例,男5例,女8例,年龄30～72岁。其中系统性红斑狼疮5例,类风湿、风湿性病变4例,进行性系统性硬化症2例,皮肌炎2例。8例经纤维支气管镜活检,10例做了肺功能检查,13例均做了X线及CT或HRCT检查。结果:胶原性疾病引起机体组织的粘液性水肿、炎性坏死、类纤维蛋白变性和成纤维细胞增生,致广泛的弥漫性肺间质病变。表现为磨玻璃样、片状浸润状、网状、结节状、蜂窝状改变,最终导致肺间质纤维化。结论:胶原性疾病可导致弥漫性肺间质病变。X线、CT检查是诊断本病的重要手段。尤其是HRCT的应用为间质性肺疾病的早期诊断、病变定位、引导肺活检、动态随访等具有重要意义和价值。

胺碘酮所致肺损伤与肺摄取Tc-HMPAO关系的研究

杨志杰, 张蕊, 付鹏

Objective To investigate the lung uptake of 99Tcm-HMPAO in the amiodarone-induced lung injury and the mechanism of its abnormal uptake. Methods Eighteen Harbin white rabbits were randomly divided into three groupsA B and C 10mgkg 50mgkg 150mgkg amiodarone was given everyday respectively. Prior to 99Tcm-HMPAO static images were taken on baseline and 1 week 2 weeks 3 weeks 4 weeks after having amiodarone. 7×5 pixel ROIs were drawn on the right lungR and right upper limbB. RB was calculated and shown as x±s. At the same time 2.5ml vein blood were taken on the ear marginal vein. The content of endothelin were detected by the radio-immuno analysis method. Two weeks after taken amiodarone in C and 4 weeks in A B all the rabbits were killed by cutting the lower limb artery. Lungs were taken out immediately to have light microscopic and electron microscopic detection. Results Compared with the baseline lung uptake of 99Tcm-HMPAO there is statistical difference in A Bboth 3 weeks later and C1 week later(P<0.05). The blood endothelin concentration also showed great difference at different time in each group compared to the control group. Light microscopy revealed typical interstitial pneumonia. While electron microscopy showed edematous changes in the endothelial cytoplasm. Conclusion 99Tcm-HMPAO can be used to detect early lung injury in amiodarone-induced lung toxicity. Microvascular endothelium of lung is presumably the main location site of 99Tcm-HMPAO abnormal concentration.

肺硬化性血管瘤影像表现与手术病理对照分析

李家梅, 杨春波, 赵兴圣, 刘静, 罗惠光

目的:探讨肺硬化性血管瘤(SHL)的影像特点,提高其术前诊断的准确性。材料和方法:搜集11例经手术病理证实的SHL,其中男3例,女8例,平均48岁。将其影像学表现与手术病理结果进行回顾性对照分析。结果:SHL多好发于女性,影像表现是孤立肿块,轮廓清楚,边缘光滑整齐,有时可见小的钙化和孤立性淋巴结肿大及纵隔向患侧移位。“含气新月征”具有特征性,但不常见,可见界限清楚的高密度和低密度区,高密度区强化显著,低密度囊变区无强化。并见增粗迂曲的肺门血管与病灶相连。结论:胸部平片和CT平扫仅能做出定性诊断,增强扫描尤其是薄层双期扫描对病变的诊断和鉴别诊断起着关键作用。

三维超声重建测量肾脏体积的实验研究

曹兵生, 盛林, 董宝玮, 梁萍, 番进勇

目的:评价三维超声对肾脏体积测量的准确性。方法:利用三维及二维超声经皮测量21枚活体肾脏体积(新西兰大白兔2只,成年杂种犬5只,小型香猪2头,拟切除移植肾3例)。移植肾和动物的肾剖腹后摘除通过水置换法测量体积。结果:三维超声和二维超声测量肾脏体积的准确率分别为97.36%和93.87%,与实际体积相比,三维超声测量值(r=0.9948,P=0.000)较二维超声测量值(r=0.9610,P=0.000)的一致性好。三维超声和二维超声测量的系统偏倚分别为0.75ml和1.67ml,一致性范围分别为-3.66～5.11ml和-8.15～10.79ml。结论:三维超声对肾脏体积的测量是可行的,具有较高的准确性和一致性。

先天性肾上腺皮质增生症的影像诊断(附14例报告)

张雷, 陈丽英, 郭启勇

目的:提高对先天性肾上腺皮质增生症的认识。材料与方法:14例确诊为先天性肾上腺皮质增生症的患儿,均行影像学检查,结合文献讨论发病机制、临床表现、影像学改变。结果:14例患儿均见肾上腺带样增粗增大,密度均匀,2例见结节样改变,CT增强可见明显强化。MR信号与肝、脾信号区别明显而易于辨别。结论:先天性肾上腺皮质增生症影像学上可见到肾上腺明显增大,结合临床病史、实验室检查可以确定诊断,为临床诊治该病提供更多信息。