Objective To evaluate the value of 3-D reconstruction in multi-detector spiral CT urography (MDCTU) for diagnosing upper urinary tract diseases (UUTDs) by means of both diagnostic sensitivity and ROC curve. Methods A total of 41 patients with UUTD were collected. All of them took MDCTU as well as reconstructions including MPR, MIP and VR. Compared with golden standards, the diagnostic value of MDCTU, MPR, MIP and VR were evaluated using both diagnostic sensitivity and ROC curve. Results a) A total of 49 upper urinary tract lesions were detected in those 41 patients; b) For UUTD, the localization diagnostic sensitivities of MPR, MIP, and VR were 48/49 (98.0%), 27/49 (53.2%), and 19/49 (38.8%), respectively; while their qualitative diagnostic sensitivities were 47/49 (95.9%), 17/49 (34.7%), and 13/49 (26.5%), respectively; the differences between MPR and the others were significantly (Plt;0.05); c) For distinguishing benign from malignant lesions, the Az value (area under ROC curve) of MPR, MIP, and VR were 0.998, 0.736 and 0.669, respectively; the differences between MPR and the others were significant (Plt;0.05); and d) MPR was completely the same as MDCTU in both diagnostic sensitivity and Az value. Conclusion The common 3-D reconstructions in MDCTU were different in value. MPR is highest in the diagnostic efficiency, which is similar to MDCTU, and is regarded as the basis of diagnosis; while MIP and VR are more stereo and intuitive. So it shows that the comprehensive application of CTU 3-D reconstructions has important value for diagnosing UUTD and distinguishing benign from malignant.
Objective To study the diagnostic value of MRI for pulmonary embolism, so as to provide information for clinical decision. Methods The trials about MRI in the diagnosis of pulmonary embolism were searched in the following databases such as PubMed, EMbase, The Cochrane Library, CBM, CNKI and VIP. The data of the included trials were extracted, the methodological quality was evaluated in accordance with the quality assessment of diagnostic accuracy studies (QUADAS), and then meta-analysis was conducted using Meta-Disc 1.4 software. The weighted sensitivity and specificity were aggregated, as well as the summary receiver operating characteristic (SROC) curve. Further, the area under the curve (AUC) was calculated to evaluate the value of MRI in the diagnosis of pulmonary embolism. Results A total of 6 English articles involing 595 patients were included. The results of heterogeneity test revealed that there was statistical heterogeneity among the results of studies. According to the random effects model, the weighted sensitivity and specificity were 0.87 (95%CI 0.80 to 0.91), and 0.98 (95%CI 0.96 to 0.99), respectively; and the AUC was 0.988 7. Conclusion MRI is a better non-invasive method as a routine examination for pulmonary embolism. It shows fairly high sensitivity and specificity, and has a good clinical value.
Objective To explore the correlation between hematocrit and slow coronary flow (SCF) in male patients. Methods We studied 205 patients with angiographically no more than one stenosis lt;40% in each major coronary artery who had admitted to the department of cardiology of the Beijing Anzhen Hospital Affiliated to Capital Medical University from August 2011 to August 2012. According to the level of hematocrit, 101 patients were classified into the trial group whose hematocrit was more 42.9%, while 104 patients into the control group whose hematocrit was no more than 42.9%. Clinical variables were analyzed and compared between the two groups. Results The age was younger in the trial group than the control group, whereas the levels of white blood cell count, mean platelet volume, triglyceride, low-density lipoprotein cholesterol, left anterior descending artery (LAD) and right coronary artery (RCA) TIMI frame count and the proportion of SCF in the LAD were higher in the trial group than in the control group (Plt;0.05). The results of correlation analysis showed that, LAD TIMI frame count (r=0.238, P=0.001), proportion of SCF in the LAD (r=0.206, P=0.003) and RCA TIMI frame count (r=0.209, P=0.003) were positively correlated with hematocrit. The results of multivariate analysis (using logistic regression with adjusted confounding factors such as age) showed that, LAD TIMI frame count (OR=1.031, 95%CI 1.006 to 1.056, P=0.014), proportion of SCF in the LAD (OR=1.919, 95%CI 1.038 to 3.547, P=0.038) were independently correlated with hematocrit. Conclusion The proportion of SCF in the LAD is independently correlated to hematocrit, which suggested that increased hematocrit may contribute to the pathophysiological change of SCF in male patients.
Objective To explore the correlation between traditional Chinese medicine (TCM) blood stasis pattern of coronary heart disease (CHD) and coronary angiography result, so as to screen dangerous patterns and provide evidence for the objectification of TCM pattern differentiation. Methods Literature on correlation between blood stasis pattern and coronary angiography results from January 1992 to May 2012 were searched in the following databases: China Academic Journal Network Publishing Database (CAJD), Chinese Biomedical Literature Database (CBM), China Doctor Dissertation Full-text Database (CDFD), Chinese Selected Master’s Theses Full-Text Databases (CMFD), PubMed and MEDLINE. According to the inclusion and exclusion criteria, literature screening, data extraction and methodological quality assessment of the included studies were conducted. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 28 studies involving 4 901 patients were included. The results of meta-analysis showed that, there is a significant significance between blood stasis pattern and the following coronary angiography result, namely, number of culprit vessels (OR=1.38, 95%CI 1.08 to 1.77, Plt;0.05), severity of stenosis (OR=1.79, 95%CI 1.04 to 3.08, Plt;0.05), and Gensini score (OR=7.74, 95%CI 3.99 to 11.49, Plt;0.05). Conclusion Compared with other TCM patterns, CHD with blood stasis pattern easily tends to present multi-vessels lesions, more than 75% stenosis and higher Gensini score, indicating the condition of CHD with blood stasis pattern is more severe than with other patterns. Due to the discrepancy of pattern differentiation and the limited quality of original studies, this conclusion is insufficient to be fully applied into clinical practice, and more large scale and high quality clinical trials are required.
【摘要】 目的 探讨多层螺旋CT低剂量扫描在小儿上尿路梗阻性疾病中的应用价值。 方法 2008年1月-2009年6月经临床手术证实尿路梗阻的患儿52例，按梗阻的原因分为结石组13例与非结石组39例。将非结石组患儿，按照年龄分为0~1岁（8例）、1~5岁（16例）和5~10岁（15例）3个组，均采用个性化的低剂量扫描方式。 结果 结石组与非结石组阳性诊断率均为100%。低剂量扫描患儿所接受的辐射剂量明显降低，CT扫描管电流不变，管电压降低1/3，CT检查的辐射剂量可降低约70%，且均可达到临床诊断要求。 结论 多层螺旋CT低剂量个性化扫描在小儿上尿路梗阻性疾病中诊断中具有明显优势。【Abstract】 Objective To evaluate low-dose multislice spiral CT for upper urinary tract obstruction in children. Methods From January 2008 to June 2009, 52 children with upper urinary tract obstruction were diagnosed via clinical surgeries. The patients were divided into two groups according to whether having renal calculus (13 patients) or not (39 patients). The patients in non-calculus group were divided into three sub-groups: aged 0-1 (eight patients), 1-5 (16 patients), and 5-10 (15 patients). Low dose multislice spiral CT with different doses was performed. Results The rate of positive predictive diagnosis was 100% in both calculus and non-calculus group. Low dose scan reduced the radiation dose of children. The fixed tube current and the decreased tube voltage (decreased 1/3) led to the decrease of the radiation dose (decreased 70%), which were feasible for diagnosis. Conclusion Low-dose multislice spiral CT was available for upper urinary tract obstruction in children.
目的:观察糖尿病患者使用造影剂后发生造影剂肾病的临床情况。方法:108例肾功能正常的患者根据血糖水平被分为3组,分别接受X线造影,观察3组发生造影剂肾病情况。结果: 血糖正常组血清肌酐造影前后无明显变化,糖尿病早期组造影后血肌酐升高,与造影前相比有统计学意义(Plt;005),糖尿病组造影后肌酐升高明显,与造影前相比具有显著统计学意义(Plt;001),且血肌酐恢复较慢,造影后第5天仍处于较高水平,与造影前相比有统计学意义(Plt;005)。结论: 糖尿病早期及糖尿病患者即使肾功能正常,使用造影剂后也容易发生造影剂肾病,对这类高危人群应尽量避免使用造影剂。
摘要:目的:通过食管吞钡造影及造影后CT平扫检查提高梨状窝瘘的诊断率。方法:平卧位左、右、前、后斜位和头低足高位食管吞钡后透视观察有无钡剂外漏后,行CT平扫检查。扫描范围上起口咽部,下至胸骨上窝,层距厚3 mm。扫描后图像作多层面重建处理。结果:透视下见到瘘管3例,另3例经CT多层面重建隐约见到瘘管,但14例均可见漏出的钡剂滞留影,可判断瘘管的存在。结论:食管吞钡造影及造影后CT平扫可提高对梨状窝瘘诊断的敏感性和诊断率。Abstract: Objective: To improve the diagnosis rate of the pyriform sinus fistula by means of esphagogram and CT scan after esphagogram. Methods:To observe whether there is the leakage of barium by Xray check after barium swallowed in the five positions of body, followed by CT scan. The scanning ranges from oropharyngeal to Waterloo on sternum. The thickness is 3mm. The image is dealt with multidimensional reconstruction after the scan. Results:Among fourteen cases, the fistula can be seen in three, and be indistinctly seen after the multidimensional reconstruction of CT scan in the other three ones. All The fourteen cases show the trace of the leakage of barium, which helps to prove the existence of pyriform sinus fistula. Conclusions: Esphagogram and CT scan after esphagogram contribute the sensitivity of the diagnosis of pyriform sinus fistula, and improve the diagnosis rate.
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：探讨在CT引导下经小关节内侧缘穿刺，应用造影剂观察药物分布，准确行靶位注射胶原酶［1］治疗术后复发的腰椎间盘突出症的疗效。方法:10例经临床确诊为腰椎间盘突出症术后复发的患者,在CT引导下经小关节内侧缘入路将穿刺针直接刺入突出物内,注射欧乃派0.5 ml，观察药物分布情况后，注入胶原酶600 u。临床观察患者术后6～12个月的治疗效果，用改良的Macnab方法评价疗效。结果:10例患者穿刺针均顺利准确刺入突出物，造影剂均匀分布在突出物及盘内。治疗优、良率为100%，无严重并发症。结论: CT引导下穿刺造影，观察造影剂的扩散后，再行靶位注射胶原酶对于术后复发的腰椎间盘突出症，可以进一步提高治疗效果，减少并发症的发生。