64层CT多平面重建对肺动脉栓塞的诊断价值

目的探讨64层螺旋CT诊断肺动脉栓塞(pulmonary embolism,PE)的价值。方法回顾性分析8例肺动脉栓塞患者的影像资料,对PE的病变进行分析及分型。结果在8例患者中,共检出了28处肺动脉及其分支的栓子。28处栓子中,左、右肺动脉主干3处(右主干2处、左主干1处),肺叶动脉10处,肺段动脉10处,亚肺段动脉5处。结论64层CT诊断PE简便、安全、准确性高,为诊断PE的一可靠手段。     

多层螺旋CT三维及多平面重建在跟骨骨折中的诊断价值

目的探讨跟骨骨折的多层螺旋CT三维及多平面重建表现及其诊断价值。方法回顾性分析近1年来26例跟骨骨折的多层螺旋CT三维重建及多平面重建的表现、CT分型,帮助临床选择适合的治疗方案。结果多层螺旋CT能清楚显示各型跟骨骨折,明确骨折线的走行、骨折片的数目,距下关节面损伤情况及关节腔内骨折片数目、位置,以及足跟部肌腱和软组织均可清楚显示。结论跟骨骨折的多层螺旋CT三维重建及多平重建能准确的对跟骨骨折进行分型,帮助临床选择最适合的治疗方案。     

螺旋CT多平面重组在副鼻窦检查中的应用研究

目的利用螺旋CT多平面重组技术探讨副鼻窦轴位扫描能否代替直接冠状位扫描。方法对20例能合作的患者,均行副鼻窦轴位及冠状位扫描。利用多平面重组(MPR)技术得到冠状位、矢状位重组图像;直接冠状位扫描获取冠状位图像;将同一患者的两组不同冠状位图像比较,主要观察各鼻窦窦壁及窦口。结果轴位扫描后重组所获图像亦能从多方位、多角度观察,清楚显示各鼻窦及窦口。结论重组冠状位图像与直接冠状位扫描图像效果相同,可以取代直接冠状位扫描。避免后者检查时头部后仰造成的不适,患者容易接受,值得推广。     

多层螺旋CT血管造影在诊断肺动脉栓塞中的应用

目的探讨多层螺旋CT在肺动脉栓塞诊断中的应用价值。方法使用日本Aquilion16层螺旋CT机对21例肺栓塞病人行造影增强扫描,将原始数据进行重建再处理。结果多发性肺动脉栓塞16例,其中双侧多发13例,右侧多发2例,左侧多发1例;单发5例,其中肺动脉段2例,叶动脉1例,段动脉2例。结论多层螺旋CT肺动脉造影(MSCTPA)速度快、敏感、无创,可靠又安全,是肺动脉栓塞的首选检查方式,这为提高对本病的早期正确诊断和患者得到及时治疗提供了可能。     

肝门区胆管癌的多层螺旋CT术前评估价值

目的探讨肝门区胆管癌的MSCT表现及术前评估价值。方法对31例肝门区胆管癌进行前瞻性研究,分析MSCT平扫及增强表现,术前评估肿瘤的手术可切除性,并与手术病理对照。结果31例肝门区胆管癌均显示肝内胆管不同程度扩张,胆管狭窄、中断,其中可见肝门区肿块24例,MSCT以增强延迟强化为主。术前可切除性评估与手术病理对照,其差异性无统计学意义(P>0.05)。结论MSCT平扫结合三期增强对显示肝门区胆管癌的直接和间接征象有较大帮助,大大提高了术前评估的准确性。     

16层螺旋CT薄层及三维重建技术对筛板骨折的诊断价值

目的探讨16层螺旋CT在筛板骨折的应用价值。方法对2007年10月至2008年8月125例前颅窝多发性骨折患者进行了筛板区16层螺旋CT的二维薄层重建,并进行MPR、VPT等多层面显示。结果显示筛板骨折65例,其中典型骨折55例,不典型骨折10例,漏诊病例6例。结论16层螺旋CT薄层重建能大大提高骨折的检出率,以重建层厚为1.5mm的二维重建能明显提高筛板骨折图像的空间分辨率,使骨折更易检出,而三维重建技术包括MPR、VRT等能更清晰的观察到骨折的移位情况及与邻近组织的关系,为临床治疗提供更多的信息。     

肺真菌性感染的多层螺旋CT表现及文献复习(附4例报告)

目的探讨多层螺旋CT(MSCT)在肺真菌性感染诊断中的临床应用价值,提高对肺真菌性感染影像学表现认识。方法回顾性分析4例经穿刺活检和支气管镜检或痰培养确诊的肺真菌性感染患者的胸片、MSCT的影像学表现。结果MSCT均显示胸片发现的阳性病变特征,主要表现为:1例肺结核伴肺曲菌病,病灶空洞内有可移动肿块及半月形空气征;3例念珠菌感染表现分别表现为:蜂窝状改变中见小团块密度影(1例);软组织肿块,边缘可见"晕轮征"(1例);多叶段多发不规则结节渗出影(1例)。结论肺真菌性感染的影像表现缺乏特征性,寄生于空洞内的肺曲菌病的诊断较容易,其它真菌性感染的诊断较困难,需要病理或细菌学检查确诊。     

视网膜母细胞瘤的螺旋CT诊断

为了提高对视网膜母细胞瘤CT影像表现的认识,回顾性总结分析19例视网膜母细胞瘤病例,包括临床表现、影像学检查。所有病人均采用西门子16排螺旋CT机扫描,常规眼眶CT横轴位扫描,层厚5mm,进行多平面重建,矢状位及冠状位重建,图像直观、易懂。19例均行CT平扫。结果左眼病变12例,右眼病变5例,双眼均有病变2例,合并眼球萎缩5例,合并视网膜剥离4例,17例病灶中有钙化,呈斑片状、块状及小斑点状,其中1例呈环状钙化。结论螺旋CT对视网膜母细胞瘤的诊断准确率高,对病灶钙化敏感,图像直观易懂,直接显示病灶的部位及范围,还能显示其合并症,简单、易懂,由于大部分病灶内有钙化,具有特征性,所以诊断率高。     

高分辨率CT在肺气肿诊断中的应用

目的分析不同类型肺气肿的表现,评估高分辨率CT在肺气肿诊断中的价值。方法对58例经临床确诊的患者进行高分辨率CT扫描,分析不同类型肺气肿的CT表现。结果58例患者中小叶中央型27例,全小叶型26例,间隔旁型13例,瘢痕旁型7例,小叶中央型表现为小片状无壁低密度灶,全小叶型表现为大片肺内广泛低密度灶,肺纹理纤细、稀疏,间隔旁型表现为胸膜下片状低密度灶,可有壁,瘢痕旁型表现为肺内纤维化病灶周围囊状低密度影。结论高分辨率CT对肺气肿的早期诊断及分类有价值。     

多排螺旋CT三维重建技术在膀胱癌诊断中的应用

目的探讨多排螺旋CT三维重建技术对膀胱癌的诊断的应用。使用西门子公司Somatom Sensation 16 CT机,对36例膀胱癌患者进行仰卧或兼俯卧位常规平扫及增强扫描,使用Wizard工作站进行多平面重建(MPR)、最大密度投影(MIP)、曲面重建(CPR)重建。结果结合平扫、增强扫描及三维重建技术提供了膀胱癌的诊断准确率。结论三维重建成像可以从二维及三维立体成像上获得更多的诊断信息,MPR、MIP更直观的显示病灶的大小、形态和密度、范围、毗邻,可从不同的方位显示病灶的基底部及蒂的情况,能够清楚显示病变与膀胱壁之间的关系。     

双层螺旋CT图像重建在胫骨平台骨折中的应用价值

目的探讨双层螺旋CT表面遮盖法三维重建(SSD-3D)和多平面重建(MPR)在胫骨平台骨折中的临床应用价值。方法对35例具备完整普通X线及CT影像资料并经手术或临床随访证实的病例进行回顾性分析。结果横断面结合SSD-3D和MPR重建图像CT发现了包括平片上可疑和漏诊的全部骨折。SSD-3D图像像立体地显示了骨表面碎骨片的形态、大小、空间位置以及骨折的分离移位情况,但对细小的骨折线显示欠佳或难以显示,对胫骨平台塌陷深度不能准确测量;MPR矢状及冠状重建图像清晰显示髁间隆凸骨折及分离移位情况,能准确测量胫骨平台骨折的塌陷深度,特别是MPR能清晰了显示骨折线累及关节面的细节。结论螺旋CT三维和多平面重建是X线片和轴位CT扫描图像的有效补充,能为胫骨平台骨折的准确显示、术前分类、治疗方案的选择等提供更多的客观依据,有很高的临床应用价值。     

Current Advances in 3D Tissue and Organ Reconstruction

Bi-dimensional culture systems have represented the most used method to study cell biology outside the body for over a century. Although they convey useful information, such systems may lose tissue-specific architecture, biomechanical effectors, and biochemical cues deriving from the native extracellular matrix, with significant alterations in several cellular functions and processes. Notably, the introduction of three-dimensional (3D) platforms that are able to re-create in vitro the structures of the native tissue, have overcome some of these issues, since they better mimic the in vivo milieu and reduce the gap between the cell culture ambient and the tissue environment. 3D culture systems are currently used in a broad range of studies, from cancer and stem cell biology, to drug testing and discovery. Here, we describe the mechanisms used by cells to perceive and respond to biomechanical cues and the main signaling pathways involved. We provide an overall perspective of the most recent 3D technologies. Given the breadth of the subject, we concentrate on the use of hydrogels, bioreactors, 3D printing and bioprinting, nanofiber-based scaffolds, and preparation of a decellularized bio-matrix. In addition, we report the possibility to combine the use of 3D cultures with functionalized nanoparticles to obtain highly predictive in vitro models for use in the nanomedicine field.     

基于逆向工程的三维模型重构

通过手持式三维激光扫描仪获取安全帽表面的点云数据,用逆向工程软件Imageware对点云数据进行处理与曲面重构;利用Creo构造冲击实验模型,再用Ansys Workbench进行冲击实验,随后进行优化分析。结果表明:安全帽应力和变形主要集中在顶部,并向底部逐渐降低;最大应力及变形均位于冲击处,最大应力为0.528 MPa,最大变形为9.852 mm。优化后的模型,其最大应力降低了33.52%,最大应变降低了13.88%。     

基于轴测图的化工工艺管道三维重建的研究

化工工艺管道的轴测图广泛存在于化工企业的设计和生产中,其表达接近于人们的视觉习惯,形象、逼真,从固定角度观察,有较好的立体感。分析了化工管道轴测图的表达方法和特点,研究了其从二维世界坐标到三维世界坐标的转换算法,阐述了重建过程中图形预处理,图形识别,信息提取,坐标变换和数据存储方法。在Auto CAD环境下,利用二次开发功能,实现了化工管道轴测图的三维重建,验证了算法的可行性。论文的研究结果可以推广至水利、煤气和供暖等领域的工程图纸三维重建。     

胃石症的X线诊断与临床

目的分析胃石症的临床表现与X线钡餐造影的影像学特征与价值,以提高影像诊断水平。方法回顾性分析经X线钡餐确诊的20例胃石症的影像表现,其中4例行胃镜检查。结果 20例胃石症中19例食用新鲜柿子,1例食用柿饼子,最大者20cm×8cm,最小者5.2cm×4cm,年龄最小者20岁,最大者82岁,男性14例,女性6例,食用柿子后至发病时间,最长3个月,最短7d,其中6例多次食用多个新鲜柿子,13例一次食用多个新鲜柿子,1例一次食用多个柿饼子。结论 X线钡餐造影能清晰显示结石大小、形态及内部结构,能够明确诊断;对临诊治有一定参考价值,患者易于接受,为首选检查方法之一。     

Diagnostic Value of MAML2 Rearrangements in Mucoepidermoid Carcinoma

Mucoepidermoid carcinoma (MEC) is often seen in salivary glands and can harbor MAML2 translocations (MAML2+). The translocation status has diagnostic utility as an objective confirmation of the MEC diagnosis, for example, when distinction from the more aggressive adenosquamous carcinoma (ASC) is not straightforward. To assess the diagnostic relevance of MAML2, we examined our 5-year experience in prospective testing of 8106 solid tumors using RNA-seq panel testing in combinations with a two-round Delphi-based scenario survey. The prevalence of MAML2+ across all tumors was 0.28% (n = 23/8106) and the majority of MAML2+ cases were found in head and neck tumors (78.3%), where the overall prevalence was 5.9% (n = 18/307). The sensitivity of MAML2 for MEC was 60% and most cases (80%) were submitted for diagnostic confirmation; in 24% of cases, the MAML2 results changed the working diagnosis. An independent survey of 15 experts showed relative importance indexes of 0.8 and 0.65 for “confirmatory MAML2 testing” in suspected MEC and ASC, respectively. Real-world evidence confirmed that the added value of MAML2 is a composite of an imperfect confirmation test for MEC and a highly specific exclusion tool for the diagnosis of ASC. Real-world evidence can help move a rare molecular-genetic biomarker from an emerging tool to the clinic.     

Evaluation of the Usability of a Low-Cost 3D Printer in a Tissue Engineering Approach for External Ear Reconstruction

The use of alloplastic materials instead of autologous cartilage grafts offers a new perspective in craniofacial reconstructive surgery. Particularly for regenerative approaches, customized implants enable the surgeon to restore the cartilaginous framework of the ear without donor site morbidity. However, high development and production costs of commercially available implants impede clinical translation. For this reason, the usability of a low-cost 3D printer (Ultimaker 2+) as an inhouse-production tool for cheap surgical implants was investigated. The open software architecture of the 3D printer was modified in order to enable printing of biocompatible and biologically degradable polycaprolactone (PCL). Firstly, the printing accuracy and limitations of a PCL implant were compared to reference materials acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA). Then the self-made PCL-scaffold was seeded with adipose-tissue derived stem cells (ASCs), and biocompatibility was compared to a commercially available PCL-scaffold using a cell viability staining (FDA/PI) and a dsDNA quantification assay (PicoGreen). Secondly, porous and solid patient-customized ear constructs were manufactured from mirrored CT-imagining data using a computer-assisted design (CAD) and computer-assisted manufacturing (CAM) approach to evaluate printing accuracy and reproducibility. The results show that printing of a porous PCL scaffolds was possible, with an accuracy equivalent to the reference materials at an edge length of 10 mm and a pore size of 0.67 mm. Cell viability, adhesion, and proliferation of the ASCs were equivalent on self-made and the commercially available PCL-scaffolds. Patient-customized ear constructs could be produced well in solid form and with limited accuracy in porous form from all three thermoplastic materials. Printing dimensions and quality of the modified low-cost 3D printer are sufficient for selected tissue engineering applications, and the manufacturing of personalized ear models for surgical simulation at manufacturing costs of EUR 0.04 per cell culture scaffold and EUR 0.90 (0.56) per solid (porous) ear construct made from PCL. Therefore, in-house production of PCL-based tissue engineering scaffolds and surgical implants should be further investigated to facilitate the use of new materials and 3D printing in daily clinical routine.     

Fracture Mirrors in Nanoscale 3Y-TZP

The strengths of fine-microstructural scale yttria-stabilized tetragonal zirconia polycrystal rectangular bars and circular disks were measured by four-point flexure and flat ball (piston) on three-ball methods. Fracture mirror sizes were measured and correlated to the strengths. Although it was difficult to precisely judge the mirror boundary location in this material, consistent readings could be obtained once simple guidelines were followed.     

超敏C-反应蛋白在急诊胸痛患者中的诊断意义

目的检验超敏C-反应蛋白(hs-CRP)在急诊胸痛患者中的水平,以分析其在治疗中的诊断意义。方法入选2009年1月至2009年9月期间我院急诊科接诊主诉为胸痛的患者,对267例进行hs-CRP测定,以及心电图、心肌酶谱检查。结果各组心血管性疾病患者(140例)血清hs-CRP浓度显著高于对照组[62例,(1.22±0.96)mg/L]。心血管性疾病患者的hs-CRP水平显著高于对照组,而非心血管性疾病组与对照组相比无显著差别。结论hs-CRP的测定可辅助急诊胸痛患者预测心源性疾病的发生,这将有助于急诊科医生对于心源性疾病的快速诊断。     

循证护理在预防老年人股骨骨折术后深静脉血栓的临床价值

目的探讨循证护理对预防下肢深静脉血栓的价值。方法对41例老年股骨颈骨折手术患者进行循证护理后的临床资料进行回顾性分析。结果 41例患者均无出现术后下肢深静脉血栓。结论循证护理将护理研究和护理实践有机地结合起来,提高了护理质量。