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中国继续医学教育 第7卷 第1期 143参考文献[1]贾国庆，王志东，高建梅. 钡剂灌肠与动态排粪造影对功能性便秘的影像诊断价值[J]. 内蒙古医学杂志，2012，44(9): 1116-1117.[2] 施付强，袁冠芳，许宜选. 排粪造影结合钡灌肠检查在便秘患者中的应用[J].中国医学创新，2014，11(19): 60-63.[3] 郭振民. 结肠运输实验联合动态排粪造影对便秘的诊断价值[J]. 现代医用影像学，2012，21(4): 234-235.研究肝肾间隙占位病变的CT诊断及鉴别诊断常桂萍作者单位：123100 辽宁省阜新蒙古族自治县人民医院CT 室【摘要】 目的 研究肝肾间隙占位病变的CT 诊断及鉴别诊断价值。
方法 选取来我院进行CT 诊断并最终经病理证实的肝肾间隙占位病变患者22例，22例患者均采取CT 扫描的方式进行临床诊断，CT 扫描的层厚为8 mm，CT 扫描的层距为8 mm，CT 扫描的范围从患者的膈顶到肿块结束平面。
对22例患者的CT 扫描资料进行分析，以此来研究CT 诊断在肝肾间隙占位病变临床诊断中的价值。
结果 22例患者经CT 诊断发现，其肿瘤平均大小为5.0 cm×7.0 cm×6.0 cm，CT 扫描横断面上肝肾间隙均消失。
结论 CT 扫描对肝肾间隙占位病变能够做出定位诊断，病变中心位置及病变周围脏器受压方向有助于CT 定位。
【关键词】肝肾间隙占位病变；CT 诊断；鉴别；价值【中图分类号】R816 【文献标识码】B 【文章编号】1674-9308（2015）01-0143-02doi ：10.3969/j.issn.1674-9308.2015.01.119CT Diagnosis and Differential Diagnosis of Placeholder Lesions of Liver and Kidney ClearanceCHANG Guiping (Fuxin Mongolian autonomous county people's hospital of CT exam room, Fuxin 123100, China)[Abstract] Objective To study the liver and kidney clearance placeholder lesions in the value of CT diagnosis and differential diagnosis. Methods chose 22 patients with liver and kidney clearance placeholder lesions in our CT and finally confirmed by pathological diagnosis, adopt the method of CT scan in all 22 cases for clinical diagnosis, CT scan was 8 mm, with a thick layer of the layer from the CT scan was 8 mm, CT scan range from patients with diaphragmatic dome to lump end plane. The CT scan data of 22 patients were analyzed, in order to study the CT diagnosis of placeholder lesions in the liver and kidney clearance value in clinical diagnosis. Results 22 cases by CT, found that the average tumor size of 5.0 cm x 7.0 cm x 6.0 cm, a CT scan on the cross-sectional hepatorenal clearance all disappear. Conclusion CT scan of liver and kidney clearance placeholder lesions can make localization diagnosis of the lesion center position and direction of compression of adjacent organs lesion help CT positioning.[Key words] Kidney clearance placeholder lesions, CT diagnosis, Identification, Value遍使用的一种影像诊断方法，在对机体排便程序进行全程监控的基础上，可有效探明便秘病因，为临床治疗提供依据[1]。
肝脏占位性病变的影像学检查周康荣 摘要:肝脏占位性病变的影像学检查,近年来取得了很大进展,无论是病灶的检出率和定性诊断准确率都有很大提高,对肝脏和肝脏病变的血供研究进一步深入。
US和C T在肝脏占位病变的检测中应用最为普遍,敏感性也相仿,但螺旋CT双期或多期增强扫描的定性能力更强,动脉期扫描的价值得到充分肯定,但动脉期的标准、起始时间、持续时间,以及与造影剂注射计划的关系,文献报道比较混乱,作者根据多年的临床和科研资料积累,作了较详细的讨论。
磁共振成像SE T1W、T2W加上快速梯度回波序列动态增强对肝脏占位病灶的诊断尤其定性能力略优于SCT,尤其对小的血管瘤、RN、DN的鉴别意义更大。
作者把肝内占位病变分成多血供和少血供两大类,并对常见病变的CT、M R表现与特征作了扼要介绍。
最后还对肝脏特异性M R造影剂的发展前景以及多层螺旋CT的临床应用价值作了论述。
Imaging Examination of Hepatic Space Occupying LesionsZhou K angrongDepartment of Radiology,ZhongS han Hospital,Shanghai200032Abstract:I n recent years,imag ing examina tio n of the liver,mainly focused on the space occupying or focal le-sions has been developing very fast.W hatever the detectability o r the accuracy of the preo perative diagnosis of the fo-cal liver lesion were sig nificantly improved.T he study on the bloo d supply to the liver and hepatic lesions w as further deepened.U S and the most commonly applied imaging modalities in the examnina tio n of the liver,bo th have similar sensitivity in the detection of the lesions,but dual phase dy namic enhancement SCT is better in the characterization of the lesions,and particularly,its arterial phase is approved to be very valuble.How ever,it is still and quite confus-ing problem as to what is the criteria,initial time,ending time and duration of the enhancement of the arterial phase, as well as the relation w ith the contrast injection protocol.The author discussed it in detail on the basis of his o wn clinical and research data collected in a few years.It is also considered by the author that M RI including SE T1W, T2W and dynamic enhancement with F M PSPGR sequence mig ht be superior to SCT in the diagnosis of the focal liv er lesions,especially small hemangioma,RN and DN.A ccording to the deg ree of the blood supply,the lesio ns can be divided into tw o catego ries:hy pervascular and hypov ascular.T ha t may be helpful fo r differentiation of the diseases on the images.CT findings and features of some co mmon diseases of the liver were presented briefly in this series.Final-ly,the futute development of specific liver M R contrast agents such as M n-DPDP,SPIO,and the present or future applicatio n of the new CT scanner,namely multislice SCT were also involved in the discussion and evaluation. 随着U S、CT和M RI等影像学检查技术的不断发展,以及临床经验的积累,肝脏占位性病变尤其小病灶的检出率明显提高,术前诊断准确性也得以提高。
肝脏常见占位灶的影像学诊断与鉴别诊断【摘要】目的研究肝脏占位灶在CT影像学征象上的表现，提高放射科及临床医生对肝内占位灶在影像学征象上的判别及鉴别诊断。
方法搜集2008年至2015年4月经手术切除并病理确诊的肝内占位灶（直径>=1.0cm，实性成分为主）150例并对其CT图像进行回顾性分析研究。
结果原发性肝癌75例，转移瘤19例，肝脏血管瘤38例，FNH9例，肝腺瘤7例，肝脓肿2例；结论肝脏恶性肿瘤是肝内常见的占位灶，患者症状出现晚，一旦出现临床症状，多属晚期，5年生存率低，这就需要我们提高对肝内占位灶良恶性鉴别诊断的能力，争取做到早发现，早诊断，早治疗。
【关键词】肝内常见占位灶；体层摄影术；X线计算机；CT诊断肝脏占位灶是临床常见病变，以恶性肿瘤多见，MSCT图像具有良好的密度分辨率，能准确定性，显示病变的形态、大小、数目以及与周围脏器的关系，图像的采集是连续的，且大多数患者可在一次屏气状态下完成整个肝脏扫描，消除了呼吸移动导致的病灶遗漏，并能得到最优的血管及肝实质强化图像。
加之螺旋CT能在一次注射造影剂的情况下完成肝动脉、门静脉及延迟扫描，观察占位灶的动态增强特征，并可提供连续性数据，所以使三维图形重建成为可能，同时对显示血管闭塞和血管受包绕的征象方面十分有用，为术前影像诊断及临床手术方式、术后疗效提供帮助。
1 资料与方法1.1 一般资料收集我院2008年至2015年4月收治的经手术病理证实的肝内以实性成分为主的占位灶150例，其中男109 例，女41 例，年龄29-78岁，平均年龄53.5岁，患者临床表现有所不同，但多以肝区不适、疼痛，食欲较差为主，部分恶性肿瘤患者有消瘦。
1.2 检查方法采用Philips16层螺旋CT机，高压注射器（美国Liebel-Flarlsheim公司），非离子型造影剂（碘海醇300mgI/ml），Philips图像处理工作站。
平静呼吸下屏气时扫描，扫描范围自剑突至双侧髂嵴连线，常规延时60S后增强，注射总量按每千克1.5ml为标准，注射速率2ml/s。
