1、多层螺旋 CT 在肺撕裂伤中的表现及其应用价值摘要你好：审核发现 ，部分是抄袭博士或硕士，别人发表论文的长篇章节，表，图。格式不符合要求，研究方向，分类号不正确。表格不是三线表。前言太多，统计有误。讨论和前言及综述重复太多。近 5 年参考文献太少，英文文献太少。请修改。4 月 3 日交医学院。麻烦让 抓紧修改，不要在敷衍我了，以前说好自己写的，可是这都是摘抄网上的。背景 随着社会信息化和现代化的不断发展，医学技术的不断深入研究在社会中的地位和作用也越来越重要。医学科技的数字化、可视化为临床信息的读取和存取提供了极大的便利性，同时，也显著提高信息读取、存取的效率和准确性。此外，随着中国人口的不断
2、激增，各种交通意外事故的频发骇人听闻，所导致的严重后果如胸部创伤、头颅创伤等在医院急诊病例中亦非常常见。肺撕裂伤患者需要 CT 及时诊断并进行肺胸膜破裂口的修补，如果不够及时准确的判断，将严重危及患者的生命安全。探索多层螺旋 CT 在肺撕裂伤中的表现及其应用价值，旨在提高 CT 动态观察病情变化的准确认识，更好地完善医疗诊断技术，降低患者的死亡率。目的 研究分析多层 CT 扫描技术应用于肺撕裂伤中的临床表现及其应用价值的探讨。1.探讨高分辨计算机多体层的扫描(multi-slice spiral computed tomography, MSCT)图像在显示肺撕裂伤、气道及胸膜变化的问题上对肺
3、组织观数据与临床诊断结合的分析。2.深入总结多层螺旋 CT 技术的应用，使得临床上对于肺撕裂伤患者可获得形态学详细描述3.通过比较多层螺旋 CT 技术与 X 线平片、MRI、CT 等如今临床医学上常用的医学影像学手段之间的相同点和不同点，从而更加形象具体的探讨分析多层 CT 扫描技术应用于肺撕裂伤中的临床表现及其应用价值。方法 选择 2014 年 6 月份我院收治的 60 例外伤患者为研究对象，均对其使用多层 CT 机进行胸部平扫，观察并记录所有患者的病变情况。然后 1）对研究Comment y1: 英文部分等稿子定下来后再进行最后的修改。 暂未做修改患者 CT处理数据进行分析，了解肺撕裂伤、
4、气道及胸膜变化的问题上确立了主导地位，同时经过科学系统化的数据处理后，减少人为的主观干预，对患者不同程度肺撕裂伤进行定性定量的分析诊断。2）利用科学的表面遮盖显示(surface shaded display，SSD)技术对所有研究患者进行三维立体肺部（ three-dimensional lung model，3D-lung)建模，并根据研究需要对其进行手工切除校正。3）讨论 VRT作为立体图像的代表，能够进行任何方位的旋转观察同时与 MIP技术的联合应用比较，效果更加直观清晰的展现出患者的状况，而 MPR技术则是将对患者的病情的透射性结果，特别是当中的一些细节性的问题，使得对患者的诊断结果
5、判定的可信度提高分析。结果：1）CT 表现：所有受测患者当中，共发现肺气肿患者 15例，病灶35个，其中扁形病灶 15个，圆形或椭圆形的病灶 15个，囊肿壁厚薄不均匀的病灶 3个，囊肿壁薄而均匀的病灶 2个，囊肿壁周围都有片状的磨砂玻璃样阴影，气肿大小在 3-28mm。其次在图像中可清晰的看出有一定程度的肺气液囊肿，在所有的患者 CT图像观察中分析，肺气液囊肿患者共有 25例，发现病灶部位 65个，都可以明显的看出有气液平，且肺气液囊内的液体数量不等，其中呈弧形病灶 30个，呈裂隙样病灶 5个，表现成圆形或椭圆形的病灶 30个。针对肺血肿患者的图像，患者中共有 15例出现肺血肿现象，一共发现病
6、灶 15个，其形态表现主要为椭圆形，且血肿边界较清晰，大小在 40-5-HU。其余的 5例患者呈现蜂窝样改变，表现出低密度的蜂窝样阴影，内有许多小圆形的、裂隙样的气影，边界模糊不清。结论：通过多层螺旋 CT技术，可以清晰地观察到患者的肺部组织内的空腔的大小、分布、形态及其演变的变化规律，对于肺撕裂伤患者而言，诊断时快速有效，复查时，可以避免漏诊或误诊，安心放心。且多层螺旋 CT在早期的诊断中，多层螺旋 CT应用于临床检查或诊断，效果极具参考价值，值得推广使用。【关键词】多层螺旋 CT；肺撕裂伤；肺气囊肿；应用价值Performance and application value of mult
7、i-slice spiral CT in pulmonary laceration ofAbstractObjective To explore the research and analysis of multilayer CT scan technology in pulmonary laceration in the clinical manifestation and its application value. Discussion on high resolution computer multi body layer scanning (multi-slice spiral co
8、mputed tomography, MSCT) analysis of the image in the display of pulmonary laceration, airway and pleural changes on the question of lung tissue and clinical diagnosis of leisure view data binding. Application and in-depth summary of multi-slice spiral CT technology, makes the patients with pulmonar
9、y laceration patients can obtain morphology described in detail, whether can be observed in patients with early secondary infection of lung surface, caused by pulmonary interstitial and pleural changes? Get detailed information on patients with early lung function status whether can quantitatively i
10、n clinical diagnosis?By comparing the same points between multi-slice spiral CT and X-ray plain film, MRI technology, CT is now commonly used clinical medicine medical imaging teaching means and different point, analysis and discussion of multislice CT scanning technology in the application of pulmo
11、nary laceration in the clinical manifestation and its value of application specific and thus more image, including the problems of its combination magazine reported at home and abroad were introduced, further complement the results of this study, to make the test results more persuasive.Methods 60 c
12、ases of traumatic patients in our hospital from 2014 to June as the research object, on the use of multilayer CT chest scan, observe and record the lesions in all patients. Then 1) of study on CT in patients with treatment of data for analysis, understanding the laceration of the lung, airway and pl
13、eural change issue to establish a dominant position, at the same time, through scientific system of data processing, greatly reduced the effect of subjective human intervention on the patients with different degree, pulmonary laceration by qualitative and quantitative analysis method to diagnose bet
14、ter. 2) shaded display using scientific surface (surface shaded display, SSD) for three-dimensional lung for all study patients Technology (three-dimensional lung model, 3D-lung) modeling, and research needs to carry on the manual correction according to resection. Observation of the three-dimension
15、al model, research, analysis.The combined application of processing technology of CT scanning technology, including CPR, VRT, after MPR and MIP in the multi technology, describes the CPR technology can rib imaging bending in a plane to said, for patients suffered form does not obviously occult fract
16、ure shows more intuitive performance, discuss VRT as a representative of the stereo image, combination of rotating observation can be obtained at any range at the same time with MIP technology, the effect is more direct and clear to show the condition of patients, and the technique of MPR is to the
17、patients condition of transmission of the results, especially some details of the problem, make the patients diagnosis results the determination of the reliability is improved analysis.Results: 1) CT showed: in all the patients, were found in 15 cases of patients with emphysema, and 35 lesions, 15 l
18、esions of the flat, round or oval lesions in 15, cyst wall of uneven thickness of 3 lesions, cyst wall is thin and uniform 2 lesions, cyst wall all around the shadow frosted glass like sheet, emphysema size in 3-28mm. Then in the image can be clearly seen with lung cysts to some extent, the analysis
19、 in the patients with CT were observed in all of the images in lung liquid cyst patients, a total of 25 cases, the lesions were found in 65, can be seen clearly with air fluid level, and the number of lung sac inside the liquid range, which is in the shape of an arc lesions 30, a slit like 5 lesions
20、 showed round or oval, 30 lesions. According to the image of pulmonary hematoma patients, patients with a total of 15 cases of pulmonary hematoma phenomenon, found a total of 15 lesions, the morphological manifestations were oval, and hematoma boundary is clear, size in 40-5-HU. The remaining 5 case
21、s patients showed honeycombing, showed a honeycomb like shadow of low density, air in the shadow of many small round, slit like, blurred boundary.2) the application value and significance: the application of multi-slice spiral CT technology, makes the patients with pulmonary laceration patients can
22、obtain a detailed description of the external morphology, can be observed in patients with early secondary infection of lung surface, caused by pulmonary interstitial and pleural changes, get detailed information on patients with early pulmonary function can be quantitatively in clinical diagnosis t
23、he. Clinical observation of the patients with mild pulmonary laceration of lung damage, because of its very slight changes, lesions of X ray imaging without specific differences in check, at the same time symptoms and chest X-ray worsening of patients may be accompanied by the inspection results sho
24、w different degree was a certain parallel relationship.The combined application of processing technology of CT scanning technology, including CPR, VRT, after MPR and MIP multi technology, CPR technology in rib imaging bending in a plane, for patients suffered form does not obviously occult fracture
25、show more intuitive, VRT as the representative of stereo images, rotating observation can be obtained at any range, and combined application with MIP technology, the effect is more direct and clear to show the condition of patients, and the technique of MPR is to the patients condition of transmissi
26、on of the results, especially some of the details of the problem, which makes the patients diagnosis result to determine the reliability is improved. In order for the patients in the presence of early pulmonary laceration and change the localized pulmonary laceration, can significantly improve the d
27、etection rate of patients with pulmonary trauma. Multislice spiral CT in clinical diagnosis and dynamic observation of pulmonary laceration best examination method, has the important guiding value in clinical treatment.3) 3D reconstruction image display, image three dimensional surface reconstructio
28、n of 60 patients showed pulmonary tissue of both sides is not smooth, the lack of full. Rotate through multi multi angle to it, can be very intuitive found with radian diaphragm and apex in the lung surface occurs. At the same time in the 3D reconstruction image in individual patients can be seen on
29、 certain points and cord like shadows, scattered punctate shadow and groove back and groove. In the use of computer technology for acquisition and processing of data at the same time, and later on referred to as processing technology for medical imaging processing technology. Image analysis includin
30、g image description and image segmentation, image description, simply have a basic knowledge of the image, and according to the different characteristics and the relationship between different image description, so before analysis to deal with all the image segmentation. Including the different imag
31、es of liberal arts, color, gray statistical characteristics, such as the distinction between different tissues or organs, after the image segmentation process after the many changes in the area of lesion changes and compared with the normal tissue, which can in multi-directional, multi angle more in
32、tuitive display effect. At present the most clinically commonly used two kind of display technology are surface reproduction (surface rendering, SR) and volume rendering (volume rendering, VR), commonly used SR technology as a kind of SSD post processing. In the observation of Figure 2, showing a sm
33、all shadow is very important for the diagnosis, at present mainly relies on the High KV chest is defined, its deep roots and overlapping and resolution under caused judgment is not accurate, the observation shows that, in the three-dimensional surface reconstruction image of the patient shows, the v
34、isceral pleura and diaphragm, apex muscle surface not smooth, suggesting that is caused by certain large consequences of pulmonary laceration, although there was no serious stretching deformation change, but the small punctate spots have been in local distribution, not related to the whole lung, a m
35、ore stable state.Conclusion: Clinical on pulmonary laceration mild patients, need to adopt some relatively higher sensitivity means or diagnostic measures, and to further improve the patients with mild pulmonary laceration of the inspection effect, can take the necessary intervention or timely treat
36、ment measures, never stable condition of the patient, to prevent secondary infection to prevent the further development of the disease, improve the quality of life of patients and health. General pulmonary laceration were associated with different degree of pulmonary contusion and injury of chest in
37、juries to some extent, is of great significance for the differential diagnosis of clinical medicine. At the same time in the diagnosis and treatment for patients at the same time, should be closely combined with the conditions of patients with a history of trauma, and the clinical features of dynami
38、c observation of absorption analysis. Multi slice spiral CT technique is a simple, comprehensive and strong, can be an image repeated operation, convenient and practical medical examination method, this technique is also the modern clinical medicine major hospitals to check pulmonary laceration pati
39、ents an important diagnostic methods, by multi-slice spiral CT technology, can clearly observe the to the cavity in patients with lung tissue within the size, distribution, morphology and its evolution law of change, for pulmonary laceration patients, rapid and effective diagnosis, follow-up time, c
40、an avoid misdiagnosis, peace of mind at ease. And multi-slice spiral CT in the early diagnosis of chest, relative to the comparison group, can detect the air bag or slit image containing a circular or oval accurate, multi-slice spiral CT in clinical examination or diagnosis, effect of great referenc
41、e value, it is worth to promote the use of.In the future, image navigation technology will be closely linked with the clinical, combined, the most obvious progress is the 3D image and two-dimensional X-ray techniques perfect if achieved, will be an important breakthrough in the clinical history, nam
42、ely through image combined positioning technology, matching data and CT images of the data in the operation phase, also X-ray CT imaging technology can establish the operation through the C arm with a center, image navigation will believe in surgical trauma has extensive application.keyword multisli
43、ce spiral CT; pulmonary laceration; lung cyst; application value前言1987 年，西门子公司研制并推出了世界上第一台螺旋 CT1，连续螺旋扫描的方式开启了医学领域新的时代。1998 年，在医学技术人员的不断努力下，在单螺旋、双螺旋的基础上推出了多层螺旋 CT（MSCT，Multi-slice CT），将CT 技术的发展又推向了一个新的水平 2。多层 CT 采用锥形 X 线束，多排探测器，可以连续旋转进行扫描且旋转一周可获得多层图像，大大提高了临床影像扫描的速度，旋转一周的扫描时间可短至 0.5 秒。由于多层螺旋 CT 能快速容积扫
44、描，可以在短时间内对患者身体的大范围进行持续性的数据信息采集，然后通过计算机的科学处理，就能获得一层由多种技术综合形成的仅有 0.75mm 的图像 3。肺撕裂伤是由胸部闭合性创伤引起的肺组织损伤，轻度的患者表现和肺挫伤大致相同，一般不易诊断发现 6。重度的患者表现出肺组织破裂形成囊肿，且囊肿内有积液或气体 7，更严重的则会形成血肿，同时如果伴有胸膜撕裂（血液和空气进入胸膜腔），就会导致血气胸。临床上患者常见胸痛、咯血 8，有的患者甚至发生昏迷、休克。研究发现，肺血肿的发生可为单个过多个，在患者没有继发性感染的情况下，血肿会随着时间不断被自身吸收，短则数周至数月，但其完全消退可能需要半年或一年的
45、时间，血肿在消退后可留下少许线条状疤痕。现在临床上针对于肺撕裂伤的诊断需要与患者的肺内炎性病变的检测进行鉴别分析，如果患者有非常明确的创伤史，特别是在患者受创时发生的昏迷等症状，在对于肺撕裂伤患者的实际诊疗中发现 9，必须与球形肺炎、肺部肿瘤以及肺囊肿等疾病进行区别，在有创伤史的多发性肺血肿，多与肺气囊肿或肺液气囊肿相伴，并且一般的患者在短期复查时会出现缩小的情况，病灶部位周围常见肺挫伤。至于临床上比较严重的创伤性液气囊肿在鉴别的同时需要仔细区分开与肺囊肿合并感染、空洞型肺癌、肺脓肿以及肺结核空洞等疾病，且患者的病灶部位多位于临近胸膜处，另外，在对于创伤性肺气囊肿的诊断鉴别中，则需要区分与肺囊
46、肿、肺大泡的区别，通常患者肺部会出现椭圆形或是长条状的团块伪影，在明确外伤史及诊断治疗后复查，无明显改变。目前临床上对于肺撕裂伤主要以 X 线胸片和多层螺旋 CT 为主要的诊断依据 13，但 X 线胸片存在的分辨率低、前后重叠没有立体感等缺点使得患者小阴影的显现不明显，给医生患者带来极大的不便 14。多层螺旋 CT 技术的应用，使得临床上对于肺撕裂伤患者可获得形态学详细描述外，是否可以观察患者早期继发性感染引起的肺表面、肺间质及胸膜的改变？ 15是否可以在临床诊断中定量的获得患者早期肺功能状况的详细信息？多层螺旋 CT 技术是一种简便快捷、全面性强、可重复操作、方便实用的医学上的一种影像学检查
47、方式 16，这种技术也是现代临床医学上各大医院检查肺撕裂伤患者的一种重要的诊断方式，通过多层螺旋 CT 技术，可以清晰地观察到患者的肺部组织内的空腔的大小、分布、形态及其演变的变化规律，对于肺撕裂伤患者而言，诊断时快速有效，复查时，可以避免漏诊或误诊，安心放心 17。本课题选择 2014 年 6 月份我院收治的 60 例外伤患者为研究对象，均对其使用多层 CT 机进行胸部平扫，观察并记录所有患者的病变情况，并以此来进一步研究分析多层 CT 扫描技术应用于肺撕裂伤中的临床表现及其应用价值的探讨。第一部分多层螺旋 CT 对肺撕裂研究对象的临床表现研究临床上常见的外伤中，胸部创伤已成为一种普遍创伤
48、19，其中肺撕裂伤是胸部创伤的一种特殊表现疾病，医学上通常通常采用 CT 诊断和动态观察来判断患者受伤情况。目前，临床上逐渐推广使用的多层螺旋计算机体层扫描(multi-spiral computed tomography, MSCT)技术越来越多的运用到肺撕裂伤患者的诊断分析中 20，许多人针对于肺撕裂患者借助 MSCT 进行观察对象的诊断，仅仅只是作为一种有效于 X 线胸片的诊断辅助手段。在肺撕裂伤患者中局部的肺组织已经开始发生一定程度的损害，为了能及时的对患者的病情做出合理有效的诊断，除了临床上基本的根据患者的身体特征和表现症状以外，可以借助拥有强大的后处理功能的 MSCT 技术对患者进
49、行损害部位的定位及定量分析，详细的了解到患者的肺组织的损害程度情况，这样也就更加直观的了解了患者肺表面以及内部组织的病理性变化，从而为肺撕裂患者的早期治疗提供更加客观的诊断依据，并通过对研究数据的分析讨论肺撕裂伤的 CT 表现特点 21，并以此来加深对肺撕裂伤的认识。1 资料与方法1.1 研究对象选择 2014 年 6 月份我院收治的 60 例外伤患者为研究对象，其中男 37 例，女 23 例，年龄 16-58 岁，平均年龄（2612）岁，其中坠落伤患者 22 例，车祸伤患者 26 例，撞击伤患者 12 例。患者临床表现：大部分患者意识清醒，多为复合创伤；小数患者出现意识不清、失血性休克及呼吸困难等，多为高空坠落或车祸造成；无严重患者出现死亡情况。所以患者为均在 2h 内进行对其使用多层 CT 机进行胸部平扫，观察并记录所有患者的病变情况。根据临床治疗后，36 例患者进行 CT 复查，32 例患者进行 X 线复查。排除标准：有毒气物质接触史，患有肺部影像学检查诊断的疾病或接尘、非接尘引起的肺功能异常性疾病。1.2 检查方式及设备1）准备工作实验前首先要做好患者在检查前的准备工作，操作人员要认真仔细的查看试验中所用的配套设备和实验仪器是否正确，开机是否正常等，设备的参数设置一定要恰当，顺序一定要按
