耳鼻喉课件：如何减少漏诊.ppt

突发乏力、出冷汗 全面了解疾病的特征 女，鼻塞一年 检查的关注点不准确 男，45岁， 上腹不适2月， 黄疸2周。 成像的基础知识不扎实 窗技术 1mm 5mm 层厚 培养良好的阅片习惯 性格缺陷 小结 对于影像科医师而言， 影像解剖、病理、临床特点等全面的学习是避免漏诊的关键。 责任感是医生的基本素质！ E-mail: cjr.gongruozhen@* * * 腭帆提肌肿胀-早期鼻咽癌的征象，左侧脂肪间隙反折消失 （91％）咽隐窝变浅消失，腭帆提肌肿大 * * 外：鼓膜松弛部；内：锤骨颈。 下：锤骨短突；顶：锤外韧带。 * 单孔缺如，前庭神经孔融合 * 对其他病变的评估十分重要，颞骨CT检查包括轴位、冠状位及面神经管斜矢状位。 突发肢体活动障碍 * * (a) Nonenhanced CT scan obtained 5 hours after the onset of stroke in a 65-year-old woman with MCA occlusion demonstrates obscuration of the lentiform nucleus (long white arrow) and of the head of the caudate nucleus (arrowhead) as well as hypoattenuation of the insular ribbon (short white arrow) and effacement of the sulci of the temporoparietal MCA territory (black arrows). (b-d) Color maps of TTP (b), CBF (c), and CBV (d) demonstrate a ribbon-shaped area of nonperfusion (small white arrows) and markedly reduced perfusion in the residual MCA territory. The reduction of CBF and CBV appears to be more severe in the temporoparietal MCA territory (arrowhead) than in the frontal territory (large arrow). (e, f) Image and graphs illustrate TACs obtained within the superior sagittal sinus (1), normal brain parenchyma (2), the anterior part of the MCA territory (3), the temporoparietal MCA territory (4), and a nonperfused area (5) and compared with a TAC obtained within a branch of the MCA. Enhancement starts approximately 5 seconds later in the superior sagittal sinus than in the MCA. Although the maximum slopes of the TACs are nearly identical, maximum enhancement is much higher within the large superior sagittal sinus due to less partial volume effects. The reduction of the maximum slope in the anterior part of the MCA territory compared with the superior sagittal sinus and the normal brain parenchyma is compatible with moderately reduced blood flow. There is further reduction of the maximum slope and decreased maximum enhancement in the temporoparietal MCA territory compared with the normal brain parenchyma.