發(fā)布時(shí)間：2018-03-08 06:16

  本文選題：超聲造影　切入點(diǎn)：實(shí)時(shí)三維超聲　出處：《南方醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景： 腎臟位于腎窩,周圍受到腹腔臟器、腰肌、脊柱、膈肌、肋骨的保護(hù),腎臟本身有一定的活動(dòng)度,加上腎周脂肪囊形成的保護(hù)墊緩沖外力,腎臟通常不易受到損傷。但腎臟是一血流量非常豐富的實(shí)質(zhì)性器官,質(zhì)地較脆弱,包膜較薄,當(dāng)受到較強(qiáng)的外力沖擊時(shí)可造成閉合性損傷,尤其在腎臟本身已有病變時(shí),輕微的創(chuàng)傷也可導(dǎo)致嚴(yán)重的自發(fā)性腎破裂。隨著經(jīng)濟(jì)社會(huì)的發(fā)展,交通事故傷、高處墜落傷以及各種暴力事件的發(fā)生,使得腎損傷的發(fā)生率大幅上升。據(jù)統(tǒng)計(jì),腎外傷發(fā)生率約占腹部損傷的8%～10%,其中80%～90%為閉合性損傷。及時(shí)、準(zhǔn)確合理地把握手術(shù)指征顯得非常重要,影像學(xué)檢查可為下一步救治措施的選擇提供重要的參考信息。 CT檢查被認(rèn)為是診斷腎創(chuàng)傷的重要及主要的工具,它對腹部閉合性臟器損傷的敏感性高、特異性強(qiáng)、準(zhǔn)確率高,被認(rèn)為是診斷外傷的首選方法。但CT檢查也存在一些缺點(diǎn),尤其是對患者無法避免的放射性損傷；此外,CT儀器移動(dòng)不方便,對于病情不穩(wěn)定的病人不宜做CT檢查；其造影劑的排泄需要一定時(shí)間,短期內(nèi)不能進(jìn)行重復(fù)多次造影等。 超聲以其無創(chuàng)、無輻射、移動(dòng)便捷、實(shí)時(shí)及檢查費(fèi)用低廉、允許多次檢查以動(dòng)態(tài)觀察病情變化等優(yōu)點(diǎn),成為臨床上診斷外傷的常用方法,但常規(guī)超聲對于積液的敏感性高,而對于輕度的腎損傷敏感性則較低,多種因素對其圖像的干擾也較大。 超聲造影技術(shù)的出現(xiàn),大大提高了閉合性腹部實(shí)質(zhì)臟器外傷的診斷率與準(zhǔn)確率,使得超聲在診斷閉合性腹部外傷領(lǐng)域發(fā)揮著越來越重要的作用。然而,二維超聲造影(2D-CEUS)僅能顯示單一斷面的增強(qiáng)信息,無法顯示腎損傷病灶的整體信息。 實(shí)時(shí)三維超聲造影(RT3D-CEUS)是一種新的超聲造影技術(shù),它可動(dòng)態(tài)、實(shí)時(shí)地獲得病灶造影全程的三維灌注信息,但RT3D-CEUS用于外傷方面的研究報(bào)道較少。 第一章RT3D-CEUS診斷兔閉合性腎外傷活動(dòng)性出血的價(jià)值 目的 采用自制迷你型撞擊器(SMS型撞擊器,專利號(hào)為：201220162205.6),對全身肝素化的實(shí)驗(yàn)兔進(jìn)行撞擊,建立閉合性腎外傷活動(dòng)性出血模型,探討實(shí)時(shí)三維超聲造影對兔閉合性腎損傷活動(dòng)性出血的診斷價(jià)值。 材料和方法 一、主要實(shí)驗(yàn)材料 1、實(shí)驗(yàn)儀器：SMS型撞擊器,GE Voluson E8Expert彩色多普勒超聲診斷儀,配備三維成像專用軟件及編碼造影軟件包,RIC5-9D探頭。 2、其他：聲諾維(SonoVue)注射用六氟化硫微泡,3%戊巴比妥鈉,生理鹽水,肝素鈉注射液,靜脈留置針。 二、實(shí)驗(yàn)方法 1.健康新西蘭大耳白兔15只,隨機(jī)分成3組,每組5只,經(jīng)耳緣靜脈注射3%戊巴比妥鈉1ml/kg進(jìn)行麻醉并備皮,取仰臥位固定于動(dòng)物板,于耳緣靜脈留置22G套管針。 2.采用常規(guī)超聲(包括灰階超聲及CDFI)及超聲造影檢查于撞擊前觀察正常的腎臟超聲表現(xiàn)。 3.實(shí)驗(yàn)兔股動(dòng)脈插管接壓力傳感器,經(jīng)耳緣靜脈留置針注射200U/kg肝素鈉,生理鹽水沖管。調(diào)節(jié)撞擊器,使3組實(shí)驗(yàn)兔分別接受77.2N、106.2N、135.1N的力度撞擊單側(cè)腎,建立閉合性腎外傷活動(dòng)性出血模型。 4.于撞擊后行常規(guī)超聲、二維超聲造影及實(shí)時(shí)三維超聲造影檢查,觀察撞擊后損傷腎的超聲表現(xiàn)。 5.動(dòng)態(tài)觀察實(shí)驗(yàn)兔的血壓變化。當(dāng)平均動(dòng)脈壓降至40mmHg以下時(shí),提示實(shí)驗(yàn)兔進(jìn)入休克狀態(tài),處死實(shí)驗(yàn)動(dòng)物,開腹暴露傷腎,評估傷情。結(jié)果 1、15只腎均受到損傷,共制造閉合性腎外Ⅱ傷級損傷2例,Ⅲ級損傷6例,Ⅳ級損傷5例,V級損傷2例。 2、撞擊前,灰階超聲清晰顯示了腎的內(nèi)部結(jié)構(gòu)。CDFI顯示血流灌注良好。2D-CEUS顯示了正常腎血流灌注,未見異常信號(hào)區(qū)。RT3D-CEUS顯示了立體的腎結(jié)構(gòu)及血流灌注信息,未見異常增強(qiáng)或缺失信號(hào)。 3、撞擊后,灰階超聲：傷腎包膜下均可見液性暗區(qū),液性暗區(qū)范圍逐漸增大,腎實(shí)質(zhì)可見局部異�；芈晠^(qū)。CDFI:病灶區(qū)血流信號(hào)中斷,但無法確定出血的部位。2D-CEUS:腎實(shí)質(zhì)損傷區(qū)呈楔形或不規(guī)則形無增強(qiáng)區(qū),與正常腎皮質(zhì)形成強(qiáng)烈對比,可見造影劑自破口向腎外涌出的增強(qiáng)信號(hào)。RT3D-CEUS:實(shí)時(shí)顯示腎損傷病灶,開始呈不規(guī)則凹陷的充盈缺損,之后可見造影劑自損傷病灶向腎外溢出,呈寬帶狀、云霧狀或噴射樣。 4、Ⅱ級損傷的實(shí)驗(yàn)兔約在230min、270min進(jìn)入休克狀態(tài)；Ⅲ級損傷的實(shí)驗(yàn)兔在90min～160min內(nèi)進(jìn)入休克狀態(tài)；Ⅳ級損傷的實(shí)驗(yàn)兔在40min～100min內(nèi)進(jìn)入休克狀態(tài),Ⅴ級損傷的實(shí)驗(yàn)兔在30min、50min內(nèi)進(jìn)入休克狀態(tài)。 結(jié)論 實(shí)時(shí)三維超聲造影可實(shí)時(shí)、立體、逼真地顯示閉合性腎外傷活動(dòng)性出血,可以為下一步救治提供重要的參考信息。 目的 采用自制迷你型撞擊器對實(shí)驗(yàn)兔進(jìn)行撞擊,建立閉合性腎外傷模型,探討實(shí)時(shí)三維超聲造影對兔閉合性腎損傷的診斷價(jià)值。材料和方法 一、主要實(shí)驗(yàn)材料 實(shí)驗(yàn)儀器：自制彈簧式小型撞擊器,GE Voluson E8Expert彩色多普勒超聲診斷儀,配備三維成像專用軟件及編碼造影軟件包,RIC5-9D探頭,Siemens SOMATOM Difinition雙螺旋CT。 其他：聲諾維(SonoVue)注射用六氟化硫微泡,3%戊巴比妥鈉,生理鹽水,碘帕醇非離子型對比劑,靜脈留置針。 二、實(shí)驗(yàn)方法 1.健康新西蘭大耳白兔25只,其中21只隨機(jī)分成3組,每組7只,經(jīng)耳緣靜脈注射3%戊巴比妥鈉1ml/kg進(jìn)行麻醉并備皮,取仰臥位固定于動(dòng)物板,于耳緣靜脈留置22G套管針。另外4只作為正常對照。 2.采用常規(guī)超聲(包括灰階超聲及彩色多普勒超聲)及超聲造影檢查于撞擊前觀察正常的腎臟超聲表現(xiàn)。 3.調(diào)節(jié)撞擊器,使3組實(shí)驗(yàn)兔分別接受77.2N、106.2N、135.1N的力度撞擊單側(cè)腎,建立閉合性腎外傷模型。正常對照組不作撞擊處理。 4.于撞擊后30min內(nèi)完成常規(guī)超聲、二維超聲造影、實(shí)時(shí)三維超聲造影和增強(qiáng)CT檢查,觀察撞擊后損傷腎的不同影像學(xué)表現(xiàn)。 5.檢查結(jié)束后處死實(shí)驗(yàn)動(dòng)物,開腹暴露傷腎,觀察腎表面損傷情況。取出傷腎,沿長軸剖開,觀察內(nèi)部損傷情況。參照美國創(chuàng)傷外科協(xié)會(huì)分級標(biāo)準(zhǔn)評估傷情。 6.以大體病理結(jié)果為準(zhǔn),比較常規(guī)超聲、二維超聲造影、實(shí)時(shí)三維超聲造影、增強(qiáng)CT對腎外傷診斷的敏感性與特異性。 結(jié)果 1、撞擊前,灰階超聲清晰顯示了腎的內(nèi)部結(jié)構(gòu)。彩色多普勒顯示血流灌注良好。二維超聲造影顯示了正常腎血流灌注,未見異常信號(hào)區(qū)。實(shí)時(shí)三維超聲造影顯示了立體的腎結(jié)構(gòu)及血流灌注信息,未見異常增強(qiáng)或缺失信號(hào)。增強(qiáng)CT未見明顯異常。 2、21只腎均受到損傷,撞擊力度越大,損傷級別越高。A組2例為Ⅰ級,4例為Ⅱ級,1例為Ⅲ級；B組1例為Ⅰ級,1例為Ⅱ級,4例為Ⅲ級,1例為Ⅳ級；C組1例為Ⅲ級,4例為Ⅳ級,2例為Ⅴ級。 3、撞傷后,灰階超聲：6例腎實(shí)質(zhì)未見明顯異常,余腎包膜下可見不同程度液性暗區(qū),腎輪廓不完整,腎皮質(zhì)不連續(xù),腎實(shí)質(zhì)見邊界模糊的低回聲區(qū),回聲有逐漸增高趨勢。彩色多普勒超聲：血腫區(qū)可見血流信號(hào)缺失,其中6例血流灌注良好,1例未見明顯血流信號(hào)。二維超聲造影：4例未見明顯異常,1例全程無增強(qiáng),余腎實(shí)質(zhì)內(nèi)可見楔形或不規(guī)則形無增強(qiáng)區(qū)。實(shí)時(shí)三維超聲造影：3例未見明顯異常,1例全程無增強(qiáng),其余傷腎通過調(diào)整不同角度可立體、逼真地顯示出腎損傷病灶的部位、范圍、深度及形態(tài),表現(xiàn)為凹陷型灌注缺失區(qū)。增強(qiáng)CT：實(shí)驗(yàn)組2例行增強(qiáng)掃描失敗,1例未發(fā)現(xiàn)明顯損傷,余傷腎實(shí)質(zhì)內(nèi)可見不同程度、不規(guī)則的充盈缺損區(qū)。 4、常規(guī)超聲、二維超聲造影、實(shí)時(shí)三維超聲造影、增強(qiáng)CT對閉合性腎外傷診斷的敏感性分別為71.4%、80.9%、85.7%、94.7%,準(zhǔn)確性分別為76.0%、84.0%、88.0%、95.7%。結(jié)論 1、我們自制的迷你型撞擊器可建立較穩(wěn)定的、不同損傷級別的兔閉合性腎外傷,該撞擊器具有撞擊部位準(zhǔn)確、操作簡便、重復(fù)性好等優(yōu)點(diǎn),可為閉合性腎外傷的研究提供良好的動(dòng)物模型。 2、實(shí)時(shí)三維超聲造影能實(shí)時(shí)、立體、逼真地顯示閉合性腎損傷的部位、范圍和形態(tài),有望為臨床提供更豐富的診斷信息。
[Abstract]:Research background:
The kidney is located in the renal fossa, surrounded by abdominal viscera, muscle, spine, diaphragm, rib protection, kidney itself has a certain activity, external buffer pad to protect the formation of perirenal fat and the kidneys are not easy to damage. But renal parenchymatous organ blood flow is very rich, texture the envelope is fragile, thin, when subjected to strong external shock caused by blunt trauma, especially in the kidney itself has lesions, minor trauma can cause serious spontaneous renal rupture. With the development of social economy, traffic accident, falling injury and violence, the incidence of renal the injury increased significantly. According to statistics, the incidence of renal trauma accounted for abdominal injury 8% ~ 10%, 80% ~ 90% for closed injury. Timely, accurately grasp the indication of operation is very important, imaging can be saved for the next step The choice of treatment measures provides important reference information.
CT examination is considered to be an important diagnosis of renal trauma and the main tool, its sensitivity to abdominal closed injury with high specificity, high accuracy, is believed to be the first choice for the diagnosis of trauma. But CT also has some shortcomings, especially for patients with radiation injury can not be avoided; in addition, CT the instrument is not convenient to move, for the unstable condition of the patient should not do CT inspection; its excretion of contrast agents need a certain time, the short term can not be repeated angiography.
Ultrasound with its non-invasive, no radiation, mobile and convenient, real-time and cheap, allowing multiple advantages to check the dynamic observation of changes, has become a common method for clinical diagnosis of trauma, but conventional ultrasound for effusion and high sensitivity, and the sensitivity of mild renal injury is low, many disturbing factors on the the image is larger.
Ultrasonic imaging, greatly improving the diagnosis of blunt abdominal trauma and the rate of accuracy, the ultrasound plays an increasingly important role in the diagnosis of blunt abdominal trauma. However, two-dimensional contrast-enhanced ultrasound (2D-CEUS) enhanced information can only display a single section, unable to display the overall information of renal injury lesions.
Real time three dimensional contrast-enhanced ultrasound (RT3D-CEUS) is a new technology of ultrasound contrast. It can dynamically and realtime obtain the whole three-dimensional perfusion information of focal angiography. However, there are few reports on RT3D-CEUS for trauma.
The value of RT3D-CEUS in the diagnosis of closed renal traumatic active bleeding in rabbits
objective
Using the self-made miniature impactor (SMS type impactor, patent number: 201220162205.6), the rabbits of heparinizing the impact, establishment of blunt renal trauma hemorrhage model, to investigate the fault value of real-time three-dimensional contrast-enhanced ultrasound on rabbit closed renal injury diagnosis of active bleeding.
Materials and methods
First, the main experimental materials
1, the experimental instrument: SMS impactor, GE Voluson E8Expert color Doppler ultrasound diagnostic instrument, equipped with 3D imaging software and coded imaging software package, RIC5-9D probe.
2 other: SonoVue (SonoVue) Sulphur Hexafluoride Microbubbles for Injection, 3% pentobarbital sodium, saline, Heparin Sodium Injection, venous indwelling needle.
Two, experimental method
1. healthy New Zealand white rabbits 15, were randomly divided into 3 groups, 5 rats in each group, intravenous injection of 3% pentobarbital sodium 1ml/kg anesthesia and skinpreparation supine fixed on animal plate from the ear vein indwelling 22G trocar.
2. ultrasonography (including gray scale ultrasound and CDFI) and contrast-enhanced ultrasonography were used to observe normal renal sonography before impact.
3., the femoral artery cannula was connected to the pressure sensor in the experimental rabbits. The 200U/kg heparin sodium was injected through the ear vein catheter, and the saline was washed into the tube. After adjusting the impactor, the 3 groups of rabbits were subjected to the impact of 77.2N, 106.2N and 135.1N on the unilateral kidney, respectively, and a closed renal trauma active bleeding pattern was established.
4. after the impact, conventional ultrasound, two-dimensional ultrasound contrast and real-time three-dimensional ultrasound examination were performed to observe the ultrasonic manifestations of the injured kidney after the impact.
5., we observed the change of blood pressure in rabbits dynamically. When the average arterial pressure drops below 40mmHg, it indicates that the experimental rabbits entered the shock state, and the experimental animals were killed, and the kidneys were exposed to expose the kidneys.
All 1,15 kidneys were injured, and 2 cases of closed renal II injury were made, 6 cases of grade III injury, 5 cases of grade IV injury and 2 cases of grade V injury.
2, before the impact, gray scale ultrasound clearly showed the internal structure of the kidney..CDFI showed good blood perfusion..2D-CEUS showed normal renal perfusion. There was no abnormal signal area..RT3D-CEUS showed three-dimensional renal structure and perfusion information, and no abnormal enhancement or deletion signal was seen.
3, after the collision, injury of renal subcapsular gray-scale ultrasound showed liquid dark area, liquid dark area gradually increased, the renal parenchymal.CDFI: visible local abnormal echo lesions blood flow signal interruption, but unable to determine the site of bleeding.2D-CEUS: renal parenchymal damage zone is wedge-shaped or irregular enhanced area, the formation of strong compared with the normal renal cortex, visible contrast to break springs from the extrarenal enhanced signal.RT3D-CEUS: real-time display of renal injury lesions, irregular depression began filling defect, visible after contrast agent damage to renal lesion overflow, a wide band, cloudy or spray.
4, rabbit II injury around 230min 270min into a state of shock; III injury of rabbits in 90min ~ 160min in shock rabbits; IV injury in 40min ~ 100min into a state of shock, V-grade injury in rabbit model of 30min, a state of shock into the 50min.
conclusion
Real time three-dimensional ultrasound imaging is a real time, three-dimensional, and realistic display of closed renal traumatic bleeding, which can provide important reference information for the next treatment.
objective
A self-made Mini impactor was used to impacted the experimental rabbits, and a closed renal trauma model was established. The diagnostic value of real-time three-dimensional contrast-enhanced ultrasound in closed renal injury in rabbits was discussed.
First, the main experimental materials
Experimental instruments: self made spring small impactor, GE Voluson E8Expert color Doppler ultrasound diagnostic instrument, equipped with 3D imaging software and coding and contrast software package, RIC5-9D probe, Siemens SOMATOM Difinition double helix CT..
Other: SonoVue (SonoVue) Sulphur Hexafluoride Microbubbles for Injection, 3% pentobarbital sodium, saline, iopamidol nonionic contrast agent, venous indwelling needle.
Two, experimental method
1. healthy New Zealand white rabbits 25, of which 21 were randomly divided into 3 groups, 7 rats in each group, intravenous injection of 3% pentobarbital sodium 1ml/kg anesthesia and skinpreparation supine fixed on animal plate from the ear vein indwelling trocar. The other 4 22G rats as normal control.
2. conventional ultrasound (including gray scale and color Doppler ultrasound) and contrast-enhanced ultrasonography were used to observe normal renal sonographic findings before impact.
3., adjusting the impactor, the 3 groups of rabbits were subjected to the impact of 77.2N, 106.2N and 135.1N on the unilateral kidney respectively, and a closed renal trauma model was established.
4., we performed routine ultrasound, two-dimensional ultrasound, real-time three-dimensional contrast-enhanced ultrasound and enhanced CT scan after 30min, and observed the different imaging findings of renal injury after impact.
5. after the end of the examination, the experimental animals were sacrificed, and the kidneys were exposed to expose the kidneys. The surface damage of the kidneys was observed. The injured kidneys were removed, and the internal injuries were observed along the long axis.
6. the sensitivity and specificity of CT in the diagnosis of renal trauma were enhanced with general pathological results, compared with conventional ultrasound, two-dimensional ultrasound contrast, and real-time three-dimensional ultrasound contrast.
Result
1, before the impact, gray scale ultrasound clearly showed the internal structure of the kidney. Color Doppler showed good blood perfusion. 2D ultrasound angiography showed normal renal perfusion, no abnormal signal area. Real time three-dimensional ultrasound angiography showed that the renal structure and blood perfusion information of three-dimensional, no abnormal enhancement or lack of enhanced CT no obvious signal. Abnormal.
2,21 kidneys were all injured. The greater the impact force was, the higher the injury level was. The higher the injury level was, the higher the injury level was, the 2 cases in group.A were grade I, 4 cases were grade II, 1 cases were grade III, 1 cases in group B were grade I, 1 cases were grade I, 1 cases were grade II, 4 cases were grade III, 1 cases were grade IV, 1 cases in group C were grade III, 4 cases were grade IV, 2 cases were grade V.
3, injured, ultrasound: 6 cases of renal parenchyma had no obvious abnormalities, residual renal subcapsular showed different degrees of liquid dark area, the outline of the kidney is not complete, renal cortical discontinuity, renal parenchyma see fuzzy boundaries hypoechoic echo has increased gradually. The color Doppler ultrasound: hematoma area blood flow signal loss among them, 6 cases of good blood perfusion, 1 cases had no obvious blood flow signal. Two dimensional ultrasound angiography: 4 cases had no obvious abnormalities, 1 cases of the whole no enhancement, more than renal parenchyma wedge or irregular area. No enhancement of real-time three-dimensional contrast-enhanced ultrasound: 3 cases had no obvious abnormalities, 1 cases of the whole no enhancement, rest renal injury by adjusting the different angle of stereo, vividly shows the renal injury lesion site, scope, depth and shape, is concave. The deletion region of enhanced CT perfusion: experimental group 2 cases underwent enhanced scan failed, 1 cases without obvious damage, residual renal parenchyma injury There are different, irregular filling defects.
4, the sensitivity of conventional ultrasound, two-dimensional ultrasound and real-time three-dimensional contrast-enhanced ultrasound to enhance the diagnostic value of CT for closed renal trauma is 71.4%, 80.9%, 85.7%, 94.7%, respectively, and the accuracy is 76%, 84%, 88%, 95.7%. respectively.
1, our self-made Mini impactor can establish a relatively stable and different injury level of closed renal trauma in rabbits. The impactor has the advantages of accurate location, simple operation and good repeatability. It can provide a good animal model for closed renal trauma research.
2, real time three-dimensional ultrasound imaging can show the location, range and shape of closed renal injury in real time, stereoscopic and realistic. It is expected to provide more informations for clinical diagnosis.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692;R445.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 吳紅濤,麻曉林,蔣耀光;實(shí)驗(yàn)性胸腹撞擊傷動(dòng)物模型的建立及其傷情特點(diǎn)研究[J];創(chuàng)傷外科雜志;2004年04期

2 唐毅;全學(xué)模;;超聲靜脈聲學(xué)造影評價(jià)腎外傷血腫的實(shí)驗(yàn)研究[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2007年08期

3 朱震宇;黃志強(qiáng);張愛群;董家鴻;;腹部多發(fā)臟器傷模型的建立及評價(jià)[J];解放軍醫(yī)學(xué)雜志;2009年09期

4 孫曉龍;段君華;岳偉東;石紅春;張德川;;超選擇性腎動(dòng)脈造影與栓塞在急診腎外傷中的應(yīng)用價(jià)值[J];中國介入影像與治療學(xué);2006年06期

5 張紅霞;張惠琴;項(xiàng)東英;劉冬梅;顏丹;王立淑;邢錦;何文;;超聲觀察犬急性腎損傷[J];中國介入影像與治療學(xué);2010年06期

6 鄭元義;冉海濤;;歐洲臨床超聲造影指南(2008)[J];臨床超聲醫(yī)學(xué)雜志;2008年07期

7 羅福成;二次諧波成像技術(shù)臨床應(yīng)用進(jìn)展[J];人民軍醫(yī);2001年05期

8 羅福成;三維超聲成像技術(shù)的基本原理及操作步驟[J];人民軍醫(yī);2001年06期

9 羅福成;三維超聲成像技術(shù)的基本原理及操作步驟[J];人民軍醫(yī);2001年07期

10 唐智中;鈍性腎損傷的CT表現(xiàn)及診斷價(jià)值[J];實(shí)用放射學(xué)雜志;2000年10期

，

本文編號(hào)：1582743