正常成年人骶管内硬膜外脂肪的MRI研究

目的:利用磁共振成像,建立健康成年人骶管硬膜外脂肪的正常值范围,为临床诊断提供参考基础及影像依据。方法:选择164例正常成年人(平均年龄41.4岁)行腰骶椎磁共振(MRI)扫描,分别测量骶椎各水平前、后硬膜外脂肪(AEF、PEF)的厚度,获得均数及标准差,并以性别、年龄及体重指数分组,进行组间比较及相关因素分析。结果:T1WI正中矢状面上S1~S5水平,硬膜外脂肪厚度平均值依次为6.97 mm、4.94 mm、5.53 mm、5.02 mm及3.86 mm,呈显著下降趋势。结论:本研究为临床确诊硬膜外脂肪增多、寻找神经根受压原因及骶管麻醉时入路方式的选择提供了重要的影像学参考标准。     

椎管内硬膜外非霍奇金恶性淋巴瘤一例

患者　男 ,5 6岁。腰腿痛 1年。ＣＴ检查 :腰5椎体上缘至骶1椎体中段水平椎体后缘一弧形软组织肿块 (图 1) ,后突出最大径 9ｍｍ ,ＣＴ值± 5 6ＨＵ ,压迫硬膜囊变形 (图 2 )。椎管内有效矢状径最小为 6ｍｍ ,在腰5～骶1椎间隙水平 ,该肿块与椎间盘分界不清 ,增强检查椎管内肿块轻度强化 ,ＣＴ值达 76ＨＵ。ＣＴ诊断 :腰5～骶1椎管内肿瘤。图 1　腰5 椎体后缘软组织肿块　图 2　椎管内肿块后缘压迫硬膜囊变形　图 3　病理诊断为非霍奇金恶性淋巴瘤作者单位 :2 50 1 0 1济南 ,武警山东总队医院ＣＴ室 (刘禄明 ) ,病理科 (窦传明 ) ;铁道部第…     

硬脊膜囊止点位置与止点上移征的MRI研究

目的：测量正常成人硬膜囊止点位置,探讨其对硬膜外脂肪症的诊断价值。方法：随机选择200例（男女各100例）腰骶椎MRI片，在矢状面T1WI上测量硬脊膜囊止点与腰骶椎椎体的相对位置。再以测量结果为标准，前瞻性分析9例（男4例，女5例）硬脊膜囊止点上移者，及60例（男女各30例）硬脊膜囊止点在正常范围内的硬脊膜囊末端横断面形态。结果；全组硬脊膜囊止点中位数为S2椎体上缘平面，男性组为S2椎体中部平面，女性组为S1椎体下级平面，女性硬脊膜囊止点位置比男性高（x^2=73．138，P＜0．01）。9例硬膜囊止点上移者，3例符合硬肖膜外脂肪过多症。60例硬脊膜囊止点正常者，未发现硬脊膜外脂肪过多症。结论：硬脊膜囊止点上移征对腰骶段硬脊膜外脂肪过多症具有较大诊断价值。     

正常国人腰段椎管内硬膜外背侧脂肪含量的影响因素分析

目的：探讨正常国人椎管内硬膜外背侧脂肪含量的相关影响因素。方法：在 MRI 正中矢状面图像上统计263例正常国人腰段椎管硬膜外背侧脂肪厚度,计算其中120例相应层面椎管前后径,同时计算其中50例的体重指数。将263例分为青壮年组（18～59岁,207例）和老年组（≥60岁,56例）;腰椎生理弯曲度分为三级,即明显变直、轻度变直和正常曲度。结果：腰段硬膜外各节段背侧脂肪含量均与体重指数、椎管前后径及生理弯曲度呈正相关;老年组 L3／4节段硬膜外背侧脂肪含量厚度小于青壮年组,其余节段两组间差异无统计学意义（P ＞0．05）;不同性别间硬膜外背侧脂肪厚度差异无统计学意义（P ＞0．05）。结论：正常国人腰段椎管内硬膜外背侧脂肪含量与体重指数、椎管前后径及腰椎生理弯曲度相关,与年龄、性别无相关性。     

中重度腰骶部硬膜外脂肪增多与临床腰腿痛症状相关性的MRI研究

目的 探讨中重度腰骶部硬膜外脂肪增多的发生率及其与临床腰腿痛症状的相关性.方法 回顾性分析6921例腰骶椎MRI影像,根据腰骶部硬膜外脂肪分级标准,将中重度硬膜外脂肪增多者列为研究对象,统计其发生率、与性别和年龄的关系.另外,按有无腰腿痛症状将患者分为有症状组和无症状组,研究中重度硬膜外脂肪增多与腰腿痛症状的相关性.结果 6921例中,中重度腰骶部硬膜外脂肪增多患者发生率为2.76％,其中男性和女性发生率分别为3.84％和1.79％,男性发生率明显高于女性;各年龄组间中重度腰骶部硬膜外脂肪增多发生率无统计学意义.症状组中重度硬膜外脂肪增多发生率2.21％,无症状组5.93％,症状组发生率低于无症状组.症状组中96.15％的病例有明确的腰骶部骨和/或椎间盘异常,包括椎间盘病变或退变者70.77％,椎管狭窄37.69％,小关节病变29.23％,黄韧带肥厚23.84％,退变或峡部不连椎体滑移9.23％和椎体终板炎8.46％.中重度腰骶部硬膜外脂肪增多硬膜囊末端位置多位于腰5、骶1水平,症状组与无症状组间无明显统计学差异.结论 腰骶部中重度硬膜外脂肪增多在腰腿痛患者及无症状人群中较常见,尤其在男性患者中具有较高的发生率.该现象与年龄和临床腰腿痛症状无明确相关性.只有在MRI横断位显示硬膜囊变形,而患者缺乏其他影像学异常能够解释临床腰腿疼症状时,腰骶部硬膜外脂肪增多现象才需要考虑硬膜外脂肪增多症的可能性.     

应用MRI对腰椎峡部断裂后相关解剖位置改变的基础研究

目的：对L5峡部裂病例的MRI正中矢状面图像进行形态学测量，探讨L5峡部裂患者腰椎各部的移位情况。方法：在腰椎正中矢状面T1WI上建立以S1后上缘为原点，通过S1前上缘和后上缘的直线为X轴的平面直角坐标系，对45例L5峡部裂患者(无滑脱组15例，滑脱组30例)及100例健康成人腰椎各点的坐标进行测量，并对所得数据进行统计分析。结果：与正常组比较，无滑脱组及滑脱组L5棘突基底部的横坐标显著增大、纵坐标显著减小。无滑脱组L4水平各测量点及L5椎体各测量点(L5椎体前下缘除外)的横坐标与正常组比较均无显著差异，L5水平硬膜囊前、后缘的横坐标较正常组显著增大。滑脱组L4、L5水平各测量点(L5棘突基底部除外)的横坐标显著小于正常组。峡部裂组上述各点的横坐标与L5椎体后下缘的横坐标呈线形相关。无滑脱组及滑脱组的L5椎体下缘水平椎管前后径、硬膜囊前间隙及硬膜囊后间隙显著增宽。结论：L5峡部裂患者滑脱前期L5椎弓断端后部向后下移位，L5椎体层面硬膜囊轻度后移。滑脱期除L5椎弓断端后部向后下移位以外，L4椎体及附件、硬膜囊均随L5椎体向前移位。上述空间位置的变化是造成峡部裂患者形态学改变的基础。     

椎体终板信号变化与硬膜外注射微创治疗腰椎间盘突出效果的关系

目的：研究椎体软骨终板信号变化和硬膜外注射微创治疗腰椎间盘突出的手术效果的关系。方法：59例L1/4～L5／S1椎间盘突出并行硬膜外注射微创治疗的患MR检查，用矢状位T。WI和T：WI评价椎体软骨终板的信号变化。在T2WI图像上将软骨终板分为9个区域来测量信号变化的强度和分布。硬膜外注射微创治疗的效果用Oswestry功能障碍指数在治疗前，治疗后和3个月复查时分别评价。在35例患的亚组中终板信号变化的分布和强度同Oswestry功能障碍指数有相互关联性。结果：腰椎间盘突出的椎体软骨终板信号变化比无椎间盘突出的椎体终板信号明显增高（P〈0．001）。虽然信号变化的强度并不依赖于性别，但是随着年龄增长信号变化强度有明显的增高。硬膜外注射微创治疗的效果并不与患的性别和年龄以及椎间盘突出的类型有关。     

脊髓纵裂畸形并脊髓栓系一例

患者　女 ,2岁。小便失禁 2年 ,便秘 2年。会行走晚 ,易呕吐。体检 :颅神经未见异常 ,双下肢肌力、肌张力正常 ,双侧病理反射未引出 ;胸 5、6椎体水平及腰 5至骶 3椎体水平脊柱后凸。MR检查 :见脊髓及终丝中间分离 ,分离脊髓呈圆形 ,两侧大致均等 ,中间被脑脊液间隔 ,轴面显示最清楚 (图 1) ,MR脊髓成像见脊髓分裂始自胸 11椎体水平 ,分离脊髓呈低信号 ,位于同一硬膜囊内 ,于腰 5椎体上缘水平硬膜囊被分隔为左右均等的两部分 ,双侧肾盂肾盏扩张积水 ,尤以左侧为著 (图 2 ) ;脊髓低位 ,圆锥位于第 4腰椎上缘水平 ,终丝粗短 ,脊髓受牵拉变直…     

骶管裂孔和骶后孔穿刺点的应用研究

 目的 为骶管裂孔、骶后孔穿刺点提供解剖测量数据.方法 取成人骶骨137块,观测骶角、骶管裂孔和骶后孔的形态及位置.结果 左右侧骶角同高者占70.8%;不同高者占24.8%;扁平不显占4.4%.骶管裂孔高(18.3±8.6)mm,宽(10.5±2.7)mm.在后正中线上,骶角间点至S2后孔间点为(53.0±8.4)mm,S2后孔间点至S2后孔点为(20.5±2.8)mm.结论 骶管裂孔穿刺点为骶管麻醉常用进针点.对钩形骶骨、骶管中部狭窄、一侧阻滞麻醉不全、只需一侧阻滞麻醉以及经骶后孔穿刺骶管疗法,宜用骶后孔穿刺点.     

正常成人垂体的磁共振测量研究

目的:观察正常垂体形态、测量其大小并探讨其与年龄、性别的变化关系。方法:选取300例非鞍区病变及内分泌症状的正常成年人。按性别、年龄分为5组:20~29岁组,30~39岁组,40~49岁组,50~59岁组及60岁以上组,每组男女各30例,MRI测量矢状位腺体及后叶前后径、高径以及垂体柄前后径;冠状位腺体宽径、高径及垂体柄宽径;比较分析不同性别、年龄段上述各径线MR测量值的变化特点。结果:成人男、女正常垂体冠状高径分别为(4.01±1.08)mm、(3.99±1.37)mm,冠状宽径分别为(9.75±1.63)mm(、10.17±1.59)mm;矢状高径分别为(4.46±1.24)mm(、4.68±1.61)mm;前后径分别为(10.15±1.51)mm(、10.24±0.90)mm;垂体后叶矢状高径分别为(4.01±1.43)mm(、4.59±1.17)mm,前后径分别为(2.01±0.66)mm、(1.98±0.70)mm;垂体柄冠状宽径分别为(1.56±0.21)mm、(1.59±0.21)mm,前后径分别为(1.50±0.23)mm、(1.52±0.22)mm。垂体高径在20~29年龄组最大,有随年龄增大而逐渐减小趋势;垂体宽径及前后垂体后叶及垂体柄各径线有先增大后减小趋势。结论:成人垂体各径线随年龄的变化有先变大后减小趋势。各径线与年龄有一定统计学差异而与性别无明显统计学差异。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.