MRCP评价胰管扩张的研究进展

胰管扩张可见于胰腺癌、十二指肠乳头癌、胆总管末段癌、壶腹癌、胰腺导管内乳头状黏液性肿瘤、胰腺炎、胰腺假性囊肿、Oddi括约肌功能障碍、胰腺损伤、胰腺分裂、环形胰腺、胰腺结核、腹主动脉瘤、寄生虫感染等疾病,通过对磁共振胆胰管成像(MRCP)上扩张胰管形态、程度、部位、梗阻端形态等的分析,可鉴别胰管扩张的病因。     

磁共振胆胰管成像显示分支胰管扩张的意义

目的 探讨分支胰管扩张的磁共振胆胰管成像(MRCP)表现及其对胰腺疾病的诊断价值.资料与方法 MRCP使用Signa Excite HD 3.0 T MR设备,研究对象为MRCP影像显示分支胰管扩张的病人.包括慢性胰腺炎45例与胰腺癌30例,所有病人均进行常规横断面T1WI、T2wI和MRCP.分析分支胰管扩张的形态、部位及程度,比较2组疾病分支胰管扩张的差异.结果 在形态方面,慢性胰腺炎组分支胰管扩张呈小囊状、分支状及两者兼有的病例数分别为19、42和16例;而胰腺癌组分别为6、29和5例.在部位方面,慢性胰腺炎组分支胰管扩张位于主胰管近段、远段及全程的病例数分别为0、10和35例:而胰腺癌组分别为1、12和17例.结论 3.0 T MRCP能清晰显示主胰管及扩张的分支胰管.认识分支胰管扩张的特征有助于慢性胰腺炎和胰腺癌的鉴别诊断.     

磁共振胆胰管成像显示分支胰管扩张的意义

目的 探讨分支胰管扩张的磁共振胆胰管成像（MRCP）表现及其对胰腺疾病的诊断价值。资料与方法 MRCP使用Signa Excite HD3.0T MR设备,研究对象为MRCP影像显示分支胰管扩张的病人,包括慢性胰腺炎45例与胰腺癌30例,所有病人均进行常规横断面T1WI、T2WI和MRCP。分析分支胰管扩张的形态、部位及程度,比较2组疾病分支胰管扩张的差异。结果 在形态方面,慢性胰腺炎组分支胰管扩张呈小囊状、分支状及两者兼有的病例数分别为19、42和16例;而胰腺癌组分别为6、29和5例。在部位方面,慢性胰腺炎组分支胰管扩张位于主胰管近段、远段及全程的病例数分别为0、10和35例;而胰腺癌组分别为1、12和17例。结论 3.0T MRCP能清晰显示主胰管及扩张的分支胰管。认识分支胰管扩张的特征有助于慢性胰腺炎和胰腺癌的鉴别诊断。     

壶腹周围癌的MR平扫、3D-LAVA技术及MRCP的综合征象评价

目的分析壶腹周围癌在磁共振平扫、三维多期动态增强扫描(3D-LAVA)及胰胆管水成像(MRCP)中的表现,利用3种磁共振检查方法,提高对不同类型壶腹周围癌的诊断及鉴别诊断水平。方法回顾性分析7例经手术病理证实的壶腹周围癌患者的磁共振检查表现,包括在MR平扫、3D-LAVA、3D-MRCP中病变的直接、间接征象及手术可切除性预测。结果不同组织类型病变均见不同程度上肝内外胆系扩张,胆总管末端突然"截断"呈长T1长T2信号,DWI(b=600)呈高信号,胰头癌病变较大,胆管下段癌及壶腹癌较小。3D-LAVA用以分析病变血供情况及与周围组织关系,胆总管下端癌、壶腹癌呈延迟强化,胰头癌呈强化不明显或弱的延迟强化,胰头癌均见肠系膜上静脉受侵。MRCP更好的观察胆胰管扩张情况,胆总管下端癌均见胆管扩张,胰管无扩张;胰头癌均呈"四管征"表现;壶腹癌呈长段伴行并呈聚拢的"双管征"。结论不同组织类型的壶腹周围癌在MR平扫、3D-LAVA及MRCP的征象有一定差异,综合分析3种检查征象有利于壶腹周围癌的诊断及鉴别诊断。     

壶腹周围癌的CT和MRI征象分析

目的：探讨ＣＴ和ＭＲ在壶腹周围癌检测中的应用价值。方法：对３７例经手术病理证实的壶腹周围癌进行回顾性分析,并就其ＣＴ和ＭＲ表现为２５例正常腹部ＣＴ资料作对照分析。结果：壶腹部肿块为壶腹周围癌的主要征象,肿块远端胰腺不同程度萎缩、稀疏,胰后脂肪间隙模糊,胆总管远端和胰管近端间距增宽,ＭＲＣＰ显示扩张胆总管远端呈“鼠尾”状改变等征象,部分壶腹癌不能明确显示肿块,但胆总管远端和胰管近端间距缩小,ＭＲＣＰ     

三维薄层梯度回波动态增强扫描在胰腺疾病中的诊断价值

目的明确三维薄层磁共振小角度快速激发梯度回波序列动态增强扫描在胰腺疾病诊断中的价值.材料和方法对70例经证实胰腺疾病病人进行磁共振检查,采用的扫描序列分别为2D FS-FLASH T1WI、HASTE T2WI和3DFLASH动态增强扫描等.测量肿块与正常胰腺组织信号值,计算胰腺/病灶对比噪声比(CNR).结果动态增强3D FLASH扫描良好显示胰腺疾病的血流动力学特征,胰腺癌各期的CNR值分别为4.46±2.21,12.71±2.91,6.17±1.66,慢性胰腺炎分别为4.15±1.25,9.27±1.38,4.96±10.85,壶腹周围癌分别为5.49±1.35,11.52±2.24,5.55±1.33.30例胰腺癌、11例慢性胰腺炎、14例壶腹周围癌出现胰管扩张.70例胰腺疾病的敏感性为100%(70/70),诊断准确性为98.6%(69/70).结论三维梯度回波序列动态增强扫描能良好显示胰腺病变的解剖细节及血流动力学特征,在胰腺疾病的定性诊断中有较高的应用价值.     

磁共振胰胆管成像形态学分析对慢性胰腺炎与胰腺癌的诊断价值

目的 研究磁共振胰胆管成像(MRCP)对慢性胰腺炎与胰腺癌的诊断价值.方法 分析31例胰腺癌与31例慢性胰腺炎患者的MRCP表现.结果 慢性胰腺炎组的MRCP特征包括: (1)胰管多呈现粗细不均扩张(87.1%),可贯通病灶区(93.5%);(2)胆管扩张者占29%;胆总管远端多呈现锥形狭窄(48.4%)或正常(48.4%),突然截断者少见(3.2%);(3)合并胰管结石(25.8%)及假性囊肿(29%).胰腺癌组的MRCP特征包括: (1)"双管征"多见(67.7%);(2)胰管多呈光滑连续扩张(61.3%),在肿块处突然截断(74.2%);(3)胆管扩张者较多(74.2%),胆总管远端常于胰头或钩突水平突然截断(71%).结论 慢性胰腺炎与胰腺癌的MRCP表现有一定特征,认识这些征象对两者的鉴别诊断有一定帮助.     

壶腹周围癌MRI诊断与鉴别诊断

目的 探讨MR及MRCP成像在壶腹周围癌诊断和鉴别诊断中的价值.方法 回顾性分析经手术病理证实的54例壶腹周围癌病人的MR平扫、增强及MRCP图像,对相关结果进行χ~2检验及两独立样本t检验,并与病理结果相对照.结果 胰头癌32例,7例(21.9%)表现为"四管征";胆总管下段癌16例,9例(56.3%)表现为"三管征".2种征象在胰头癌和胆总管下段癌中差异具有显著性(P<0.05).胰头癌MRI及术中测量肿块最大面积与胆总管直径之比也明显大于胆总管下段癌(P<0.05).结论 MRI和MRCP对壶腹周围癌的诊断具有重要价值.     

同层动态磁共振胰胆管成像的临床研究

目的 :利用动态磁共振胰胆管成像 (MRCP)分别评价Oddi括约肌功能及口服果汁对改善胰管显示方面的作用。方法 :将 3 8例经临床或手术病理证实有胰胆管系统疾病的患者 ,分成三组 :A组 (n =15 )为有壶腹部周围的梗阻性病变伴胆道扩张 ;B组 (n =13 )为有壶腹部以上的梗阻性病变伴胆道扩张 ;C组 (n =10 )为未见明显梗阻性病变但有胆道扩张。各组分别摄取动态MRCP图像并观察括约肌舒张情况 ;19例正常志愿者 ,口服果汁 (Orange lemonjuice ,OLJ)前及口服果汁后 15、3 0、45、60、75、90min分别摄取动态MRP图像。结果 :3 8例患者MRCP图像上 ,胆总管远端出现乳头状 ,逐渐狭窄 ,平头状及倒杯口状 4种改变 ,其中倒杯口状改变仅出现于A组 ,与其它两组间差异有显著性意义 (P <0 .0 5 ) ;乳头状、逐渐狭窄及平头状改变 ,各组间差异无显著性意义。动态MRCP可反映括约肌段舒张频次 ,其在A组与其它两组间差异有显著性意义 (P <0 .0 5 )。正常人口服果汁后MRCP成像显示胰管管径增粗 ,管腔信号强度升高 ,体、尾部胰管的显示率提高。结论 :动态MRCP能很好地评价Oddi括约肌功能 ,提高对壶腹部病变的诊断准确性 ;果汁能促进胰腺外分泌 ,改善胰管显示。     

3.0T MRI对胰腺假性囊肿的研究

目的 研究急性胰腺炎与慢性胰腺炎后胰腺假性囊肿(PPC) 的MRI 特征.资料与方法 回顾分析2007 年-2011 年40 例连续的胰腺假性囊肿病人的临床与影像学资料,2 名有经验的放射科医师比较分析急性胰腺炎与慢性胰腺炎后假性囊肿在不同MR 脉冲序列的影像学表现.观察项目包括病灶部位、大小、边界、形态、壁结节、囊内分隔、囊液信号、囊内碎屑及假性囊肿与主胰管关系.结果 急性胰腺炎后假性囊肿囊内碎屑发生率高于慢性胰腺炎后假性囊肿(χ2=12.931,P=0.000),慢性胰腺炎后假性囊肿与主胰管交通显示率高于急性胰腺炎后假性囊肿(χ2=8.913,P=0.003),且组间差异均有统计学意义.T1WI、T2WI 及磁共振胆胰管成像(MRCP)对PPC 与主胰管交通的显示率分别为12.24%、34.69%、40.82%,其差异具有统计学意义(χ2 =10.716,P=0.005).结论 综合应用各种MR 脉冲序列能够对PPC 做出准确评价.     

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.     

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     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

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.     

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.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

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.