脑胚胎癌影像学诊断及鉴别诊断

目的:探讨脑胚胎癌的MRI、CT表现特征及其诊断价值.方法:通过回顾性分析经手术病理证实4例脑胚胎癌MRI及CT表现并复习文献,总结MRI及CT影像特征.结果:CT表现为不均匀等密度或稍高密度影,MRI表现为T1WI不均匀低信号、T2WI混杂高信号影,增强扫描呈不均匀显著强化.早期无明显占位效应,晚期肿瘤内可有不同程度坏死、囊变及出血.结论:脑胚胎癌MRI及CT表现具有特征性,其影像学诊断需结合临床,必要时需行诊断性放、化疗.     

睾丸原发性淋巴瘤的CT及MRI表现(附5例报告)

目的 分析睾丸原发性恶性淋巴瘤CT及MRI表现以提高对该病的认识.方法 回顾性分析5例经手术病理证实的睾丸原发性恶性淋巴瘤的CT及MRI表现.4例行CT平扫及增强扫描.1例行MRI横断面、冠状面及矢状面平扫及增强扫描.结果 CT表现,肿块边缘基本清楚,平扫密度相对均匀,增强后轻度强化,密度欠均匀或明显不均.MRI表现T1WI呈较均匀等信号,T2WI呈均匀低信号,增强扫描后有轻度均匀强化.其他表现,易侵犯附睾和精索,同时伴有腹膜后淋巴结受累,包绕推移血管,呈漂浮征.结论 睾丸原发性恶性淋巴瘤CT/MRI表现有一定的特征性.     

MRI在原发性输卵管癌临床分期中的应用价值

目的探讨MRI在原发性输卵管癌临床分期中的应用价值。方法回顾性分析9例经手术病理证实的输卵管癌患者的MRI资料,将肿瘤的定位、局部浸润、淋巴结转移、腹膜转移及远处转移等影像学表现,与手术所见、病理结果及临床分期相结合进行分析。结果本组9例均为单侧(左6例/右3例),腹盆腔积液5例,仅盆腔积液1例,子宫/卵巢受累7例,盆腔其它脏器受累6例,盆腔外腹膜种植转移5例,淋巴结阳性3例,远处转移1例。影像学分期IA期2例,IIA期1例,IIB期1例,IIIC期5例。淋巴结阳性诊断正确率75%,其余上述影像学表现及分期的诊断符合率均为100%。结论 MRI增强检查对原发性输卵管癌周围结构的侵犯及远处转移情况,均能清楚、准确显示,从而指导临床制定适合患者的手术方案。     

肾集合管癌的CT和MRI诊断

目的:分析肾集合管癌的CT和MRI表现,提高对肾集合管癌诊断的准确性.方法:回顾性分析7例经病理证实的肾集合管癌的临床表现、影像学及病理学特征.其中5例行CT平扫及增强扫描,2例行MRI平扫及增强扫描.结果:7例中男4例,女3例.年龄44～76岁,中位年龄58岁.肿瘤位于左肾5例,右肾2例.肿瘤直径3.6～6.7cm,平均5.2cm.7例均是实性肿块,形态不规则、边界不清.5例肾脏轮廓改变.CT平扫为等密度,T1WI为等或稍高信号,T2 WI为低信号,密度或信号多不均匀,内可见片状坏死区,增强后呈轻度不均匀延迟强化.5例有腹膜后淋巴结肿大,其中1例有同侧肾上腺转移,1例有颈部淋巴结转移.3例有肾静脉癌栓形成.结论:肾集合管癌的CT和MRI表现有一定的特征性,在肾内出现以髓质为中心、边界不清、增强后轻度延迟强化肿块,早期即有淋巴结转移时应考虑此病的可能.     

肾盂癌MRI表现

目的:分析肾盂癌的MRI信号特点。方法:搜集有完整临床资料及经病理证实的肾盂癌32例,均作T1WI、T2WI、STIR序列检查,其中15例作MRI动态增强检查,层厚/间距:8/0mm。必要时为4/0mm。结果:移形上皮细胞癌28例,鳞状上皮细胞癌3例,腺癌1例。T1WI均匀低信号21例,混杂信号7例,均匀等信号4例。T2WI均匀高信号20例,混杂高信号7例,等信号5例。腹膜后淋巴结转移5例,肾门淋巴结转移2例。注入对比剂后,皮质期均匀强化10例,不均匀强化5例;实质期及肾盂期13例病灶强化程度几乎没有改变,2例增强程度明显提高。MRU,肾盏饱满积水6例,肾盂积水扩张4例,肾盂内充盈缺损影3例。结论:仔细分析病灶信号特点,MRI能够准确诊断肾盂癌且能了解向肾实质及远处转移情况。     

睾丸副睾肿块的CT和MRI表现

目的探讨睾丸副睾肿块的CT和MRI影像学表现。方法回顾性分析20例经手术病理证实的睾丸副睾肿块,其中3例行CT平扫及增强扫描,3例行CT直接增强,8例行MRI平扫及PWI动态增强,6例行MRI平扫,然后观察肿块的分布、形态大小、境界、内部结构、强化特点及周围侵犯转移情况及影像学显示方法,并与病理结果对比。结果病理结果示21个睾丸副睾肿块,睾丸肿块18例,副睾肿块2例,恶性肿块12例(精原细胞瘤5例,胚胎性癌3例,畸胎瘤1例,淋巴瘤1例,附睾横纹肌肉瘤1例,阴茎根部原始神经胚叶肿瘤1例),良性肿块8例(畸胎瘤1例,睾丸间质细胞瘤2例,非异性炎性肿块1例,结核1例,表皮样囊肿2例,单纯囊肿1例);恶性肿块4个局限睾丸,8个累及被膜及附睾,良性肿块1例累及附睾。影像学结果示恶性肿块直径平均大于50mm,肿块大多实性结节状,结节间纤维分隔,肿块强化不均匀,其中3例向周围侵犯及伴淋巴结转移;良性肿块直径平均小于20mm,肿块部分强化不均匀,较少伴淋巴结转移。MRI多序列及灌注检查,分辨肿块内、外组织成分,周围组织累及情况,鉴别肿块良、恶性方面优于CT检查。结论睾丸副睾肿块CT、MRI表现有一定特征,CT、MRI检查有助于诊断及鉴别诊断,对提示其良、恶性有意义。     

阴茎癌的CT诊断价值

目的 探讨阴茎癌的CT表现及其诊断价值.资料与方法 回顾性分析12例经手术病理证实的阴茎癌患者的CT表现.结果 CT表现为阴茎头不规则分叶状或菜花状软组织肿块,密度均匀,肿瘤直径1-9 cm不等,平均3.5 cm.增强扫描动脉期病变呈中度强化,此期显示肿瘤侵犯深度更加清楚,7例显示阴茎海绵体受累,1例阴茎根部皮肤受累.8例淋巴结转移,其中双侧转移5例,单侧转移3例(右侧2例,左侧1例).12例患者中均未发现盆腔淋巴结及其他脏器转移.结论 CT可显示阴茎癌原发肿瘤的大小、形态及对阴茎侵犯深度,同时可显示淋巴结及远处转移情况,为临床制定治疗方案提供参考.     

节细胞神经瘤的CT、MRI诊断

目的 探讨CT和MRI在诊断节细胞神经瘤中的价值.方法 回顾性分析19例经病理证实的节细胞神经瘤患者的CT和MRI影像学表现及临床资料,其中15例行CT增强扫描,4例行MRI扫描(3例增强).结果 所有病灶均为单发.1例位于颈部,7例位于后纵隔,3例位于腹膜后间隙,8例位于肾上腺.边界均清楚,形态多呈椭圆形或不规则形.CT平扫呈均匀或不均匀低密度,动脉期无明显强化,静脉期呈渐进性不均匀强化.4例病灶内见斑点状、结节状钙化.MRI表现为T1WI低信号,T2WI不均匀高信号为主,增强后不强化或轻度强化.2例病灶内呈现"漩涡征".结论 节细胞神经瘤的生长方式及影像学表现具有一定的特征性,CT延迟增强及MRI扫描对其诊断和鉴别诊断有很大的价值.     

儿童睾丸肿瘤的CT诊断

探讨CT在儿童睾丸肿瘤诊断中的应用价值。材料和方法：回顾性分析经手术和病理证实的28例儿童睾丸肿瘤的组织病理、临床特点和CT表现。结果：良性畸胎瘤16例，内胚窦瘤7例，胚胎细胞癌5例。总体发病年龄平均14个月；良性畸胎瘤和内胚窦瘤分别为12个月和14个月，差异无显著性意义（P〉0．05）；胚胎细胞癌49个月，和前两者差异有显著性意义（P〈0．05）。内胚窦瘤和胚胎细胞癌患者的血清甲胎蛋白值明显升高，和良性畸胎瘤患者的差异有显著性意义（P〈0．05）。CT平扫5例良性畸胎瘤含钙化、脂肪成分，具有特征性，其余平扫CT征象在3种肿瘤中的差异无显著性意义（P〉0．05）。增强后内胚窦瘤和胚胎细胞癌均显著不均匀强化，而良性畸胎瘤多轻度均匀强化或无强化，差异有显著性意义（P〈0．05）。7例内胚窦瘤中肺部转移1例。5例胚胎细胞癌中同侧精索增粗伴明显强化2例，其中1例伴后腹膜淋巴结肿大。1例内胚窦瘤和3例胚胎细胞癌患者术后进行了为期1年的随访，血清甲胎蛋白、盆腹腔CT和胸部x线平片均正常。结论：CT扫描并与临床资料相结合，在鉴别儿童睾丸肿瘤良恶性、肿瘤术前分期和术后随访方面具有重要价值。     

腹膜后良性神经鞘瘤的影像学特征

目的分析腹膜后良性神经鞘瘤的 CT 和 MRI 表现,总结其影像学特征.资料与方法经手术病理证实的27例腹膜后良性神经鞘瘤患者中,21例行多层螺旋 CT 检查,9例行 MRI 检查.观察 CT、MRI 平扫和增强时肿瘤的特征性改变.结果27例腹膜后良性神经鞘瘤边缘规则光整,直径多在5~10cm之间,CT 平扫肿瘤呈实性或囊实性.CT 增强后动脉期轻至中度强化10例,主要呈云絮状、索条状强化;动脉期9例可见纤细血管显影.门脉期及延迟扫描轻度渐进性强化13例.MRI 平扫呈不均匀长 T1长 T2影,DWI 呈高信号,4例可见靶征改变,增强后门脉期及延迟呈渐进性强化.无一例发生淋巴结转移.结论腹膜后良性神经鞘瘤影像学表现具有一定特异性,CT 结合 MRI 检查及多期增强扫描对其诊断有一定价值.     

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.