正常成人伏隔核体积磁共振测量初探

目的:利用3.0磁共振分析成人伏隔核体积双侧差异及性别差异.方法:健康志愿者42例(男24例,女18例),年龄范围18～55岁,中位年龄25岁,利用磁共振对伏隔核进行常规扫描和冠状面容积扫描.在容积扫描图像上对伏隔核分割并进行体积测量,比较双侧体积差异及性别差异.结果:所有志愿者以及男、女性志愿者伏隔核平均体积均右侧大于左侧(P<0.001).男女之间伏隔核总体积差异不存在统计学意义(P>0.05).结论:健康成人右侧伏隔核体积大于左侧,性别之间伏隔核总体积无明显差异.     

伏隔核磁共振容积扫描参数的研究

目的 探讨伏隔核3.0T磁共振容积扫描的最佳扫描参数.方法 健康志愿者72人,平均分为12组.利用T1WI三维快速扰相梯度回波序列,在其它参数固定的情况下,分别采用4个不同准备时间与3种矩阵组合成的12种方案对伏隔核进行容积扫描.测量其邻近脑白质与伏隔核的对比噪声比(CNR)并进行分析.结果 在所有组中第1组所得的图像CNR最高(P<0.05).当矩阵为256×256时,第1组图像CNR最高(P<0.05);当矩阵为342×342时,第5～8组之间不存在统计学差异;当矩阵为512×512时,第9组的图像CNR分别最高(P<0.05).结论 利用3.0T磁共振三维快速扰相梯度回波序列扫描伏隔核时,在TR=8.1 ms ,TE=3.6 ms ,FOV=24 cm×19.6 cm ,层厚=1.4 mm ,层间距=-0.7 mm ,反转角=20°,NEX=2的情况下,较合适的矩阵应为342×342,准备时间为350～500 ms.     

应更加重视伏隔核：基于MRI早期PSD患者核团体积及形态改变

【摘要】目的：基于MRI分析脑梗死后早期抑郁症（PSD）患者的伏隔核、海马和杏仁核的体积及形态变化,探讨早期PSD的发病机制。方法：对28例梗死后抑郁症（PSD）和18例梗后无抑郁症（PSND）和13例单纯抑郁症（De）患者及11例健康志愿者（对照组）行高分辨MR扫描,采用计算机自动分割及顶点分析方法,测量双侧伏隔核、海马和杏仁核的体积并进行标准化处理,采用组间分析法比较各组间各部位体积和形态的差异。结果：PSD组的双侧伏隔核和海马的体积均小于PSND、De和对照组,双侧杏仁核体积小于De和对照组、仅稍高于PSND组,其中双侧伏隔核体积的组间差异有统计学意义（P<0.05）,进一步两两比较,右侧伏隔核体积的组间差异有统计学意义的是PSD与NC组（P<0.01）,PSD与De组（P<0.001）,PSND与NC组（P<0.05）,以及PSND与De组（P<0.001）;左侧伏隔核体积的组间差异有统计学意义的是PSD与De组（P<0.01）以及PSND与De组（P<0.05）。核团形态的组间差异有统计学意义（P<0.05）的部位主要为右侧伏隔核的顶部及尾部、双侧海马体部的腹内侧。结论：早期PSD患者的伏隔核、海马和杏仁核即存在体积及形态改变,尤其是伏隔核,提示中脑腹侧背盖区-伏隔核多巴胺奖赏环路的损害可能是早期PSD发病机制中的主要原因之一。     

DRD2基因多态性对伏隔核功能连接影响的性别特异性研究

目的探讨多巴胺受体(DRD2)基因rs1076560位点多态性及在不同性别中对伏隔核功能连接(FC的调控作用。方法前瞻性纳入280名健康青年人,平均年龄(22.7±2.4)岁;男性132名,女性148名。测定被试DRD2基因rs1076560位点G/T等位基因多态性,根据基因型分为T基因携带者组和GG纯合子组。采集静息态功能MR成像数据及奖赏行为学数据。采用Matlab的SPM12软件进行静息态MRI数据分析。以双侧伏隔核为种子点,进行与全脑的FC分析。采用独立样本t检验对DRD2两组基因型的伏隔核与全脑的FC值进行比较,并分别比较男性和女性的DRD2两组基因型的伏隔核与全脑FC值。对差异区FC值与奖赏依赖评分进行Pearson相关分析。结果2组双侧伏隔核与全脑FC值的差异均无统计学意义(P0.05)。女性被试中,2组间伏隔核与全脑FC值的差异也无统计学意义(P0.05)。男性被试中,与GG纯合子组相比,T等位基因携带组左侧伏隔核与双侧前扣带FC(AlphaSim校正,体素数73,P=0.004)、右侧伏隔核与双侧前扣带(AlphaSim校正,体素数184,P0.001)和左侧腹内侧前额叶(AlphaSim校正,体素数64,P=0.009)FC均减低。差异区FC值与奖赏依赖评分之间无相关性(P0.05)。结论DRD2基因多态性对双侧伏隔核FC的影响存在性别特异性。     

基于3.0T MR及MIMICS对阿尔茨海默病患者侧脑室的研究

目的 比较分析阿尔茨海默病(AD)患者与正常老龄人侧脑室容积及形态,实现间接对AD患者脑实质萎缩进行评估.方法 运用3.0T MR对20例AD患者及20例正常老龄人进行头颅扫描,获得侧脑室切面图,测量侧脑室容积及侧脑室前角、后角及颞角,并运用比利时MIMICS软件对切面图像进行重建分析.结果 与正常老龄人侧脑室容积相比,AD组左侧脑室容积(LV)、右侧脑室容积(RV)及整体容积(TV)均明显增大,差异有统计学意义(P<0.05);与正常老龄人侧脑室前后角及颞角相比,AD组双侧前角及颞角度数显著增大,差异有统计学意义(P<0.05);AD组患者LV、RV、TV、左侧脑室前角、右侧脑室前角、左侧脑室颞角及右侧脑室颞角均与认知功能评定简易智能状态检查表(MMSE)呈负相关且有统计学意义(P<0.05).结论 AD患者侧脑室容积及角度均显著大于正常老龄人,相关测量数据可更为便捷准确提示AD患者脑实质萎缩状况.     

磁共振3D-TSE(SPACE)序列在评估健康受试者踝关节解剖结构的应用研究

目的 分析3T磁共振3D-TSE(SPACE)序列及常规2D-TSE序列对健康受试者踝关节解剖细节显示的价值.方法 选取30例健康受试者踝关节进行磁共振成像(年龄22~29岁,平均25岁),使用Siemens Magneton Trio Tim 3.0T磁共振扫描仪及膝关节线圈.本研究所使用的MRI序列为二维脂肪抑制T2加权(2D-FS-T2WI-TSE)和三维脂肪抑制T2加权快速自旋回波(perfection with application optimized contrasts using different flip angle evolutions,3D-FS-T2WI-SPACE).扫描范围包括踝关节的冠状位、矢状位和轴位.分别计算胫距关节骨软骨,跟骨骨髓,比目鱼肌,胫距关节腔关节液,跟腱及距腓后韧带的信噪比(SNR);分别计算关节液-软骨,关节液-韧带的对比噪声比(CNR).分别就伪影、毗邻结构的鉴别、信号均一性、部分容积效应以及韧带结构起止点等方面来评价2个序列显示图像质量的能力;就感兴趣韧带或肌腱进行任意曲面重建,显示其全长.结果 SPACE序列上各结构SNR及CNR显著优于常规2D序列,二者之间的差异具有统计学意义(P<0.05).就图像质量的评估方面,SPACE序列与常规2D序列之间显示结果一致,二者之间的差异没有统计学意义(P>0.05).结论 SPACE是一种新的磁共振成像序列,可以进行不同加权图像的扫描,对踝关节正常解剖结构的显示清晰,可以满足临床诊断的需要.     

HDCT能谱技术提高肝硬化门静脉血管成像图像质量的价值研究

目的探讨能谱技术在提高肝硬化患者CT门静脉血管成像质量方面的价值。方法 45例肝硬化患者,采用的能谱扫描模式行动脉期门脉期扫描后,运用能谱分析软件获得门静脉期最佳对比信噪比(CNR)单能图像和传统混合能量图像(QC图像),并对门静脉及侧枝血管进行容积再现(volume rendering,VR)、最大密度投影(maximum inten-sity projection,MIP)重建。采用双盲法对重建质量进行评估。对二组图像的评分数据行两独立样本T检验分析。结果最佳CNR单能图像的VR、MIP重建图像对门静脉与侧枝血管及肝内分支的显示级别均优于混合能量图像,差异有显著统计学意义(P<0.01)。结论最佳CNR单能图像能明显提高肝硬化CTPV门静脉与侧枝血管及肝内分支显示的图像质量。     

肺结节磁共振扩散加权成像技术优化

目的:探讨采用容积匀场和矩形视野采集技术的磁共振扩散加权(DWI)扫描方式进行肺结节成像的价值.方法:连续的25例肺结节患者纳入研究,采用3.0T MRI超导成像仪(Philips Achieva 3.0T TX)进行DWI,先进行常规扫描(普通匀场、正方形视野采集),然后改进方式扫描(容积匀场、矩形采集),B值为0、300、600、900和1200s/mm2.两位资深胸部影像医生和一位技师共同评价两组图像,测量各组图像的AppCNR、SNR以及肺结节ADC值,并统计分析.结果:改进组图像质量主观评分(2.56±0.04)高于常规组(1.52±0.06) (P＜0.05).改进组各B值图像的AppCNR和SNR均对应显著高于常规组(P＜0.05).两组间的ADC值无显著性差异(P＞0.05).结论:附加容积匀场并减小相位方向视野的DWI扫描方式可以提高图像质量且不影响ADC值.     

首发未用药精神分裂症病人壳核及伏隔核静息态功能连接的研究

目的 采用基于兴趣区相关性的方法研究首发未用药精神分裂症（SCH）病人壳核和伏隔核的静息态功能连接。 方法 纳入首发未用药SCH病人25例和健康对照32例,均行静息态功能MRI检查和临床功能评估（包括韦氏记忆量表第3版空间广度测验、连线测试、简易视觉空间记忆测验-修订版、阳性与阴性症状量表）。在Matlab平台上使用脑成像数据处理和分析工具对2组的静息态功能MRI数据进行预处理,分别选取双侧壳核和伏隔核为兴趣区与全脑其他体素时间序列进行Pearson相关分析,获得的功能连接值采用两样本t检验比较组间差异。最后,在病人组中提取2组间存在差异脑区的功能连接系数,与4种临床功能评估结果进行偏相关分析。结果 与健康对照组相比,病人组右侧壳核与左侧舌回、右侧伏隔核与下丘脑/右侧海马旁回、左侧伏隔核与下丘脑的功能连接均减弱（体素水平 P<0.001,高斯随机场理论校正,簇水平P<0.05）。病人组右侧伏隔核-下丘脑/右侧海马旁回连接系数与韦氏记忆量表第3版空间广度测验评分呈正相关（r=0.533, P=0.009）。 结论 首发未用药SCH病人右侧壳核、双侧伏隔核分别存在功能失连接表现,可能是病人存在认知障碍的原因之一。     

3D SPACE序列对女性内生殖器显示的应用

目的:观察3D SPACE序列MRI在女性内生殖器成像中的应用价值。方法:对20例受检者采用SIEMENS Magnetom Avanto 1.5T磁共振成像系统,行常规女性内生殖器MRI扫描后加扫3D SPACE序列。并利用3D后处理软件对其原始图像进行矢状位、冠状位和横轴位重建;比较3D SPACE图像与常规T2WITIR M图像显示输卵管、卵巢、子宫的清晰度。由两位高年医师对图像质量采用双盲法评分,应用配对t检验进行统计学分析。结果:20例患者中,3D SPACE组所获图像明显优于T2WI-TIRM组所获图像,两组图像显示输卵管、卵巢评分差异存在显著性意义(t值13.043、12.389,P<0.05)。显示子宫的评分无统计学意义(t=2.096,P>0.05)。结论:用3D SPACE序列能清晰显示输卵管、卵巢、子宫,具有重要临床应用价值。利用重建软件对SPACE序列进行各个方向和层面的重建,可简化图像采集过程,为临床诊断提供更多信息。     

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.