肝腺瘤的综合影像诊断

目的：描述肝腺瘤的超声（US），CT和MRI表现与病理基础，探讨综合影像对肝腺瘤的诊断价值。方法：回顾性分析经手术切除，病理症实的6例肝腺瘤的US，CT和MRI表现，并与病理所见对照。结果：6例肝腺瘤均为单发肿块，1例术前综合影像诊断为肝腺瘤，4例误诊为肝癌，例误诊为肝局灶结节性增生。US：6例呈稍低或低回声，4例有低回声晕，彩色多普勒显示6例肿块内有较丰富的门脉样血流和低速动脉样血流，CT：6例为稍低或低密度，4例有假包膜，4例动脉期，门脉期均轻度强化，1例动脉期中度强化，门脉期轻度强化，MRI：T1WI和T2WI上，6例表现为以高信号为主的混杂信号，用脂肪抑制后T1WI上的高信号无变化；2例动脉期显著强化，门脉期和延迟期轻度强化，3例动脉期，门脉期和延迟基匀轻度强化。6例均有假包膜，且在门脉期或延迟期现轻度强化。结论：肝腺瘤的综合影像表现缺乏特性性。对有假包膜和混杂高信号（用脂肪抑制后T1WI上的高信号无变化）的多血供肿块应考虑到肝腺瘤的诊断。     

MSCT和MRI对肝脏局灶性结节增生的诊断价值

目的：探讨肝脏局灶性结节增生（FNH）CT和MRI表现及其诊断价值。方法：回顾性分析11例FNH患者的影像学表现。所有患者均行16层螺旋CT及MRI平扫和动态增强扫描检查。结果：CT平扫显示病灶均呈稍低密度灶,1例在脂肪肝背景下呈相对高密度。增强扫描动脉期示病灶均呈明显均匀强化,2例可见扭曲扩张的供血动脉,8例病灶中央可见瘢痕区无明显强化;门静脉期及延时期示病灶稍高于、等于或低于周围肝实质,中心瘢痕灶延时期强化。MRI检查示病变呈等信号或稍低T1信号及稍高T2信号,增强扫描动脉期示病灶明显强化,门脉期和延时期呈稍高信号或等信号,11例显示病灶中央疤痕呈延迟强化。1例行MRS检查提示Cho峰明显升高。4例行DWI检查,病灶呈等信号或稍高信号,ADC图上呈等信号或稍低信号。结论：MRI较CT能更全面地显示FNH的病理特征,DWI和MRS检查有重要辅助诊断价值。     

肝细胞腺瘤CT与MRI的诊断价值

目的 分析肝细胞腺瘤(HCA)的CT、MRI特征性表现.方法 收集本院行CT、MRI检查并经病理证实的11例HCA患者,对所有研究对象的影像学特征进行回顾性分析比较.结果 11例中共发现18个病灶,CT平扫时均表现为低或稍低密度,其中2个病灶内可见不规则高密度区.而病灶的CT值在动脉期显著高于正常肝组织,且存在统计学差异(P<0.05).MRI扫描时2个病灶T1WI呈低或稍低信号,16个病灶呈稍高信号;14个病灶T2WI呈高信号,4个病灶呈低信号;动态增强扫描,动脉期所有病灶呈显著强化;17个病灶见假包膜强化.DWI扫描测量18个病灶,病灶的ADC值大于正常肝实质的ADC值.结论 CT三期动脉增强扫描定量分析结合MRI扫描及ADC值测量对HCA有一定鉴别诊断价值.     

肝炎性肌纤维母细胞瘤的影像学特征

目的：探讨肝炎性肌纤维母细胞瘤（hepatic inflammatory myofibroblastic tumor ,HIM T ）的影像表现特征,提高对该病的认识和诊断准确性。方法回顾性分析经病理证实的7例 HIM T的影像表现,其中4例行CT 扫描,3例行MR检查。结果7例7个病灶,位于肝右叶5例,位于肝左叶2例;CT 平扫呈低或稍低密度,T1WI为稍低信号,T2WI呈等或稍高信号;CT 及MR增强动脉期明显强化2例,轻中度强化4例,不强化1例;门脉期及延迟期持续明显强化6例,边缘强化1例。结论 HIM T影像表现多样,T2 WI呈等或稍高信号、动态增强门脉期及延迟期持续强化有一定特征,但本病少见,确诊尚需组织病理学及免疫组化检查。     

周围型肝内胆管细胞癌的影像学表现与病理对照分析

目的探讨周围型肝内胆管细胞癌的影像学表现及病理基础。方法回顾性分析经手术及病理证实的周围型肝内胆管细胞癌25例,所有病例均行B超检查;21例行CT平扫和增强扫描;11例行MRI检查;9例行DSA检查。结果B超显示病灶15例为低回声,10例为略强或强回声,均匀或不均匀;CT平扫病灶均为低密度,边界不清,MRI表现为T1WI低信号,T2WI呈较高信号伴中心低信号,动态CT及MRI检查病灶多表现为渐进性的向心性强化;病灶局部肝包膜可有回缩,周围肝内胆管可有轻度扩张和结石;选择性动脉造影呈乏血管肿瘤改变,超选择性动脉造影显示动脉期肿瘤血管纤细、呈绒球状改变,实质期肿瘤染色明显,轮廓不清;病理表现镜下为低分化或未分化腺癌,血管分布稀少,癌巢之间为大量纤维结缔组织。结论周围型肝内胆管细胞癌的影像学表现有一定的特征性。     

肝脏孤立性坏死结节的CT及MRI表现

目的:探讨肝脏孤立性坏死结节(SNN)的螺旋CT及高场强MRI表现,提高对SNN的诊断准确性。方法:回顾性分析30例(34个)经手术病理证实的SNN患者的影像学表现。其中10例行螺旋CT平扫和3期动态增强检查,20例行MRI平扫及增强检查。结果:CT发现11个病灶,MRI发现23个病灶。CT平扫示病灶均呈低或稍低密度,6例中央可见星芒状更低密度区,增强扫描动脉期病灶均无明显强化,延迟期4个病灶有边缘强化。MRT1WI示23个病灶均为低或稍低信号,10个病灶中心见点状、星状更低信号;T2WI示5个病灶呈稍低信号、18个为稍高信号;增强扫描动脉期所有病灶均未见明显强化,8个病灶门脉期及延迟期边缘强化。16个病灶中心更低密度/信号区均未见强化。结论:CT平扫和动态增强及MRI能较好地反映SNN的影像学特点,提高了对SNN的诊断准确性。.     

脾脏窦岸细胞血管瘤的影像学表现

目的探讨脾脏窦岸细胞血管瘤(LCA)的影像学特点,提高CT及MRI诊断脾脏窦岸细胞血管瘤的准确率。方法回顾性分析嘉兴市第一医院及嘉兴市中医院经手术病理证实的12例脾脏窦岸细胞血管瘤的影像学表现。其中4例行CT、MRI平扫及增强扫描,6例行CT平扫及增强检查,2例行MRI平扫及增强检查,分析病灶形态、大小、密度、信号及强化方式,总结其CT及MRI影像学表现特点。结果 12例患者,10例表现为脾肿大,其中4例表现为单发病灶,8例表现为多发病灶。病灶呈类圆形,病灶最大直径7.1cm,最小直径0.4cm,平均直径2.4cm;CT平扫8例病灶呈相对于脾脏稍低密度改变,4例病灶呈等密度而显示不清;增强扫描动脉期,部分病灶呈边缘"花边样"强化,病灶中央呈渐进性强化;3例多发病灶相对于脾脏稍低密度改变,增强呈较均匀的明显强化。MRI平扫均表现为T1WI稍低、T2WI稍高信号,DWI为高信号改变;MRI增强扫描呈"边缘强化,逐渐填充"的强化特点;部分病灶小于1.0cm,动脉期由于脾脏的"花斑样强化"特点,因而病灶显示欠清,平衡期因脾脏均匀强化,而逐渐凸显病灶。结论脾脏窦岸细胞血管瘤在CT及MRI上具有一定特征性的表现,把握这些征象有利于提高诊断的准确率。     

肝脏局灶性结节增生的CT及MRI表现

目的:探讨肝局灶性结节增生(FNH)的螺旋CT及高场强MRI的影像学表现,提高FNH诊断准确率.方法:回顾性分析60例经手术病理证实的66个FNH.螺旋CT检查32例,MRI检查30例,其中2例同时做了CT和MRI.结果:CT发现33个病灶,MRI发现35个病灶,其中平扫中CT31个为均匀的低或稍低密度,2个为等密度,T1WI30个为低或稍低信号,5个为等信号,T2WI均呈高或稍高信号.病灶中心见点状,星状,裂隙状更低密度/信号:CT11个,T1WI16个,T2WI19个为更高信号.动脉期所有病灶均明显强化,病灶中心更低密度/信号区均未强化,病灶周围有增粗,扭曲血管影:CT7个,MRI10个.门脉期呈高或稍高密度/信号:CT21个,MRI33个.呈等密度/信号:CT10个,MRI2个.呈稍低密度:CT2个.病灶中心更低密度/信号强化:CT1个,MRI6个.延迟期呈高或稍高密度/信号:CT4个,MRI30个.呈等密度/信号:CT24个,MRI5个.呈稍低密度:CT5个.病灶中心更低密度/信号强化:CT10个,MRI15个.结论:平扫和动态增强螺旋CT及高场强MRI能较全面显示FNH的病理特征和血供特点,提高了和其它肝脏肿瘤的鉴别诊断能力.     

肝脏上皮样血管平滑肌脂肪瘤的影像学表现

目的 探讨肝脏上皮样血管平滑肌脂肪瘤(Epi-HAML)的影像学表现,旨在提高对该病的认识和诊断准确率. 方法 同顾性分析经手术病理证实的8例Epi-HAML的影像学及临床资料.其中4例行CT平扫和三期动态增强扫描,3例行MRI平扫和多时相动态增强扫描,1例行CT和MRI检查.结果 8例Epi-HAML中女7例,男1例.术前均误诊,其中4例术前误诊为肝癌,1例误诊为海绵状血管瘤,1例误诊为局灶性结节增生(FNH),2例误诊为腺瘤5例位于肝右叶,3例位于肝左叶.8例Epi-HAML均为单发,边界清楚.CT平扫呈稍低密度,2例密度均匀;2例病灶中间及边缘分别见局限性斑点及弧线样低密度影,CT值约-13 ～-17HU.MRI平扫T1WI呈稍低信号,T2WI呈稍高信号同反相位末见明显信号改变.增强扫描动脉期肿瘤呈不均匀或均匀明显强化.增强模式为“快进慢出”型5例、“快进快出”型3例.动脉期4例病灶可见“早期引流静脉”,2例在动脉期可见中心强化血管征 结论 Epi-HAML的影像学表现具有一定特征性,可与其他肝脏肿瘤相鉴别,但其诊断与鉴别仍主要依靠组织病理学及免疫组织化学检查.     

肝脏上皮样血管平滑肌脂肪瘤的影像学表现与病理对照分析

目的探讨肝脏上皮样血管平滑肌脂肪瘤(epithelial angiomyolipomas,EAML)的影像学表现及病理特征,提高对该病诊断的准确性。方法回顾性分析9例经病理证实的肝EAML的临床表现及影像学资料。其中3例行MRI平扫和多时相动态增强扫描,5例行CT平扫和三期动态增强扫描,1例同时行CT和MR检查。9例均误诊,其中6例术前误诊为肝癌,1例误诊为血管瘤,1例误诊为局灶性结节增生(FNH),1例误诊为转移瘤。结果 9例肝EAML均为单发的类圆形肿块,边界清楚;6例位于肝右叶,3例位于肝左叶。CT平扫呈稍低密度;MRI平扫T1WI呈稍低信号,T2WI呈稍高信号;增强扫描动脉期呈明显不均匀强化,少数可均匀明显强化,6例动脉期可见早期引流静脉,8例动脉期或门脉期中央或周边可见明显强化的粗大畸形的血管;强化方式为快进快出或快进慢出。结论 EAML影像学表现具有一定特征性,结合临床资料,对术前正确诊断具有重要意义,但诊断有赖于穿刺活检。     

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.