羊脑泡状棘球蚴病实验模型建立可行性探讨

目的：探讨建立羊脑泡状棘球蚴(AE)病实验模型的方法,以利于人类脑 AE 病的相关研究。方法选择实验用健康新疆大尾羊10只,直视下颅骨穿刺,脑内接种 AE 源头蚴,8个月后用 MRI 观察羊脑 AE 生长状况,剖检后分析形态学及病理学特点。结果经病理及 MRI 证实,成功建模4例,成虫率40%(4/10),4例均为单发病灶,1例影像学表现具有特征性,T2 WI 表现为低信号背景下多发小囊泡群,3例 T2 WI 表现为低信号,光镜下观察病灶区有大量淋巴细胞、嗜酸性粒细胞及浆细胞浸润,周围小血管闭塞并伴有炎性反应。结论人工接种鼠源性 AE 原头蚴悬液建立羊脑 AE 病模型可行性高,方法简单,具有可重复性。     

上海地区急性前葡萄膜炎与HLA-A、B抗原相关性分析

目的调查不同地区人白细胞相关抗原(HLA)抗原与急性前葡萄膜炎之间的相关性,为急性前葡萄膜炎与HLA-B27关联的免疫遗传背景提供信息。方法30例急性前葡萄膜炎患者和318例无关健康对照随机配组,以微量淋巴细胞毒试验检定HLA-A、B位点共25种抗原型。结果急性前葡萄膜炎患者中HLA-B27抗原的频率为43%,显著高于正常对照(4%)(P<0.001)。急性前葡萄膜炎患者中HLA-A11的频率可能有升高的倾向。结论急性前葡萄膜炎与HLA不同抗原的相关性在不同人群中可能有差异,系统研究可提供更多信息。     

轻度认知障碍磁共振扩散张量成像研究的Meta分析

目的用Meta分析法评价磁共振扩散张量成像对轻度认知障碍(mild cognitive impairment,MCI)的诊断价值。材料与方法使用计算机检索数据库Pubmed、CNKI、万方、维普等,收集有关磁共振扩散张量成像对MCI研究的文献,检索时限均为自建库至2015年1月31日。从文献中提取轻度认知障碍组与正常对照组(NC)所使用的定量指标各向异性(fractional anisotrophy,FA)值对不同脑区(额叶、顶叶、颞叶、枕叶、后扣带束、海马、海马旁回、内囊后肢、上、下纵束、穹窿、胼胝体膝部及压部、钩束)的测量数据,用Meta分析软件(Review manager 5.3)对最终符合标准的文献进行汇总分析,获得汇总加权均数差(weighted mean difference,WMD)及95%可信区间(95%CI)。结果共纳入47篇文献(30篇英文、17篇中文),MCI组的FA值低于NC组,汇总WMD及95%CI为–0.05[–0.05,0.04],上述脑区除枕叶外差异均具有统计学意义。结论 MCI患者存在脑白质微细结构的损害,弥散张量成像(diffusion tensor imaging,DTI)技术能够提供MCI的早期诊断指标。     

玻璃体晶状体切除保留前囊膜治疗复杂性眼外伤的疗效观察

复杂性眼外伤不仅导致眼前段结构紊乱,如角膜、巩膜裂伤,晶状体损伤或脱位,还常常伴有后段损伤,如玻璃体积血、眼内异物或合并视网膜脱离。随着玻璃体手术的进展,玻璃体视网膜手术联合晶状体切除术已成为复杂眼外伤治疗的常规手术[1]。2005年6月以来,我们对30例眼外伤需行晶状体和玻璃体切除的患者,在术中保留晶状体前囊膜,为植入后房型人工晶状体     

玻璃体黄斑界面疾病的光相干断层扫描特征

玻璃体视网膜界面疾病主要包括玻璃体黄斑牵引综合征、特发性视网膜前膜和特发性黄斑裂孔.光相干断层扫描( OCT)检查可以发现黄斑区玻璃体视网膜界面强反射的光带并与内层视网膜表面粘连或下方视网膜神经上皮之间有大小不等的间隙、黄斑中心凹轮廓改变和神经上皮全层裂孔等特征性表现,这些特征性表现在玻璃体视网膜界面疾病诊断、鉴别诊断和治疗预后判断方面均具有重要作用.深入观察玻璃体视网膜界面疾病的OCT检查特征,将有助于加深对其发病机制的了解和提高临床治疗效果.     

MRI弥散张量成像用于躯体化障碍患者小脑微结构研究

目的探讨躯体化障碍患者是否存在双侧小脑,尤其是小脑齿状核微观结构异常。方法应用3．0TMRI成像仪对28例躯体化障碍患者（SD组）及28例体检健康者（对照组）进行MRI弥散张量成像,测量2组双侧小脑髓质、齿状核表观弥散系数和各向异性分数值,比较2组左右侧小脑差异。结果SD组右侧小脑齿状核各向异性分数值较左侧升高（P〈0．05）,右侧表观弥散系数与左侧比较差异无统计学意义（P〉0．05）;对照组左、右侧小脑髓质和齿状核表观弥散系数、各向异性分数值比较差异无统计学意义（P〉0．05）;2组左、右侧小脑髓质、齿状核表观弥散系数和各向异性分数值比较差异均无统计学意义（P〉0．05）。结论SD患者双侧小脑齿状核不对称性较正常人增强,存在小脑结构侧化性类型异常。     

特发性黄斑前膜的频域光相干断层扫描特征以及与视力的相互关系

Objective To observe the Fourier-domain optical coherence tomography(FD-OCT) characteristic of idiopathic epiretinal membrane (ERM) and its correlation with the patients visual acuity. Methods The 116 eyes (112 patients) with idiopathic epiretinal membrane were included in this study. All the patients had undergone examination of visual acuity (LogMAR chart), ocular fundus (direct ophthalmoscope and fundus pre-set lens), and FD-OCT (Zeiss HD-OCT) with the speed of 27 000 A scan/s, area of 6.0 mm× 6.0 mm, and mode of 512 × 128. The central fovea thickness (CFT), volume (V), average thickness (AT) were collected from the OCT readings, and the fovea thickness (FT) was measured manually. Data were analyzed using SPSS 16.0. Results The traction on retina caused by ERM can be divided into 3 types according to the OCT findings., no traction (9.48 %), tangential traction (84.48 %) and tangential traction with anterior-posterior traction (6.04 %). A total of 97 eyes (83.62 %) had retinal edema (diffuse or cystoid) and the edema located at the outer nuclear layer(ONL), outer plexiform layer(OPL)and inner nuclear layer (INL). A total of 14 eyes (12. 07%) had retinal nerve fiber layer (RNFL) schisis and 27 eyes (23.28%) had inner segment/outer segment j unction(Ls/OS) impairment. Statistic analysis revealed that BCVA was not related to the age, gender, types of traction, presence of IS/OS damage or RNFL schisis(P>0.05), but was related with CFT(P<0.05). Conclusions Idiopathic ERM can exert different types of traction on the macular, and cause different types of retinal lesions. OCT is a useful tool to measure these lesions. CFT reading is closely related to patients" visual acuity.     

临床医学成人教育《医学影像学》本科教学的问题与对策分析

该文分析临床医学成人教育《医学影像学》本科教学存在的问题。以学生实际情况为基础,培养学生运用影像学解决临床基本问题的能力为目的,通过调整教学内容、选择合适的教学方法,来提高《医学影像学》教学质量。     

改良双回波成像对肝脏脂肪测量的探讨

目的探讨改良双回波成像技术对肝脏脂肪含量的定量分析及影响因素。方法应用30°小翻转角射频脉冲,通过短回波时间(TE:2.1ms)成像,校正同相位图像信号强度,改良双回波成像技术。双回波技术、改良双回波技术及氢质子波谱成像技术(~1H-MRS)分别测量肝脏左右叶脂肪含量,计算脂肪酸含量分数%F、%F_(corrected)与%F_(MRS);以%FMRS为标准,评价三种方法测量脂肪酸含量分数、比较其相关性及一致性。结果三种方法测量脂肪酸含量分数差异无统计学意义(P均0.05)。%F、%F_(corrected)与%F_(MRS)均呈正相关,相关系数r分别为0.876、0.911,(P均0.0001);Kappa值分别为0.865(95%可信区间0.676～0.903)、0.901(95%可信区间0.816～0.937),一致性均较好;%F_(corrected)与%F_(MRS)的一致性较%F与%F_(MRS)的高。结论改良双回波成像技术能够纠正T_1偏倚,减少T_2*衰减及脂肪峰多重性/J耦合的影响;能更准确半定量评价肝脏脂肪酸含量。     

视网膜静脉阻塞黄斑水肿的光相干断层扫描观察

目的 观察视网膜静脉阻塞(RVO)黄斑水肿的光相干断层扫描(OCT)图像特征以及与临床的关联,探讨新型频域OCT在RVO患者黄斑水肿形态和定量分析中的临床价值.方法 回顾分析临床确诊的RVO患者91例92只眼的OCT检查资料.其中,视网膜中央静脉阻塞(CRVO)35例35只眼;视网膜分支静脉阻塞(BRVO)56例57只眼.所有患者接受最佳矫正视力(BCVA)、直接或间接检眼镜、裂隙灯显微镜加前置镜检查.其中60例60只眼还接受了荧光素眼底血管造影(FFA)检查.5线扫描(5 Line Raster)模式下通过中心凹的水平+垂直两条扫描线的分析,对黄斑水肿类型和累及层次以及视网膜外层的细微结构进行观察,用软件自带cliaper功能模块手工测量黄斑中心凹厚度(FT)、浆液性视网膜脱离高度、中心凹囊腔的高度和宽度、中心凹囊腔下光感受器层厚度.在立方体(Cube)扫描模式下,采用软件自带的功能模块对黄斑中心厚度(CFT)、黄斑中心凹体积(V)、平均厚度(AT)进行测量.回顾分析时,重点分析黄斑水肿类型、OCT图像特征以及不同黄斑水肿类型与视力的相互关系.结果 RVO患者黄斑水肿表现为弥漫性水肿、囊样水肿、浆液性视网膜脱离、混合性水肿等多种形态.其中,弥漫性水肿表现为视网膜组织增厚,结构疏松,反射轻度降低;囊样水肿表现为视网膜神经上皮层内有单个或多个低反射囊泡,其间又可见组织柱分隔;浆液性视网膜脱离表现为视网膜神经上皮与色素上皮分离,其间有低反射液性空腔;混合性水肿表现为以上几种水肿形式的混合.92只眼中,弥漫性水肿12例12只眼,占13.0%;囊样水肿21例21只眼,占22.8%;浆液性视网膜脱离37例37只眼,占40.2%;混合性水肿58例59只眼,占64.1%.水肿位于外网状层/外核层91例92只眼.占100.0%;位于内核层67例68只眼,占74.2%;位于神经节细胞层23只眼,占25.0%.光感受器内外节连接(r=3.778 6,P=0.000)、外界膜完整性(r=4.462 2,P=0.000)和FT(r=-0.451 3,P=0.000)与其BCVA有相关性;而CFT(r=0.269 7,P=0.121)、V(r=0.052 8,P=0.054)和AT(r=0.060 8,P=0.075)与视力无相关性.结论 RVO所导致的黄斑水肿其形态和层次可表现为多种不同的类型,频域OCT可以对这些改变进行有效观察,其中有些改变与视力密切相关;定量分析在RVO黄斑水肿患者中的价值有待进一步确定.

Abstract：

Objective To observe the images characteristics of optic coherence tomography (OCT) on macular edema in retinal vein occlusion (RVO), and to explore the application value of Fourier-domain (FD)OCT in RVO macular edema. Methods The clinical data of 91 RVO patients (92 eyes) were retrospectively analyzed. All patients received examinations of best corrected visual acuity (BCVA), direct or indirect ophthalmoscope, slit lamp ophthalmoscope, and 60 patients (60 eyes)also underwent fundus fluorescein angiography. There were 35 patients (35 eyes) with central retinal vein occlusion (CRVO) and 56 patients (57 eyes) with branch retinal vein occlusion (BRVO). The type and involved layer of macular edema, and subtle structure changes of the outer retina were observed through the horizontal and vertical scanning lines through the foveal under the model of 5 Line Raster. The foveal thickness (FT), height of serous retinal detachment, width and height of foveal cystoid spaces and thickness of foveal photoreceptor layer were measure manually. The central fovea thickness (CFT), volume (V) and average thickness (AT) were collected from the OCT readings. Further analysis was focused on different type of the edema, characteristics of OCT images and the relationship between the different type of the edema and vision. Results The manifestation of macular edema was variable by OCT scanning, and can be categorized into diffuse edema (sponge-like thickening of the retina with reduced reflectivity) 12 patients ( 12 eyes, 13.0% ), cystoid edema (multi-cyst-like space in the neuro-retina separated by tissue column) 21 patients (21 eyes, 22.8%) and serous retinal detachment (separation of neuro-retina and retinal pigment epithelium by space with low reflectivity) 37 patients (37 eyes, 40. 2%) and mixed edema(mix of the above several edema form) 58 patients (59 eyes, 64.1 %). The edema can happen at different layers of the neuro-retina, including outer nuclear layer/outer plexiform layer (ONL/OPL) in 92 patients (92 eyes, 100. 0%), inner nuclear layer (INL) in 68 patients (68 eyes, 74.2%) and ganglion cell layer (GCL) in 23 patients (23 eyes, 25.0%).Statistic analysis revealed that BCVA was related to the integrity of IS/OS (r=3. 778 6, P=0. 000), ELM (r=4.462 2, P= 0. 000 ) and FT (r=-0.4513, P=0. 000 ), but not related to CFT (r=0.269 7, P=0.121), V(r=0.0528, P= 0. 054 ) and AT (r=0.0608, P=0.075). Conclusion he manifestation of macular edema associated with RVO is variable. FD-OCT can demonstrate its fine details, and some changes are related to visual acuity. Therefore, the value of quantitative analysis in these patients needs further confirmation.