应用最大似然法鉴别诊断周围型肺癌、肺错构瘤和结核球的初步研究

目的:探讨应用最大似然法鉴别周围性肺癌、肺错构瘤及结核球3种孤立性肺结节(SPN)的诊断价值。方法:对150例经临床和手术病理证实的SPN(周围性肺癌、肺错构瘤、结核球各50例)的HRCT影像学征象进行分类统计分析,运用最大似然判别法,将其各种征象转化为记分值,以数值的大小来判定肺结节所属的类型。结果:最大似然法对周围型肺癌、肺错构瘤及结核球的诊断正确率分别为86%、92%及90%,平均诊断正确率为89.3%,高于常规阅片法的82%,但两组间差异无统计学意义(χ2=2.434,P>0.05)。最能提示为肺癌的征象依次为空泡征、分叶征、支气管充气征和血管集束征;最能提示为肺错构瘤的征象依次为脂肪、边缘清楚及钙化;最能提示为结核球的征象依次为空洞、卫星灶、钙化及胸膜凹陷征。结论:最大似然法对常见SPN的鉴别诊断正确率有所提高,是一种辅助影像学诊断的有价值的方法。     

高分辨率CT正向概率判别法在肺结节鉴别诊断中的应用研究

目的　利用高分辨率CT(HRCT)分析肺结节样病灶的影像学特征 ,结合正向概率判别法探讨对肺结节鉴别诊断有价值的影像学征象。方法　搜集经手术病理证实的 1 2 0例肺结节 ,其中周围型肺癌、炎性结节、结核球及肺内良性肿瘤各 30例 ,所有的患者均于术前行常规平扫和增强扫描 ,并结合HRCT扫描。采用正向概率判别法对结节病灶常见的CT征象进行分析总结 ,并转化为概率值后判定结节的性质 ,为鉴别诊断提供帮助。结果　正向概率判别法对周围型小肺癌、炎性结节和结核球的总体诊断正确率 (78 9%)较常规阅片法 (6 8 9%)为高 ,两者比较差异有统计学意义 (χ2 =4 2 7,P <0 0 5 )。结论　在HRCT扫描的基础上对肺结节样病灶进行概率判别分析法有助于提高诊断正确率。     

18F-FDG PET/CT结合高分辨率CT对孤立性肺结节的

 目的 探讨18F-FDG PET/CT显像结合高分辨率CT(high resolution CT,HRCT)对孤立性肺结节(solitary pulmonary nodule,SPN)的诊断价值。方法 回顾性分析124例SPN患者的18F-FDG PET/CT检查资料,其中76例加做HRCT扫描,所有病例经病理或临床随访证实。18F-FDG PET/CT通过目测法和半定量法判断病灶的代谢情况,结合CT或HRCT病灶的形态学特征判断良、恶性。结果 48例仅行18F-FDG PET/CT检查的SPN患者,正确诊断32例为恶性,8例为良性,假阳性与假阴性各4例。76例加做HRCT的患者,正确诊断62例恶性与8例良性,假阳性与假阴性分别为2例和4例。18F-FDG PET/CT 结合HRCT与单纯18F-FDG PET/CT诊断SPN的灵敏度、特异性及准确率分别为94%、80%、90%与89%、67%、83%。结论 18F-FDG PET/CT协同HRCT可提高对SPN性质判断的灵敏度、特异性及准确率。     

人工神经网络在孤立性肺结节CT诊断研究中的应用

目的将人工神经网络理论应用于孤立性肺结节(SPN)的CT诊断研究,建立一种全新的模式判别方法,用于高分辨率CT(HRCT)或薄层CT上良恶性结节的鉴别。方法搜集经手术或穿刺病理证实的SPN 200例(原发性肺癌135例,良性结节65例),分析3项临床指标(年龄、性别及是否有痰中带血丝)和9项HRCT或薄层CT指标(部位、长径、短径、轮廓形态、毛刺、晕征、气腔密度影、结节与周围血管及胸膜的关系)。采用完全随机法从中选择140例样本作为训练集,建立人工神经网络(BP网络)诊断模型,并与软件SPSS分析处理的Logistic回归模型作比较。结果BP神经网络对所有样本的诊断符合率为98.0%(196/200),高于Logistic回归模型的符合率(86.0%,172/200)(P<0.001);ROC曲线下面积分别为0.996±0.004和0.936±0.017,差异有统计学意义(P<0.001)。结论结合神经网络理论,利用HRCT和薄层CT鉴别诊断SPN的良恶性很可能成为一种实用而可靠的临床诊断手段。     

肺内2cm以下结节的HRCT诊断(附63例分析)

目的 :分析 2 .0cm以下肺内结节的HRCT表现。探讨提高早期肺癌的诊断正确率的征象 ,并与其他结节进行鉴别。方法 :行CT平扫检查 ,发现病灶后行HRCT连续扫描。结果 :6 3例均为单发结节 ,其中肺癌 4 7例 (占 74 .6 0 % ) ,结核 11例 ,炎性假瘤 3例 ,错构瘤 2例。结节与支气管关系的分类可分为五型 ,4 7例肺癌中Ⅲ、Ⅳ型表现者占 6 7% ,Ⅲ、Ⅳ型高度疑诊肺癌 (t =2 .4 6 9;P <0 .0 1)。普通平扫与HRCT相比征象确定率分别为 5 2 .38%和 87.2 0 %。结论 :HRCT在诊断肺内 2 .0cm以下结节上有较大优势 ,所见征象更真实、可靠 ,提高了早期肺癌诊断正确率 ,并可与其他结节作出较明确的鉴别诊断     

HRCT扫描结合MSCT动态增强扫描在肺内孤立性结节的诊断价值

目的：评价HRCT扫描结合MSCT动态增强扫描在诊断肺内孤立性结节（SPNs）的价值。方法：收集直径小于3cm的肺内孤立性结节患者48例,其中周围型肺癌28例,单发转移瘤5例,肺炎性假瘤5例,结核瘤4例,肺血管瘤2例,支气管肺腺瘤2例、肺错构瘤2例。48例患者均先行常规胸部CT扫描,然后对兴趣区行HRCT扫描,然后行胸部动态增强扫描,并测量其CT值增强幅度。结果：HRCT扫描结合MSCT动态增强扫描诊断肺内孤立性小结节的正确率为90%,HRCT扫描可以更好显示病灶边缘特征及内部结构,动态增强扫描可见肺内恶性结节大多均匀增强,且增强CT值大于20HU,平均增强CT值为35HU。良性结节多周边增强,且增强CT值小于10HU。结论：根据SPNs的HRCT基本形态特征,并结合MSCT动态增强扫描强化特征有助于肺内孤立性结节的定性诊断,提高术前诊断正确率。     

支气管扩张的高分辨率CT诊断价值

目的 评价高分辨率CT(HRCT)在支气管扩张检查中的应用价值.资料与方法 搜集临床可疑支气管扩张及常规CT扫描(层厚8 mm)局部肺纹理增粗者64例,行HRCT扫描(层厚1 mm)、大矩阵和高分辨率骨算法.结果 常规CT可疑者HRCT清晰显示了支气管扩张的部位、类型和范围,可不同程度显示"双轨征"、"树芽征"、"指套征"及"印戒征".64例中常规CT扫描诊断支气管扩张38例(88个肺段),其中柱状型23例,静脉曲张型3例,囊状型12例和混合型26例.HRCT诊断支气管扩张64例(198个肺段),其中柱状型33例,静脉曲张型8例,囊状型23例和混合型42例.结论 HRCT诊断支气管扩张具有更高的敏感性、特异性及准确性,不仅能显示支气管扩张的范围、程度和部位,而且无创伤.可作为诊断支气管扩张的首选检查方法.     

高分辨率CT对肺孤立性结节的诊断价值

目的 评价高分辨率CT(HRCT)与常规螺旋CT(CSCT)为准确诊断肺孤立性结节(SPN)提供信息的能力。方法 18例经手术、痰细胞学或临床证实为SPN的息者均经HRCT与CSCT检查。18例患者中，良性结节(BSPN)13例，其中炎性病变8例，结核球3例，以及错构瘤2例；恶性结节(MSPN)5例，均为原发性肺癌。所有结节的直径介于0．5cm～3．0cm之间，平均为2．2cm。对18例SPN在HRCT与CSCT发现之内部、边缘及周围征象进行了分析。结果 在HRCT像上，分叶征见于4例BSPN(31％)和5例MSPN(100％)，毛刺征见于4例BSPN(31％)和5例MSPN(100％)，胸膜凹陷征见于4例BSPN(31％)和3例MSPN(60％)，棘状突起见于1例BSPN(8％)和2例MSPN(40％)。支气管充气征仅见于2例BSPN(炎性结节)(15％)，结节内脂肪成分仅见于2例BSPN(错构瘤)(15％)。周围型肺气肿仅见于2例BSPN(结核球)(15％)。CT晕征仅见于3例BSPN(23％)。然而，坏死区，锯齿状边缘，卫星病灶，以及限局性胸膜增厚则仅见于MSPN。CSCT虽能证实全部病例的SPN存在，但上述多数HRCT上显示的征象是看不到的。结论 HRCT对SPN内部、边缘及周围征象的评价明显优于CSCT，且能在多数病例中将BSPN同MSPN加以鉴别。     

64层螺旋CT扫描与多平面重组联合检查

目的 探讨64层螺旋CT(64-SCT)扫描联合多平面重组(MPR)对孤立性肺结节(SPN)的诊断价值.方法 收集84例SPN患者,采用东芝64-SCT行常规轴位扫描及薄层螺旋靶扫描,并采用骨算法及软组织算法重建,经MPR进行后处理,显示SPN中相关的支气管及血管关系.结果 (1)64-SCT行螺旋靶扫描结合图像后处理,极好地显示SPN与相关支气管及血管的关系.(2)84例SPN中与支气管有关系80例(95.2%),其中恶性结节54例(64.2%),良性结节26例(31.0%).(3)与血管有关系的84例中恶性结节56例(66.7%),良性结节28例(33.3%).结论 64-SCT扫描及结合MPR图像重建能清晰显示SPN与支气管及血管关系,对SPN的定性诊断具有重要价值.     

孤立性肺结节高分辨率CT诊断及病理对照

 目的研究孤立性肺结节(SPN)界面影像分布特征、病理基础,探讨其定性诊断价值.方法分析病理证实的37例周围型肺癌的瘤周高分辨率CT(HRCT)影像分布特征,并随机选择23例肺良性结节作对照,双盲法观察SPN瘤-肺交界区近端和远端HRCT的影像改变.其中25例周围型肺癌及16例肺良性结节的病灶肺叶术后标本行Heitsman法固定48～72h后HRCT扫描,再将标本制成病灶肺全叶切片及病灶组织切片,观察结节-肺界面HRCT表现的病理基础.结果瘤-肺交界区HRCT表现为远端模糊和(或)毛糙、毛刺影,周围型肺癌79%,肺良性结节22%(P＜0.05);光整,周围型肺癌14%,良性结节74%(P＜0.05).术后标本HRCT、大体病理切片的变化完全吻合.结论瘤-肺交界区HRCT的模糊和(或)毛糙、毛刺影等影像改变的不对称性远端优势分布,对小于3.5 cm的周围型肺癌的定性诊断有重要价值.病理基础是癌灶所致的支气管阻塞及癌结节远端淋巴管回流障碍、肺间质内纤维组织增生及癌细胞浸润.     

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 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.     

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).     

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).     

人体中的镭-226、镭-228、钋-210、铅-210

本文报道了广东阳江高本底地区6名、对照地区8名人尸体的骨²²⁶Ra、²²⁶Ra的浓度以及部分居民内脏器官中。²¹⁰Po、²¹⁰Pb的浓度。结果轰明阳江高本底地区和对照地区居民骨镭-226、镭-228的浓度分别为29.9pCi/kg, 26.9pCi/kgl 8.7pCi/kg, 8.2pCi/kg.由此估算出阳江高本底地区屠民骨中²²⁶Ra、²²⁸Ra的负薄璧及对骨衬、骨髓所产生的剂量当量分别为对照地区民民的3.4倍, 3.3倍。两地区居民内脏器官中^{210Po、210Pb的测定分析铡数较少但仍看出, 高本底地区均明显高于对照地区.}