多模态MRI对原发性中枢神经系统淋巴瘤的诊断价值

目的探讨多模态MRI在原发性中枢神经系统淋巴瘤(PCNSL)诊断中的价值。方法回顾性分析25例经病理证实的原发性中枢神经系统淋巴瘤的常规MRI平扫和增强的特点,以及在DWI、PWI、1H-MRS上的表现。结果 25例患者共检出42个病灶,单发15例,多发10例,主要分布于深部近中线脑白质处。MRI平扫病灶T_1WI呈等或稍低信号,T_2WI呈等或稍高信号,瘤周水肿多表现为轻中度。增强扫描后病灶实质部分呈结节状、团块状强化,囊变坏死少见。13个病灶出现"脐凹征",8个病灶出现"尖角征",4个病灶累及胼胝体,出现"蝶翼征"。DWI显示42个病灶实质部分呈高或稍高信号,ADC信号明显低于正常脑实质。14例患者共25个病灶进行PWI扫描,17个病灶呈低灌注,8个病灶呈等灌注。4例患者共5个病灶行1H-MRS检查,均表现为肌酸(creatine,Cr)、N-乙酰天门冬氨酸(N-acetyl aspartate,NAA)峰降低,胆碱(choline,Cho)峰升高,并可见高耸的脂质(Lipid,Lip)峰。结论多模态MR成像技术能够提供更多的影像诊断信息,有助于提高PCNSL诊断的准确率。     

磁共振常规及其功能成像在原发性颅内淋巴瘤的应用价值

目的：探讨磁共振成像(MRI)、扩散加权成像(DWI)、磁共振灌注成像(PWI)、磁共振波谱成像(MRS)在原发性颅内淋巴瘤诊断及鉴别诊断中的应用价值。方法回顾性分析27例原发性颅内淋巴瘤患者的 MRI、DWI、PWI、MRS 影像资料。结果所有病灶 T1 WI 呈低-等信号,T2 WI 呈等、稍高、高信号,DWI 呈稍高、高信号。增强扫描22例病灶呈明显均匀强化,5例病灶呈不均匀强化。19例病灶可见“蝶翼征”“握拳征”“缺口征”“尖角征”。18例病灶均为低灌注表现。MRS 表现为病灶实质区 NAA 峰明显降低或消失,Cho 峰增高,23例出现高大 Lip 峰,12例出现 Lac 峰。结论磁共振常规及其功能成像在原发性颅内淋巴瘤的诊断及鉴别诊断中具有很高的应用价值,低灌注、肿瘤实质区出现高耸的 Lip 峰是原发性颅内淋巴瘤的特征性表现。     

脑脱髓鞘性假瘤的磁共振成像表现

目的探讨脑脱髓鞘性假瘤的磁共振成像表现,提高对该病的磁共振(MR)诊断水平。方法回顾性分析2例均行常规MRI检查、氢质子磁共振波谱成像(1H-MRS)及脑灌注成像,并与病理结果对照,总结脱髓鞘性假瘤的MRI特点。结果 2例患者均为青年男性,急性起病入院,MRI表现为T1WI高低混杂信号,T2WI高信号,1H-MRS为NAA峰降低,胆碱(Cho)峰升高,并出现乳酸(Lac)和胶质(Lip)峰,MR灌注成像(PWI)示脑血流量、脑血容量降低,平均通过时间及峰值时间延长。结论脑脱髓鞘性假瘤常规MRI表现具有一定特征性,联合功能成像有助于作出正确诊断。     

海绵窦海绵状血管瘤的MRI诊断及意义

目的 分析经手术和病理证实的21例海绵窦海绵状血管瘤(CHCS)的MRI表现,探讨MRI对CHCS诊断价值.方法 21例均行MRI平扫、增强及扩散加权成像(DWI),5例行单体素1 H-MRS检查.结果 典型CHCS多数体积较大,呈“横葫芦状”横跨蝶鞍内外.MRI-T1 WI呈等或稍低信号,T2 WI呈类似脑脊液高信号.增强扫描病变呈非常显著的均匀或不均匀强化.DWI呈等或稍低信号.1 H-MRS 5例均表现为NAA峰、Cr峰和Cho峰消失,4例出现Lip峰.结论 MRI平扫、增强扫描及DWI、1H MRS等检查方法可对CHCS准确定位并作出术前定性诊断,有助于手术方案的选择并确定手术入路,指导精确手术,降低致残率.     

CT、MRI和MRS在原发性基底节区生殖细胞瘤中的诊断价值

目的 研究基底节区生殖细胞瘤的CT、MRI及氢质子磁共振波谱(1H-MRS)表现,以提高对该病的诊断水平.资料与方法 搜集6例经活检或手术病理证实的生殖细胞瘤,全部病例均行MRI平扫加增强扫描,其中4例加做CT平扫及增强扫描,3例行MRS检查,5例行追踪复查.对其影像学表现进行回顾分析.结果 CT表现:2例点状钙化,2例囊实性肿块.MRI表现:3例为肿块状,3例为片状(复查时示肿块状).T1WI上病灶呈低或等信号,T2WI呈高信号.增强后3例呈环状强化,2例轻度片状强化,1例显著均匀强化.3例呈片状肿瘤者行MRS检查,首诊时胆碱(chohne,Cho)、氮-乙酰天门冬氨酸(N-acetyl aspartate,NAA)、肌酸(creatine,Cr)峰的形态大致正常,2例NAA/Cho和NAA/Cr下降,并见脂质(Lip)/乳酸(Lac)峰,1例复查时Cho峰升高,NAA、Cr峰降低.结论 CT、MRI在基底节区生殖细胞瘤的诊断中具有一定的局限性,1H-MRS发现NAA/Cho、NAA/Cr比值下降和出现Lip/Lac峰,建议临床进行穿刺活检以早期诊断.     

鞍旁海绵状血管瘤的MRI诊断

目的 分析鞍旁海绵状血管瘤(PCH)的MRI表现与特征,探讨MRI对该病的诊断价值.方法 回顾性分析9例PCH的临床资料,所有病例均行MRI平扫及增强扫描.结果 PCH位于鞍旁,体积较大,并不同程度伸入到蝶鞍内,外形不规则,瘤周无水肿.T1WI呈稍低信号,T2WI呈高信号,FLAIR较高信号,DWI为等或稍低信号,ADC图呈高信号.1H-MRS表现5例无NNA峰、Cho峰和Cr峰,4例可见较低的Cho峰、NAA峰及Lip峰.增强扫描延迟明显异常强化.结论 PCH具有特征性的MRI表现,MRI对PCH的诊断及鉴别诊断具有重要价值.     

磁共振多技术联合应用对诊断原发性脑内恶性淋巴瘤的价值

目的:探讨常规MRI扫描通过结合DWI、PWI、TDC、MRS多项技术联合应用对原发性脑内恶性淋巴瘤的诊断价值。方法:回顾性分析29例经临床病理证实的原发性脑内恶性淋巴瘤病例,其治疗前常规MRI信号特点与DWI、PWI、TDC和MRS的表现。结果:原发性脑内恶性淋巴瘤T₁WI呈等或稍低信号,T₂WI呈稍高信号,灶周中度水肿,增强后大多呈均匀强化,顶叶病灶可见"压迹征",病变累及胼胝体时呈"蝴蝶征";DWI多呈均匀高信号,ADC值与对侧正常脑实质相比明显降低;PWI示rCBV呈等或等低灌注,与正常脑白质灌注相似,多呈黄绿或蓝色;TDC负性增强上升支与下降支基本对称,信号强度回复前出现一小的再下降波形,增强后基线水平较增强前基线水平呈缓慢上升;MRS示Cho峰明显升高,病灶内NAA中度、Cr峰轻度降低,可见Lip峰、Cho/Cr、Lip/Cr、Lac/Cr均明显升高,NAA/Cr明显降低。结论:原发性脑内恶性淋巴瘤常规MRI具有一定特征性,通过联合应用DWI、ADC、PWI、TDC和MRS表现可提高对其诊断水平。     

颅内脱髓鞘假瘤的MRI表现

目的：探讨颅内脱髓鞘假瘤(DPTs)的 MRI 影像表现。方法回顾性分析10例经临床最终诊断为 DPTs 的 MRI 影像资料,所有患者均行 MRI 平扫,其中9例行增强扫描,7例行扩散加权成像(DWI),2例行单体素短回波1 H-MRS。结果其中8例患者病灶周围伴有轻~中度水肿,5例表现为多发病灶,3例表现为单发结节灶,2例表现为单发片状病灶。增强扫描中4例为开环形强化,3例为环形强化,1例结节状强化,1例斑片状强化。病灶在 DWI 上均表现为高信号,1 H-MRS 示2例均有 NAA 峰不同程度降低,Cho 峰、Lac 和 Lip 峰升高,1例谷氨酸/谷氨酰胺复合物(Glx 峰)明显升高。结论DPTs 在 MRI 影像上有一定特点,特征性表现为开环形强化,结合 DWI 及1 H-MRS 技术有助于 DPTs 和其他病变鉴别。     

3.0T ~1H-MRS在脑内高级别星形细胞瘤及单发转移瘤鉴别诊断中的价值

目的:探讨多体素氢质子磁共振波谱(1 H-MRS)对脑高级别星形细胞瘤、单发脑转移瘤的鉴别诊断价值。方法:收集经手术、活检病理证实的颅脑肿瘤患者37例,其中高级别星形细胞瘤(Ⅲ~Ⅳ级)17例(间变性星形细胞瘤5例,胶质母细胞瘤12例),脑单发转移瘤20例。37例行颅脑常规MRI检查及多体素1 H-MRS分析,分析肿瘤实质强化区、强化边缘区、对侧相应正常区域脑组织的生化代谢物及其比值,并进行对照。结果:1脑高级别星形细胞瘤、脑转移瘤1 H-MRS与对侧相应正常区域对比均表现为Cho峰升高,NAA、Cr峰下降。12例胶质母细胞瘤中,显示Lip峰者11例。20例脑转移瘤中,11例见Lac峰升高,9例Lip峰升高。2高级别星形细胞瘤肿瘤实体区的Cho/NAA明显高于脑转移瘤(P0.05);高级别星形细胞瘤瘤周水肿的Cho/Cr、Cho/NAA明显高于脑转移瘤(P0.05)。结论:3.0T1 H-MRS分析对高级别星形细胞瘤、脑单发转移瘤的诊断和鉴别诊断有重要价值,可作为一种非损伤性的鉴别手段;肿瘤瘤周水肿带的波谱更有利于胶质瘤与转移瘤的鉴别。     

鞍旁海绵状血管瘤的CT和MRI诊断

目的总结7例鞍旁海绵状血管瘤CT、MRI和磁共振波谱（MRS）表现,探讨其诊断和鉴别诊断。资料与方法7例均经手术病理证实,均行CT和MR平扫,2例行CT增强扫描,7例行MR增强扫描,5例行MR扩散加权成像（DWI）,6例行^1H MRS检查。结果鞍旁海绵状血管瘤体积大,并同时伸入到鞍内。CT平扫病变呈等或稍高密度,密度均匀,MR T1WI呈等或稍低于脑灰质信号,T2WI呈类似脑脊液高信号。增强扫描病变呈非常显著强化。DWI呈等或稍低信号,但表观扩散系数（ADC）值明显高于正常脑实质。。HMRS表现为NAA峰、Cr峰和Cho峰消失。可出现Lip峰。结论CT检查时鞍旁海绵状血管瘤与脑膜瘤和垂体瘤鉴别困难,MRI表现很有特点,T2WI呈极高信号,增强扫描非常显著强化,ADC值明显升高而DWI接近等信号,MRS检查无NAA峰、Cr峰和Cho峰,MRI可以对海绵窦海绵状血管瘤作出定性诊断。     

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.     

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).     

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.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.