特发性甲状旁腺功能减退症的颅脑CT、MR表现

目的:探讨特发性甲状旁腺功能减退症(IHP)的脑内CT及MRI特征表现及诊断价值.方法:回顾性分析21例IHF患者颅脑CT(16/21)和MR(5/21)表现和临床特征,观察病变的范围和密度、信号特点.结果:IHF主要表现为脑内多发钙化病变,CT上表现为高密度,MR表现为T1WI呈稍高或高信号,T2WI呈等或稍高信号,21例均有双侧尾状核、苍白球、壳核钙化,双侧额、颞、顶、枕叶皮层下对称性钙化16例,双侧丘脑钙化3例,中脑钙化3例;双侧小脑齿状核钙化11例,全部病例内囊区均未见受累.结论:基底节和大脑内皮层下钙化是IHP的特征性表现,CT对病变显示明显优于MR,结合临床结果,对IHF定性诊断具有重要意义.     

磁共振成像对急性甲苯中毒性脑病的诊断价值分析

目的 探讨磁共振成像对急性甲苯中毒性脑病的诊断价值。方法 选取2015年5月～2020年6月在我院进行治疗的急性甲苯中毒性脑病患者20例纳入观察组,另选入同期在我院进行体检的正常健康人20例作为对照组。采用美国通用HDi 1.5T超导型磁共振扫描仪,采用NV头颈联合线圈,使用T1FLAIR序列、FRFES T2WI序列、T2FLAIR序列、DWI序列及脑灌注成像。对所有研究对象进行MRI扫描,测量白质、外囊、苍白球、丘脑及齿状核的平均表观扩散系数(ADC)并对比;测量对比两组研究对象的双侧白质区、灰质区及基底节区的平均脑血流量(CBF)。结果观察组患者均表现为白质、外囊、苍白球、丘脑、小脑齿状核及深部白质有弥漫性、对称性T2WI高信号。双侧外囊对侧性"括弧"状高信号改变。T2 FLAIR表现为高信号,T1WI表现为低信号,DWI高信号;观察组白质、外囊、苍白球、丘脑及齿状核的平均ADC均明显低于对照组,差异有统计学意义(P0.05);两组在白质、灰质及基底节的CBF比较差异无统计学意义(P0.05)。结论 急性甲苯中毒性脑病在磁共振检查的影像中存在特征性表现,可显示脑组织结构的变化和生化信息,具有较高的诊断价值,利于评估患者病情。     

MRI在Wernicke脑病的临床应用价值

目的:探讨Wernicke脑病(Wernicke's encephalophy,WE)的MRI表现特点,以提高诊断水平。方法:回顾性分析13例临床确诊WE的MRI影像学表现。结果:发生部位:9例病变累及双侧丘脑,5例病变累及乳头体,4例病变累及中脑导水管周围灰质,2例病变累及第三脑室周围灰质,累及第四脑室周围灰质、壳核、小脑齿状核、小脑上蚓、延髓、四叠体各1例。MRI表现:13例病变于T1WI为稍低信号,T2WI表现为高信号,FLAIR序列呈高信号;6例急性期病变DWI图像呈高信号,ADC图为低信号。1例增强扫描病例示乳头体呈结节状强化,1例增强扫描病例示中脑导水管边缘线状强化。结论:Wemicke脑病具有特征性的MRI表现,是诊断本病的重要影像学方法。     

慢性核黄疸所致脑性瘫痪的磁共振成像特征及临床意义

目的 探讨慢性期核黄疸所致脑性瘫痪的磁共振成像(MRI)特征.方法 回顾性分析13例慢性核黄疸所致脑性瘫痪患儿的头颅MRI图像,并以同期6例年龄匹配的正常小儿头颅MRI作对照.该13例患儿临床诊断为不随意运动型(手足徐动型)脑性瘫痪.结果 在MRI T2WI上,13例患儿双侧苍白球呈对称性高信号,在T1WI未见明显病变.结论 双侧苍白球对称性T2WI高信号是慢性核黄疸引起脑性瘫痪的MRI特征性表现,有助于判断脑性瘫瘫的类型.     

MRI观察婴幼儿期斯特奇-韦伯综合征脑部影像特征

目的 探讨MRI观察婴幼儿期斯特奇-韦伯综合征(SWS)脑部病变的影像学特征。方法 回顾性分析接受CT平扫和MR平扫加增强扫描的7例婴幼儿期SWS患儿的临床和影像学资料。结果 单侧病变6例,双侧1例,累及单个或多个脑叶。CT主要表现为受累脑实质密度增高,夹杂磨砂状钙化灶。MR平扫病变区T1WI呈等或稍高信号,T2WI和FLAIR呈低信号,FLAIR脑回边缘可见线状高信号,增强后脑膜明显强化,且T2 FLAIR增强图像显示病灶效果优于T1WI。结论 婴幼儿期SWS脑部MRI表现有特征性,可作为首选检查方法。     

泪腺淋巴细胞增生性病变的CT、MRI诊断

目的 研究泪腺淋巴细胞增生性病变的CT和MRI表现及其诊断价值.方法 回顾分析10例经病理学证实的泪腺淋巴细胞增生性病变患者的CT及MR影像资料,总结病变影像学表现.结果 反应性淋巴细胞增生5例,表现为泪腺体积增大,CT呈均匀等密度,MRI T1WI、T2WI呈低或等信号,1例T2WI呈高信号,增强扫描呈明显强化.非典型性淋巴细胞增生1例,CT表现为双侧泪腺弥漫性增大,密度均匀.泪腺淋巴瘤4例,表现为双侧泪腺弥漫增大.结论 泪腺淋巴细胞增生性病变的CT及MRI表现与炎性病变相似,但有助于与泪腺上皮性肿瘤鉴别,并可准确显示病变累及范围.     

原发骨骼肌非霍奇金淋巴瘤的影像学表现特点

目的分析6例原发性非霍奇金肌肉淋巴瘤的CT、MRI表现特点,提高对本病的认识.方法回顾分析经病理学证实的6例原发性非霍奇金肌肉淋巴瘤病人的CT、MRI和病理资料,均行CT和MRI平扫及增强扫描.结果 1例为单块肌肉受累,5例为多块相邻肌肉受累.CT平扫及MRI T1WI信号与周围正常肌肉相似,T2WI高于肌肉信号,且内部信号轻度不均匀;CT、MRI增强扫描显示病变密度或信号高于正常肌肉.病变肌肉呈弥漫性增大,累及整块肌肉.结论原发骨骼肌非霍奇金淋巴瘤CT和MRI表现为肌肉弥漫性膨胀,密度或信号均匀,于CT和MRI TIWI上与肌肉呈等密度或信号,MRI T2WI上呈高信号.增强扫描呈弥漫性均匀强化.     

CT及MRI在尿毒症脑病的诊断价值

目的:探讨CT及MRI在尿毒症脑病(uremic encephalopathy,简称UE)中的诊断价值。材料与方法:回顾性分析16例尿毒症脑病的临床和影像学资料,16例患者中,男性9例,女性7例。临床表现为出现神经、精神及不自主运动等中枢神经系统方面的异常,而行颅脑CT或MRI检查,其中CT扫描3人,MRI扫描16人,DWI扫描10例,增强扫描4例。结果:CT及MRI显示病灶主要位于双侧顶枕叶皮质及皮质下白质,呈基本对称分布,脑内其它区域亦可受累。CT表现为稍低密度影;MRI表现为T1WI呈等或稍低信号,T2WI及FLAIR呈高信号。DWI表现呈较低或等信号,ADC图上呈较高信号;DWI表现呈高信号,ADC图上则呈较低信号。增强扫描均未见明显强化。结论:CT及MRI检查能够明确尿毒症脑病患者脑部病变的部位及性质,从而进一步指导治疗,预防并发症。     

3．0TMR对肝豆状核变性颅脑病变的诊断及临床意义

目的探讨3．0TMR肝豆状核变性（HLD）的颅脑MRI表现与及其临床意义。方法对临床和实验室检查证实的23例肝豆状核变性患者行颅脑MRI平扫,扫描序列包括T1FLAIR、T2WI、TEFLAIR、DWI。分析颅脑异常MRI表现部位及临床体征,评估其临床相关性。结果23例颅脑MRI均有异常发现,病灶呈稍长或长T1、稍长或长T2信号,FLAIR高信号,部分病灶呈低信号,DWI进展期病灶呈高信号。脑MRI异常信号发病部位依次为豆状核（21／23）、丘脑（19／23）、中脑（18／23）、内囊后肢（14／23）、桥脑（13／23,其中桥脑背侧、腹侧）、尾状核头（11／23）、齿状核（8／23）、小脑中脚（5,23）、额叶（5,23）、胼胝体压部（4／23）、枕叶（1／23）,脑萎缩14例,且基底节、丘脑、中脑及齿状核多对称分布,形如“八字”或“展翅蝴蝶”样,MR病变部位与临床症状有一定相关性。结论HLD颅脑MRI最具有特征性征象为双侧基底节、丘脑等对称性的异常信号,可广泛累及其他部位,多伴脑萎缩,而DWI可以反映进展期病灶情况,且受累部位与临床症状有一定相关性,从而指导临床诊治。     

少见原因的脑内灰质核团异常信号的MRI 诊断

目的：描述脑内灰质核团铁、铜、锰和钙沉积的MRI表现,结合文献讨论其发生机制及其病理改变。方法：回顾性分析Hallervorden-Spatz病、Wilson病、肝脑变性以及各种原因引起的钙在脑内灰质核团沉积的病例共38例的MRI表现。结果：Hallervorden-Spatz病表现为双侧苍白球和黑质T2WI明显的低信号,并可见苍白球的前内侧对称出现的点状高信号（虎眼征）;Wilson病4例均表现为双侧壳核、中脑出现对称性的T2WI高信号,其中1例还可见双侧苍白球对称的T2WI低信号,肝脑变性表现为双侧苍白球（27／29）,壳核（6／29）,垂体前叶（13／29）,中脑红核周围（18／29）等部位出现高信号;特发性钙化所致钙在脑内灰质核团沉积表现为基底节、丘脑、齿状核对称出现的等和短T1信号。结论：脑内灰质核团的异常信号有其特定的病因学和病理学基础及相应的MRI表现,结合临床表现及实验室检查,可以做出正确的诊断。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.