高分辨对比增强三维MR血管成像对显示肝动脉的价值

目的与DSA对照，评估高分辨对比增强三维MR血管成像（high-resolution 3D MRA）显示肝动脉解剖的价值。方法回顾性分析26例肝肿瘤（24例为原发性肝癌，2例为转移性肝癌）患者腹部高分辨对比增强3D MRA和DSA检查的资料。对高分辨对比增强3D MRA和DSA的各段肝动脉显影质量行4级评分（1级记为1分，2级为2分，3级为3分，4级为4分），并对两者显影质量行weighted Kappa分析；分析评估肝动脉解剖或变异，以及病理情况，与DSA进行比较。结果26例患者高分辨对比增强3D MRA和DSA对肝总动脉（显影评分平均为3．96、3．96）、胃十二指肠动脉（评分为3．85、3．88）的显示有很好的一致性（Kappa值分别为0．99、0．85），对肝右动脉（评分为3．92、3．96）、肝左动脉（评分为3．77、3．92）、胃左动脉（评分为3．73、3．85）、肝右前（评分为3．35、3．70）和右后动脉（评分为3．31、3．73）及第Ⅳ段动脉（评分为2．92、3．46）有较好的一致性（Kappa值分别为0．65、0．43、0．43、0．53、0．46、0．51），而对肝第Ⅱ（评分为2．15、3．35）、Ⅲ段动脉（评分为2．19、3．35）一致性差（Kappa值分别为0．18、0．21）。以DSA为标准，高分辨对比增强3D MRA准确显示18例正常解剖和7例变异[显示的准确度为96．1％（25／26）]，1例胃十二指肠动脉闭塞。结论高分辨对比增强3D MRA是一项能准确评估肝动脉的检查技术，可以达到肝段动脉的显示水平。     

肾动脉高分辨力三维增强磁共振血管成像术:透视触发和并行采集技术使用初探

目的:评估透视触发和并行采集技术用于肾动脉高分辨力三维增强磁共振血管成像术的可行性和对肾动脉的显影诊断效果。方法:90例临床诊断或怀疑肾动脉或腹主动脉病变的患者行高分辨力肾动脉三维增强磁共振血管成像(3D CE MRA)。使用透视触发软件启动肾动脉3D CE MRA扫描,扫描采用K空间中心填充法和加速因子为2的并行采集技术。分析图象质量和病变显示情况,并与其它检查结果对照。结果:肾动脉3D CE MRA显示了90例患者共810支动脉段(100%显示率),平均显示等级为3.88。3D CE MRA显示8例11支副肾动脉,显示等级均为4.0。肾动脉段级分支的显示率为73%(66/90例)。所有病例在动脉显示区静脉均未显影或显影很淡,平均等级为0.20。3D CE MRA发现639支动脉段正常;66支动脉段管壁不规则;55支动脉段轻度狭窄;37支动脉段严重狭窄;2支动脉段闭塞;11支动脉段动脉瘤形成。其中96支肾动脉存在狭窄,11支副肾动脉均正常。共有43例病例,肾动脉3D CE MRA与其它血管成像技术作了比较,3D CE MRA的检查结果与之完全符合。结论:透视触发并行采集肾动脉高分辨力3D CE MRA简单可行,成像时间短,空间分辨力高,能清楚显示肾动脉且无静脉污染。     

肾动脉纤维肌层发育不良的高分辨力三维增强MR血管成像

目的:评价高分辨力三维增强磁共振血管成像术(3D CE MRA)诊断肾动脉纤维肌层发育不良(FMD)的价值.方法:5例经临床和DSA造影确诊的肾动脉FMD患者行肾动脉高分辨力3D CE MRA检查,扫描同时使用透视触发和并行采集技术.分析所有患者的肾动脉和FMD显示情况,并与DSA对照.结果:肾动脉3D CE MRA清楚显示5例患者10支肾动脉主干及其近端段级分支,且静脉均未显影或显影很淡.5例FMD均为单侧肾动脉受累,2例表现为肾动脉主干和近端段级分支串珠状改变,3例表现为肾动脉中段局限性狭窄.3D CE MRA显示结果与DSA一致.结论:高分辨力肾动脉3D CE MRA能较好检出肾动脉主干和近端分支的FMD.     

肝脏增强三维磁共振血管成像双期扫描的价值

目的：与常规血管造影对照,评价肝脏增强三维磁共振血管成像（three-dimensional contrast-enhancedMRA,3DCEMRA)双期扫描显示肝动脉和门脉系统的价值。材料和方法：共有２２例患者做了肝脏３ＤＣＥ ＭＲＡ双期扫描,分别获得肝动脉和门脉ＭＲＡ图像,分析３ＤＣＥMRA上肝动脉的解剖和变异、肝动脉有无肿瘤经及、门脉主干和肝内门脉左右分支的开放性以及侧支循环发生的部位和严重程度。3D CE MRA的显示结果与常规血管造影术（包括腹腔动脉造影和直接或间接门脉造影术）相对照。评价两者的符合情况以获得3D CE MRA的诊断准确性。结果：3DＣＥＭＲＡ与腹腔动脉造影两种方法对肝动脉系统,包括腹腔干、肝总、肝固有、肝右和肝左动脉显示符合率为９７％,３ＤCE MRA准确示22例中4例肝动脉解剖变异并可检出肝动脉受肿瘤经及。22例患者66支门脉主干和左右分支中,有65支两种检查方法显示门脉的开放性的结果相同,符合率为98%。22例中有15例存在侧支循环,3DCEMRA准确显示其中的14例,与门脉造影符合率为93%。结论：肝脏3D CE MRA双期扫描能较准确地显示肝动脉和门脉系统的主干和二级分支,对肝脏血供提供了有用信息。     

三维动态增强磁共振血管成像在肝移植术前的应用

 目的探讨三维动态增强磁共振血管成像(3D DCE MRA)三期扫描技术,评价其在肝移植术前的诊断价值.方法对拟进行肝移植的183例患者进行术前3D DCE MRA成像扫描,采用Siemens Symphony 1.5T超导MRI扫描机,圆形极化相控阵体线圈,3D DCE MRA三期(动脉期、门脉期和静脉期)扫描技术,即对所得图像进行综合评价.结果全部病例均获得了满意的血管成像图像,肝动脉可显示2～3级分支,门静脉可显示2～5级分支,肝静脉可显示1～2级分支.183例肝移植患者,5例显示肝动脉变异,其中2例起自肠系膜上动脉,2例直接起自腹腔干,1例起自胃左动脉.单纯肝硬化门脉高压103例,其中,冠状静脉和食道胃底静脉曲张23例、脐周静脉曲张5例、肠系膜静脉曲张2例、脾门周围静脉曲张30例,门静脉玻璃样变性1例;原发性肝癌79例,5例肝动脉包埋、僵直、推移,2例肝内动-静脉瘘,门静脉右支癌栓23例,门静脉左支癌栓7例,门静脉主干癌栓3例,同时发生门静脉左右支癌栓的2例,MRA表现为门静脉呈半月形或杯口形缺损或不显影.7例肝静脉出现栓塞,5例下腔静脉受压推移,1例下腔静脉瘤栓.结论 3D DCE MRA三期扫描能很好的显示肝动脉、门静脉、肝静脉及下腔静脉系统病变,肝移植术前应用3D DCE MRA,基本达到临床要求,是术前血管评估的有效方法.     

肝动脉解剖变异的64层螺旋CT血管成像研究

目的：评价64层CT血管成像（MSCTA）对显示肝动脉解剖变异的价值。方法：回顾性分析100例行肝脏4期增强扫描患者的影像学资料,对动脉早期增强扫描图像进行后处理,结合原始横断面、最大密度投影（MIP）、容积再现（VR）及曲面重组（CPR）图像观察患者肝动脉解剖变异。结果：28例患者显示有肝动脉解剖变异,6例为肝总动脉起源于肠系膜上动脉,9例替代肝右动脉起源于肠系膜上动脉,4例肝左动脉起源于胃左动脉,4例副肝右动脉起源于肠系膜上动脉,2例替代肝左动脉起自腹腔干,2例替代肝右动脉起自胃十二指肠动脉,1例替代肝右动脉起自腹腔干。有DSA对照的10例,MSCTA对肝动脉解剖变异的诊断符合率为100％。结论：MSCTA可以准确地显示肝动脉的解剖变异,对肝脏病变的介入治疗及外科手术具有重要的临床意义。     

肝总动脉变异的多层螺旋CT血管造影表现

目的 应用64层螺旋CT血管造影技术评价肝总动脉变异.方法 对1 129例受检者的64层螺旋CT腹部血管造影检查(CTA)进行回顾性分析,评价肝总动脉变异及分类.结果 1 129例受检者的CTA显示肝总动脉变异46例,占4.1%(46/1 129).肝总动脉变异分为3组:(1)肝总动脉起源变异31例.包括肠系膜上动脉起源23例,腹主动脉起源6例,胃左动脉起源2例.(2)肝总动脉路径变异4例.表现为肝总动脉起源正常,自腹腔干发出后在胰腺上、门静脉后走行,在发出胃十二指肠动脉后延续为肝固有动脉.(3)肝总动脉缺如11例.此型变异的胃十二指肠动脉均独立起源于腹腔干,肝动脉起源包括肠系膜上动脉起源4例;替代右肝动脉和左肝动脉分别起自腹主动脉、胃左动脉4例;替代右肝及左肝动脉分别起自肠系膜上动脉、胃左动脉3例.结论 64层螺旋CT血管造影检查可准确判断肝总动脉起源和解剖路径变异,对变异的范围及与邻近器官的关系也能进一步评估,弥补了血管造影(DSA)的不足.     

非对比剂增强MR血管成像技术在肝动脉血管成像中的应用价值

【摘要】目的：以CTA为对照,探讨基于多反转空间标记脉冲技术的非对比剂增强MR血管成像技术（SLEEK-MRA）在肝动脉血管成像中的应用价值。方法：37例同时行CTA及SLEEK-MRA检查的临床怀疑肝脏占位患者纳入研究,CTA检查后7天内行SLEEK-MRA检查。由两位腹部影像诊断医师分别对CTA和SLEEK-MRA图像进行独立评估,评估内容包括四分法图像质量主观评价及最大显示分支级别评估。比较CTA与SLEEK-MRA在肝动脉成像图像质量及最大显示分支级别上的差异。结果：两位医师对CTA及SLEEK-MRA图像质量评分的一致性均为良好及以上（Kappa值:CTA为0.645~0.814;SLEEK-MRA为0.633~0.877）。除肝左动脉一级分支和肝右动脉一级分支外,SLEEK-MRA与CTA两种方法在肝总动脉、肝固有动脉、肝左动脉及肝右动脉血管成像图像质量评分上差异均无统计学意义（P值均>0.05）。CTA显示最大分支级别的能力优于SLEEK-MRA（P=0.020）。37例病例中,CTA显示有7例出现肝动脉变异,SLEEK-MRA显示了其中6例。结论：SLEEK-MRA作为一种无创、无辐射、无需使用对比剂的血管成像方法,在肝动脉血管成像上具有一定的应用价值。     

16排螺旋CT血管成像对腹腔镜下胃切除术的价值

目的 探讨腹腔镜辅助下胃切除术前16排螺旋CT血管造影(MSCTA)评价胃周血管解剖的价值. 资料与方法 24例拟行腹腔镜辅助下胃远端切除术的患者行MSCT双期扫描,其动、静脉期图像采用容积再现重组技术分别行三维CTA. 结果 24例中三维CTA准确显示胃左动脉24例,胃右动脉23例,胃左静脉24例.6例CTA伴有替代肝左动脉.CTA显示胃左动脉、胃左静脉和替代肝左动脉敏感性和阳性预测值均为100%;显示胃右动脉敏感性为100%,阳性预测值为96%. 结论 MSCTA能够准确评价胃的血管解剖,有利于腹腔镜辅助下胃远端切除术.     

用LAVA进行多期增强MR血管成像显示肝脏血管系统

目的：应用肝脏三维容积超快速（LAVA）多期增强MR血管成像（LAVA CE MRA），评估其对肝脏内血管显示的价值，以及对肝脏病变诊断的意义。材料和方法：对52例疑有腹部病变者行常规MRI扫描及Gd-DTPA增强并LAVA多期扫描，采用最大强度投影（MIP）重建血管，显示肝动脉、门静脉、肝静脉，并得到各血管时间-信号强度曲线。对MIP重建肝内血管的显示情况进行分析，评估LAVA CE MRA对肝内血管显示的价值。同时记录肝脏病变信号的动态变化，以及与周围血管的关系。结果：52例患者肝脏LAVA CE MRA图像能清晰显示肝脏内血管形态，达到诊断要求。肝动脉、门静脉、肝静脉3级和3级以上分支显示率100％，门静脉、肝静脉4-5级以上分支显示率达到96．8％。肝脏病变的动态强化显示良好，部分病变供血来源显示清晰。结论：LAVA CE MRA能良好地显示肝内各血管及其与肝脏病灶的关系，提高对肝脏病变的诊断能力。     

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).     

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.