类风湿性关节炎的MRI表现及其临床价值

目的:探讨类风湿性关节炎的MRI表现及其临床价值。方法:回顾性分析56例经临床诊断的类风湿性关节炎病例的MRI资料,其中5例行增强扫描。结果:56例患者中膝关节受累31例,腕关节受累18例,掌指关节7例。所有受累关节滑膜弥漫性增厚,表现为稍长T1、稍长或长T2信号,T2WI压脂序列呈稍高信号,增强扫描可鉴别关节积液与增厚滑膜。骨髓水肿13例,表现为骨质斑片状稍长T2稍长T1信号,T2WI压脂序列呈稍高信号,界限不清,软骨及骨侵蚀30例,软骨侵蚀表现为T1WI和T2WI压脂序列上信号减低或升高,骨侵蚀在T1WI上为低信号,在T2WI及T2WI压脂序列上为低-高信号,韧带、半月板及肌腱受累50例,表现为增厚滑膜与其界限不清,T1WI及T2WI上信号增高。结论:类风湿性关节炎在MRI各序列上的信号特点具有一定特征性,可作为临床上类风湿性关节炎的重要检查方法。     

膝关节树枝状脂肪瘤的MRI征象分析及其与骨性关节炎关系的探讨

目的 研究膝关节树枝状脂肪瘤(LA)的典型MRI表现以及伴随病变,并探讨其与骨性关节炎的关系.方法 回顾性分析13例LA患者的膝关节(n=15) MRI图像,其中2个膝关节为病理证实,其余13个膝关节有典型MRI表现诊断.所有患者均行MR平扫,其中1例行增强扫描.结果 全部病例均累及髌上囊,其中3例同时蔓延至关节周围滑膜,MR表现为滑膜呈“树叶”状、“树枝”状、“绒毛”状增厚,T1WI序列上为高信号、T2 WI序列上为稍高信号,脂肪抑制序列上呈低信号,1例增强后滑膜呈明显强化.其中局灶结节型6.7％ (1/15),弥漫型53.3％ (8/15),混合型40.0％ (6/15).15个受累膝关节均伴关节积液;其中93.3％(14/15)伴骨性关节炎改变;40.0％ (6/15)伴半月板损伤;26.7％ (4/15)伴滑膜囊肿;20.0％(3/15)伴关节旁滑膜增厚;6.7％ (1/15)伴滑膜骨软骨瘤病.结论 膝关节LA在MRI上有特征性的形态信号改变,LA是引起骨性关节炎的因素之一.     

MRI特异性对比剂铁羧葡胺对肝脏局灶性病变检出的比较研究

目的 通过比较MR平扫、应用对比剂钆喷替酸葡甲胺（Gd—DTPA）增强MRI及MRI特异性对比剂铁羧葡胺增强MRI对肝脏局灶性病变的检出，验证铁羧葡胺在病灶检出方面的优势。方法 2003年12月至2004年7月，选择怀疑为肝脏局灶性病变的病例59例，根据相对金标准判定共133个病灶。所有病例均先行梯度回波（GRE）T1WI、去脂快速自旋回波（FSE）序列T2WI、动态梯度回波Gd—DTPA增强MRI，48h后行铁羧葡胺动态GRE增强扫描及去脂FSE T2WI与GRE TW^＊W延迟扫描。统计各序列对局灶性病变检出的敏感性。结果 铁羧葡胺延迟增强去脂FSE T2W序列、动态GRE增强扫描、GRE T2^＊W延迟增强扫描检出病灶数分别为130、115、127个；平扫GRE T1WI序列、去脂FSE T2WI检出病灶分别为84和106个；Gd—DTPA动态GRE增强检出123个病灶。对于其中44个的微小病灶（〈1cm），铁羧葡胺延迟增强去脂FSE T2WI检出率达到932％（41/44），铁羧葡胺动态增强检出率为727％（32/44），铁羧葡胺延迟增强GRE T2^＊WI检出率为886％（39/44），Gd—DTPA动态增强检出率为795％（35/44），平扫去脂FSE T2WI检出率为545％（24/44），平扫GRE T1WI检出率为34.1％（15/44）。铁羧葡胺延迟增强去脂FSE T2WI及GRE T2WI显著提高了对于微小病灶（〈1cm）的检出率，与平扫MR（包括去脂FSE T2WI和GRE T1WI）及Gd—DTPA动态增强MR相比差异有统计学意义（P〈005）。结论 铁羧葡胺延迟增强去脂FSE T2WI及GRE T2^＊WI序列优势主要为提高肝微小病灶（〈10cm）的检出率。     

MRI对痛风性关节炎的诊断

【摘要】目的：探讨痛风性关节炎的MRI表现及其诊断价值。方法：回顾性分析经临床及病理证实的18例痛风性关节炎患者的MRI资料。结果：18例中单关节发病14例,多关节发病4例,共累及24个关节。其中第一跖趾关节8个,膝关节6个,踝关节5个,髋关节2个,肘关节2个,跗骨间关节1个。磁共振表现：滑膜增生（n=18）,关节腔或滑膜囊积液（n=16）,关节周围软组织肿胀（n=21）,穿凿状或不规则状骨质破坏（n=14）,骨髓水肿（n=6）,关节间隙狭窄（n=10）,关节增生（n=12）;14个关节可见痛风结节,其中2个单发,12个多发;共发现痛风结节35个,T1WI呈低信号,T2WI信号强度不同,T2WI上8个病灶呈低信号,17个呈低及稍高混杂信号,10个呈稍高信号,增强后26个病灶呈不均匀强化,以边缘强化为明显,5个强化均匀,4个无强化。结论：痛风性关节炎具有多种MRI表现,MRI有利于显示痛风结节及早期病变,对痛风性关节炎的诊断具有较高的价值。     

免疫介导关节炎的MRI：超顺磁性氧化铁和Gd-DTPA的比较

目的：探讨MRI超顺磁性氧化铁（USPIO）增强诊断抗原诱导的免疫介导关节炎的作用及其影像特征，与Gd-DTPA增强MRI的影像特征进行比较。方法：人工诱导建立12只SD鼠的右膝关节免疫介导关节炎，左膝关节注入盐溶液作为对照，双膝关节均在场强为2T的磁共振仪进行扫描，     

磁共振STIRFIR序列对膝关节外伤的诊断准确性

目的 评价短反转时间快速反转恢复（STIRFIR）序列对膝关节外伤的诊断准确性。方法 60例膝关节外伤的患者均经磁共振检查，其中，35例有关节镜资料证实，对膝关节外伤的患者于外伤后2h～7d行STIR FIR序列、扰相梯度T2加权（Spoiled gradient T2 Weighted Image，GRE T2WI）序列并对其磁共振影像（MRI）表现进行比较分析。结果 扰相GRE T2WI序列显示前交叉韧带损伤40例，后交叉韧带损伤24例，半月板损伤21例，骨挫伤21例，骨挫伤区或其周围发现隐性骨折线19条；STIR序列检出前交叉韧带损伤41例，后交叉韧带损伤25例，半月板损伤21例，骨挫伤60例，骨挫伤区或其周围发现隐性骨折线182条。结论 与GRE T2WI序列比较，STIR FIR序列对膝关节外伤中的骨挫伤、隐性骨折具有更明显的诊断优势，可作为膝关节外伤MRI检查的常规序列。     

膝关节色素沉着绒毛结节性滑膜炎的MRI表现与病理对照研究

目的：探讨膝关节色素沉着绒毛结节性滑膜炎（PVNS）的MRI特征与病理变化的关系。方法通过对11例膝关节PVNS的MRI表现与病理结果进行对照分析,评价膝关节PVNS的MRI影像特点。结果11例中,弥漫型10例,局限型1例;不同程度关节腔积液及关节内脂肪垫受侵7例,半月板及交叉韧带受累4例,软骨或骨受累8例。11例MRI影像均有关节滑膜增厚、滑膜内软组织结节表现,结节于T1WI呈等或低信号,于T2WI呈低信号,1例见滑膜结节内出血,表现为T1WI及T2WI高信号。病理均可见数量不等的增生滑膜绒毛结节,有丰富血管和含铁血黄素沉着。结论PVNS绒毛结节内T1WI呈等或低信号、T2WI呈低信号为其特征性表现,与术中及病理相符,MRI对PVNS的诊断和鉴别诊断具有重要的临床价值。     

不同MR扫描序列在SPIO增强大鼠肝癌模型的对比研究

目的：比较多种扫描序列超顺磁氧化铁（SPIO）增强扫描对显示大鼠肝癌病灶的能力，找出最佳扫描方案。TSE T2WI、SE双回波的T2WI＋PDWI、GRE T1WI、T2^＊WI，分析增强前后大鼠肝癌病灶的强化特征，并进行病理学检查对照分析。结果：注射SPIO对比剂后，所有扫描序列均显示肝脏的信号强度较增强前有不同程度的下降，肝癌病灶CNR均分别高于平扫。增强后GRE T2^＊WI中病灶的CNR明显高于其它序列，但增强后TSE T2WI和常规SE T2WI在显示病变的SNR、CNR方面没有显著性差异。结论：SPIO增强后检测肝癌病灶的各种序列中，以GRE T2^*WI最为敏感，其次是双回波的T2WI＋PDWI序列。     

MRI预测急性脑梗死后出血的价值

目的探讨急性脑梗死患者MR早期增强T1WI中脑实质强化及大脑中动脉高信号（HMCA）征与继发性脑出血（HT）的关系。方法回顾性分析24例发病6．0h内[平均（4．3±1．4）h]的急性脑梗死患者首次T1WI及随后1周内复查的MRI和（或）CT资料，了解首次增强T1WI脑实质强化和HMCA征与HT的关系。早期脑实质强化为脑梗死6．0h内缺血的脑组织区域在增强T1WI出现高信号；HMCA征为增强T1WI上大脑中动脉增粗（与对侧相比）、出现边缘模糊的高信号。结果24例患者中10例发展为HT（出血组），其中6例首次T1WI可见脑实质强化，5例出现HMCA征；14例未出现HT（无出血组），均未发现脑实质强化和（或）HMCA征。2组相比，T1WI脑实质强化、HMCA征出现率差异均有统计学意义（P值均〈0．01）。结论T1WI早期脑实质强化和HMCA征有可能预测急性脑梗死后HT。     

滑膜软骨瘤病的MRI诊断

目的 探讨滑膜软骨瘤病的MRI特征.方法 搜集经病理证实的26例滑膜软骨瘤病MRI影像资料,分析其MRI表现.结果 滑膜软骨瘤病的MRI表现为关节滑膜肥厚、关节内悬垂体及游离体、关节腔积液和骨性关节炎改变.26例中,Milgram病理分期Ⅰ期5例,3例表现为关节滑膜的不规则结节状肥厚,2例滑膜均匀肥厚,2例增强扫描肥厚的滑膜及结节明显强化;Ⅱ期9例,Ⅲ期12例,表现为既有关节滑膜的结节状肥厚,又有关节内悬垂体和游离体的形成,悬垂体呈中等T1、中等T2信号,增强扫描呈明显强化或环形强化,游离体于T1WI及T2WI上呈低信号,表现为大小不一、数目不等、形态不同的圆形、卵圆形钙化或骨化结节影,其中11例游离体中央呈短T1信号,脂肪抑制序列PDWI上呈低信号,增强扫描无明显强化.10例继发骨性关节炎改变.结论 滑膜软骨瘤病具有典型的MRI特征,当游离体钙化或骨化时可明确诊断,对较早期病变的诊断亦具有重要价值.     

Suicide by a rifle with a muzzle brake: a particular entrance wound

The authors describe a case in which a 21-year-old male committed suicide using a rifle equipped with a muzzle brake, placed in contact with his head. A muzzle brake for firearms is a device positioned at the mouth of a weapon, which dissipates the gases, that are generated subsequent to the gun being discharged. Generally, when a gun is pressed against an anatomical region, where the skin lies on the bone surface without interposition of other soft parts, the entrance wound consists of many lacerated branches, originating from a central lack of tissue. In this case report, the use of a rifle with a muzzle brake generated an unexpected wound, circular in shape, with a diameter of 0.8 cm. This lesion was surrounded by a bruised area, circular in shape, and an abrasion collar of the height of 0.5 cm. In addition, a muzzle imprint mark consisting of intradermal bruises, composed of a narrow red line concentrically encircling the entrance hole, was found. In order to analyze in detail if this particular entrance wound could be associated with a weapon equipped with the muzzle brake, ballistic tests – with weapons compatible with that used by the victim – were performed.     

Atypical manifestation of a fistula between a hydatid cyst of a liver and a gallbladder: A case report

The hydatid cyst of the liver is the most common location of hydatid disease. Complications in this form are dominated by superinfection of the cyst and rupture into the bile ducts or the peritoneal cavity. We report the case of a 54-year-old female patient with a hydatid cyst of the liver complicated by a rupture in the gallbladder revealed by urinary symptoms.     

Identification of a cannabimimetic indole as a designer drug in a herbal product

A cannabimimetic indole has been identified as a new adulterant in a herbal product being sold illegally in Japan for its expected narcotic effect. Liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry analyses indicated that the product contained two major compounds. One was identified as a cannabinoid analog (1RS,3SR)-3-[4-(1,1-dimethyloctyl)-2-hydroxyphenyl]cyclohexan-1-ol (1) by direct comparison with the authentic compound, which we reported previously. The other compound (2) showed a molecular weight of 341 daltons, and accurate mass spectral measurements showed its elemental composition to be C₂₄H₂₃NO. Both mass and nuclear magnetic resonance spectrometric data revealed that 2 was 1-pentyl-3-(1-naphthoyl)indole [or naphthalen-1-yl-(1-pentylindol-3-yl)methanone] being identical to JWH-018, which was synthesized by Wiley and coworkers in 1998. This compound was reported as a potent cannabinoid receptor agonist possessing a pharmacological cannabimimetic activity.     

A Little to a Lot or a Lot to a Little?

PURPOSE: To determine whether a little dose to a large normal lung volume or a high dose to a small lung volume is more critical for induction of clinical pneumonitis. The second question is if dose-volume histogram (DVH) parameters are more reliable, if the lungs are analyzed as separate organs or as a whole organ. PATIENTS AND METHODS: We analyzed the clinical and DVH data from 49 patients treated for a thoracic malignancy using 3-D conformal treatment plans. 18 patients had developed a clinical pneumonitis (CTC II or III). The majority of patients (n = 48) received radiochemotherapy for non-small-cell lung cancer (NSCLC) with a combination of paclitaxel and carboplatin. Patients were generally treated 5 fx/week, single dose 2 Gy, using a two-series approach (shrinking field) up to a total dose of 60-70 Gy. For every individual patient, the overall dose distribution was recalculated in the Helax-TMS by means of adding dose plans according to the total dose applied in each series. The lungs were defined both as separate organs and as a whole organ. Low-dose volume (< or = 10 Gy, Vlow), moderate-dose volume (> 10-40 Gy, Vmod) and high-dose volume (> 40 Gy, Vhigh), as well as V10-V40 and mean lung dose (MLD) were defined from the cumulative DVH. Dose-effect relationships were fitted with a logistic regression model. RESULTS: Manifestation of clinical pneumonitis was within 3 months from termination of irradiation in all cases. For the ipsilateral lung, the incidence of pneumonitis was closely correlated to Vhigh. The pneumonitis rate increased from 13% up to 60%. By contrast, with increasing Vlow the pneumonitis rate dropped to < 10%. A similar but less pronounced effect was seen for the total lung. The lung volumes Vlow, Vmod and Vhigh of the ipsilateral, contralateral and whole lung were significantly correlated to the corresponding MLD. The incidence of pneumonitis increased with increasing MLD for the ipsilateral lung with a D50 of 32 Gy and a gamma 50 of 0.98. For the whole lung, the observed increase was less steep. MLD showed a close correlation to NTCP calculated by the Kutcher model. However, NTCP calculation overestimated the pneumonitis risk for the ipsilateral lung and underestimated the risk for the whole lung due to the steeper gradient. The logistic regression curve for the DVH parameters V10-V40 showed an increase of steepness toward higher doses. From the logistic regression curves, a DVH template indicating critical borders of V10-V40 was generated for the ipsilateral as well as for the total lung. CONCLUSION: Our data indicate that it is reasonable to disperse the dose outside the target volume over large areas in order to reduce the volumes of lung receiving > 40 Gy. Reducing the high-dose volume reduces the pneumonitis rate more than a corresponding reduction in the low-dose regions of the DVH. Landmarks for DVH optimization as defined in this analysis may serve as a basis for DVH contrains in IMRT planning. Separate organ analysis produced more reliable results and should be preferred to whole-organ analysis, if techniques mainly involving one side of the lung are applied. Further validation of these constraints is necessary prior to general recommendation.     

Establishing a contract for a PACS managed service

This review considers the process of contracting for a picture archiving and communication system (PACS) using the private finance initiative (PFI) managed service route. The PFI process is reviewed and the advantages and disadvantages of a managed service detailed. During contract negotiations several areas of conflict were encountered. These are discussed with an outline of how they were resolved. CONCLUSION: A contract for a PACS has been achieved by a large acute hospital Trust using a managed service provision through PFI. In detailing the specific problems encountered in the course of negotiations, it is intended that other Trusts entering on this course will be equipped and strengthened in the finalizing of satisfactory and robust contracts.     

Ecografía intestinal en pediatría

Ultrasonography is the imaging technique of choice for studying the digestive tract in pediatric patients from the neonatal period to adolescence. Its dynamic character, absence of radiation, and scant preparation required make ultrasonography preferable to contrast-enhanced fluoroscopy, computed tomography, or magnetic resonance imaging. Technical advances in ultrasound, including high-resolution multifrequency probes, panoramic studies, color Doppler, Doppler with microvascularization, elastography, and contrast agents for use in children, have increased the sensitivity and specificity of this technique.Intestinal ultrasound is indicated for conditions with diverse etiologies and pathogenesis: congenital, infectious, inflammatory, tumor-related, and vascular. Knowledge of embryological development and the normal characteristics of the digestive tract help in identifying, recognizing, and interpreting the ultrasound findings of the different conditions in pediatric patients.This paper aims to show the indications for ultrasound studies of the digestive tract in children, the findings on these studies, and the management of the most common gastrointestinal conditions in pediatric patients.     

CT-Guided Placement of a Drainage Catheter Within a Pelvic Abscess Using a Transsacral Approach

A 66-year-old man underwent CT-guided drainage catheter placement within a pelvic abscess with a diameter of 46 mm. We performed the drainage by a transsacral approach because it was considered the safest and most feasible approach. An 8G bone marrow biopsy needle was used to penetrate the sacrum to create a path for subsequent drainage catheter insertion. After withdrawal of the biopsy needle, a 6 Fr catheter was advanced into the abscess cavity through the path using the Seldinger technique. Except for bearable pain, no procedure-related complications occurred. Twenty-nine days after the placement, the catheter was withdrawn safely and the abscess cavity had shrunk remarkably.