骨恶性纤维组织细胞瘤的CT诊断(附11例报告)

目的：探讨骨恶性纤维组织细胞瘤的ＣＴ表现及其诊断价值。方法：对１１例手术病理证实的骨恶性纤维组织细胞瘤的ＣＴ表现进行回顾性分析。结果：１１例骨恶性纤维组织细胞瘤的基本ＣＴ表现为（１）溶骨性骨破坏，可呈地图样、虫蚀样或无结构的溶骨性破坏。（２）软组织肿块，范围大于溶骨病变，软组织块内可见钙化点。（３）患骨破坏区呈膨胀性改变。结论：Ｘ线平片仍是检出骨肿瘤的首次检查主要手段，但ＣＴ通常能更清晰显示骨和软组织的解剖和病理结构细节，象肿瘤大小、范围、形状、轮廓、密度、钙化、坏死等，因此，ＣＴ在诊断骨恶性纤维组织细胞瘤上具有重要价值     

胸部X线摄影术与CT诊断胸壁结核的对照研究

目的评价胸部X线摄影术及CT在胸壁结核诊断中的价值。方法对21例经手术、穿刺活检证实的胸壁结核作了影像学分析，其中男8例，女13例，年龄在19—84岁，中位年龄34岁；全部病例均作了胸部X线摄影术和CT扫描，9例作了增强CT扫描。结果（1）胸部X线平片仅4例显示骨质破坏。（2）CT平扫则全部可见肋骨旁软组织肿块；16例边缘密度较高，中央密度较低，3例呈较高密度中有多发低密度，2例呈均匀较低密度。5例肋骨破坏，3例为膨胀性溶骨性骨破坏。增强扫描时8例肿块呈边缘强化。（3）21例CT所见的胸壁肿块，胸片均未能发现（X^2=42．000，P〈0．01）；4例CT上可见的4个纵隔及腋窝肿大淋巴结，胸片上均未能见到（X^2=4．421，P〈0．05）；2种影像学检查差异具有统计学意义。结论CT，特别是增强CT扫描是确诊本病的首选方法。     

甲醇中毒导致脑部损害的影像学表现

目的 探讨甲醇中毒导致脑部损害的CT、MRI特点及与其发病相关因素的关系。方法 39例饮假酒致甲醇中毒的患者，发病的潜伏期为0～4d。发病后1～6d行血液学检查、头颅CT平扫，其中4例行头颅MR平扫。结果 双侧壳核低密度改变6例，其中合并双侧皮质下白质区低密度改变2例；单侧内囊低密度改变4例；皮质下白质区低密度改变1例。CT阳性与饮假酒量（Z=-2．244，P〈0．05）、临床分期呈正相关（X^2=4．232，P〈0．05）；与血液中甲醇浓度（Z=-1．430．P〉0.05）、潜伏期（X^2=0．001，P〉0．05）无明显相关性。结论 MRI较CT更能早期发现脑部损害。病变的特点以双侧壳核发病为主，合并皮质下白质区的损害者往往提示预后不佳。     

乳腺微小钙化与乳腺癌的相关性研究

目的：探讨数字化乳腺钼靶摄影时乳腺微小钙化的表现及分型对乳腺疾病的定性诊断价值。方法：74例患者行数字化乳腺钼靶摄影检查,记录钙化灶单簇个数、分布直径、形态分型（根据Le Gal乳腺微小钙化分型,Ⅰ型：环形钙化;Ⅱ型：形态规整的点状钙化;Ⅲ型：泥沙样钙化;Ⅳ型：形态不规则的点状钙化;Ⅴ型：蠕虫样钙化）、是否沿导管分布、是否伴有肿块等x线特点．并与手术活检病理学资料进行对比分析。结果：74例中36例为乳腺恶性病变（48．65%）、38例为良性病变（51．35％）。单因素分析结果显示,单簇个数（P〈0．001）、微小钙化的形态分型（P〈0．001）、是否沿导管分布（P=0．001）以及是否伴有肿块（P=0．007）对乳腺良恶性病灶的鉴别有一定价值。多因素分析发现,钙化的形态分型（P=0．0008）和是否伴有肿块（p=0．003）是诊断乳腺癌的独立预测因子。微小钙化的形态分型中Ⅳ和Ⅴ型钙化、Ⅲ型钙化伴有肿块或单簇个数〉10个以及Ⅱ型钙化伴有肿块或分布直径〉20mm者恶性率较高。结论：Ⅳ和Ⅴ型钙化、Ⅲ型钙化伴有肿块或单簇个数〉10个以及Ⅱ型钙化伴有肿块或分布直径〉20mm诊断乳腺癌的阳性预测值较高,应积极定位手术活检明确诊断、及时治疗。     

SPECT和CT融合骨显像在小儿神经母细胞瘤中的应用

目的探讨SPECT和CT融合骨显像在探测小儿神经母细胞瘤（NB）转移性骨肿瘤中的临床价值。方法回顾性分析24例NB患儿,均行全身平面骨显像及局部SPECT和CT融合骨显像。将骨病灶显示的清晰度分为5级（不可见、模糊、可见、清晰、非常清晰）,良恶性诊断的确定性分为3级（不确定、可以确定、十分确定）,诊断效能指标包括灵敏度、特异性及准确性。对显像图像在骨病灶的清晰度显示、良恶性确定性诊断及探测恶性骨病灶的诊断效能方面进行分析,采用秩和检验及χ^2检验进行比较。结果24例NB患儿,全身平面骨显像发现骨病灶72个,有5个骨病灶未能显示,SPECT和CT融合显像和单独SPECT显像均分别发现骨病灶77个。对骨病灶的清晰度显示SPECT和CT融合显像,单独SPECT显像均优于平面显像（日值均为69．000,P均〈0．05）。平面显像和SPECT显像诊断恶性骨病灶的准确性分别为45．45％（35／77）和62．34％（48／77;χ^2=4．416,P〈0．05）,SPECT和CT融合诊断恶性骨病灶的灵敏度、特异性和准确性均较平面显像有提高,分别为82．35％（42／51）和53．19％（25／47）、88．46％（23／26）和40．00％（10／25）、84．42％（65／77）和45．45％（35／77）,χ^2=12．571,14．016和25．667,P均〈0．01。与SPECT显像的特异性（14／26,53．85％）和准确性（48／77,62．34％）相比,SPECT和cT融合诊断恶性骨病灶的特异性和准确性提高（χ^2=7．589,9．606,P均〈0．01）,两者间灵敏度差异无统计学意义（χ^2=2．942,P〉0．05）。SPECT和CT融合显像骨病灶良恶性的确定性诊断优于SPECT（H=28．000,P〈0．05）和平面显像（H=21．000,P〈0．05）。结论SPECT和CT融合骨显像能探测到NB患儿更多的骨病灶,是一种较好的探测NB患儿转移性骨肿瘤的显像方法。     

骨恶性间叶瘤的影像学表现(附4例病例报告并文献复习)

目的:探讨骨恶性间叶瘤的影像学表现,以提高影像诊断水平,减少误诊。方法:回顾性分析经手术病理证实的4例骨恶性间叶瘤患者的X线、CT及MRI表现,其中X线平片检查4例,CT和MRI各检查2例。结果:骨恶性间叶瘤的主要影像学表现为:①软组织肿块:形态不规则,直径多>10 cm,边缘清楚或模糊,肿块内有钙化、骨化,CT显示肿块内有脂肪组织,MR T_1WI上肿块呈等、低信号,T_2WI呈混杂高信号,CT增强扫描示肿块不均匀强化;②骨质改变:呈浸润性斑片状骨质破坏,部分破坏边缘有硬化,MR T_1WI呈低信号,T_2WU呈混杂高信号,骨膜反应少见;③骨破坏程度与软组织肿块大小不成比例。结论:骨恶性间叶瘤影像学表现有一定特征,影像检查有助于本病的诊断和鉴别诊断。     

原发性胸骨动脉瘤样骨囊肿一例

患者　女 ,18岁。发现胸部肿物 4个月余 ,时有疼痛 ,近来疼痛加重伴肿物逐渐增大而来院诊治。体检 :胸骨柄下见约 6 0cm× 6 0cm大小肿物 ,呈骨性、压痛明显、不能移动、边缘光整、局部皮温不高。实验室检查无异常。CT、MR检查 :图 1为CT横断面扫描 ,骨窗显示胸骨近端膨大如球样骨质破坏 ,无明显钙化及骨性分隔 ,周边为薄层高密度骨壳 ,大小约为 5 0cm× 4 8cm。图 2为CT横断扫描与图 1同一平面 ,软组织窗示球样骨质破坏区密度略不均匀 ,呈阶梯样液 液平面 ,CT值分别为 5 5HU和 19HU ,不伴有周围软组织肿块。图 3为MR矢状面快速自…     

3.0T MR TSE-17-db-iPAT T_2WI序列在周围型肺肿块诊断中的价值

目的：探讨3．0 T MR TSE-17-db-T2-iPAT T2WI序列对周围型肺肿块各种形态学征象的显示能力及对肺良恶性肿块的诊断价值。方法：对56例周围型肺肿块（直径1．5～6．3cm,平均3．47cm）行3．0TMRI,通过与常规CT对照,分析MRI对肿块的形态学征象,包括肿块的大小、形状、毛刺、分叶、内部结构及与支气管的关系等的检出及显示能力;采用5分制评分法对肿块的性质进行评分,评价CT、MRI诊断肺部良、恶性病灶的敏感性、特异性。结果：3．0TMR TSE-17-db-iPAT T2WI对显示肿块的大小、形状和分叶能力与CT比较差异无显著性意义（P〉0．05）;CT显示肿块血管集束征（16例）、肿块与支气管关系（12例）比MRI（分别为7和4例）更有优势（P〈0．05）;而3．0TMR TSE-17-db—iPAT T2WI显示肿块内部结构（47例）比CT（13例）更有优势（χ2=32．03,P〈0．01）;评分大于等于3分（病灶不确定,但可能为恶性）判为癌症,MRI诊断周围型肺肿块的敏感度为73．7％,特异度为50．0％;CT诊断周围型肺肿块的敏感性为81．6％,特异性为55．6％。结论：3．0TMR TSE-17-db-iPAT T2WI序列对显示肺内肿块内部结构比CT更有优势;在周围型肺肿块的鉴别诊断中有-定价值。     

平片与CT对股骨颈区囊样病变诊断价值(附49例分析)

目的　比较和评价X线平片与CT扫描 2种检查方法对股骨颈区囊样病变的诊断价值。方法　回顾性分析X线平片与CT扫描并经临床与手术病理证实的 49例股骨上段囊样病变 ,其中骨脓肿 7例 ,骨结核 2例 ,软骨瘤 4例 ,成骨细胞瘤 1例 ,成软骨细胞瘤 6例 ,骨巨细胞瘤 8例 (Ⅰ级 5例 ,Ⅱ级 3例 ) ,非骨化性纤维瘤 3例 ,软骨黏液样纤维瘤 2例 ,骨纤维异常增殖症 6例 ,骨嗜酸性肉芽肿 3例 ,骨囊肿 5例 ,软骨肉瘤 2例。结果　 49例进行平片检查 ,显示软组织肿胀 3例 ,无软组织肿块 ;骨膜反应 11例 ;病灶呈单囊 2 1例 ,呈多囊 2 8例 ;显示囊内钙化 3例。 3 8例进行CT扫描 ,显示软组织肿胀 5例 ,软组织肿块 7例 ;骨膜反应 2例 ;病灶呈单囊 13例 ,呈多囊 2 5例 ;显示囊内钙化 11例。结论　CT扩展和加深了对囊样病变征象的认识 ,可为临床提供较平片更为准确、全面的影像学信息 ,但X线平片仍是股骨上段囊样病变影像学诊断的最基本的和首选的检查方法     

X线、CT、MR对膝关节外伤检查的对比分析

目的：通过对膝关节外伤后X线、CT、MR检查影像分析对比来讨论X线、CT、MR检查的价值。方法：通过对外伤后50例患者的检查（其中50例均行X线检查，45例行X线与CT检查，42例行X线与MR检查）。结果：50例中X线显示有明显骨折的29例，软组织肿胀者41例；CT有明显骨折的33例，软组织肿胀的43例，关节囊积液44例，半月板明显撕裂伤5例：MR显示明显骨折33例，关节囊积液47例．前后交叉韧带损伤5例，内外侧副韧带撕裂8例；在X线与CT检查骨折均为阴性的17例中伴有骨挫伤15例。结论：在显示膝关节损伤的检查中。CT、MR更具有定位准确，显示优良的优点，尤其MR对骨的微创伤有着无可替代的地位。     

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.