垂体瘤与原发性甲状腺功能减低致垂体增生的MRI鉴别

目的 探讨垂体瘤与原发性甲状腺功能减低(甲减)致垂体增生的MRI影像表现及鉴别诊断.方法 对术后病理已确诊垂体瘤64例及治疗后确诊原发性甲减致垂体增生17例患者的年龄、性别及MRI影像表现进行回顾性分析.结果 垂体瘤组平均年龄为(53.2±18.9)岁,明显高于原发性甲减致垂体增生组[(24.5±16.3)岁],差异有显著统计学意义(t=4.282,P＜0.01);两组患者性别差异无统计学意义(x2=0.594,P＞0.05);垂体大腺瘤组的平均高度为(18.2±7.2) mm,高于原发性甲减致垂体增生组病变平均高度[(10.6±2.6)mm],差异有统计学意义(t=2,432,P＜0.05).垂体瘤因其血供差而易发生囊变、出血和坏死,MRI上常呈高低混杂信号影,常侵犯附近组织结构,垂体后叶高信号消失,垂体柄偏移或中断,增强扫描垂体瘤不均匀异常强化;原发性甲减致垂体增生MRI表现为垂体前叶均匀增大,上缘对称性山包状隆起,呈等T1、等T2信号,其垂体后叶高信号清晰可见,垂体柄居中,增强扫描均匀一致强化,无异常强化或延迟强化区域.结论 两者具有一定特征性的影像表现,MRI具有重要的诊断与鉴别诊断价值.     

青春前期儿童甲状腺功能减退致垂体增生的MRI表现

目的探讨青春前期儿童甲状腺功能减退（甲减）致垂体增生的MRI表现。资料与方法分别对10例临床已确诊为甲减的儿童和10名青春前期的正常儿童行垂体MRI平扫及增强检查并对照分析。结果10例甲减患者表现为垂体上缘呈对称性隆起,形态呈钟形,垂体明显均匀强化,垂体高9．4～16．0nm,垂体柄横径为1．4～1．7mm。结论甲减所致垂体增生具有一定的影像学特征,结合临床可明确诊断。     

鞍区肿瘤的MRI表现与鉴别诊断

目的：明确不同类型鞍区肿瘤的MRI特征。材料与方法：回顾性分析44例经手术病理证实的鞍区肿瘤MRI表现。结果：19例垂体大腺瘤、12例颅咽管瘤、9例鞍区脑膜瘤及4例鞍上池表皮样囊肿均有其一定的特征性MRI表现。垂体大腺瘤起源于垂体，大多数向上生长呈“雪人”形，个别向下生长突破鞍底，瘤体内可发生囊变（47％）或出血（32％）而致信号强度不均；颅咽管瘤多发生于鞍上，少数累及鞍内，囊实性或囊性者居多，其中于T1加权像上囊液可呈低、等、高不同信号强度为其特点；脑膜瘤多位于鞍上池前部，信号均匀与脑灰质相似，增强扫描有时可见脑膜尾征；发生于鞍上池的表皮样囊肿沿脑池生长，边缘不规则，信号强度与脑脊液相似。结论：MRI对鞍区肿瘤有重要的鉴别诊断价值。     

鞍区原始神经外胚层肿瘤一例

患者 女,35岁.因头痛、视物模糊2个月于2011年1月4日到我院就诊.体检:右眼睑下垂,右眼直接、间接对光反射迟钝.影像检查:CT平扫示鞍区不规则软组织肿块,以实性成分为主,并突向鞍上池生长,大小约54 mm×36 mm×39 mm,蝶鞍扩大;增强扫描病灶轻度均匀强化(图1);鞍区(鞍底、部分后床突)骨质破坏、吸收.CT诊断:鞍区占位性病变,垂体大腺瘤可能性大.MR平扫示鞍区形态不规则肿块,T1WI呈等、稍低信号,T2WI呈等、稍高混杂信号(图2,3),信号较均匀,病变向上突入鞍上池,向下突入蝶鞍,垂体受压变薄,蝶鞍扩大;增强扫描肿块明显均匀强化,其内见低信号流空血管影,肿块压迫周围组织,并向上突破鞍区长入鞍上池内,视交叉受压上移,鞍上池、桥前池及第三脑室受压,双侧海绵窦受侵,双侧颈内动脉海绵窦段被肿块包绕;病变向前突入蝶窦;病灶向下压迫鞍底,垂体受压(图4～6).     

鞍区生殖细胞瘤的影像学分析

目的 探讨鞍区生殖细胞瘤的临床影像特点,提高诊断准确率.方法 经手术病理证实8例和放射治疗协诊4例.回顾性分析鞍区生殖细胞瘤的CT及MRI影像特点.结果 12例鞍区生殖细胞瘤中,5例肿瘤形态不规则,侵犯垂体和垂体柄,垂体后叶T1WI高信号消失;5例肿瘤累及垂体柄增粗;2例肿瘤仅累及下丘脑.CT平扫显示所有肿瘤均无钙化,呈等或略高密度.MRI检查,肿瘤在T1WI等信号,T2WI为高信号.增强示肿瘤明显均匀强化.3例瘤体呈环状强化.其中3例肿瘤由下丘脑浸润三脑室旁伴周围脑质轻度水肿.另外1例沿脑脊液发生种植性播散,右侧外侧裂池内有一结节病灶.结论 鞍区生殖细胞瘤的影像学表现有一定特征性,结合临床资料分析,有较高的诊断准确性.     

MRI对鞍区病变的诊断价值

目的探讨MRI对鞍区病变的诊断价值。方法分析71例经手术病理证实的鞍区病变的MRI征象。结果垂体腺瘤37例,颅咽管瘤15例,鞍区脑膜瘤6例,鞍区生殖细胞瘤3例,垂体Rathke's囊肿2例,鞍区胶质瘤2例,胆脂瘤2例,脊索瘤2例,鞍上池巨大蛛网膜囊肿、结核性肉芽肿各1例。结论MRI能正确显示鞍区病变的部位、形态、大小、范围以及周围结构的受累情况,对鞍区病变的诊断具有重要意义。     

原发甲状腺功能减低致垂体肿瘤样增生一例

患者女,24岁,因月经失调、不孕不育4年人院,入院MRI示鞍底下陷,垂体增大,大小约13 mm×19 mm×9 mm,上缘膨隆,呈穹隆状,信号均匀,T1WI呈等信号,T2WI呈稍高信号,垂体后叶高信号存在,增强扫描明显均匀强化,视交叉受压上抬,垂体柄显示不清(图1A ～D).经激素替代治疗后MRI示垂体上缘稍凹陷,大小...     

垂体少见病变的MRI诊断

目的 分析垂体少见病变的MRI表现.方法 回顾分析20例垂体少见病变的MR表现,其中颅底型垂体瘤8例、垂体单纯出血5例、垂体脓肿5例及淋巴细胞性垂体腺炎2例.全部病例均行MRI平扫,除垂体出血外其余均行MRI增强扫描.结果颅底型垂体瘤呈等T1稍长T2信号影向鞍下及蝶窦内发展,并可见部分残留垂体;垂体单纯出血表现为垂体内呈片状短T1长T2信号影,垂体显示不清;垂体脓肿表现为垂体内长T1长T2信号影,增强扫描呈环形强化;淋巴细胞性垂体腺炎表现为蝶鞍不扩大,垂体腺明显增生肥大向鞍上发展.结论 MRI平扫加增强扫描是垂体少见病变的首选影像学检查方法.     

学龄前儿童原发垂体性生长激素缺乏症的MR影像学表现

目的：研究学龄前儿童原发垂体性生长激素缺乏症垂体的MRI特征。方法：回顾分析46例原发垂体性生长激素缺乏症儿童（病例组）垂体的MR影像特征,并与35例同龄健康儿童（对照组）作对照比较。结果：病例组腺垂体平均高度（2.32±0.78）mm,与脑干对比,34例T1WI信号低于脑干,12例信号与脑干相等;44例垂体柄完整连续,矢状面平均宽径（0.89±0.51）mm;2例垂体柄缺如;2例垂体后叶异位于下丘脑漏斗底部的正中隆起。4例合并中枢神经系统畸形。对照组腺垂体高度、垂体柄宽径分别为（3.76±1.21）mm、（1.64±0.59）mm。病例组腺垂体高度、垂体柄矢状宽径均比正常对照组小,差异具有显著性意义。结论：MRI能够清楚的显示原发垂体性生长激素缺乏症垂体的影像学特征,表现为垂体前叶变小,信号低于或等于脑干,垂体柄变细或缺如,大多数垂体后叶位置正常,少数病例后叶异位,以及合并的中枢神经系统畸形。     

垂体少见疾病的MRI诊断及鉴别诊断

目的探讨垂体少见疾病的MRI特点,提高对垂体少见疾病的认识。资料与方法回顾性分析10例经临床或病理证实的垂体少见疾病的MRI表现,包括Rathke＇s囊肿3例,垂体增生3例,淋巴细胞性垂体炎3例,颗粒细胞瘤1例。结果Rathke＇s囊肿表现为垂体内边界光滑、信号均匀的囊性病变。垂体增生表现为垂体增大,垂体柄增粗,明显均匀一致的强化。淋巴细胞性垂体炎3例,表现为垂体增大,垂体柄增粗,与垂体信号相仿,2例信号均匀,1例信号不均匀,增强扫描病变明显强化;1例有邻近的硬膜强化。颗粒细胞瘤表现为垂体柄均匀增粗,明显均匀一致的强化。结论MRI能清楚地显示病变的范围和特点,具有重要的诊断和鉴别诊断价值。     

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.