腰骶丛DTI对慢性炎性脱髓鞘性多发性神经根神经病的诊断价值

【摘要】目的：探讨腰骶丛神经DTI对慢性炎性脱髓鞘性多发性神经根神经病（CIDP）的诊断价值。方法：采用3.0T MR仪对11名健康志愿者及16名CIDP患者进行腰骶丛常规MRI扫描和腰骶丛神经DTI扫描。其中DTI扫描范围包括L3～S1神经根,在DTI参数图上行FA、λ1、λ2、λ3的参数值测量,通过所得测量值计算出FA、AD、RD、MD参数值。健康志愿者组及CIDP组对应的FA、AD、RD、MD参数值行两独立样本t检验。结果：健康对照组FA、AD、RD、MD值分别为0.263±0.091、（4.993±0.647）×10-3mm2/s、（4.435±0.745）×10-3mm2/s、（4.672±0.642）×10-3mm2/s;CIDP组FA、AD、RD、MD值分别为0.225±0.053、（5.261±0.365）×10-3mm2/s、（5.657±0.292）×10-3mm2/s、（4.872±0.312）×10-3mm2/s。CIDP组与健康对照组相比FA及ADC值明显下降,AD、RD、MD值明显升高（P＜0.05）。结论：CIDP患者的腰骶丛神经DTI参数的变化对CIDP早期诊断和分期具有重要价值。     

3.0 T MR扩散张量成像在颈椎病诊断中的应用

目的 探讨3.0 T MR扩散张量成像(DTI)作为一种定量分析方法在颈椎病中的应用价值.方法 21名健康志愿者(对照组)和84例颈椎病患者行颈髓DTI,根据T2WI表现将颈椎病组分为A(单纯硬膜囊受压)、B(颈髓轻度受压)、C(颈髓受压,T2WI可疑高信号)、D(颈髓受压,T2WI信号增高)4组,每组21例,以健康组为对照,分析颈椎病组表观扩散系数(ADC)、分数各向异性(FA)值及本征(λ1、λ2、λ3)值的变化,对所有受检者行颈髓纤维束成像.结果所有受检者DTI显示满意.21名对照组颈髓平均ADC值为(0.78±0.08)×10-3mm2/s,FA值为0.72±0.03,λ1、λ2、λ3值分别为(1.51±0.15)×10-3mm2/s、(0.42±0.09)×10-3mm2/s、(0.41±0.10)×10-3mm2/s.对照组与硬膜囊受压组比较,ADC(q=1.451)、FA(q=1.999)、λ1(q=1.137)值差异无统计学意义(P值均＞0.05),与λ2(q=3.039)、λ3(q=2.982)值差异存在统计学意义(P值均＜0.05).对照组与B、C、D 3个颈髓受压组比较,ADC值的q值分别为7.982、8.532、14.073,FA值的q值分别为12.206、15.889、26.306,λ1值的q值分别为4.601、4.845、6.631,λ2值的q值分别为6.502、11.060、20.480,λ3值的q值分别为9.782、9.416、16.949,差异均存在统计学意义(P值均＜0.01).结论 ADC、FA、λ1、λ2、λ3值是检测颈髓微结构改变的敏感指标.     

正常人颈髓不同节段磁共振扩散张量成像分析

目的 定量分析正常人颈髓不同节段弥散张量成像(diffusion tensor imaging,DTI)的参数值及其相关性.方法 使用单次激发自旋回波平面回波(single-shot spin echo echo-planar image,SS-SE-EPI)序列、12个扩散敏感梯度磁场方向、b值为0 s/mm2和500 s/mm2,对20例健康志愿者行颈髓DTI检查,测量颈髓各节段各向异性分数(fractional anisotropy,FA)值与表观扩散系数( apparent diffusion coefficient,ADC)值,同时感兴趣区(ROI)分别选择16 mm2和26 mm2.结果 纤维示踪图显示颈髓纤维束连续,粗细均匀;颈髓各节段FA值之间存在差异,C2/3椎间盘及C3椎体平面颈髓FA较余节段高(P<0.05);而各节段颈髓ADC值之间差异无统计学意义(P>0.05).ROI面积取值不同,所测得的颈髓DTI参数值差异无统计学意义(P>0.05).颈髓FA值与ADC值之间呈负相关(P<0.05).结论 正常人颈髓不同节段FA值存在差异,ADC值无明显差异;ROI面积不同,所测得参数值无明显差异;颈髓FA值与ADC值呈负相关.     

正常人颈髓弥散张量成像的初步研究

目的 探讨弥散张量成像(DTI)在正常人颈髓中的应用.方法 使用单次激发自旋回波平面成像(SS-SE-EPI)序列对30例MR检查的正常人行颈髓DTI成像,在C2～3、C4～5、C6～7节段测量颈髓平均扩散系数值(Dcavg)及各向异性分数(FA).结果 (1) 正常人颈髓在Dcavg图及FA图上为较均匀的等信号及高信号,在彩色Dcavg图及FA图上为深蓝色及红色信号. (2) C2～3、C4～5、C6～7节段Dcavg值(1×10-3mm/s)分别为0.882±0.034、0.811±0.042 、0.717±0.068,FA值分别为 0.719±0.038、0.618±0.051、0.537±0.034.(3)C2～3、C4～5、C6～7节段的Dcavg值及FA值均有统计学意义(P<0.05).结论 SS-SE-EPI序列能够获得满意的颈髓DTI图像.颈髓的平均Dcavg值为(0.803±0.082)×10-3mm/s,FA值为0.624±0.091.     

肌萎缩侧索硬化症的颈髓MR扩散张量成像研究

目的 了解常规MR检查阴性的肌萎缩侧索硬化症(ALS)患者颈髓DTI的各项参数值的变化情况.方法 选取临床诊断为ALS患者(ALS组)16例及16名年龄、性别匹配的健康志愿者(正常组)行颈髓常规MRI及横断面DTI.DTI图像经工作站(AW4.2)后处理,获得ADC图、部分各向异性(FA)图和相对各向异性(RA)图.在C3椎体水平层面分别在颈髓前索区、后索区及双侧皮质脊髓侧束区4个区域内选取面积约5 mm ×5 mm的ROI,测定其ADC值、FA值和RA值.使用独立样本t检验对两组间各项参数值进行比较,使用Pearson相关分析分别对ALS患者异常参数值与ALS患者病程、Norris评分及功能质量相关评分(ALSFRS)进行相关性分析.结果 ALS组左、右侧皮质脊髓侧束的FA、RA值较正常组减低.其中ALs组左侧皮质脊髓侧束的FA、RA值为0.762±0.089、0.762±0.107,正常组为0.863±0.098、0.890±0.105;ALS组右侧皮质脊髓侧束的FA、RA值为0.751±0.065、0.772±0.082,正常组为0.843±0.118、0.863±0.134,差异均具有统计学意义(t值分别为2.575、4.195、2.246、2.218,P值均<0.05).ALS组左、右侧皮质脊髓侧束的ADC值分别为(0.744±0.162)、(0.767±0.141)×10~(-3)mm~2/s,正常组为(0.640±0.149)、(0.643±0.168)×10~(-3)mm~2/s,两组间差异无统计学意义(t值分别为-1.319、-1.087,P值均>0.05).ALS组前索FA、RA及ADC值分别为0.637±0.113、0.622±0.138、(0.950±0.354)× 10~(-3)mm~2/s,正常组分别为0.670±0.117、0.656±0.136、(0.865±0.238)×10~(-3)mm~2/s,两组间差异无统计学意义(t值分别为0.854、-0.704、-1.155,P值均>0.05).ALS组后索FA、RA及ADC值分别为0.886±0.073、0.920±0.100、(0.613±0.137)×10~(-3)mm~2/s,正常组分别为0.906±0.078、0.914±0.135、(0.636±0.224)×10~(-3)mm~2/s,两组间差异也无统计学意义(t值分别为1.655、-0.148,-1.360,P值均>0.05).ALS患者左、右侧皮质脊髓侧束FA、RA值与ALS病程、临床Norris评分及ALSFRS之间均无相关性(P值均>0.05).结论 SE-EPI序列DTI用于ALS患者颈髓的检测,其扫描方法简单且比较敏感,可以反映常规MRI上未能显示的病理学改变.     

扩散张量成像鉴别子宫肉瘤和变性子宫肌瘤初探

【摘要】目的：探讨磁共振扩散张量成像（DTI）对子宫肉瘤（US）和变性子宫肌瘤（DUF）的鉴别诊断价值。方法：回顾性分析经手术病理证实且术前均行1.5T MR 平扫（T1WI、T2WI、DWI、DTI）和LAVA多期增强扫描的14例US和30例DUF患者的病例资料。由两位观察者在ADW4.6工作站上使用Functool软件对DTI和DWI图像进行分析和测量。采用Spearman分析法评价数据的相关性,使用独立样本t检验或非参数Mann-Whitney U检验比较DTI的ADC（ADCT）值及DWI的ADC值和FA值在US与DUF之间的差异。应用ROC曲线分析ADCT值、FA值和ADC值鉴别US与DUF的诊断效能。结果：US的ADCT值、FA值和ADC值均小于DUF,分别为（1.110±0.198）×10-9 vs （1.624±0.225）×10-9mm2/s、0.168±0.063 vs 0.254±0.111、（1.118±0.238）×103 vs （1.522±0.189）×10-3mm2/s,差异均有统计学意义（P＜0.05）。以ADCT值1.322×10-9mm2/s、FA值0.192、ADC值1.292×10-3mm2/s作为鉴别诊断阈值,相应的敏感度和特异度分别为96.7%和92.9%、86.7%和85.7%、78.6%和90.0%,AUC分别为0.974、0.831和0.875。结论：DTI定量参数能有效鉴别子宫肉瘤和变性子宫肌瘤,其中DTI的ADCT值较DWI的ADC值具有更好的诊断效能。     

肌萎缩侧索硬化症的颈髓MR扩散张量成像研究

Objective To determine whether normal-appearing cervical spinal cord in patients with amyotrophic lateral sclerosis (ALS) has abnormal changes based on the quantitative measurement in healthy volunteers. Methods Conventional MRI and axial DTI were obtained in 16 patients with ALS (ALS group) and 16 age-matched control subjects (normal group) . ADC, fractional anisotropy (FA) and relative anisotropy(RA)imagcs were obtained on workstation (AW4. 2). ROIs (5 mm × 5 mm) were placed in anterior funicalus, posterior funiculus, and bilateral lateral corticospinal tracts (LCTs), respectively, at the same slice (C3). Independent-sample t test was used for comparison of parameters between the two groups. Correlations between DTI parameters of ALS and ALS course, Norris score, and ALSFRS were carried out separately by Pearson correlation analysis. Results FA and RA values of bilateral LCTs were decreased significantly. FA/RA values of left LCT were 0.762±0.089 and 0.762±0.107 in ALS group, while they were 0.863±0.098 and 0.890±0.105 in control group, respectively. FA/RA values of right LCT were 0.751±0.065 and 0.772±0.082 in ALS group, and they were 0.843±0.118 and 0.863±0.134 in control group, respectively, they were decreased significantly (t = 2.575、4.195、2.246、2.218, P < 0.05). There were no significant differences (t = - 1.319, - 1.087, P > 0.05) between ADC values of left and right CSTs in ALS group [(0.744±0.162) × 10-3, (0.767±0.141) × 10-3 mm2/s] and control group [(0.640±0.149) ×10-3, (0.643±0.168) ×10-3 mm2/s)]. FA, RA and ADC values of ALS patients in anterior funiculus were 0.637±0.113, 0.622±0.138, (0.950±0.354)×10-3 mm2/s, in control group they were 0.670±0.117, 0.656±0.136, (0.865±0.238) × 10-3 mm2/s, there were no significant differences (t = 0.854, - 0.704, - 1.155,P > 0.05). FA, RA and ADC values of ALS patients in posterior funieulus were 0.886±0.073, 0.920±0.100, (0.613±0.137)×10-3 mm2/s, in control group they were 0.906±0.078, 0.914±0.135, (0.636±0.224) × 10-3 mm2/s, there were no significant differences (t = 1.655, - 0.148, - 1.360; P > 0.05). No significant correlation existed between FA and RA values and disease course, Norris and ALSFRS score (P > 0.05), in left and right LCTs. Conclusion DTI with SE-EPI technique is simple and sensitive to detect the pathological changes of the cervical spinal cord in ALS patients. DTI can reveal the abnormalities which are "normal appearing" on conventional T2WI.     

用MR扩散张量成像评价犬急性脊髓损伤后神经前体细胞移植的作用

目的用MR扩散张量成像(diffusiontensorimaging,DTI)观察神经前体细胞移植对犬急性脊髓损伤的影响。方法经端粒酶转染人胚胎脑室下区(subventricularzone,SVZ)细胞建立永生化的神经前体细胞系,并转基因表达绿色荧光蛋白(greenfluorescentprotein,GFP)用于标记和示踪。制作犬T13脊髓左半横断损伤模型。8只犬于损伤后1周行细胞移植,移植点取脊髓半切损伤头侧和尾侧邻近区域的灰白质交界处,不用免疫抑制剂。分别于损伤前、损伤后1周、移植后1周(即损伤后2周)、移植后4周用DTI测量损伤侧和未损伤侧的表观扩散系数(apparentdiffusioncoefficient,ADC)值及部分各向异性(fractionalanisotropy,FA)值,并对结果进行统计学分析。结果损伤前、损伤后1周、移植后1周、移植后4周损伤侧的ADC值分别为(1.00±0.15)、(1.65±0.45)、(1.44±0.48)、(1.43±0.26)×10-3mm2/s,不同时间的差异有统计学意义(F=6.038,P=0.005);损伤侧的FA值分别为0.59±0.11、0.30±0.17、0.36±0.25、0.34±0.11,不同时间的差异有统计学意义(F=5.221,P=0.009)。未损伤侧的ADC值分别为(1.01±0.17)、(1.32±0.06)、(1.10±0.24)、(1.14±0.22)×10-3mm2/s,不同时间的差异无统计学意义(F=1.303,P=0.306);未损伤侧的FA值分别为0.60±0.09、0.38±0.25、0.46±0.15、0.50±0.21,不同时间的差异无统计学意义(F=2.797,P=0.072)。结论DTI对实验性脊髓损伤后脊髓损伤和修复过程的观察能提供有价值的信息。     

急性颈髓外伤的DTI临床应用

【摘要】目的：探讨磁共振扩散张量成像（DTI）在急性颈髓外伤中的临床应用价值。方法：41例急性颈髓外伤（外伤后3天内）患者行常规MRI、DTI和扩散张量纤维束成像（DTT）检查。41例患者按照常规T2WI上有无异常信号,分为阳性组（17例）和阴性组（24例）;选取年龄、性别相匹配的15例健康人作为对照组。分析各组中表观扩散系数（ADC）、各向异性分数（FA）、平行于颈髓长轴、前后径和左右径的本征值（λ1、λ2、λ3）的变化。结果：与对照组比较,颈髓外伤患者的FA值均降低,T2WI阳性组中ADC、λ2、λ3均增高,而T2WI阴性组中λ3值升高,差异均有统计学意义（P＜0.05）。与T2WI阴性组比较,阳性组中λ3值较高,FA值较低,差异有统计学意义（P＜0.05）。DTT图显示颈髓损伤处神经纤维有不同程度的稀疏、移位、扭曲及断裂等征象。结论：FA、λ3值是检测颈髓外伤早期颈髓微结构改变的敏感指标,纤维束图能直观显示纤维束的细微变化情况。     

扩散加权成像在脊髓梗死中的应用

目的研究扩散加权成像(DWI)在脊髓梗死中的诊断及鉴别诊断价值。方法6例临床诊断为脊髓梗死患者,在发病后1～30d内采用1.5T磁共振仪行常规MRI和DWI。DWI均采用导航回波校正多次激励平面回波序列,并在矢状面进行表观扩散系数(ADC)值的测量。结果均成功行常规MRI和DWI检查,颈髓2例,胸腰段4例。常规T2WI表现为矢状面条状和片状长T2信号(6/6),早期多伴有肿胀(5/6),轴面表现为对称长T2信号,部分呈典型“蛇眼征”。其中,1例仅累及脊髓后动脉,表现为脊髓后部长T2信号。DWI除1例接近等信号外(发病后30d),余(发病1～12d)均表现为明显高信号,ADC平均值[(0.37±0.10)×10-3mm2/s],较正常值[(0.89±0.08)×10-3mm2/s]明显减低,差异有统计学意义(t=4.71,P<0.01)。本组中2例在3个月内进行复查,DWI信号逐渐减低,同时ADC值逐渐升高至正常,分别为0.85×10-3mm2/s和0.95×10-3mm2/s。结论DWI是脊髓梗死较为特异的诊断和鉴别诊断方法,值得推广应用。     

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.