磁共振扩散加权成像在恶性肿瘤诊断中的应用进展

磁共振扩散加权成像(DWI)反映了水分子的微观扩散运动,是从细胞及分子水平研究疾病的病理生理状态的一种技术,可用于判断功能及定性诊断.DWI主要用于脑缺血的早期诊断.近年来逐渐应用于恶性肿瘤的诊断及鉴别诊断.全身DWI基于传统DWI技术,结合全身成像技术,可一次完成全身检查,全面检出原发灶及分布全身的远处转移灶,有助于恶性肿瘤的分期及治疗方案的制定,逐渐成为一种恶性肿瘤全身转移灶筛查的有力工具.     

非小细胞肺癌的16层螺旋CT TNM分期与其病理相关性的研究

目的探讨16层螺旋CT(16-SCT)在诊断非小细胞肺癌TNM分期与病理TNM分期的相关一致性。方法选用由16-SCT检查并经手术治疗的84例非小细胞肺癌病例,采用国际肺癌TNM分期(1997年)标准进行诊断,将16-SCT诊断的TNM分期结果与手术、病理分期结果进行比较,分析16-SCT诊断分期结果与手术病理TNM分期相关一致性。结果16-SCT诊断肺癌的TNM分期与病理分期有良好的一致性。在总的TNM分期中,16-SCT的符合率、灵敏度、特异度分别达到91.7%、82.2%、93.7%。16-SCT在诊断非小细胞肺癌T、N分期中,与病理的Kappa值分别为0.84、0.79。结论16-SCT能够准确诊断非小细胞肺癌TNM分期,16-SCT为非小细胞肺癌的诊断治疗提供重要的影像学资料。     

DWI评估肺癌术前纵隔淋巴结状态的研究

目的 比较CT与扩散加权成像(DWI)评估肺癌术前纵隔淋巴结状态的诊断价值.方法 搜集36例肺癌患者术前的CT和DWI资料,以病理结果为参照,对CT图像进行观察和分析,对MR图像运用感兴趣区技术分别测量淋巴结的表观扩散系数值.计算CT和DWI相应的敏感性、特异性、阴性预测值、阳性预测值及准确性.对符合正态分布者采用两独立样本t检验.结果 受试者工作特征曲线分析显示转移性胸部淋巴结的表观扩散系数值明显低于非转移性淋巴结(P =0.000).CT诊断肺癌胸部淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为62.1％、72.2％、59.3％、74.7％和67.9％,DWI分别为59.8％、87.4％、77.6％、74.8％和75.7％,DWI的诊断效果与CT未见明显差异(P =0.202),但特异性明显高于CT(P =0.004),准确性稍高于CT(P =0.080).结论 DWI及表观扩散系数值对诊断肺癌淋巴结转移有一定价值.     

MRI DWI及DCE-MRI综合使用对直肠癌临床分期与诊断价值

目的 MRI DWI及DCE-MRI综合使用,对病灶进行诊断及分期,比较其与术后病理诊断及分期的相关性,探讨其对直肠癌临床分期、诊断及治疗的指导意义。方法收集2012年12月15日~2015年2月29日间临床怀疑为直肠癌并完成直肠MR检查的患者41例,最后纳入经手术病理证实并分期的患者32例。MRI、MRI+DWI及MRI+DCE-MRI分期诊断与病理分期诊断的对照关系。结果 32例均由手术后病理分期诊断,证实性质均为恶性,吻合率100%;MRI常规成像总体T分期准确率78.13%,N分期准确率78.13%;MRI示直肠癌典型表现为不规则等T1/长T2信号肿块突向肠腔。MRI+DWI成像T分期总准确度81.26%,N分期总准确率90.62%;DWI示直肠癌不同分化程度及不同分期的直肠癌ADC值无差别(P0.05)。MRI+DCE-MRI成像T分期总准确度84.37%,N分期总准确率90.62%;DCE-MR示其动态增强曲线迅速上升缓慢下降或呈平台期改变32例不同分期及不同分化程度的直肠癌Tpeak值无差别(P0.05)。Tpeak值是直肠癌诊断可靠指标,范围约23~62s之间。结论 MRI、DWI及DCE-MRI综合使用检查对临床直肠癌诊断、分期及治疗具有较高指导意义。     

磁共振扩散加权成像在肺部的应用和研究进展

随着磁共振快速成像序列的开发和软硬件技术的发展,磁共振功能成像已成为国内外研究热点.磁共振扩散加权成像(DWI)更是发展迅速,已经不仅仅局限于神经系统的研究,在全身体部各脏器均取得了日趋成熟的经验,使得肺部病变的DWI研究也有所突破.本文就DWI在肺部病变特别是肺癌筛查、诊断、分期和疗效评价中的应用和研究进展做一综述.     

肺癌的MR全身DWI与PET成像的对照研究

目的：探讨MR DWI及PET成像在肺癌诊断及鉴别诊断中的应用价值。方法：26例临床高度怀疑为肺癌且接受了PET检查的患者行MR DWI检查,通过三维图像重组及黑白翻转技术,得到＂类PET＂图像,观察病变的形态、大小和分布,并与PET影像进行比较,在工作站上测量肺部病变的ADC值及SUV值,进行相关性分析。最终的诊断结果依据影像学检查、病理诊断和随访复查共同确定,其中肺癌19例,肺部炎性假瘤1例,慢性炎症4例,淋巴结反应性增生2例。结果：以病理结果为金标准,PET检出肺癌的敏感度为100%,特异度为57.1%;MR DWI的敏感度为94.7%,特异度为71.2%。肺癌与炎性病变的ADC值及SUV值差异均有统计学意义（P〈0.01）,肺癌病灶的ADC值与SUV值没有明显线性相关关系（r=-0.293,P〉0.05）。结论：MR DWI及PET成像对肺癌的诊断有较高的敏感度及特异度,两种方法互为补充,可为肺癌的诊断及鉴别诊断提供更多的信息。     

Evaluation of diffusion-weighted MRI in the preoperative staging of rectal cancer

目的:探讨MR扩散加权成像在直肠癌诊断中的临床应用价值.方法:回顾性分析43例直肠癌患者的MRI资料,所有患者均行常规序列T1 WI、T2 WI及DWI检查,将MRI诊断结果与手术病理结果进行对照分析.结果:常规序列T1分期的诊断符合率为60.0％(3/5),T2、T3、T4分期分别为80.0％(12/15)、66.7％(12/18)和80.0％(4/5);常规序列联合DWI的T1分期诊断符合率为100％(5/5),T2、T3、T4分期分别为100.0％(15/15)、83.3％(15/18)和100.0％(5/5).常规序列及常规序列联合DWI的直肠癌T分期总诊断符合率分别为72.1％和93.0％.结论:MR扩散加权成像结合常规序列能够对直肠癌T分期做出较准确的诊断.     

MRI常规序列结合DWI对盆腔内结直肠癌术前临床分期的价值

目的 :探讨MRI常规序列结合DWI对盆腔内结直肠癌术前T-N分期的价值。方法 :53例经病理证实结直肠癌患者,术前对其行MRI常规序列及DWI检查。并根据AJCC 2010版癌症分期手册制订影像学分期标准,进行术前T分期和局部N分期,与术后病理T分期(pathological T stages,p T)和局部的N分期(pathological N stages,p N)比较。结果:MRI对p T1~2期的诊断准确率88.7%,p T3期83.0%,p T4期94.3%,对T分期总诊断准确率83.0%,与病理分期一致性好(K=0.582,P0.01)。MRI对N分期诊断准确率81.1%,特异性89.2%,敏感性62.5%,阳性预测值71.4%,阴性预测值84.6%,与病理分期一致性好(K=0.536,P0.001)。结论:MRI常规序列结合DWI对盆腔内结直肠癌术前T-N分期具有重要价值。     

MRI平扫结合扩散加权成像在直肠癌中的临床应用价值

目的:探讨MRI平扫结合扩散加权成像(DWI)在直肠癌中的临床应用价值.方法:对28例直肠癌患者行MRI平扫及DWI检查,评价肿瘤形态、T分期、淋巴结转移、环周切缘(CRM)状态、肿瘤下缘距肛缘的距离,并与术后病理结果进行对照.MRI与病理对T分期、N分期及环周切缘受累评估的一致性采用Kappa检验.结果:MRI平扫及DWI能准确显示肿瘤的部位及形态.MRI平扫结合DWI对28例直肠癌T分期总的诊断符合率为78.57％(22/28),T1～T2期、T3期、T4期的诊断符合率分别为85.71％、78.57％、92.86％,MRI与病理对T分期的诊断具有较高的一致性(Kappa值=0.656).MRI平扫结合DWI对判断N分期的符合率为71.43％ (20/28),判断淋巴结转移的敏感度为66.67％(6/9),特异度为73.68％(14/19),MRI与病理对N分期的诊断具有中度一致性(Kappa值=0.489).MRI判定CRM状态的总体符合率为85.71％ (24/28),敏感度为90.90％(10/11),特异度为82.35％(14/17),阳性预测值为76.92％(10/13),阴性预测值为93.33％(14/15),MRI与病理对环周切缘受累的评估具有较高的一致性(Kappa值=0.710).MRI矢状面图像能测量18例下段直肠癌肿瘤下缘距肛缘的曲线距离.结论:MRI平扫结合DWI对直肠癌、T分期、环周切缘状态的判断及肿瘤下缘距肛缘的距离的测量有重要临床价值.     

MR扩散加权成像在宫颈癌诊断和分期中的应用价值

目的 探讨磁共振扩散加权成像（DWI）在宫颈癌诊断的敏感性、分期的准确性及盆腔淋巴结转移的检出率和定性准确率中的应用价值.方法 回顾性分析经术后病理证实的98例宫颈癌患者的影像资料,比较DWI联合常规MRI序列与单纯常规MRI序列在宫颈癌诊断、分期及盆腔淋巴结转移方面的差异.结果 DWI联合常规MRI序列对Ⅰb期的漏诊率（1/20）低于单纯常规MRI序列漏诊率（5/20）.DWI联合常规MRI序列对Ⅱb期分期准确率（21/23）高于单纯常规MRI序列准确率（14/23）;其余各期分期,两者无明显差异.DWI联合常规MRI序列对盆腔淋巴结转移的检出率（135/148）和定性准确率（76/82）均高于单纯常规MRI序列的检出率（101/148）和定性准确率（56/82）.结论 相对于常规MRI序列,DWI联合常规MRI序列对宫颈癌的诊断更敏感,Ⅱb期分期更准确,盆腔淋巴结检出率和定性准确率更可靠.     

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.     

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.     

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.     

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）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme