磁共振DWI成像技术在脊髓型颈椎病的临床研究

目的：研究扩散加权成像（DWI）在脊髓型颈椎病（CSM）中的应用价值。方法：对26例临床及影像学证实为CSM患者,22例非CSM患者行颈髓MRI和扩散加权成像,分析病变表现并测量其ADC值。结果：48例均获得弥散加权图像和弥散系数。CSM患者受压部位ADC值明显高于邻近部位和正常颈髓ADC值,差异有统计学意义（P〈0.05）;17例CSM脊髓受压部位T2WI出现高信号,ADC值增高;9例T2WI表现为等信号,其中有6例表现为脊髓受压部位ADC值增高,DWI显示不同信号组受压部位平均ADC值差别无统计学意义（P〉0.05）,但不同信号组受压部位与相应邻近正常部位平均ADC值比较,差异有统计学意义（P〈0.05）。结论：DWI可以通过受压脊髓ADC值改变更早的判断脊髓内部变化,比常规T2WI能更早、更准确显示脊髓受压的情况,从而有助于早期诊断和治疗。     

扩散加权成像在脊髓型颈椎病中的应用

目的:研究扩散加权成像(DWI)在脊髓型颈椎病(CSM)中的应用价值。方法:30例临床及影像学证实为CSM患者,行颈髓MRI和扩散加权成像,分析病变表现并测量其ADC值。结果:30例中除2例因伪影明显未行ADC值测量外,余28例均成功行DWI及ADC值测量。CSM的MRI主要表现为颈椎曲度异常、椎体骨质增生、椎间盘突出、后纵韧带及黄韧带增厚等,相应部位的脊髓均有不同程度的受压改变,伴有椎管狭窄者20例。T2WI脊髓受压部位出现高信号者18例,其中16例DWI相应部位均表现为ADC值增高,2例表现为ADC值略减低;10例T2WI未见异常信号者中有5例亦表现为脊髓受压部位不同程度的ADC值增高。3例手术后复查DWI显示病变部位ADC值不同程度减低。结论:DWI对CSM的早期诊断具有较高的敏感性,且可以在手术疗效监测方面发挥重要作用。     

MRS与DWI联合成像在颈髓损伤诊断中的应用价值

目的：探讨 MRS 与 DWI 序列在颈髓损伤诊断中的价值。方法对95例颈髓损伤患者的 MRI 平扫图像进行分析,根据 T2 WI 上脊髓信号有无改变,分为 A 组———不完全损伤组(T2 WI 信号无异常)63例和 B 组———完全损伤组(T2 WI 高信号)32例,C 组———对照组50例,进行 MRS 及 DWI 检查,分别测量氮-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌酸(Cr)、乳酸(Lac)波峰面积及表观扩散系数(ADC)值,并分析 NAA/Cho、NAA/Cr、Cho/Cr、Lac/Cho 值及 ADC 值。结果在 MRS 序列上,B 组较A 组中 NAA/Cho、NAA/Cr 显著减低(P <0.05);B 组与 C 组比 NAA/Cho、NAA/Cr 值降低,Lac/Cho 值升高(P <0.05);A 组与 C组比仅 Lac/Cho 值升高(P <0.05)。在 DWI 上,A 组 ADC 值为(0.79±0.17)×10-3 mm2/s,低于 C 组(0.93±0.15)×10-3 mm2/s (P =0.026);B 组 ADC 值为(1.21±0.20)×10-3 mm2/s,明显高于 C 组(P =0.017);A 组与 B 组比较,前者 ADC 值低于后者,但差异无统计学意义(P =0.143)。结论MRS 可以无创定量测定创区颈髓相关代谢介质的变化,从代谢及分子水平反映颈髓损伤的不同程度;DWI 对颈髓损伤的早期诊断具有较高的敏感性;DWI 及 MRS 联合成像对临床制订合理的治疗方案及预后评估有重要的意义。     

3.0 T DWI对髓外硬膜下肿瘤鉴别诊断价值的初步研究

目的 应用3.0T超导型磁共振对髓外硬膜下肿瘤行扩散加权成像(DWI)检查,探讨DWI对髓外硬膜下肿瘤鉴别诊断的价值.方法 74例髓外硬膜下肿瘤患者行3.0 T DWI检查,采用单次激发自旋回波平面成像(SE-EPI)序列,扩散梯度因子b值为600 s/mm2,分析不同肿瘤DWI图像信号特点,比较不同肿瘤ADC值的差异.结果 74例患者均获得较满意的DWI和ADC图像.神经源性肿瘤中16例在DWI图上表现为不均匀稍低信号,10例在DWI图上表现为不均匀稍高信号;17例脊膜瘤表现为均匀或不均匀等或稍高信号;8例脂肪瘤完全为均匀低信号;14例表皮样囊肿为不均匀高信号.而9例畸胎瘤呈混杂信号.各肿瘤之间及与邻近脊髓间ADC值均具有明显统计学差异(P＜0.05).结论 DWI通过各肿瘤间DWI图像信号强度不同及定量测量ADC值,有助于对髓外硬膜下不同肿瘤鉴别诊断.     

颈髓MR扩散加权成像优化b值初步研究

目的：探讨1.5T磁共振颈髓扩散加权成像（DWI）b值的选择及获取正常脊髓表观扩散系数（ADC值）。方法：50例健康志愿者进行颈髄DWI检查,采用单次激发平面回波（SSH-EPI-DWI）序列,扩散梯度因子b值分别取300、500和1000 s/mm^2,分3组进行扫描,测量正常人颈髓ADC值并分析各组DWI图像及ADC图像质量,对比不同b值对成像效果的影响。结果：50例受检者均获得较满意的DWI和ADC图像并测得正常人颈髓ADC值。随着b值由300 s/mm^2升高到1000 s/mm^2,图像信号强度逐渐降低。以b值为500 s/mm^2时成像效果较好,信噪比和对比度较高,伪影较少。在500s/mm^2时测得的50例正常颈髓的平均ADC值为（95.70±11.01）×10-5mm^2/s。结论：利用SSH-EPI-DWI序列,正常人颈髓在b值为500 s/mm^2时可获得颈髓较满意的DWI和ADC图像。     

弥散MRI诊断颅内表皮样囊肿的价值

目的:探讨磁共振弥散加权成像(DWI)及表观弥散系数(ADC)图诊断颅内表皮样囊肿的价值.材料和方法:分析19例表皮样囊肿常规MRI和DWI的信号特征,定量测定表皮样囊肿、正常脑实质和脑脊液的ADC值.结果:17例表皮样囊肿T1WI、T2WI呈等或稍高于脑脊液信号,2例T1WI呈高低混杂信号.肿瘤边缘弧线形增强或不增强.19例肿瘤DWI呈明显高于脑实质和脑脊液信号,肿瘤较脑脊液的平均ADC值显著减低,较脑实质的平均ADC值显著增高.结论:DWI优于常规MRI发现颅内表皮样囊肿,DWI上表皮样囊肿的高信号可能是肿瘤组织的T2余辉效应所致.     

扩散加权成像在脊髓急性外伤中的应用

目的　研究扩散加权成像(DWI)在脊髓急性外伤中的应用价值。方法　急性脊髓外伤18例,在72h内行常规MRI和DWI(Philips1. 5TMR仪),其中2例行单次激发DWI(ssh DWI),16例行多次激发DWI(msh DWI)。结果　2例行ssh DWI者,均显示为脊髓病灶局部明显高信号,但图像质量较差,无法行表观扩散系数(ADC)值测量。其余16例均行msh DWI,图像质量明显改善,按照损伤程度和DWI表现不同分为3型: (1)水肿型:本组10例,损伤病灶呈不同程度DWI高信号,损伤部较正常部ADC值有明显减低(t=7. 515,P<0. 01),但本组急性期( 72h)内ADC值在24h内(4例)和25~48h(5例)两组间差异无统计学意义(t=0. 844,P>0. 05); (2)混合型: 4例,病灶混合出血与水肿,DWI呈混杂高信号; (3)出血型: 2例,病灶以出血为主,DWI呈低信号,相应T2WI呈不均匀高信号,T1WI低信号。结论　DWI为脊髓外伤的超早期诊断、帮助判断脊髓传导功能的完整性和脊髓压迫损伤的程度,以及是否合并出血等提供了新的客观手段,值得进一步临床研究和应用。     

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。     

宫腔积脓的MRI表现及与病理对照分析

目的 分析宫腔积脓的MRI表现及与病理相关性.方法 回顾性分类总结12例经手术病理证实为宫腔积脓患者的常规MRI、扩散加权成像(DWI)表现特点,计算平均表观扩散系数(ADC)值,并对照分析相对应病理成分.结果 根据积脓MRI信号均匀性分类:信号均匀型2例,T1WI呈稍低信号,T2WI呈稍高信号,DWI呈高信号,脓液中各成分分布较均匀;信号混杂型5例,MRI示脓液底部或周围混杂稍短T2信号,DWI呈混杂高信号,脓液底部见沉淀物;液-液平面型5例,上层呈水样信号,下层T2WI信号较上层低,其中3例下层信号均匀,DWI呈均匀高信号,脓液中各成分分布均匀,2例下层信号混杂,为血性积脓,DWI呈高低混杂信号.12例宫腔积脓平均ADC值为0.532×10-3 mm2/s.12例子宫体积均增大,其中10例子宫壁变薄,另2例子宫壁炎性浸润、增厚;8例患有宫颈癌;5例合并盆腔积液.结论 宫腔积脓的MRI表现具有特征性,其MRI表现与病理成分高度相关,且ADC值在其诊断中具有重要价值.     

The Clinical Value of Combined MRI and Diffusion Weighted Imaging in Ankylosing Spondylitis

目的 探讨MRI联合DWI对强直性脊柱炎(AS)的诊断价值.资料与方法 搜集经修订纽约标准确诊的31例AS病例和25例正常对照组,两组均行两侧骶髂关节常规MRI横断位和冠状位抑脂T2WI、T1WI联合SE/EPI扩散加权成像(DWI)横断位扫描(b值0,600 s/mm2),观察两组骶髂关节的信号改变,测量表观扩散系数(ADC)值并作统计学检验.结果 31例病例组中的24例双侧或单侧骶髂关节面下骨质抑脂T2WI呈高信号,29例DWI呈高信号,25例对照组骶髂关节面下骨质T2WI、DWI均呈等信号,测量ADC值,病变组为(0.993±0.169)×10 -3mm2/s,对照组为(0.649±0 395)×10 -3 mm2/s,病变组ADC值明显高于对照组(t=4.14,P＜0.001),两者间差异有统计学意义.结论 MRI联合DWI对AS早期诊断有重要的临床价值.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.