胃肠道阴性对比剂在磁共振胰胆管成像中的应用

目的：评价马根维显（Gd—DTPA）溶液作为胃肠道阴性对比剂对改善磁共振胰胆管成像（MRCP）质量的价值。方法：对30例疑有胰、胆管系统疾病的患者口服对比剂前后分别行常规腹部MR和MRCP检查,采用相同的扫描参数及定位。结果：所有病例口服对比剂后MRCP扫描,胃及十二指肠内液体高信号均较前有明显下降,图像质量明显提高。口服稀释的Gd—DTPA溶液前后,MRCP检查胆总管、胰管及胆囊结构的显示效果具有显著性意义（P〈0．05）。结论：口服稀释的Gd—DTPA溶液是一种安全有效降低胃肠道液体高信号强度、改善MRCP图像质量的方法。     

胃肠道阴性对比剂在磁共振胰胆管成像中的应用研究

目的　研究胃肠道阴性对比剂在改善磁共振胰胆管成像 (MRCP)质量的应用。方法　体外实验 :将马根维显 (Gd -DTPA)和欧乃影注射液分别用温开水稀释为不同浓度制剂盛入 10ml注射器内 ,以温开水作空白对照 ,然后行MRCP扫描 ,以获取对比剂最佳稀释倍数。临床实验 :对 3 9例临床疑胰胆管系统疾病申请MRCP检查患者行口服稀释 3 0 0倍马根维显溶液前后常规腹部MR和MRCP检查 ,扫描参数及定位完全相同。结果　体外实验 :稀释 3 0 0倍的马根维显溶液和稀释 2 0 0倍的欧乃影溶液为最佳浓度。临床实验 :所有病例口服稀释 3 0 0倍的马根维显溶液后 ,胃与十二指肠内的液体高信号被明显抑制 ,MRCP胆管显示效果对比在服对比剂前后具有显著性意义 (P <0 .0 5 )。结论　口服稀释 3 0 0倍的马根维显溶液作为胃肠道阴性对比剂可有效地改善MRCP图像的质量。     

口服枸橼酸铁铵在梗阻性黄疸MRCP检查中的应用价值评估

目的评价采用枸橼酸铁铵作为胃肠道口服阴性对比剂对提高梗阻性黄疸患者磁共振胰胆管成像(MRCP)检查质量的作用。方法对50例临床怀疑梗阻性黄疸的患者行MRCP检查,将患者随机分为2组:试验组25例患者,在检查前30min时口服枸橼酸铁铵冲剂;对照组25例患者,不服用任何对比剂。观察患者对口服对比剂的耐受性;对所有患者进行冠状位厚层的半傅立叶单次激励快速自旋回波序列(HASTE)和呼吸触发的3D快速自旋回波序列(RT-3D-TSE)扫描。由2位放射科医师单盲阅片,对2组患者MRCP图像的对比效果和图像质量作评估和分级。结果所有患者对枸橼酸铁铵溶液都有很好的耐受性。口服枸橼酸铁铵溶液后所有试验组MRCP图像上的胃肠道高信号都有很大程度的抑制,对比效果和图像质量有明显改善,胆道解剖结构显示的清晰性明显提高。结论口服枸橼酸铁铵溶液作为安全的胃肠道阴性对比剂在梗阻性黄疸患者的MRCP检查中可以有效降低胃肠道高信号所造成的影响及假象,改善胆道系统的显示情况,便于诊断。     

口服静脉用钆喷替酸葡甲胺对MR胰胆管成像质量影响的研究

目的 选择出静脉用钆喷替酸葡甲胺(Gd-DTPA)作为MR胰胆管成像(MRCP)口服胃肠道阴性对比剂的最佳浓度及容量;评价口服Gd-DTPA对比剂在抑制胃肠道高信号、改善MRCP图像质量中的作用.方法 (1)体外实验:对不同浓度Gd-DTPA稀释液及温开水空白对照组行T1WI、T2WI、二维单层快速自旋回波(FSE)序列及三维半傅立叶单次激发快速自旋回波(HASTE)序列扫描,测量不同成像序列上的信号强度并计算增强率,选择出最佳浓度;(2)临床实验:分别配制不同容量的最佳浓度Gd-DTPA稀释液作为MRCP口服胃肠道阴性对比剂,选择出最佳容量;以最佳浓度和容量Gd-DTPA对比剂对24例临床疑有胰胆管病变的患者行口服前及口服后5～10、10～15 minMRCP扫描,分析图像质量.统计方法采用计算机软件包SPSS 10.0版,对实验结果进行方差分析.结果 T1WI上对照组均为低信号,Gd-DTPA浓度≤0.01 mol/L时为完全高信号;T2WI上对照组为明亮高信号,Gd-DTPA浓度≥0.015 mol/L为完全低信号;2D FSE单层MRCP图像上对照组为明亮高信号,Gd-DTPA浓度在0.0025～0.0300 mol/L之间均为低信号;3D HASTE MRCP图像上对照组为明亮高信号,Gd-DTPA浓度≥0.01 mol/L时为完全低信号;容量≥100 ml浓度为0.01 mol/L的Gd-DTPA对比剂对胃及十二指肠内液体高信号的抑制效果完全;24例患者口服100 ml浓度为0.01 mol/LGd-DTPA对比剂10～15 min后MRCP图像上肝内1、2、3级胆管、肝总管、胆囊、胆总管、胰管头、体、尾的平均等级分数(分别为3.63、3.46、3.08、3.71、3.87、3.88、3.79、3.71、3.50)略高于5～10 min的图像(分别为3.54、3.46、3.00、3.79、3.96、3.87、3.71、3.67、3.54),差异无统计学意义(P值均>0.05),而口服对比剂后肝内3级胆管、胆总管、胰管的等级分数明显高于口服对比剂前(分别为2.79、3.71、3.50、3.42、3.25),差异有统计学意义(F值分别为4.36、4.75、7.86、8.05、7.55,P值均<0.05).结论 100 ml浓度0.01 mol/L的Gd-DTPA对比剂能使胃及十二指肠内潴留液高信号抑制完全,可作为MRCP理想的胃肠道阴性对比剂;口服对比剂后5～10 min行MRCP扫描,图像质量效果最佳.     

口服超顺磁性氧化铁在MRCP中的应用

目的：研究超顺磁性氧化铁(SPIO)作为胃肠道阴性对比剂在改善磁共根胰胆管成像(MRCP)质量的应用。方法：30例受检者口服2mmol/Fe／1的SPIO液100m1后进行TSE MRCP检查，采用西门子1．5T MRI扫描机，服药前后常规行单层和多层扫描，原始图像经工作站处理后，采用最大信号强度投影技术重建获得新图像。结果：口服SPIO溶液可以完全抑制胃及十二指肠内液体信号，排除其干扰，使MRCP时胰胆管显影更加清晰。结论：口服SPIO，行MRCP检查，能抑制胃肠道内液体信号，使胰胆管显影更加清晰，特别是在TSEMRCP成像时效果更佳。     

口服复锐明在MRCP检查中的应用价值

目的探讨口服复锐明溶液作为阴性对比剂在进行MRCP检查时,通过抑制胃肠道液体信号,提高胰胆管系统显示质量的价值。方法从139例进行MRCP的患者中,选择胃肠道液体高信号干扰胆管系统显示质量的患者40例,服用复锐明后再次进行MRCP检查,对服药前后的图像质量进行评价及对比。结果 40例患者中,服用复锐明前MRCP图像质量为3、4级的患者有25%,服用复锐明后,升为92.5%,在显示解剖结构及病变细节方面,诊断价值均优于未服复锐明组(P<0.005)。结论口服复锐明溶液可不同程度的抑制胃十二指肠道内液体信号,明显改善MRCP图像质量,特别是提高对于胆总管、胰管的显示质量,可进一步提高胰胆管疾病的正确诊断水平。     

MRCP 2D和3D FASE序列显示术后胰胆管系统的比较

目的 :评价比较磁共振胰胆管成像 (MRCP)二维高级快速自旋回波 (2DFASE)序列和三维高级快速自旋回波(3DFASE)序列对胆道术后胰胆管系统的显示及图像质量评估。方法 :对 72例胆道术后出现不明原因发热、黄疸、肝功能异常、右上腹痛等症状的患者同时行MRCP的两种序列检查 ,并分别与手术、直接胆道造影图像进行对照。结果 :MRCP的这两种序列均能很好显示术后胰胆管系统解剖 ,3DFASE序列显示肝内一、二级胆管优于 2DFASE序列 ,但差异无显著性意义 (P >0 .0 5 ) ;3DFASE序列显示胰管优于 2DFASE序列 ,差异有显著性意义 (P <0 .0 5 )。MRCP两种序列均获得了较好的图像 ,两种序列图像质量差异无显著性意义 (P >0 .0 5 )。结论 :MRCP 3DFASE序列较 2DFASE序列更适于胆道术后胰胆管系统的检查。     

口服枸橼酸铁铵溶液在MRCP中的初步临床应用

目的:研究使用枸橼酸铁铵(FAC)溶液作为胃肠道阴性对比剂在改善磁共振胰胆管成像(MRCP)图像质量中的应用价值。方法:对40例受检者分别进行服用FAC前和服用后5、10、15min的MRCP检查,采用厚层SSFSE序列成像,且参数保持一致,观察胃肠道信号的消除情况、图像质量的改善情况及药物的可接受性。结果:口服FAC后胃和十二指肠的对比信噪比均有明显下降,其中胃和十二指肠均表现为服药前与服药后5、10、15min的对比信噪比,均为P<0.001,同时十二指肠服药后10min与服药后15min,P<0.001;服药后5min与服药后15min,P<0.01;MRCP的图像质量由服药前的2.9298±1.2499增至10.8865±0.8137,P<0.001。受检者均可接受该药物,极个别有轻微不适,症状自行消除,均无延迟不良反应。结论:口服FAC溶液能有效且安全的消除MRCP图像中胃肠道的高信号,明显改善图像质量,更清晰显示胰胆管结构及病变部位,有利于临床诊断。     

口服静脉用钆喷酸葡胺稀释液改善MRCP质量的研究

目的　口服静脉用钆喷酸葡胺 (Gd DTPA)稀释液作为胃、十二指肠阴性对比剂 ,改善磁共振胰胆管成像(MRCP)质量。资料与方法　实验部分 :取Gd DTPA静脉注射液 1、2、3、4、5、6和 7ml分别加温开水配制成浓度分别为 4 .6 4、9.2 7、13.91、18.5 4、2 3.19、2 7.82和 32 .4 6mg/ml稀释液各 80ml,并依次分组。设立 80ml温开水对照组。行T1WI(SE)和重T2 WI(IR EXPRESS )成像 ,测量各组在不同成像序列的信号强度 ,并计算增强率。临床应用 :对 2 1例经多方位MRCP不能避开胃、十二指肠内高信号背景干扰者 ,行口服稀释液前和后立即、5和 10min放射状多角度MRCP ,然后对各解剖结构显示情况加以判定。结果　浓度为 2 3.19、2 7.82和 32 .4 6mg/ml稀释液在重T2 WI(IR EXPRESS)成像序列中信号强度和增强率最小 ,且无明显差别。口服稀释液前与后 5、10minMRCP图像对胆总管、胰管、胆囊结构的显示具有显著性差异 (P <0 .0 5 ) ;而口服稀释液后 5与 10minMRCP图像对上述结构的显示无明显差异 (P >0 .0 5 )。结论　可选用浓度为 2 3.19mg/mlGd DTPA稀释液 80ml,作为胃、十二指肠阴性对比剂抑制高信号背景 ;口服稀释液后 5min成像可获得较为理想的MRCP图像。     

口服枸橼酸铁铵在磁共振胰胆管成像中的价值

目的　研究枸橼酸铁铵作为胃肠道阴性对比剂对改善磁共振胰胆管成像 (MRCP)质量的价值。方法　 6 0例受检者归入本次研究 ,其中 30例受检者口服枸橼酸铁铵溶液 (内含 6 0 0mg枸橼酸铁铵 )后进行MRCP检查 ,30例则直接进行MRCP检查 ,均采用GE 1 5TMR扫描仪 ,冠状面常规薄层成像 ,原始图像经工作站处理 ,采用最大信号强度投影 (MIP)技术获得新图像。资深放射科医生对2组图像进行评估后行统计学分析。结果　采用非参数检验Raddit分析 ,未服用枸橼酸铁铵溶液组Raddit值的均数为 0 2 75 ,服用枸橼酸铁铵组Raddit值的均数为 0 72 5 ,计算U值为 6 0 37,P <0 0 0 1。结论　口服枸橼酸铁铵溶液可完全抑制胃及十二指肠内液体 ,排除其干扰 ,使MRCP更能清楚地显示胰胆管     

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.     

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     

改进的定位技术在胸部肿瘤穿刺活检中的应用

目的：探索CT-SIM三维定位系统、体模固定技术和PET-CT融合影像导引定位技术在胸部肿瘤经皮穿刺活检中的应用价值。方法：对380例胸部肿瘤患者行改进的CT定位技术下的经皮穿刺活检术。根据肿瘤的大小、深度、毗邻关系、活动度以及患者的心肺功能状态,综合运用CT-SIM系统、体模固定技术和PET-CT融合影像导引技术,为患者进行穿刺前定位。统计穿刺定位时间长度、成功率、确诊率、并发症发生情况,并与210例采用传统铅栅定位下胸部肿瘤穿刺活检的相应资料进行比较。结果：采用改进的CT定位技术的380例患者穿刺定位精确,平均定位时间（9.5 min）较传统方法（16.8 min）缩短7.3 min,活检成功率和确诊率分别是98.7%和95.3%,高于传统定位方法的93.3%和83.3%,两者差异均具有统计学意义（P〈0.05）。穿刺并发症发生率相似,气胸发生率分别为2.8%和2.9%,咯血发生率分别为11%和12.8%。结论：根据患者状态及肿瘤特点,在CT-SIM系统快速精确定位技术的基础上,综合运用体模固定技术和PET-CT融合影像导引技术,能显著缩短经皮穿刺活检的定位时间,提高活检成功率。