双源CT大螺距、低管电压扫描联合迭代重建技术在经导管主动脉瓣置换术术前评估中的应用价值

目的 探讨双源CT大螺距、低管电压（kV）扫描联合迭代重建技术在经导管主动脉瓣置换术（TAVR）术前评估中的应用价值。方法 顺序入组疑主动脉瓣狭窄的60例患者行胸腹主动脉CT血管成像（CTA）检查,按随机数字表法分成大螺距扫描组、联合低kV+迭代重建组和常规扫描组,每组各20例,分别对3组主客观图像质量、对比剂用量及辐射剂量进行对比分析。结果 主观图像质量评分常规扫描组仅3例符合TAVR术前评估要求,大螺距扫描、联合低kV+迭代重建组均明显高于常规扫描组（t=17.083、16.667,P<0.05）,但大螺距扫描组与联合低kV+迭代重建组间差异无统计学意义（P>0.05）;3组间客观图像质量参数信噪比（SNR）、对比噪声比（CNR）差异均无统计学意义（P>0.05）;对比剂用量大螺距扫描、联合低kV+迭代重建组明显低于常规扫描组（t=-13.645、-14.647,P<0.05）,但大螺距扫描、联合低kV+迭代重建组间差异无统计学意义（P>0.05）;辐射剂量参数容积CT剂量指数（CTDI_vol）、剂量长度乘积（DLP）及有效剂量（E）值,联合低kV+迭代重建组均明显低于大螺距扫描、常规扫描组,且3组间差异均存在统计学意义（F=2 564.398、651.616、653.308,P<0.05）。结论 双源CT大螺距、低kV扫描联合迭代重建技术的图像质量能满足TAVR术前评估,同时可大大降低辐射剂量及对比剂用量。     

宽体探测器联合全模型实时迭代重建在肥胖患者上腹部扫描中的应用

目的 探讨宽体探测器联合全模型实时迭代重建技术（ASIR-V）在肥胖患者上腹部低辐射剂量扫描中的应用价值。方法 根据体模实验找出常规上腹部扫描（管电压为120 kVp,噪声指数为10 HU）最佳前置及后置ASIR-V比例;在体模实验基础上,前瞻性收集需行上腹部CT增强的87例肥胖患者（体质量指数≥30 kg/m²）,依随机数表法分为试验组（43例）和对照组（44例）。试验组采用宽体探测器（80 mm）CT联合前置40% ASIR-V行上腹部双期增强扫描获得A1组图像（默认为后置40% ASIR-V）,再联合60%后置ASIR-V技术重建获得A2组图像。对照组采用常规探测器CT（40 mm）扫描后联合40%自适应统计迭代重建技术（ASIR）重建获得B组图像。比较试验组和对照组的辐射剂量、图像的对比噪声比（CNR）、图像噪声和主观评分（5分制法）。结果 常规上腹部扫描最佳前置及后置ASIR-V比例分别为40%及60%。试验组的有效剂量E为（4.55±0.95）mSv,低于对照组的（9.58±2.04）mSv（t=-14.773,P<0.001）。A2组除双期肝脏外,各部位CNR均高于A1及B组（q=2.160~3.209,P<0.05）,双期图像噪声低于A1及B组（q=-4.212~-3.202,P<0.05）,双期总体图像质量评分高于A1及B组（Z=-5.155~-2.561,P<0.05）。A1组双期各部位CNR及图像噪声与B组差异均无统计学意义（P>0.05）,双期总体图像质量评分低于B组（Z=-3.298~-3.030,P<0.05）。A组双期图像质量评分均>3分,均能满足临床诊断需求。结论 肥胖患者采用宽体探测器联合前置40% ASIR-V技术,可比常规探测器扫描减少约53%的辐射剂量;联合后置ASIR-V重建技术,可在保持或提高图像CNR的同时优化总体图像质量。     

第三代双源CT低剂量扫描在新型冠状病毒肺炎筛查中的应用

目的 探讨第3代双源CT低剂量扫描模式结合迭代重建技术在新型冠状病毒肺炎筛查中的应用价值,并评价其辐射剂量。方法 回顾分析2019年12月至2020年2月在华中科技大学同济医学院进行新型冠状病毒肺炎筛查患者120例,按随机数表法分成试验组和常规组,各60例。试验组采用第3代双源CT机,Turbo Flash扫描模式,开启CARE kV,参考管电压90 kV,螺距2.0,ADMIRE算法。常规组采用128排CT机,常规螺旋扫描模式,固定管电压120 kV,螺距1.2,FBP算法。比较两组图像中主动脉、脊柱后方肌肉及皮下脂肪CT值、主动脉噪声、信噪比（SNR）、对比噪声比（CNR）,通过这些客观参数来评价图像质量,由2位高年资影像专家采用双盲法对图像质量进行主观评分,并比较两组图像的CT容积剂量指数（CTDI_vol）、剂量长度乘积（DLP）及有效剂量（E）。结果 试验组患者主动脉、脊柱后方肌肉的CT值分别为（45.38±4.77）和（53.41±8.44） HU,主动脉SNR为2.82±0.59,明显高于常规组的（39.68±6.26）、（42.66±6.32） HU和2.58±0.61（t=5.608、7.897、2.162,P<0.05）,而主动脉噪声、CNR及主观评分差异均无统计学意义（P>0.05）。试验组患者CTDI_vol、DLP、E分别为（3.09±1.02） mGy、（107.57±32.81） mGy·cm、（1.51±0.46） mSv,常规组分别为（7.00±1.80） mGy、（261.65±73.93） mGy·cm、（3.66±1.03） mSv,试验组明显低于常规组（t=-14.680、-14.756、-14.756,P <0.05）。结论 在新型冠状病毒肺炎的筛查中,使用第3代双源CT低剂量扫描模式结合迭代重建技术,在获得满足临床需求图像的同时,不仅有效地降低了辐射剂量,还提高了图像的SNR。     

自动管电流调制技术结合迭代重建算法在低剂量CT肺动脉成像中的应用

目的 探讨自动管电流调制技术结合idose4迭代重建算法在低剂量CT肺动脉成像（CTPA）中的应用价值。方法 连续收集行CTPA的受检者80例,采用随机数字表法将其分为对照组和实验组,每组40例。两组管电压均采用80 kV。对照组固定管电流为180 mAs,采用滤波反投影法重建,获得A组图像;实验组采用自动管电流调制技术,分别采用滤波反投影法和idose4迭代重建算法重建,获得B组和C组图像。统计分析A、B和C 3组的图像质量主观评分、肺动脉平均CT值、图像噪声值、肺动脉的信噪比（SNR）和对比噪声比（CNR）。比较实验组和对照组的有效剂量（E）。结果 实验组、对照组的E分别为（1.2±0.2）和（1.9±0.3）mSv,实验组的ED较对照组明显降低了36.8%（t=-3.998,P<0.05）。3组图像质量主观评分均≥3,满足临床诊断要求,且差异无统计学意义（P>0.05）。3组SNR、CNR和噪声值组间比较,差异有统计学意义（F=10.4 11、7.630、13.021,P<0.05）;而肺动脉平均CT值差异无统计学意义（P>0.05）。结论 自动管电流调制技术结合idose4迭代重建算法在低剂量CTPA检查中,在获得良好图像质量的同时,可进一步降低辐射剂量。     

双源CT低电压迭代重建联合分次注射法低辐射泌尿系造影的可行性研究

目的 评估双源CT （DSCT）低电压迭代重建联合分次注射法（SBI）行CT泌尿系造影（CTU）的辐射剂量、图像质量和影像诊断准确率。方法 连续80例临床初诊为泌尿道疾病而准备行CTU检查的患者依据随机数字表法分为对照组和试验组两组。对照组40例采用常规注射,常规电压（120 kV）,滤波反投影法（filtered back-project,FBP）重建,试验组40例采用分次注射法,低电压扫描（80 kV）,正弦迭代重建（sinogram affirmed iterative reconstruction,SAFIRE）,评估两组的有效剂量E、图像质量及影像诊断准确率。结果 共77例患者顺利完成检查和图像评估,其中对照组39例,试验组38例。试验组的平均有效剂量E为（3.93±0.85）mSv,低于对照组的（26.68±4.07）mSv （t=-33.78,P<0.05）。两组图像质量主观评分分别为（4.49±0.79）分和（4.39±1.53）分,差异无统计学意义（P>0.05）。试验组的信噪比（SNR）为127.3±15.9,明显高于对照组的109.6±13.2,差异有统计学意义（t=4.49,P<0.05）,但对比噪声比（CNR）分别为100.84±12.92和108.96±14.42,差异无统计学意义（P>0.05）。两组最终诊断准确率分别为84.62%和81.58%,差异无统计学意义（P>0.05）。结论 双源CT低电压扫描迭代重建联合分次注射法CTU检查可大幅度降低辐射剂量,但图像质量主观评分、CNR值和影像诊断准确率未受明显影响。     

双定位像结合Care Dose 4D和Care kV技术在降低肺部CT辐射剂量的临床应用价值

目的 探讨双定位像结合Care Dose 4D和Care kV技术在肺部CT检查中的可行性及其临床应用价值。方法 连续纳入临床确诊为肺部肿瘤行肺部CT扫描的患者60例,按随机数表法分为对照组和试验组,每组各30例,对照组行单定位像（AP）结合Care Dose 4D和Care kV技术扫描,试验组行双定位像（AP和lat）结合Care Dose 4D和Care kV技术扫描。由2位高年资医师采用双盲法对两组图像和病变组织的信噪比（SNR）、对比噪声比（CNR）,及整体图像质量进行综合分析和评价,同时计算有效辐射剂量。结果 60例患者均成功完成肺部CT检查,试验组整体图像质量评分为4.57±0.45,与对照组的4.73±0.45相比差异无统计学意义（P>0.05）。对照组图像SNR、CNR、病变组织SNR、CNR与试验组相比差异均无统计学意义（P>0.05）。试验组和对照组的容积CT剂量指数CTDI_vol、剂量长度乘积（DLP）、有效剂量（E）,差异有统计学意义（t=8.514、8.464、8.464,P<0.001）。与对照组相比,试验组有效剂量降低了33.3%。结论 较单定位像（AP）肺部CT检查,双定位像（AP和lat）结合Care Dose 4D和Care kV技术肺部CT检查可获得满足诊断及临床需求图像,同时明显降低辐射剂量,可成为肺部CT常规检查方式。     

迭代重建算法在双源CT三低方案冠状动脉血管成像中的应用价值

目的 探讨迭代重建（SAFIRE）算法在双源CT三低方案（低管电压、低剂量对比剂、低流速注射）冠状动脉血管造影（CCTA）中的应用价值。方法 连续选取120例体质量指数（BMI）18.6~24.9 kg/m² 和心率<65次/min的患者,均使用对比剂碘海醇350 mgI/ml,其中包括滤波反投影技术（FBP）组和SAFIRE组,每组60例。FBP组采用120 kV管电压、对比剂剂量0.9 ml/kg、注射流速5.0 ml/s,进行前瞻性心电门控扫描,图像重建采用FBP;SAFIRE组采用80 kV管电压、对比剂剂量0.7 ml/kg、注射速率3.5 ml/s,进行前瞻性心电门控大螺距扫描,图像重建采用SAFIRE。测量两组动脉管腔内及左心室底部肌肉的CT强化值和噪声,计算信噪比（SNR）及对比噪声比（CNR）。采用双盲法对冠状动脉节段以4分法进行评价,其中1分为不可诊断图像。记录每一个患者的平均容积CT剂量指数（CTDI_vol）和剂量长度乘积（DLP）,并计算有效剂量。结果 两组动脉管腔内CT值、图像噪声、SNR、CNR,差异均无统计学意义（P>0.05）;SAFIRE组有效剂量（0.39±0.02）mSv较FBP组显著降低（4.99±1.36）mSv,差异有统计学意义（t=26.31,P<0.05）。结论 在BMI为18.6~24.9 kg/m ²、心率<65次/min的患者中,应用双源CT前瞻性心电触发大螺距三低方案联合迭代重建算法冠状动脉血管成像,能得到满意的图像,又降低了辐射剂量。     

低kV结合迭代重建在下肢动脉CT血管造影中的应用

目的 探讨低管电压联合自适应性迭代低剂量(AIDR-3D)技术在下肢动脉CT血管造影(CTA)应用的可行性。方法 60例疑诊下肢动脉闭塞的患者按随机数字表法分为对照组(120 kV)和试验组(100 kV)各30例,采用Toshiba Aquilion ONE完成CTA。对照组采用传统滤波反投射法(FBP)进行重建,试验组采用FBP和AIDR-3D两种重建。分别比较两组的主观图像质量及血管内密度(VD)、噪声、信噪比(SNR)、对比信噪比(CNR)和剂量长度乘积(DLP)。结果 试验组DLP较对照组明显减低[(503.5±104.7)vs. (1099.4±151.7) mGy·cm,t=15.7,P<0.05]。FBP重建的试验组图像的VD和噪声明显高于对照组(t=-3.13、-3.61,P<0.05)。AIDR-3D重建的图像噪声明显低于FBP重建图像(t=13.59,P<0.05)。与对照组相比, AIDR-3D重建的试验组图像噪声明显减低(t=2.14,P<0.05),而VD、SNR和CNR明显增高(t=-3.75、-4.19、-4.15,P<0.05)。结论 在320排CT下肢动脉CTA检查中,100 kV联合AIDR-3D重建可提高图像质量,并大幅减低辐射剂量。临床试验注册 中国临床试验注册中心,CHiCTR-DPD-16008054。     

低管电压联合迭代重建算法对胸部CT血管造影图像质量及辐射剂量的影响

目的 探讨低管电压联合迭代重建算法对胸部CT血管造影成像图像质量及辐射剂量的影响.方法 利用ATOM 701-D型成年男性仿真人胸部模型,配置碘水混合对比剂注入输液管后置入胸部模拟胸部血管.采用320排容积CT以80、100和120 kV分别联合自适应迭代降剂量技术(AIDR 3D)迭代重建4个等级(关闭、轻、标准、强)共12种方案按管电流等其他参数不变进行胸部扫描,记录辐射剂量.获得横断面输液管CT值及噪声水平、纵隔区软组织CT值、信噪比(SNR)和对比噪声比(CNR).比较不同管电压扫描及不同迭代算法水平重建对图像质量的影响.结果 容积CT剂量指数(CTDI_vol)、剂量长度乘积(DLP)及有效剂量(E)在120 kV时为12.50 mGy、453.50 mGy ·cm、6.35 mSv;在100 kV时为7.60 mGy、276.50 mGy ·cm、3.87 mSv;在80 kV时为3.80 mGy、138.70 mGy ·cm、1.94 mSv.随着管电压的降低,辐射剂量显著降低.不同管电压时,输液管CT值、噪声标准差(SD)、SNR、CNR差异均具有统计学意义(F=1 029.24、8.56、3.44、4.09,P<0.05).按不同重建算法,输液管SD、SNR、CNR差异均具有统计学意义(F=33.99、54.80、54.72,P<0.05),但对输液管CT值没有显著影响(P>0.05).管电压或重建算法对纵隔区软组织CT值的影响差异均无统计学意义(P>0.05).结论 80 kV管电压扫描联合标准水平的迭代重建算法方案可降低有效剂量,并获得较高质量的胸部血管图像.     

超重患者肺动脉CT血管成像70 kV/sn150 kV联合高级模拟迭代重建的图像质量评估

目的 定量评价超重（25 kg/m²≤BMI<30 kg/m²）患者低剂量双能量（70 kV/sn150 kV）肺动脉成像中70 kVp、非线性融合联合高级模拟迭代重建（ADMIRE）图像的质量。方法 2018年10月至2019年3月行双源CT双能量肺动脉成像的可疑肺栓塞患者共70例,70 kV/sn150 kV扫描模式的体质量指数正常者及超重者各35例,对比剂用量均为30 ml。患者扫描后均获得70 kVp、150 kVp、线性融合及非线性融合图像,评估体质量指数正常者70 kVp （组1）、体质指数正常者非线性融合（组2）、超重者70 kVp （组3）、超重者非线性融合（组4）图像质量指标,包括肺动脉CT值、图像噪声（SD）、信噪比（SNR）、对比噪声比（CNR）,辐射剂量参数包括CT容积剂量指数（CTDI_vol）、剂量长度乘积（DLP）、有效剂量（E）。结果 4组肺动脉CT值差异无统计学意义（P>0.05）。段动脉SD值组1高于组4（t=2.69,P<0.05）。肺动脉主干、亚段动脉SNR值组2高于组3（t=1.44、5.40,P<0.05）。左肺动脉干SNR值组2高于组3、组4（t=1.52、1.52,P<0.05）。肺动脉主干、亚段动脉CNR值组2高于组3（t=1.45、5.01,P<0.05）。左肺动脉干CNR值组2高于组3、组4（t=1.50、1.50,P<0.05）。正常体质量指数组、超重组有效剂量为（1.60±0.54）、（1.88±0.45） mSv。结论 对于超重患者,肺动脉CT血管成像70 kV/sn150 kV双能量模式联合ADMIRE迭代重建的图像质量满足临床诊断,且对比剂用量及辐射剂量较低,是一种可行的双能量肺动脉扫描模式。     

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.     

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.     

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）