99Tcm-MIBI断层双时相显像诊断乳腺癌的临床价值

目的 探讨99Tcm-甲氧基异丁基异腈(MIBI)乳腺断层双时相显像诊断乳腺癌的临床价值.方法 采用自制乳腺断层显像装置对26名健康对照者和93例乳腺肿块患者行99Tcm-MIBI乳腺断层双时相显像,分别计算健康对照者两侧对应部位及乳腺肿块患者早期相和延迟相肿瘤与健侧对应部位的放射性(T/NT)比值,并与术后或活组织病理检查结果对照.结果 (1)99Tcm-MIBI乳腺断层双时相显像示,健康对照组乳腺早期和延迟相T/NT比值为1.09±0.18和1.08±0.19,差异无统计学意义(t=1.443,P＞0.05);乳腺肿块良性病变组早期和延迟相T/NT比值为2.08±2.85和1.69±3.05,差异有统计学意义(t=2.814,P＜0.05);乳腺癌组早期和延迟相T/NT比值为5.00±4.34和6.79±11.94,差异无统计学意义(t=-0.884,P＞0.05);健康对照组、良性病变组和乳腺癌组间早期相T/NT比值差异有统计学意义(t值分别为2.912,2.412和3.940;P均＜0.05).(2)99Tcm-MIBI乳腺肿块断层双时相显像诊断乳腺病变的灵敏度为97.1%,特异性为79.3%,准确性为86.0%,阳性预测值为73.9%,阴性预测值为97.9%,总的诊断符合率为86.0%.在乳腺癌组中诊断准确性为97.1%,在乳腺良性病变组中诊断准确性为79.3%.(3)乳腺癌肿块直径＜2 cm、2～5 cm及＞5 cm组99Tcm-MIBI乳腺断层双时相显像的灵敏度分别为5/6,100%(21/21)和8/8.结论 99Tcm-MIBI乳腺断层双时相显像是一种高灵敏度和特异性的乳腺癌检测方法,对鉴别乳腺良恶性病变有较高的临床价值.     

^99mTc—HL91肿瘤乏氧显像与^18F—FDG符合线路显像的比较

目的:探讨99mTc-HL91在肿瘤组织内的摄取,评估99mTc-HL91肿瘤乏氧显像的临床价值,并与18F-FDG符合线路显像比较分析.材料和方法:对17例恶性肿瘤患者分别进行18F-FDG符合线路成像及99mTc-HL91乏氧显像.结果:1、4小时99mTc-HL91断层显像与18F-FDG符合线路显像的肿瘤与周围正常组织放射性比值(T:N值)分别为1.60、2.60、4.73.以T:N值1.5作为截断点,99mTc-HL91显像的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为88.9%、80.0%、87.5%、96.0%、57.1%,18F-FDG符合线路显像发现的恶性肿瘤病灶中,均见99mTc-HL91摄取.结论:99mTc-HL91显像对探测肿瘤乏氧有意义,与18F-FDG显像一样为临床判断肿瘤预后和采用干预措施提供信息.     

用ROC曲线法分析99Tcm-HL91肺肿瘤阳性显像的诊断效能

目的探讨半定量分析及接受器工作特性(ROC)曲线法在99Tcm-4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)肿瘤阳性显像鉴别肺部良恶性肿块中的价值.方法经CT检查发现肺部肿块的患者50例,均经活组织检查或手术病理检查证实.根据病理检查结果分为恶性组37例和良性组13例.术前行99Tcm-HL91 2 h、4 h平面显像及4 h断层显像,分别使用视觉判断法、半定量分析及ROC曲线法分析显像结果.结果①视觉判断法99Tcm-HL91显像的灵敏度、特异性和准确性分别为97.3%、69.2%和90.0%.②肿瘤/正常肺组织(T/N)比值半定量分析及ROC曲线法恶性组2 h、4 h平面显像及4 h断层显像T/N比值分别为1.52±0.19、1.73±0.28及2.84±0.97;良性组分别为1.20±0.16、1.24±0.20及1.52±0.40.各个时相的曲线下面积分别为0.909±0.056、0.945±0.039、0.953±0.034.从99Tcm-HL91断层显像ROC曲线的界值点找到1个界点(T/N=1.76),以其作为判断良、恶性的诊断阈值,灵敏度、特异性和准确性分别为100%、84.6%和96.0%.③视觉判断法与半定量分析法比较T/N比值半定量分析及ROC曲线法使诊断的灵敏度、特异性和准确性都有提高,尤其特异性.但两种方法间差异无显著性(P均＞0.05).结论半定量分析及ROC曲线法的诊断阈值可进一步提高99Tcm-HL91肺部肿瘤阳性显像的诊断效能.     

99Tcm-HL91乏氧显像在甲状腺结节良恶性鉴别诊断中的应用

目的 评价99Tcm4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)对甲状腺结节良恶性鉴别诊断的临床价值.方法 对58例经触诊或超声检查存在甲状腺结节的患者进行99Tcm-HL91甲状腺早期(10 min)及延迟(4 h)平面显像,应用感兴趣区(ROI)技术计算靶/非靶(T/N)比值并进行比较.组间比较采用成组设计两样本均数t检验,率的比较用χ2检验.结果 患者均经手术或细针穿刺病理检查,其中21例为甲状腺癌,37例为甲状腺良性结节.99Tcm-HL91显像诊断甲状腺癌的灵敏度、特异性和准确性分别为85.7%,94.6%和91.4%,不同甲状腺癌病理类型的显像灵敏度差异无统计学意义(χ2=0.778,P＞0.05),但结节越大灵敏度越高.甲状腺癌与甲状腺良性结节组早期及延迟相T/N比值分别为1.07±0.04,1.25±0.03和0.92±0.10,0.91±0.12,组间在10 min时T/N比值差异无统计学意义(t=1.900,P＞0.05),4 h时T/N比值差异有统计学意义(t=3.885,P＜0.001).结论 用99Tcm-HL91乏氧显像判断甲状腺结节的良恶性有一定的临床价值,显像时间以4 h为佳.     

99Tcm-MIBI显像对甲状腺结节良恶性鉴别诊断价值的研究

目的 观察99Tcm-MIBI甲状腺结节双时相显像的特征,对照病理学检查结果,探讨99Tcm-MIBI早期及延迟显像对甲状腺良恶性结节的鉴别诊断价值.方法 89例经手术病理证实的甲状腺病变患者,其中,甲状腺癌患者38例,甲状腺良性病变患者51例,分别行甲状腺99Tcm-MIBI早期显像及延迟显像,对比分析早期及延迟显像中两组患者的T/NT值.结果 99Tcm-MIBI早期显像中,甲状腺癌组T/NT值(1.32±0.03)与甲状腺良性病变组T/NT值(1.26±0.22)相比,差异无统计学意义(t=0.63,P＞0.05).99Tcm-MIBI延迟显像中,甲状腺癌组T/NT值(1.72±0.39)较甲状腺良性病变组T/NT值(1.20±0.36)增高,差异有统计学意义(t=3.45,P＜0.05).结论 甲状腺99Tcm-MIBI早期显像对甲状腺癌的诊断有较高的灵敏度,但特异性较低;99Tcm-MIBI延迟显像能提高诊断的特异性,对甲状腺结节良、恶性的鉴别有较好效果.     

~(99)Tc~m-HL91乏氧细胞分子显像对甲状腺冷结节的诊断价值

目的 :探讨99Tcm-HL91乏氧细胞分子显像对甲状腺冷结节的诊断价值。方法 :对30例99TcmO4-甲状腺扫描提示为冷结节的患者术前行99Tcm-HL91早(10 min)、中(2 h)、晚(4 h)三时相显像,对显像结果进行定性和半定量分析,并对照病理结果。30例中,经病理或细针穿刺活检证实恶性病变18例,良性病变12例。结果 :根据病理检查结果 ,99Tcm-HL91乏氧细胞定性诊断的灵敏度、特异度及准确度分别为88.9%(16/18)、83.3%(10/12)、86.7%(26/30)。半定量分析:延迟4 h诊断的灵敏度、特异度及准确度分别为94.4%(17/18)、91.7%(11/12)、93.3%(28/30);良性组与恶性组三时相的靶本比值(T/N)、早期摄取比值(ER)、延迟2 h摄取比值(DR1)、延迟4 h摄取比值(DR2)差异均有统计学意义,良性组与恶性组的延迟2 h滞留指数(RI1)差异无统计学意义,延迟4 h滞留指数(RI2)差异有统计学意义。结论:99Tcm-HL91乏氧细胞分子显像对甲状腺孤立冷结节良恶性的鉴别诊断有一定的临床价值;半定量分析较定性分析更能准确鉴别结节性质;延迟4 h显像较2 h更能提高诊断的灵敏度、特异度和准确度。     

99Tc-HL91乏氧显像评价30例鼻咽癌患者放疗疗效

目的 探讨99mTc-4,9-二氮杂-3,3,10,10-四甲基十二烷-2,11-二酮二肟(99Tc-HL91)乏氧显像评价鼻咽癌放疗疗效的临床价值.方法 鼻咽癌患者30例,放疗前经肘静脉注射99mTc-HL91 1110 MBq后1h、4h,分别进行头颈部SPECT,用感兴趣区技术求出肿瘤组织/头皮本底(T/B)比值,放疗结束后4周按WHO标准进行放疗疗效评价.结果 ①30例鼻咽癌患者99mTc-HL91显像1h和4h的T/B比值均值分别为1.370±0.207和1.883±0.358,具有统计学差异(t=6.794,P＜0.001).②放疗有效组与无效组的1h和4h T/B比值均值分别为1.273±0.196与1.498±0.147和1.679±0.232与2.152±0.318,也具有统计学差异.结论 99mTc-HL91显像可探测鼻咽癌病灶乏氧状态,在预测放疗疗效方面有一定的应用价值.     

99Tcm-MIBI亲肿瘤延迟断层显像对肺占位病灶的诊断价值

目的 探讨99Tcm-MIBI亲肿瘤延迟断层显像在肺部占位病灶中的诊断价值.方法 对28例肺部占位患者静脉注射740 MBq99Tcm-MIBI后1 h行延迟断层显像,以占位病灶(T)/对侧相应部位或邻近正常组织(N)的摄取比值T/N＞1.31为恶性病变标准对肺部占位病灶进行良、恶性判断.结果 肺占位在良性占位组显像剂浓聚多数轻度增强,恶性占位组多数明显增强.肺占位诊断恶性病灶的灵敏度为76.9%,特异度为86.7%,假阳性为13.3%,假阴性为23.1%.结论 99Tcm-MIBI亲肿瘤延迟断层显像以其无创、灵敏、图像质量及特异性较高的优点,可作为在肺占位病灶良、恶性鉴别诊断的重要辅助检查手段.     

肺部良性疾病摄取99Tcm-HL91特点临床研究

目的探讨肺部良性疾病对乏氧组织显像剂99Tcm-4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)的摄取特点,以提高对肺癌诊断的特异性。方法32例肺部良性疾病患者在静脉注射99Tcm-HL91 1110 MBq后1h(早期相)及4 h(延迟相)进行平面显像,根据显像进行目测和半定量分析[计算病灶与对侧正常肺组织摄取99Tcm-HL91的放射性计数比值(T/N)],并同时获得4 h T/N与1 h T/N之相对比值(RR)。结果肺部良性疾病对99Tcm-HL91摄取表现为3种类型:(1)早期相及延迟相显像均未见异常放射性摄取,前后T/N值相比无统计学差异(1.10±0.01与1.09±0.01,n=14,t=1.87,P(0.05)。(2)病灶对99Tcm-HL91表现为早期相明显摄取及延迟相无明显清除,前后T/N值相比无统计学差异(1.46±0.33与1.50±0.37,n=13,t=0.29,P(0.05)。(3)病灶对99Tcm-HL91表现为早期相明显摄取及延迟相明显清除,前后T/N值相比有统计学差异(1.43±0.22与1.11±0.19,n=5,t=2.46,P<0.05)。3种类型的RR值分别为1.01±0.01、1.12±0.10、0.90±0.11,均<1.25。结论肺部良性疾病对99Tcm-HL91的摄取具有多样性,熟悉这些多样性,并结合半定量分析技术,尤其是RR值,有助于提高对肺癌诊断的特异性。     

18F-FDG代谢显像对原发性乳腺癌的诊断价值

目的探讨利用符合线路(DHC)18F-FDG代谢显像对原发性乳腺癌鉴别诊断的临床价值.方法51例乳腺包块患者行DHC18F-FDG代谢显像,利用计算机感兴趣区(ROI)技术,计算靶/非靶比值(T/NT),全部患者均显像后经细针穿刺组织学活检确诊分为良性组和恶性组.结果活检病理组织学确诊乳腺癌33例(65%),良性乳腺包块18例(35%);定性诊断18F-FDG代谢显像33例,恶性患者中29例显像阳性,4例阴性;良性组3例为阳性,其余为阴性;DHC18F-FDG显像定性诊断的灵敏度、特异性和准确度分别为88%、83%和86%.恶性组和良性组摄取18F-FDG的T/NT比值分别为2.25±0.18和1.35±0.37(P＜0.01);以T/NT比值1.5为诊断阈值,DHC18F-FDG显像诊断的灵敏度、特异性和准确度分别为94%、89%和92%.结论 DHC18F-FDG显像诊断乳腺癌具有一定的临床价值,定性与定量结合有利于提高诊断效能.     

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.     

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）     

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.