菲立磁增强MRI对肝脏局灶性病变诊断的临床意义初探

目的　探讨菲立磁增强MRI检查对肝脏局灶性病变的诊断价值。方法　对 2 4例经CT和MRI检查确定或怀疑有肝脏病变者 ,进行菲立磁增强MRI检查 ,包括原发性肝癌 6例 ,肝转移瘤 7例 ,肝血管瘤 3例 ,肝硬化 5例 ,肝囊肿 1例和肝局灶增生结节 2例。全部病例均经手术、病理证实。分别测量增强前、后肝脏病变及背景噪声的信号强度 ,计算病灶 -肝脏背景信号强度对比值。结果　菲立磁增强后 ,①所有病例肝脏背景信号均明显减低 (Ρ <0 .0 1) ;② 4例原发性肝癌 ,3例肝转移瘤 ,2例肝硬化病人发现了更多的病灶 ;③病灶 -肝脏背景信号强度对比值测量中发现 ,原发性肝癌、肝转移瘤对比值明显升高 (Ρ <0 .0 1) ,肝血管瘤对比值降低(Ρ <0 .0 5 ) ,而肝硬化结节则无明显变化。结论　菲立磁增强MRI检查对肝局灶性病变的检出及定性诊断具有一定的临床意义     

肝脏特异性磁共振对比剂——菲立磁的临床应用初探

目的 探讨菲立磁增强MRI检查对肝脏疾病的临床应用价值。材料与方法 对22例经CT或MRI检查确定或怀疑有肝病变者进一步行菲立磁增强MRI检查,分别测量增强前后肝脏、病变及背景噪声的T2WI信号强度（SI）,计算增强前后肝脏及病变的信噪比（SNR）、对比噪声比（CNR）。结果 增强后肝脏的SI、SNR明显降低（P＜0．01）;恶性病变的SI、SNR变化不明显（P＞0．05）。囊肿、血管瘤增强后T2WI SI下降不明显。增强后病变－肝脏CNR比增强前明显增高（P＜0．01）。增强后0．5小时与3小时相比肝脏SNR以及CNR无差异（P＞0．05）。增强后病变的检出数量增加,而且其边界、大小显示更清楚。结论 菲立磁增强磁共振扫描可显著降低肝脏T2WI SI,而对恶性肿瘤T2WI信号的影响不明显,显著提高了恶性肿瘤－肝脏的CNR。因此,它对恶性肿瘤的检出及定性诊断具有临床意义。     

菲立磁增强MRI在肝脏局灶性病变诊断中的价值

目的 评价菲立磁增强MRI在肝脏实性占位性病变诊断中的应用价值。材料与方法 对21例怀疑有肝脏局灶性占位病变患者行MR平行及菲立磁增强MRI检查。扫描序列包括频率选择脂肪抑制及非脂肪抑制ASTE T2WI、True FISP T2WI、频率选择脂肪抑制FLASH T1WI。比较增强前后T2WI及T2WI病灶及肝脏的信噪比（SNR）及对比噪声比（CNR）;观察增强前后病灶数量及形态;结合MR平扫及增强MRI表现进行定性诊断。结果 菲立磁增强T2WI及T2WI肝脏信号强度较平扫明显下降,病灶与肝脏的CNR较平扫明显提高,差异具有统计学意义。结论 菲立磁增强T2WI及T2WI可明显提高肝脏实性占位性病灶的检出率。菲立磁增强T1WI在脏局灶性病变的定性诊断中具有潜在价值,有待于进一步开发与研究。     

菲立磁增强MRI检测肝脏占位病变与三期动态增强CT扫描的比较研究

目的　比较菲立磁增强MRI和增强CT扫描在肝脏实性占位病变检测中的应用价值。方法　对 18例肝内局灶性占位患者行MR平扫及菲立磁增强扫描。观察肝脏与病灶信号强度变化 ,形态及数目 ,比较增强前后T2 WI病灶及肝脏的信噪比 (SNR)及对比噪声比 (CNR) ,做出MRI定性诊断 ,并与增强CT扫描诊断进行比较。其中肝细胞肝癌 4例 ,复发性肝癌 4例 ,转移瘤 4例 ,肝血管瘤 6例。结果　菲立磁增强明显降低正常肝组织信号强度 ,而恶性肿瘤的信号强度无强化 ,病灶—肝脏信噪比增加可清晰显示病变 ,并发现新病灶。肝血管瘤的血池效应与增强CT扫描比较有鉴别诊断意义。结论　做为增强CT扫描和Gd -DTPAMR增强的补充方法 ,SPIO增强MRI对肝脏占位病变的显示 ,小病灶发现和定性诊断中有重要的临床意义     

肝硬化对肝脏菲立磁增强磁共振的影响初步研究

目的　探讨肝硬化对肝脏菲立磁增强磁共振的影响。方法　对 45例患者进行磁共振平扫和菲立磁增强扫描 (手术和穿刺活检证实 16例肝癌周边为正常肝脏 ,2 9例为肝硬化 ,肝功能A级 11例 ,B级、C级 18例 ) ,分析菲立磁增强前后病理证实非肿瘤区肝脏、椎体骨髓信号强度的变化及其与肝脏实验室检查结果的关系。结果　菲立磁增强后 ,肝功能A级组病理证实非肿瘤区肝脏、椎体骨髓的信号下降程度与正常组相似 (Ρ >0 .0 5 ) ,而肝功能B、C级组病理证实非肿瘤区的肝脏、椎体骨髓的信号下降程度低于正常组 (Ρ <0 .0 5 )。肝脏的信号下降程度与总胆红素、白蛋白、GOT相关系数分别为 0 .31、-0 .2 6、0 .15。结论　肝硬化肝功能轻度损害对肝脏菲立磁增强无明显的影响 ,而肝功能严重损害对菲立磁增强有一定影响     

超顺磁性氧化铁诊断肝脏小病灶的临床应用价值初探

目的：探讨超顺磁性氧化铁（商品名为菲立磁,Feridex)对肝脏小病灶的临床应用价值,以及滴注后的最佳扫描时间。方法：17例经B超或CT检查发现肝脏内小病灶患者,经常规MR平扫和增强扫描1－3d后,经静脉滴注菲立 （0.05ml/kg),并于0.5,3.6h后进行扫描。主观目测菲立磁增强后肝脏小病灶的显示情况,定量分析菲立磁增强后肝脏信号下降情况。结果;菲立磁增强后扫描可显著肝脏内直径小于1cm的病灶21个,明显多于常规MR检查（8个）。菲立磁应用后小肝癌和容易与肝癌混淆的局灶性结节增生和再生结节信号变化明显不同。菲立磁增强后扫描,肝脏T2WI,T1WI信号均较增强前下降（P＜0．01）,滴注菲立磁后0.5,3,6h扫描,T2WI各时间点的脏脏信号下降统计学上差异无显著性意义（P＞0．05）。结论：菲立磁能显著提高肝脏小病灶的检出率,而且对肝脏小病灶的鉴别诊断可提供有利的依据。     

MRI 增强后扩散加权成像鉴别乳腺良恶性肿瘤临床应用研究

目的：评估乳腺疾病患者中钆对比剂对 MRI 扩散加权成像(DWI)和病变的表观扩散系数(ADC)是否有显著性影响,分析增强前后 ADC 值在乳腺良恶性病变鉴别中的价值。方法收集本院行乳腺 MRI 检查的35例患者共计38个病灶,所有病灶均经病理证实。笔者对比了增强前后正常乳腺组织及病灶的信噪比(SNR)和对比噪声比(CNR),以及病灶增强前后的 ADC 值。结果(1)增强前后 DWI 的 SNR 及 CNR 无统计学差异;(2)恶性病灶增强前后的 ADC 值存在统计学差异,增强前后 ADC 值平均降幅11.6%;良性病灶增强前后的 ADC 值无统计学差异。结论增强后 ADC 值能够更好地反映乳腺病变的恶性潜能。     

菲立磁增强MRI检测肝脏局灶性病变的初步报告

目的 探讨菲立磁增强磁共振在肝脏局灶性病变中的诊断价值。材料与方法 对21例怀疑肝脏肿瘤的患者进行常规肝脏平扫和菲立磁增强扫描,分析增强前后T2WI检测病灶数目以及肝脏、病灶、脾脏信号强度的变化。结果 菲立磁增强明显降低正常肝脏的信号强度、而病灶的信号强度无明显变化,病灶－肝脏的信号强度比增加;菲立磁增强可清晰地显示病变并可发现更多的病变。结论 菲立磁增强在检测肝脏局灶性病变中敏感性高。     

FLASH序列T1加权成像在脊柱转移性肿瘤的应用价值

目的　评价FLASH序列T1 WI对脊柱转移性肿瘤的检出能力及其限度。方法　 5 9例病人 (2 79个病灶 )接受脊柱FLASH-T1 WI序列磁共振扫描 ,评价其图像信噪比 (SNR) ,脊椎—肌肉对比噪声比 (S -MCNR) ,病灶对比噪声比 (CNR)及病变检出率 ,并与SE -T1 WI ,TSE -T2 WI作比较。结果　FLASH -T1 WI的SNR低于SE -T1 WI、TSE -T2 WI ,两者Ρ <0 .0 0 1;其病灶CNR明显高于后两者 ,两者Ρ <0 .0 0 1;其S -MCNR高于SE -T1 WI ,Ρ <0 .0 0 1,近似于TSE -T2 WI,Ρ值 >0 .5。FLASH -T1 WI病变检出率 (98.6% )略高于SE -T1 WI(95 .3 % ) ,0 .0 2 5 <Ρ <0 .0 5 ;明显高于TSE -T2 WI(63 .4% ) ,Ρ <0 .0 0 5。椎体内局灶性黄骨髓 ,良性椎体压缩性骨折 ,脊柱结核在FLASH -T1 WI像上均表现为高信号。结论　与SE -T1 WI、TSE -T2 WI作比较 ,FLASH -T1 WI对脊柱转移性肿瘤有较高的病灶对比 ,能提高其检出率。其具有较高的敏感性 ,但特异性差。     

菲立磁增强MRI对局灶性肝病的诊断价值:与螺旋CT对比的ROC曲线分析

目的 :对比分析菲立磁增强扫描与螺旋CT增强扫描对局灶性肝病的诊断价值。方法 :收集经本院完成螺旋CT增强扫描及菲立磁增强MRI扫描且临床、手术病理证实局灶性肝病 2 6例 5 7个病灶 ,采用分组盲法ROC曲线分析对比评价菲立磁增强MRI与螺旋CT增强扫描对局灶性肝病的诊断价值。结果 :联合分析平扫 +菲立磁增强MRI对病灶检出最好 ,与其它三组比较有显著性差异。对病灶定性 ,平扫 +菲立磁增强MRI组ROC曲线下面积Az 值最大为 0 92 6 0 ,准确性为 86 .8% ,差异有显著性 ,P <0 .0 5。螺旋CT增强扫描、MRI平扫及单独分析菲立磁MRI等三种方法之间差异无显著性 (P >0 .0 5 )。结论 :菲立磁增强MRI肝成像无论病灶的检出及定性诊断价值均高于螺旋CT增强扫描。联合分析平扫+菲立磁MRI较单独分析SPIO能明显改善病灶的检出能力及定性诊断能力。     

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.