320排冠状动脉CTA中等渗低浓度对比剂用量的合理选择

目的：探讨在320排冠状动脉 CTA 检查中降低等渗低浓度对比剂用量的可行性。方法选取心率≤70次/min、心律规则、体质量指数(BMI)≤24 kg/m2患者64例行320排冠状动脉 CTA,采用100 kVp 管电压,威视派克270 mg I/mL 对比剂,使用前瞻性心电门控技术,自适应迭代剂量减低算法重建。根据对比剂用量的不同将其分为3组：A 组22例注射50 mL 固定剂量对比剂,注射速率为5.0 mL/s;B 组21例按0.7 mL/kg 计算剂量,注射速率为4.5 mL/s;C 组21例按0.6 mL/kg 计算剂量,注射速率为4.0 mL/s。采用单因素方差分析比较3组间感兴趣区(ROI)的 CT 值、信噪比(SNR)、对比噪声比(CNR)以及冠状动脉节段评分的差异,并对患者碘摄入量进行比较。结果3组间患者的年龄、性别比、BMI、心率等指标差异无统计学意义(P >0.05),对比剂用量及注射时间的差异有统计学意义(P <0.05)。ROI 的 CT 值从 A 组到 B 组再到 C 组呈下降趋势,A 组明显高于 B 组和 C组,差异均有统计学意义(P <0.05),而 B 组与 C 组间差异无统计学意义(P >0.05)。3组间冠状动脉节段评分、SNR 和 CNR 的差异无统计学意义(P >0.05)。C 组的碘总量和碘注入率最低。结论在320排 CT 冠状动脉血管成像中,对于心率≤70次/min、BMI≤24 kg/m2患者,按0.6 mL/kg 剂量注射等渗低浓度对比剂,图像质量能满足诊断要求,明显减少了患者的碘摄入量,降低了发生对比剂肾病的风险。     

下肢动脉CT成像中不同对比剂注射方案与对比剂剂量的相关性研究

目的 比较下肢动脉CT成像中2种不同对比剂注射方案对对比剂剂量的影响.方法 收集临床上怀疑下肢动脉疾病行CTA检查的患者50例,随机分为A、B组,对比剂碘普罗胺(350 mg I/mL).A组注射流率4mL/s,对比剂用量1.2 mL/kg.B组第1期5 mL/s注射20 mL,第2期3mL/s注射剩余量;B组对比剂总量=1.2 mL/kg×体质量-4 mL/s×(B方案对比剂注射时间-A方案对比剂注射时间).对2组腹主动脉-髂动脉段、股动脉-腘动脉段、小腿动脉段、足背或足底动脉段4个动脉段图像质量进行评分;测量4个动脉段CT值,记录2组对比剂剂量.均进行独立样本t检验.结果 B组4个动脉段图像质量评分、平均CT值均低于A组,差异均无统计学意义(P＞0.05).A组和B组对比剂剂量为(89.08士11.45)mL和(72.61士10.34)mL,差异有统计学意义(P＜0.05).结论 对比剂流率5 mL/s+3 mL/s分期注射可在不影响图像质量的前提下降低下肢动脉CTA的对比剂用量.     

个体化对比剂注射方案提高冠状动脉造影CT值均匀性及减少对比剂用量的研究

目的:探讨冠状动脉CTA检查中,个体化对比剂注射方案与固定对比剂注射方案对冠状动脉CT值的影响。方法:前瞻性纳入临床拟行冠状动脉CTA检查的200例患者,体质量均≤80 kg,随机分为A、B 2组,各100例,使用对比剂碘帕醇(碘浓度370 mg/mL)。A组采用个体化对比剂注射方案,剂量0.85 mL/kg体质量,注射时间12 s,流率为注射总量除以注射时间。B组采用恒速恒量的注射方案,即对比剂均为70 mL,注射流率5.0 mL/s。A组和B组按照患者体质量各分为2组:A1、B1组(66 kg,n=50),A2、B2组(66～80 kg,n=50)。测量图像的主动脉根部CT值、噪声(SD值),记录对比剂剂量,并行单因素方差分析和t检验。结果:升主动脉根部强化后CT值A、B组比较差异有统计学意义(P0.001);A1、A2组比较差异无统计学意义(P=0.518),B1组高于B2组(P=0.028);A1组低于B1组(P0.001),A2组与B2组比较差异无统计学意义(P=0.226)。对比剂剂量A1组低于B1组(P0.001),A2组低于B2组(P0.001)。2组的图像噪声(SD值)比较,差异无统计学意义(P 0.05)。结论:采用个体化对比剂注射方案行冠状动脉CTA,在保证冠状动脉CT值的情况下,可明显减少低体质量患者的对比剂剂量,且CT值分布较均匀,不会因体质量变化而明显变化,优于对比剂固定注射方案。     

低对比剂剂量、低管电压冠状动脉CTA在BMI>25kg/m~2患者中的应用

目的:探讨低对比剂剂量结合低管电压冠状动脉CTA检查在BMI25 kg/m2患者中的可行性。方法:选取BMI25 kg/m2的患者60例,随机分为常规剂量组(A组)和低剂量组(B组)各30例。A组扫描参数120 k V,200 m As扫描;对比剂总量70 m L,生理盐水30 m L,注射流率5.0 m L/s,触发阈值120 HU。B组扫描参数100 k V,200 m As;对比剂总量按0.6 m L/kg体质量计算,生理盐水30 m L,注射流率5.0 m L/s,触发阈值90 HU。结果:B组主动脉平均CT值、主动脉及左冠状动脉的SNR、对比噪声比(CNR)和右冠状动脉的噪声、SNR、CNR明显高于A组(P0.05);2组冠状动脉主观图像质量评分差异无统计学意义(P=0.943 9);B组辐射剂量较A组降低41.4%,对比剂剂量降低33%。结论:对BMI25 kg/m2的患者,采用100 k V的管电压、40~50 m L的对比剂用量,可获得良好的与常规剂量组相当的冠状动脉CTA图像,但辐射剂量和对比剂用量明显降低。     

高流速稀释对比剂在低管电压冠状动脉成像中的可行性研究

目的探讨高流速稀释对比剂在低管电压冠状动脉成像中的可行性及对图像质量的影响。方法收集120例疑似冠心病患者行冠状动脉CTA检查,按照随机数字表法等分为A、B、C三组各40例。A组以4.8ml/s直接注射碘普罗胺(300mg I/ml),之后按相同速率追加注射生理盐水36ml,B、C两组以6ml/s注射稀释对比剂,其浓度为使用双流技术按对比剂与生理盐水8:2实时配比为240mg/ml,两组按相同速率追加注射生理盐水45ml。A、B、C三组对比剂用量分别为0.8ml/kg、1ml/kg、0.8ml/kg,三组所得扫描数据均使用迭代算法(AIDR 3D)重建图像,扫描管电压设置分别为100k V、100k V、80k V。比较三组之间升主动脉、降主动脉、左冠状动脉主干、左前降支近段、左回旋支近段及右冠状动脉近段平均强化CT值(SI)、噪声(SD)、对比噪声比(CNR)、信噪比(SNR)有效辐射剂量(E)及冠状动脉图像质量评分。结果三组年龄、心率、管电流、体质指数(BMI)、体重、身高均无统计学差异(P0.017),A组与B、C两组注射压力有统计学差异(P0.017),B组与A、C两组对比剂注射用量有统计学差异(P0.017),C组与A、B两组间注射时间、总碘含量、辐射剂量(ED)有统计学差异(P0.017)。三组间总节段质量得分及各大段平均质量得分均无统计学差异(P0.05)。A、C两组升主动脉、右冠状动脉近段血管强化值及右冠状动脉、左冠状动脉主干、左前降支近段噪声有统计学差异(P0.017),B、C两组升主动脉血管强化值、右冠状动脉及左回旋支近段噪声有统计学差异(P0.017)。三组之间胸主动脉及各冠状动脉血管近段SNR、CNR无统计学意义(P0.05)。结论使用6ml/s的高流速240mg/ml稀释对比剂在低管电压冠状动脉CTA中可以满足诊断需求并且不降低图像质量。     

不同对比剂对双源CT冠状动脉成像中患者心率的影响

目的 探究双源CT冠状动脉成像中,静脉注射碘克沙醇320与碘普罗胺370对比剂对患者心率的影响.方法 回顾性搜集行冠状动脉CTA检查的389例患者的病例资料,根据注射对比剂不同分为2组,A组采用碘克沙醇320,B组采用碘普罗胺370,记录CT增强扫描前屏气状态下心率(基础心率)、扫描过程中注射对比剂时屏气状态下心率(注射时心率).基础心率<75次/min时,舌下含服硝酸甘油0.25 mg.比较所有患者注射对比剂前后的心率变化并对2组患者的心率变化进行比较.结果 注射对比剂后心率变化>10次/min的患者A组有8例(4.4%),B组有10例(4.8%),2组无统计学差异(P>0.05).经静脉内注射对比剂时,2种对比剂均使患者心率减低(碘克沙醇下降4.2次/min、碘普罗胺下降2.7次/min,P>0.05),服用硝酸甘油均减轻对比剂对心率的影响.结论 经静脉注射碘克沙醇320与碘普罗胺370后,均约有4%的患者心率变化>10次/min,2种对比剂对心率的影响是一致的.     

64排CT主动脉血管造影个体化对比剂用量的可行性研究

目的:探讨体质量小于60kg的患者在主动脉CT造影中减少对比剂用量的可行性。方法:60例行主动脉CTA患者按体质量分为A、B组:A组体质量≥60kg,注射浓度370mgI/mL非离子型对比剂60mL后用40mL生理盐水冲洗,注射速率均为5mL/s;B组为60kg患者,注射同种对比剂,剂量按1mL/kg体质量计算,后用40mL生理盐水冲洗,注射速率均为5mL/s。扫描延迟时间采用自动触发技术,测量升主动脉、T7及L2水平降主动脉、主动脉分叉处CT值;各由1名高级和中级职称影像诊断医师对血管强化程度、重建血管清晰度进行评价,并由另一影像医师比较两者的评价是否存在差异。结果:A组在升主动脉、T7及L2水平降主动脉、主动脉分叉处测得平均CT值为383.19HU,B组为391.58HU,2组差异无统计学意义。A组和B组患者图像重建后血管清晰度差异无统计学意义。结论:在不影响图像质量前提下,体质量小于60kg患者可以使用少于60mL剂量的对比剂行胸腹主动脉造影。     

三期团注法对比剂注射方案在肺动脉CTA检查中的应用研究

目的:探讨MSCT肺动脉成像三期对比剂注射方案对于降低对比剂用量及提高检查成功率的可行性。方法:搜集在我院行肺动脉CTA检查的63例连续患者。将63例患者分成两组(三期组和两期组),三期组(30例)采用优化的对比剂注射方案,第一期注射混合液(对比剂占10%,生理盐水占90%),流率5mL/s,总量25mL;第二期注射对比剂,流率5mL/s,总量0.2～2.5mL/kg体重;第三期注射生理盐水,流率5mL/s,总量20mL。二期组(33例)采用传统对比剂注射方案,第一期注射对比剂20mL,第二期生理盐水30mL,流率均为5.5mL/s。分别测量肺动脉主干、左右肺动脉干、肺叶动脉、肺段动脉、肺亚段动脉、左右肺动脉分叉层面上腔静脉、主肺静脉及升主动脉的CT值。记录两组患者的对比剂用量。结果:两组患者肺动脉主干、上腔静脉及主动脉CT值比较差异有统计学意义(P<0.05)。对比剂平均用量三期组为(10.73±1.72)mL,二期组为20mL,三期组较二期组减少46%,差异有统计学意义(P<0.05)。结论:与传统双期注射方案比较,优化的三期对比剂注射方案可提高肺动脉CTA的检查成功率,同时降低对比剂用量。     

房间隔缺损患者行冠状动脉CTA检查的个性化对比剂注射方案研究

目的：探讨房间隔缺损患者行冠状动脉CTA检查的理想对比剂注射方案。方法：将连续90例拟行介入治疗或外科手术治疗中老年房间隔缺损患者,于术前行冠状动脉CTA检查,依据不同的对比剂注射方案将患者随机分为3组。A组：单期相注射方案（仅注射基础量对比剂,不注射生理盐水）;B组：双期相注射方案（先注射基础量对比剂,后以40mL生理盐水冲洗）;C组：三期相注射方案（先注射基础量对比剂,后注射30％生理盐水与对比剂的混合物30mL,最后注射40mL生理盐水冲洗）。基础量对比剂按1mL／kg计算,注射流率均为5．0mL／s。比较3组方案CTA图像上冠状动脉及左、右心系统的CT值及房间隔缺损的可评估性。结果：3组患者在平均年龄、体重及心率方面差异无显著性意义。各组患者冠状动脉、升主动脉及左心房、左心室的CT值差异无显著性意义（P〉0．05）,但各组右心房、右心室及肺动脉的CT值均数大于250HU;此外,B组对比剂用量明显低于其它2组（P〈0．05）,房间隔缺损量化评分高于C组（P〈0．05）。结论：双期注射方案由于对比剂用量减少,利于房间隔缺损评估,因而是房间隔缺损患者行冠状动脉CTA检查的理想的对比剂注射方案。     

光子双源CT Flash模式联合低浓度对比剂在肺动脉成像中的应用

目的:探讨光子双源CT Flash模式联合低浓度对比剂在肺动脉成像中的临床应用.方法:200例临床怀疑肺动脉栓塞的患者随机分为A、B、C、D四组,各组50例,对比剂注射方案:A组,40mL对比剂+40mL生理盐水,流率4.0 mL/s;B组,40 mL对比剂+40 mL生理盐水,流率4.0 mL/s;C组,40 mL对比剂+40 mL生理盐水,流率4.5 mL/s;D组,40 mL对比剂+40 mL生理盐水,流率5.0 mL/s.A组对比剂采用欧乃派克(350 mg I/mL),B、C、D对比剂采用威视派克(270 mg I/mL).分析比较各组图像质量、客观评价指标及辐射剂量、碘总量.结果:患者的一般资料及CTDlvol、DLP、ED差异无统计学意义(P＞0.05).A组与其他三组相比,摄入的碘总量每位患者减少了3200mg.四组间主观评分差异有统计学意义(P＜0.05),D组优良评分病例数最多(40例).4级肺动脉显示率B组98.4％,其他三组为100％,差异有统计学意义(P＜0.05),A、D两组5、6级肺动脉显示率高于B、C两组,差异有统计学意义(P＜0.05).D、A组各支血管CT值、SNR、CNR高于B、C两组,差异有统计学意义(P＜0.05);左、右肺上叶动脉、下叶动脉噪声有差异(P＜0.05).A、D两组各支血管CT值均大于250 HU,B组共有37支血管CT值＜250 HU,C组病例共有10支血管CT值＜250 HU(P＜0.05).结论:光子双源CT Flash模式联合低浓度对比剂(270 mg I/mL),注射流率5.0 mL/s的扫描方案在肺动脉血管成像中可获得满意的图像质量,同时降低患者的碘对比剂用量.     

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.