超顺磁氧化铁粒子增强MRI区分肿瘤转移性与良性淋巴结的实验研究

目的：研究超顺磁氧化铁粒子（SPIO）增强MRI鉴别肿瘤转移淋巴结与 正常和反应增生性淋巴结的价值。方法：新西兰兔18只，体重2．0－2．5kg。分析6只正常兔平扫及皮下间隙注射SPIO（10μmol Fe/肢）后1－48h的信号变化，用于研究SPIO增强效应－时间曲线；6只兔后腿肌内注射蛋黄乳胶，用于建立Guo窝淋巴结的反应性增生模型；6只兔后腿肌肉接种VX2肉瘤，并与病理检查对照.结果：平扫时正常、反应性增生的淋巴结和肿瘤转移淋巴结的信号强度无明显差异。SPIO增强后，正常和反应性增生淋巴结的信号强度降低，在12h时最明显，至48h时仍较明显，在T1WI、T2WI、质子密度加权像（PDWI）和T2WI分别为平扫时信号强度的51％、22％、41％和11％（P值均＝0．000）；肿瘤转移淋巴结的信号强度保持不变。结论：皮下间隙注射SPIO后MR成像可鉴别肿瘤转移淋巴结与正常和反应增生性淋巴结。     

经组织间隙注射Dextran Gd-DTPA兔腘窝淋巴结MRI——一种新型MR对比剂的初步应用

目的:经组织间隙注射Dextran Gd-DTPA行兔腘窝淋巴结MR成像,探讨该新型淋巴靶向对比剂在鉴别良、恶性淋巴结病变中的价值.方法:选取22只新西兰大白兔,分成Dextran Gd-DTPA增强组和Gd-DTPA对照组,其中增强组18只,对照组4只.增强组分为3个小组:①反应正常组6只;②反应增生组6只,于双侧兔腓肠肌注射蛋黄乳胶;③肿瘤转移组6只,于双侧兔腓肠肌注射VX2肉瘤细胞混悬液.增强组行MRI平扫后,再经双侧趾蹼间隙注射10μmolGd/kg Dextran Gd-DTPA后30min及1、3、6、12和24h行腘窝淋巴结脂肪抑制T1WI扫描,测量标准化信号强度(SI)及增强率(En%),描绘浓度-信号强度曲线及时间-增强相应曲线.Gd-DTPA对照组4只,平扫后再经双侧趾蹼间隙注射50μmol Gd/kg Gd-DTPA后5、10和20min行腘窝淋巴结脂肪抑制T1WI扫描.同时在体外检测Dextran Gd-DTPA溶液中质子的自旋-晶格弛豫时间T1,并计算R1值.结果:Dextran Gd-DTPA的T1值约0.03556s,R1值约33.37l/(mmol·s),Dextran Gd-DTPA经趾蹼间隙行腘窝淋巴结成像的达峰时间约1h,正常组及反应增生组淋巴结均表现为明显强化,信号可均匀,亦可不均匀;VX2肉瘤转移性淋巴结表现为强化不明显,信号可为环状、不规则偏心缺损等不均匀的强化模式,类似邻近肿瘤的强化特征.定量分析发现,VX2肉瘤转移性淋巴结在脂肪抑制T1WI上的标准化SI和强化率(E%)2个指标均明显低于正常组和反应性增生组.在最佳达峰点,正常组Dextran Gd-DTPA的增强率远高于Gd-DTPA对照组.结论:Dextran Gd-DTPA作为组织间隙淋巴靶向对比剂,用量小,强化效应明显,可以鉴别良恶性淋巴结病变.     

组织间隙注射SPIO磁共振淋巴结增强成像:量效关系和扫描序列优化

目的：探讨不同剂量SPIO及多种扫描序列对兔Guo窝炎性淋巴结增生模型强化效果的影响。方法：建立兔Guo窝淋巴结炎性增生模型;用20μmol Fe／单侧足趾皮下注射,观察注射前、注射后6、12、24、28和72h兔Guo窝淋巴结的时间－信号强度曲线（n=3);接着观察不同剂量（5、10、20、30μmol Fe/单侧足趾注射）在SE T1加权像（T1WI）,双回波SE像（PDWI,T2WI）及FLASH T2加权像（T2WI）上强化表现。结果：（1）皮下注射SPIO后12h,Guo窝淋巴结强化达高峰;（2）注射剂量为10－30μmol Fe/单侧足趾可引起同侧Guo窝炎性淋巴结增生信号不同程度下降,但以20μmol Fe/单侧足趾为最佳剂量;最敏感扫描序列为FLASH T2WI,其次是SE T2WI和SE双回波像。结论;组织间隙注射SPIO可引起炎性淋巴结信号下降,可能是一种有效的靶向淋巴结成像技术。     

组织间隙注射Gd-PBCA纳米微粒鉴别良恶性淋巴结的实验研究

目的:制备Gd-DTPA聚氰基丙烯酸正丁酯纳米微粒(Gd-PBCA-NP),组织间隙注射Gd-PBCA-NP,评估其在良恶性淋巴结诊断和鉴别诊断中的价值.方法:采用阴离子乳化聚合法制备Gd-PBCA-NP,测定其粒径及分布、包封率及载药量,透射电镜观察其形态.选取健康成年新西兰白兔12只,采用随机数字法将其分为反应性增生淋巴结组及肿瘤转移淋巴结组2组.MRI平扫后2只反应性增生淋巴结于兔后脚掌注射后第1、3、6、12、24和48 h点扫描,其余为给药后第24 h扫描.测量淋巴结大小、平扫及增强后各组淋巴结信号强度并作统计学分析,观察增强后各组淋巴结MRI表现.结果:透射电镜观察Gd-PBCA-NP呈类圆形,大小均匀,表面平滑完整,粒子之间无粘连,具有明显的核-壳结构,其平均粒径65.7 nm,粒径分布为0.09,平均包封率和载药量分别为81.97%、51.23%.反应性增生淋巴结和肿瘤转移性淋巴结均制作成功,平扫两组淋巴结在4个序列图像上的SNR、大小差异均无显著性意义.组织间隙注射Gd-PBCA-NP后,反应性增生淋巴结信号强度呈缓慢上升,于24 h左右达到高峰,在T1WI、T1WI FS上表现为显著均匀强化,而肿瘤转移淋巴结表现为不均匀强化或无强化,两组SNR对比差异有显著性意义;在T2WI、T2*WI像上两组均未见强化,两组对比差异无显著性意义.结论:组织间隙注射Gd-PBCA-NP后,反应性淋巴结与肿瘤转移性淋巴结表现出不同的强化特征,在良恶性淋巴结鉴别中具有潜在的应用价值.     

钆喷替酸葡甲胺-脂质体在兔MRI淋巴成像的应用研究

目的 研究钆喷替酸葡甲胺(Gd-DTPA)脂质体载体的淋巴组织靶向增强效果.材料与方法采用乙醇诱导法制备包裹Gd-DTPA的交错融合脂质体.将12只新西兰兔以数字表法随机分为对照组和反应性增生组,每组6只.反应性增生组采用兔大腿肌肉和腰窝皮下注射蛋黄乳胶的方法建立胭窝、腹股沟和腹膜后淋巴结三组相连续的反应性增生模型.分析各组淋巴结在Gd-DTPA脂质体增强前后的MRI特征,并采用配对t检验进行比较.结果 Gd-DTPA脂质体平均粒径2.2μm,平均包封率为82%,平均载药量为53%.平扫时两组腹膜后淋巴结大小有差异(t=164.21,P<0.01),而信号强度在T_1WI和脂肪抑制T_1WI上均无差异(P值均>0.05).Gd-DT-PA脂质体增强后,腘窝和腹股沟淋巴结在15 min时达到最大强化,SNR与平扫时相比差异有统计学意义(t值分别为76.32和48.39,P值均<0.05).腹膜后淋巴结强化较轻,约在30 min时达到最大强化,但SNR与平扫时相比差异无统计学意义(t=0.57,P>0.05).结论 Gd-DTPA可包裹于脂质体载体内,并可以用MRI显示载体淋巴组织靶向增强效果,为下一步鉴别肿瘤转移性淋巴结与反应性增生淋巴结打下了良好的基础.     

阳性亲淋巴对比剂增强MR淋巴成像对淋巴结病变的诊断价值

目的 探讨大分子阳性亲淋巴对比剂在间质MR淋巴成像中对肿瘤转移、炎性增生淋巴结的鉴别诊断价值.方法 采用18只纯种新西兰大白兔,体质量2.0～2.5 kg.在其中9只兔一侧后肢各趾蹼处注射完全型免疫佐剂,用于建立腘窝淋巴结炎性增生模型(炎性增生组);另9只兔一侧后肢肌肉接种VX~2瘤建立腘窝淋巴结肿瘤转移模型(肿瘤转移组).对侧正常腘窝淋巴结作为对照.各组每只兔接种前后行MR淋巴成像检查.将0.2 ml二氨基乙基乙二醇醚-DTPA酰胺共聚物钆配合物(Gd-poly-DTPA-EOEA)注入各组每只兔双侧后肢足背部各趾蹼处的皮下.在注射对比剂前后分别进行3D T_1WI扫描和MIP图像重组.在增强3D MIP图像上测量每一腘窝淋巴结短轴最大径(MSAD),在每只兔胭窝淋巴结中选取直径最大者测量其延迟扫描各观察时点的信噪比(SNR).采用成组设计t检验比较炎性增生组与肿瘤转移组腘窝淋巴结接种后MSAD的差异和每一观察时点炎性增生组、肿瘤转移组、正常对照侧腘窝淋巴结间的SNR差异.分析各组腘窝淋巴结的MR淋巴成像图像,并与病理检查相对照.结果 肿瘤组2只兔接种未成功,其他模型形成良好.13个炎性增生、11个肿瘤转移腘窝淋巴结的MSAD分别为(1.32±0.14)cm和(1.33±0.12)cm,差异无统计学意义(t=0.186,P＞0.05).延迟扫描5、15、30、60、90、120 min,9个炎性增生腘窝淋巴结与正常对照侧腘窝淋巴结的SNR值分别为17.31±0.37和17.19±0.29、27.42±0.50和27.39±0.48、38.44±0.47和38.19±0.27、37.10±0.09和36.97±0.10、36.32±0.61和36.20±0.80、34.60±0.44和34.71±0.32,两组间各对应时点SNR值的差异均无统计学意义(t值分别为0.78、0.14、1.43、1.00、0.36、-0.62,P值均＞0.05).7个肿瘤转移腘窝淋巴结和正常对照侧腘窝淋巴结的SNR值分别为6.00±0.22和17.21±0.28、7.87±0.16和27.17±0.23、8.14±0.24和38.16±0.19、8.09±0.28和36.94±0.30、7.59±0.20和35.96±0.72、7.50±0.14和34.81±0.27,两组间各对应时点SNR值的差异均有统计学意义(t值分别为-84.00、-182.72、-261.27、-186.48、-100.22、-239.00,P值均＜0.01).炎性增生组淋巴结的SNR值明显高于肿瘤转移组,差异有统计学意义(t值分别为83.97、174.07、158.49、152.71、96.06、154.57,P值均＜0.01).肿瘤转移淋巴结在MR淋巴成像图像上表现为淋巴结完全或部分的信号缺损.结论 通过阳性亲淋巴对比剂增强MR淋巴成像可提供解剖背景下淋巴结解剖和功能方面的信息,是特异性地鉴别良、恶性淋巴结的敏感检查方法.     

淋巴结炎性增生和肿瘤转移动物模型的建立及其MRI初步研究

目的 :探讨建立淋巴结炎性增生和肿瘤转移模型的方法及其MRI表现。材料和方法 :18只新西兰白兔随机等分成 3组。实验组分别经股四头肌注射VX2癌细胞、经股四头肌和胁腹注射蛋黄乳胶 ,对照组不作处理。 1周后开始在不同时间行MRI平扫。病理取材 ,HE染色、光镜下观察。结果 :淋巴结炎性增生和VX2癌转移的模型成功建立。炎性增生淋巴结和VX2转移淋巴结的大小无明显差异 ,二者MRI表现均为T1WI等信号、T2WI高信号 ,且信号强度无明显差异。结论 :上述方法制作的动物模型可为医学影像学研究提供可靠的动物模型 ,MRI平扫不能区分炎性增生淋巴结和VX2转移淋巴结。     

阳性MR淋巴造影检测隐匿转移性淋巴结的实验研究

目的 初步探索皮下应用Gd-DTPA-白蛋白的阳性磁共振淋巴造影检测隐匿转移性淋巴结的价值.方法 建立腘窝隐匿转移性淋巴结新西兰兔模型,分析隐匿转移性淋巴结在平扫及皮下注射0.10 mmol/肢Gd-DTPA-白蛋白后24 h时的MRI特征,并与病理检查对照.结果 12只兔的腘窝隐匿转移性淋巴结模型成功建立,其淋巴结大小为(6.7±0.2)mm.平扫时隐匿转移性腘窝淋巴结表现为T1WI上等信号,T2WI上高信号,与正常淋巴结相似.Gd-DTPA-白蛋白增强24 h,正常淋巴结呈明显、均匀的强化,而隐匿转移性淋巴结呈不均匀强化,强化形式有环状(4枚淋巴结)、云絮状(3枚)和不规则偏心"充盈缺损"(3枚),另有2枚淋巴结不强化.在脂肪抑制T1WI像上淋巴管呈明亮高信号,转移性淋巴结的引流淋巴管明显迂曲扩张.结论 皮下应用Gd-DTPA-白蛋白的阳性MR淋巴造影可清晰显示淋巴结和淋巴管,可用于检测隐匿转移性淋巴结.     

子宫平滑肌肉瘤的MR诊断

目的：探讨子宫平滑肌肉瘤及其转移瘤的MR表现特征。方法：对8例经手术病理证实的子宫平滑肌肉瘤及其转移瘤的MR表现进行归纳性分析。6例行MR平扫和Gd—DTPA增强扫描,2例仅行MR平扫。结果：原发性子宫平滑肌肉瘤6例,其中1例伴盆腔淋巴结及腹膜多发转移,1例伴双肺转移;转移瘤4例,其中盆腔淋巴结1例,肝表面腹膜1例,双下肺1例,腹膜后淋巴结1例。主要MR表现：肿瘤信号明显不均匀,实质部分在T2WI呈稍高信号,T1WI为等信号,肿瘤内均见长T1长T2坏死囊变区,瘤内出血2例;增强扫描实质部分明显强化。结论：子宫平滑肌肉瘤及其转移瘤有类似的MR表现,不论肿瘤大小,坏死、囊变均多见,有一定的特征。     

SPIO与Gd剂增强MRI对转移性淋巴结诊断的实验研究

目的:比较SPIO与Gd-DTPA 2种增强MRI方法对淋巴结转移瘤的诊断效果。方法:①将24只新西兰大白兔随机分为2组,每组12只。第1组于后肢股四头肌内种植VX2肿瘤,建立兔腘窝转移性淋巴结模型;第2组于后肢股四头肌内注射蛋黄乳清液,建立兔腘窝反应增生性淋巴结。②MRI扫描,包括平扫、SPIO及Gd-DTPA增强。序列包括T1WI,T2WI,PDWI,GRE T2*WI。③2位影像诊断医师进行盲诊,并与病理结果对照。④进行统计学分析。结果:SPIO增强,第1组大部分淋巴结信号较平扫未见明显变化,个别淋巴结在T2WI、PDWI及GRE T2*WI序列出现斑片状低信号影;第2组淋巴结在各序列均为低信号。Gd-DTPA增强扫描,2组淋巴结出现均匀或不均匀强化。SPIO增强扫描敏感度和特异度分别为83.3%,83.3%;Gd-DTPA增强扫描敏感度和特异度分别为58.3%,66.7%。SPIO增强扫描阳性预测值及阴性预测值分别83.3%,83.3%;Gd-DTPA增强扫描阳性预测值及阴性预测值分别为63.6%,61.5%。SPIO增强扫描K=0.667,P=0.01;Gd-DTPA增强扫描K=0.25,P=0.219;2组K=0.250,P=0.219。2种方法 ROC曲线下面积分别为0.833,0.625,P值分别为0.006,0.299。结论:SPIO是一种新型MRI对比剂,与Gd-DTPA相比,对转移性淋巴结与炎症反应增生性淋巴结的鉴别诊断具有较高特异性及敏感性。     

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）