009MR扩散张量成像纤维示踪术在脊髓压迫症中的应用

临床脊髓压迫症的疗效来自于早期干预，需应用MR对其迅速诊断。扩散张量成像（DTI）技术能通过特殊的纤维示踪方法重建脊髓内的白质纤维束三维影像，明确常规T2WI未发现的异常区域。为探讨DTI中计算的各项异性分数（FA）值是否比表观扩散系数（ADC）值对急慢性脊髓受压病人脊髓异常区的检测更敏感，作对15例病人（男10例，女5例，平均年龄53．9岁）进行前瞻性研究。     

白血病脑实质浸润的弥散张量成像应用研究

目的探讨1．5T磁共振弥散张量成像（diffusiontensorimaging,DTI）,部分各向异性（fractionalanisotropy,FA）和表观扩散系数（apparentdiffusioncoefficient,ADC）及弥散张量纤维束成像（diffusiontensortractography,DTT）在成人白血病脑实质浸润的应用价值。方法回顾性分析经临床证实的8例白血病脑实质浸润病例DTI之ADC、FA参数图,分别测量病变、水肿及健侧相应部位FA值和ADC值;观察各例在DTT图的变化。结果白血病脑实质浸润的肿瘤实质部分FA值8例全部较健侧降低,ADC值5例减低,3例增高;周围水肿区FA值全部降低,ADC值全部增高;脑白质纤维束DTT显示有中断、移位、浸润。结论DTI对脑侵犯神经纤维束损伤具有独特诊断价值;DTI的参数变化能够量化神经纤维受压后微细结构的变化,DTT图像重建能直观显示脑白质纤维束的完整性及损伤程度,DTI联合DTT可更加准确地评估白血病脑侵犯的损害程度。     

基于解剖图谱DTI定量评估脊髓型颈椎病的白质纤维束损伤

目的:探讨脊髓型颈椎病(CSM)患者慢性颈髓压迫后白质纤维束的微结构变化.方法:将2019年7月-2019年12月在本院经临床及影像确诊的32例CSM患者(患者组)和年龄、性别相匹配的13例健康志愿者(对照组)纳入本研究.所有受试者均行颈髓3D T1WI、T2?WI和DTI扫描.采用脊髓专用后处理软件(SCT)计算脊髓...     

颈髓白质纤维束磁共振扩散张量成像的初步研究

目的:利用磁共振弥散张量成像(DTI)研究正常成人颈髓的各向异性程度,探讨颈髓白质纤维束成像的可能性和应用价值。方法:使用单次激发自旋回波平面回波(SE-EPI)序列对14例MR检查正常的健康志愿者行颈髓弥散张量成像检查。重建FA图,在颈髓各节段分别测量FA值。利用日本东京大学Masutani开发的DTVⅡ和VolumeOne纤维束示踪成像软件进行白质纤维束成像。结果:颈髓平均FA值0.6583±0.0737,所有FA图上颈髓显示清晰,没有明显图像失真。白质纤维束成像三维显示颈髓大部分主要的纤维束。结论:DTI有效地显示颈髓白质纤维的各向异性特征及白质纤维束的分布和走向,对颈髓疾病的研究提供了新的方法。     

成人视放射磁共振DTI和DTT研究及初步临床应用

目的应用MR扩散张量成像（DTI）和扩散张量纤维束示踪成像（DTT）研究正常成人视放射的各向异性程度和视放射纤维束的构象特征及其临床应用价值。资料与方法对30名健康志愿者和34例枕叶病变累及视放射的患者进行MR常规及DTI序列检查,重组FA图和三维彩色编码张量图,分别测量双侧视放射区的部分各向异性（FA）值和平均扩散率（MD）值。采用扩散张量纤维束追踪软件进行视放射纤维束成像。结果彩色编码张量图均清晰显示视放射,正常视放射的FA值分别为左侧0．509±0．027、右侧0．504±0．028,MD值分别为左侧（0．756±0．049）×10^-3mm^2／s和右侧（0．734±0．045）×10^-3mm^2／s,差异均无统计学意义（P〉0．05）。DTT显示的视放射纤维束构像和走行特征符合经典神经解剖学研究。20例枕叶陈旧性梗死患者可见视放射继发Wallerian变性,FA明显降低,MD明显增高;3例脑膜瘤患者视放射完整无破坏,呈被推移改变,FA轻度降低,MD轻度增高;3例胶质瘤、1例淋巴瘤、6例转移瘤和1例结核性脑脓肿均显示视放射被破坏、中断,其各向异性消失。结论DTI、DTT可清晰显示视放射纤维束生理和病理条件下的各向异性特征,对提高视放射病变的显示和诊断具有重要意义,为了解视功能与视放射之间的关系提供了新的研究手段。     

DTI在急性缺血性脑卒中所致皮质脊髓束损伤中的应用研究

目的:利用DTI探讨急性缺血性脑卒中病人大脑白质纤维束各向异性特征和皮质脊髓束受损与肌力的关系。方法:对9例正常被试和9例急性期缺血性脑卒中病人进行常规MR T1WI、T2WI和DTI检查,对数据进行离线后处理,采用dTV.II软件处理,获得FA图及方向编码彩色(DEC)图,并重建双侧皮质脊髓束3D纤维束图。结果:在正常组双侧白质纤维束FA值无明显差异,重建FA值图与方向编码彩色图可显示大部分主要的白质纤维束。在脑卒中病人组梗死区FA值显著低于健侧,两侧相比差异有显著性意义(t=4.570,P<0.001)。病变侧皮质脊髓束受压、变形、移位、部分断裂,皮质脊髓束受累情况与肌力有相关性(rs=0.888,P<0.05)。结论:DTI可显示脑内白质纤维束的走行及分布,为大脑白质纤维束的研究开辟了新的广阔领域。DTI FA值图及DEC图可以显示卒中病人梗死区白质纤维的方向与各向异性程度。3D纤维束图可以更立体直观的显示锥体束状况,有利于探讨皮质脊髓束损伤程度与肌力的关系,对临床及判断预后有重要价值。     

脑梗死患者磁共振扩散张量纤维束成像的随访研究

目的应用磁共振扩散张量纤维束成像(DTT)研究梗死灶与皮质脊髓束的空间关系,并随访观察受损纤维束的功能重组与代偿情况,探讨DTT技术对预测患者运动功能转归的价值。方法选择左侧内囊周围区脑梗死患者19例,分别于发病7、30、90天进行磁共振扩散张量成像(DTI)检查,应用DTT技术进行皮质脊髓束三维重建,采用FuglMeyer量表评价患者的运动功能,分析脑梗死灶及皮质脊髓束受累程度与患者运动功能恢复的关系。结果 DTT显示19例左侧内囊周围区梗死患者,根据患侧皮质脊髓束受累情况分为3型,I型5例,皮质脊髓束位于梗死灶外,FM评分96.46±7.68;II型6例,皮质脊髓束部分位于梗死灶内,但受侵范围1/3;或受压、迂曲、推移改变,FM评分94.20±6.84;III型8例,皮质脊髓束1/3位于梗死灶内,FM评分82.37±22.14。19例患者发病7天,皮质脊髓束损伤分型与FM评分呈显著负相关(r=-0.490,P=0.033)。DTT对患者皮质脊髓束的动态观察显示,8例III型患者中4例90天皮质脊髓束显示良好,患者运动功能完全恢复;2例患者皮质脊髓束自身发生再生修复,90天后仅遗留部分运动功能障碍;2例未发现纤维再生修复,90天仍遗留严重运动功能障碍。结论 DTT能够直观显示脑梗死患者的皮质脊髓束受累程度及其动态变化,对评价其运动功能恢复提供重要的客观影像学依据。     

缺血性脑卒中肢体运动功能及皮质脊髓束受损的DTI评价

目的:探讨脑缺血性卒中急性期患者肢体运动功能与皮质脊髓束受损的关系.方法:采用GE 1.5T磁共振成像系统,对9例脑缺血性卒中急性期患者和9例志愿者进行磁共振扩散张量成像(DTI)检查,采用dTV.Ⅱ软件进行处理,显示FA图及彩色FA方向图,并重建患者的双侧皮质脊髓束3D纤维图.Brunnstorm标准判断脑卒中患者患手肌力.结果:卒中患者梗死白质区FA值显著低于健侧,两侧相比差异有显著性意义(t=4.570,P＜0.001),病变侧皮质脊髓束受压、变形、移位、部分断裂,皮质脊髓束受累情况与肌力有相关性(rs=0.888,P＜0.05).结论:脑卒中患者患手皮质脊髓束损伤程度与肌力相关,提示可用于判断康复治疗的预后.3D纤维图可以更立体直观的显示锥体束状况.     

磁共振扩散张量成像在颈髓病变中的应用

目的：探讨磁共振扩散张量成像（DTI）技术在颈髓病变诊断中的临床应用。方法：应用1.5T磁共振机器对39例颈髓病变患者和15例健康志愿者行MRI常规和DTI检查,测定病变区和对照部位的FA值、ADC值并进行对照分析,并重建白质纤维束图。结果：健康志愿者颈髓的FA值为0.66±0.06,ADC值为（0.96±0.14）×10^-3mm^2/s。颈椎病病例FA值为0.47±0.05、ADC值为（1.16±0.28）×10^-3mm^2/s;与对照组统计学分析FA值明显降低（P〈0.01）,ADC值明显增高（P〈0.01）。颈髓急性损伤病例FA值为0.38±0.08、ADC值为（0.89±0.25）×10^-3mm^2/s;与对照组统计学分析FA值明显降低（P〈0.01）,ADC值与对照组无明显差异（P=0.130〉0.05）。颈髓炎症：FA值为0.40±0.06、ADC值为（1.25±0.40）×10^-3mm^2/s;与对照组统计学分析FA值明显降低（P〈0.01）,ADC值明显增高（P〈0.01）。所有病例通过DTI技术成功显示了白质纤维束在病变区变形、移位及中断等改变。结论：DTI可以探测到颈髓病变中常规MR未能发现的病灶;白质纤维束成像可以显示白质束的受损情况。     

DTT及VBM联合评价精神发育迟滞患者脑白质变化

【摘要】目的：联合使用扩散张量纤维束示踪成像（DTT）及基于体素的形态分析法（VBM）,探讨精神发育迟滞（MR）患者的脑白质变化。方法：精神发育迟滞患者16例及同龄健康志愿者16例（对照组）,均行MR3D-T1WI及DTI扫描,采用VBM方法比较患者组与对照组中脑白质体积的差异。同时使用DTT重建特定脑白质纤维束,比较患者组与对照组中白质纤维束的FA值、ADC值、数量和长度的差异。结果：与正常对照组比较,MR患者的脑白质体积总量减少（t=2.457,P＜0.01）,扣带束、下额枕束的FA值降低（t=-2.561、-2.92,P=0.013、0.005）,胼胝体束、下额枕束、皮质脊髓束和扣带束的ADC值增高（t=3.039、2.524、2.483、2.292,P=0.006、0.016、0.016和0.025）,皮质脊髓束、胼胝体束的数量减少（t=-2.195、-2.385,P=0.033、0.024）,胼胝体束、皮质脊髓束、扣带束长度减小（t=-2.146、-2.364、-2.048,P=0.040、0.021、0.045）,差异均有统计学意义（P＜0.05）。结论：DTT及VBM方法均可发现精神发育迟滞患者脑白质异常变化,两者联合使用对精神发育迟滞的评估有重要价值。     

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）