β-重型地中海贫血MR定量心脏铁沉积与血清铁蛋白、肝铁浓度相关性研究

目的 使用MR定量重型地中海贫血患者心脏铁沉积,探讨其与血清铁蛋白(SF)、肝铁浓度(LIC)的相关性.方法 对58例10岁以上长期接受输血治疗的β-重型地中海贫血患者行心脏MR检查并测量T2*值,采用Spearman相关分析探讨心脏T2*值和SF、LIC之间关系.分别以SF＞2500μg/L和LIC＞ 15 mg/g干重为界值将患者分组.用完全随机设计两样本秩和检验比较2组患者的心脏T2*值.以T2*＜20 ms为诊断心脏铁沉积参考标准,计算以SF＞ 2500 μg/L或LIC＞ 15 mg/g干重预测心脏铁沉积的敏感度、特异度,分别绘制用SF和LIC预测心脏铁沉积的ROC曲线.结果 58例患者的心脏T2*值范围4.7～51.1 ms,中位数14.o ms; SF范围1345 ～23 640 μg/L,中位数5741 μg/L; LIC范围9.0～ ＞43.0 mg/g干重,中位数41.4 mg/g干重.所有患者的心脏T2*值与SF尚不能认为有线性相关关系(r=-0.240,P =0.070);心脏T2*值和LIC之间呈低度负相关(r=-0.402,P=0.002).SF≤2500 μg/L组7例,心脏T2*值范围6.1 ～47.6 ms,中位数23.7 ms; SF＞2500 μg/L组51例,心脏T2*值范围4.7 ～51.1 ms,中位数13.5 ms,2组心脏T2*值之间差异无统计学意义(Z=-0.489,P=0.625).LIC≤15 mg/g干重组5例,心脏T2*值范围24.4 ～51.1 ms,中位数44.8 ms;LIC＞ 15 mg/g干重组53例,心脏T2 *值范围4.7～45.5ms,中位数13.2 ms,2组心脏T2*值之间差异有统计学意义(Z=-2.895,P =0.004).以SF＞ 2500 μg/L和LIC＞ 15 mg/g干重预测心脏铁沉积的敏感度分别为90.9％(30/33)、100.0％(33/33),特异度分别为16.0％ (4/25) 、20.0％(5/25).以SF和LIC预测心脏铁沉积的ROC曲线下面积分别为0.652、0.775.结论 MRI-T2*可以直接定量重型地中海贫血患者心脏铁沉积,心脏铁浓度与SF无相关,与LIC低度相关.临床用SF或LIC预测心脏铁沉积不可靠,对诊断及治疗提供参考价值不大.     

双能CT物质分离技术检测慢性肝炎患者肝脏铁沉积的应用研究

目的 评价双能CT物质分离技术在观测慢性肝炎患者肝脏铁沉积中的应用价值.方法 前瞻性的入组51例慢性乙型病毒性肝炎患者.所有患者先后行上腹部双能CT扫描和3.0T MR多回波T2*序列扫描.CT数据经后处理后得到铁分布图,并在该图像中测得铁叠加值(overlay值).MR数据经后处理后测得R2*值.overlay值与R2*值行Spearman相关分析,并对诊断一致性进行Kappa检验.结果 overlay值与R2*值有正相关性(r=0.709;P=0.000).R2*值诊断铁沉积的阳性率高于overlay值诊断的阳性率(P=0.031),但2种诊断方法的一致性良好(Kappa值=0.768,P=0.000).结论 双能CT物质分离技术可以作为一种可行的检测肝脏铁沉积的方法,为临床肝脏铁沉积的诊断、随访工作提供了另一种新的检测手段.     

磁共振T2* map成像在膝关节骨性关节炎中的应用价值

目的 探讨磁共振T2* map成像在膝关节骨关节炎(OA)中的临床应用价值.方法 41例受检者共41个膝关节分为正常组(n=11)、轻度OA组(n=20)和重度OA组(n=10),采用T2* map成像分别测量股骨内侧、外侧髁,胫骨内侧、外侧髁及髌软骨等5处软骨浅、深层T2*值并对各组间差异进行统计学分析.正常组浅、深层之间T2*值的比较采用独立样本t检验,正常组与轻、重度OA患者浅、深层间T2*值的比较采用q检验.结果 正常成人关节软骨浅层T2*值为19.9～34.0 ms,深层T2*值为16.1～21.9 ms,两者之间存在显著性差异(P＜0.05),轻度OA患者关节软骨浅、深层T2*值分别为27.9～43.7 ms、23.7～31.7 ms,重度OA患者关节软骨浅、深层T2*值分别为27.3～44.4 ms、23.8～31.5 ms,与正常组浅、深层T2*值之间均存在显著性差异(P＜0.05),轻度OA组与重度OA组浅、深层T2*值之间无显著性差异(P＞0.05).结论 MR T2* map成像可用于评价关节软骨生物组织构成的变化,并在早期关节软骨退变的诊断中具有一定的临床应用价值.     

The Experiment Study of MRI R2 * Value for Noninvasive Measurement of Liver Iron Content in Iron Overload Rabbit

目的 以病理学结果为对照,研究磁共振R2*成像定量评估铁过载家兔模型肝脏铁含量的可行性及R2*值与肝脏铁含量(LIC)之间的关系.材料与方法 成年健康新西兰大白兔32只,随机分成4组,每组各8只(n=8).A、B、C组每周注射一次铁剂,注射剂量分别为5、10、25 mg/kg体重,共4周.D组不予任何处理.应用MR扫描仪行肝脏的R2 StarMap成像,经后处理生成R2*图,由一名经R2*Map成像后处理技术培训的放射科医师采用设置多个小的感兴趣区( ROI)求平均值法测得肝脏的R2*值.MR扫描结束后随即取兔肝作铁含量分析,得到LIC.采用Kruskal-Wallis Test分别对R2*值、肝组织铁含量各组之间的差异性进行分析,多重比较使用Tamhane's T2法.采用两变量相关分析和曲线拟合分析R2*值和LIC之间的相关性.结果 (1)建模过程中,LIC随注射剂量增加而增加.(2)R2*值与LIC之间符合指数曲线关系,拟合的曲线回归方程为Y=EXP(1.950+ 16.200X),R=0.894.但当LIC＞ 20.00 mgFe/g干重时,曲线的拟合度差,R仅为0.186.结论 R2*值能较好地反映兔肝脏铁浓度,并与组织学研究得到的肝铁含量呈明显的指数曲线相关.但当LIC较高(＞20.00 mgFe/g干重)时,R2*值与LIC之间的相关性明显下降.     

MRI T2*技术评估地中海贫血患者心脏、肝脏及胰腺铁负荷的相关性研究

【摘要】目的：基于1.5T磁共振成像（MRI） T2*技术探讨地中海贫血（TM）患者心脏、肝脏及胰腺铁负荷的相关性。方法：收集163例TM患者不同时期MRI T2*图像数据（每次间隔6个月），并按照不同患者首次检查时间，分成间隔6个月、12个月、18个月及24个月进行亚组分析。采用CMRtools软件测量所有患者心脏T2*（H-T2*）、肝脏T2*（L-T2*）值，并探究两者之间的关系。另收集50例TM患者H-T2*、L-T2*及胰腺T2*（P-T2*）数据，探讨P-T2*与H-T2*之间、P-T2*与L-T2*之间的相关性。结果：首次检查组、6个月组及12个月组的H-T2*与L-T2*之间（r=0.431、0.492、0.430，P均<0.001）均呈中度正相关。18个月组及24个月组的H-T2*与L-T2*之间（r=0.326、0.367,P=0.031、0.046）均呈低度正相关。P-T2*与H-T2*、L-T2*均呈中度正相关（r=0.455、0.586，P=0.001，P<0.001）。结论：TM患者H-T2*、L-T2*及P-TT2*之间相关程度不明显，相互反映彼此铁负荷的可靠程度较低。采用MRI T2*技术评估TM患者铁负荷时应进行较全面的脏器铁评估。     

磁共振多回波R2*技术无创评估肝硬化铁沉积

目的 探讨磁共振多回波R2*技术评估肝硬化铁沉积的价值.方法 分别对53例肝硬化患者及28例正常对照人群进行磁共振多回波R2*序列扫描.在R2*图和T2*图上测量肝实质、脾及脊柱旁骨骼肌的T2*和R2*值,利用T2*WI图像测量信号强度,再分别计算T2*、R2*值及信号强度的肝/肌、肝/脾及脾/肌各比值.分析肝硬化及其分级对以上MR测量参数的影响.结果 MR各测量值在性别之间未见统计学差异(P>0.05).在肝硬化组,脾R2*值和T2*值与年龄均存在相关性(r值分别 为0.624和-0.616,P值分别为0.017和0.019).肝脏的R2*值最大、肌肉最小.肝硬化组肝脏和骨骼肌的R2*值明显大于对照组,而T2*值则相反(P<0.05);其余测量参数在有、无肝硬化之间未见统计学差异(P>0.05).另外,MR各测量值在ChildPugh分级之间也未见统计学差异(P>0.05).结论 MR多回波R2*技术可对肝硬化铁沉积进行量化,但其不能用于评估肝硬化时肝脏储备功能情况,肝硬化时利用肌肉作为组织铁沉积的参照物并不可靠.     

磁共振T2*评价长期输血患者肝脏铁过载的价值

目的 探讨磁共振T2*在评估长期输血患者肝脏铁过载的价值.方法 搜集2011年12月至2012年6月长期输血患者28例,输血史12～ 69个月不等.应用Siemens Magnetom Trio 3.0 T磁共振设备的梯度回波序列对全部患者肝脏进行扫描并应用CMR tool软件(2010版)计算出肝脏感兴趣区域的T2*值;同时抽取患者静脉血,用紫外分光光度法检测血清铁蛋白水平.结果 28例患者的T2*值范围为0.9～17.8 ms,均数±标准差为(3.63±4.84) ms;血清铁蛋白浓度范围为118～7855 ng/ml,均数±标准差为(2098.60±1578.68) ng/ml.应用SPSS 16.0统计软件对T2*与血清铁蛋白进行相关性分析,两者呈负相关(P =0.015),相关系数为-0.535.结论 磁共振T2*在评估长期输血患者肝脏铁过载方面有一定价值.     

采用MRI探究不同输血依赖性疾病患者肝脏铁过载及其影响因素

【摘要】目的：基于MRI R2*技术探究不同病种输血依赖性疾病患者肝脏铁过载情况及铁过载的影响因素。方法：前瞻性搜集输血依赖性疾病患者80例,其中18例再生障碍性贫血(AA),34例急性白血病（AL）,28例骨髓增生异常综合征(MDS)。于3T MRI行多回波Dixon序列扫描,测量R2*值并计算肝脏铁含量（LIC）。搜集患者累计输血量及血清铁蛋白（SF）等临床资料并计算铁摄入量。比较不同病种间临床指标及LIC差异,分析LIC影响因素,并对SF与LIC、铁摄入量进行相关性分析。结果：单因素线性分析显示铁摄入量,病程和病种与LIC线性关系显著（P＜0.01）,多因素线性分析显示仅铁摄入量为LIC的影响因素（P＜0.01）。所有患者SF与LIC及铁摄入量显著相关（r=0.480,P＜0.01）;AA、MDS组SF与LIC及铁摄入量之间均存在显著相关性（P＜0.05）,而AL组SF与LIC及铁摄入量无相关（P＞0.05）。结论：不同输血依赖性疾病均存在肝脏铁沉积,病种间的铁代谢差异对肝脏铁负荷影响较小,可利用铁摄入量评估肝脏铁过载程度。     

良性前列腺增生ESWAN成像与临床指标的对照研究

目的 对比分析良性前列腺增生(BPH)区及正常前列腺周围带(PZ)在多回波采集重度T2*加权三维梯度回波(ESWAN)序列上成像的特征,探讨多指标ESWAN评估BPH的可行性.方法 对病理证实的48例BPH患者行ESWAN扫描,分别测量BPH和PZ的R2*值、T2*值、相位值及磁矩值,比较BPH和PZ、尿潴留组(15例)和非尿潴留组(23例)增生区ESWAN指标的差异.结果 BPH的R2*值、T2*值及磁矩值分别为20.16 ±3.04、50.41±8.53、1559.88 ±261.10,正常周围带的相应各值分别为16.15±8.45、80.96±56.86、1505.53±252.48;BPH的R2*值＞PZ(P =0.006),T2*值＜PZ(P =0.000),而磁矩值＞PZ(P =0.023).BPH的相位值＜PZ,但两者差异不具统计学意义(P =0.294).尿潴留组增生区R2*值(20.61±2.47)大于非尿潴留组(18.73±2.81),且差异具有统计学意义(P =0.037);尿潴留组增生区T2*值(50.13±4.85)小于非尿潴留组(56.88±8.63),差异亦存在统计学意义(P =0.009).两组相位值及磁矩值差异均不具有统计学意义(P＞0.05).结论 BPH与正常周围带在ESWAN上具有各自的特征性,R2*、T2*值对BPH合并尿潴留有临床诊断价值,有助于进一步扩展ESWAN在前列腺疾病中的应用.     

定量MRI评价肝泡型包虫病肝储备功能的初步探讨

【摘要】目的：探讨磁共振T1-mapping、T2-mapping定量评价肝泡型包虫病（HAE）肝功能的临床应用价值。方法：搜集本院行肝脏磁共振T1-mapping及T2-mapping扫描的36例HAE患者（病例组）和20例肝脏功能正常的健康志愿者（对照组）。根据Child-Pugh分级评分将病例组分为肝功能A级组（n=14）、B级组（n=12）和C级组（n=10）。分别测量肝泡型包虫病例组及对照组正常肝实质的弛豫时间,得到T1值和T2值,采用方差分析两两比较四组间T1、T2值。结果：对照组T1值为（338.9±95.6）ms,T2值为（42.7±3.1）ms;病例A组T1值为（393.47±158）ms,T2值为（43.74±5.3）ms;B组T1值为（351.5±84.7）ms,T2值为（57.85±7.7）ms;C组T1值为（460.9±76.0）ms,T2值为（65.9±3.0）ms。各组间T1值差异均无统计学意义（P＞0.05）,对照组T2值与病例A组差异无统计学意义（P＞0.05）,对照组与病例B组、C组及病例组A、B、C各组间差异有统计学意义（P＜0.05）。结论：肝泡型包虫病例随肝功能C-P分级不同,其T2值存在差异,磁共振T2-mapping成像有望用于定量评价肝脏储备功能,为临床医师评估肝泡型包虫肝脏储备功能提供一种新的手段。T1值定量评价HAE肝功能仍需论证。     

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.     

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.     

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).     

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.