肝上皮样血管内皮细胞瘤的影像表现

目的 探讨肝上皮样血管内皮细胞瘤(epithelioid hemangioendothelioma,EHE)的影像表现特征.资料与方法 回顾性分析经肝穿刺病理证实的5例肝EHE患者的CT表现.结果 5例CT平扫均表现为肝内多发低密度结节,大小不等,境界清楚,均未见明显钙化及包膜征象,病灶多位于肝周及肝包膜下.3例可见部分病灶有融合,1例可见局部肝包膜轻度凹陷形成“肝包膜凹陷征”.5例增强扫描动脉期病灶边缘轻度强化,门静脉期病灶进一步向心性强化,但病灶密度仍低于周围正常肝实质(呈低密度).2例增强扫描部分病灶表现为边缘强化呈高密度,中央见无强化的低密度区,病灶周边可见薄层更低的环形低密度带形成“晕环征”.2例增强扫描示肝内静脉主干及分支逐渐变细伸向低密度的结节,终止于结节的边缘形成“棒棒糖征”.3例增强扫描可见部分病灶内有静脉分支存在或静脉分支在病灶内穿行.结论 “肝包膜回缩征”、“晕环征”及“棒棒糖征”是肝EHE的影像表现特征,尤其是“棒棒糖征”具有一定的特异性,有助于其诊断与鉴别诊断.     

多排螺旋CT对肝脏孤立性坏死结节的诊断价值

目的探讨肝脏孤立性坏死结节的CT表现特征,以提高诊断准确率。方法对6例肝脏孤立性坏死结节进行常规CT平扫及增强扫描,全部病例均经病理证实,观察并记录病灶的大小、形态、边界、密度及增强特点。结果病灶多位于肝表面和肝浅表实质内,呈圆形或类圆形,边界清楚,最小的1.7cm×2.1cm,最大的4.9cm×3.7cm,CT平扫4例为低密度影,1例为等密度影,其中1例内部密度不均匀,可见片状等密度影,增强后5例病灶在动脉期、门静脉期及延迟期呈内部无增强表现,1例病灶内部见多发斑块状与肝实质等密度强化灶,病灶边缘见细环形强化且在延迟期更明显。结论病灶内部三期基本无强化和周边可伴有或不伴有环形强化为肝脏孤立性坏死结节主要CT表现,MSCT是诊断肝脏孤立性坏死结节有价值的检查方法。     

肝腺瘤的螺旋CT表现

目的探讨肝腺瘤的螺旋CT表现。方法结合文献回顾性分析临床病理确诊的9例10个肝腺瘤的螺旋CT平扫和增强三期扫描(动脉期、门脉期和延迟期)的表现。结果9例10个肝腺瘤的平扫及增强螺旋CT表现如下:病变边界光滑清晰,无明显分叶。位于肝右叶7个,左叶3个。平扫呈等密度1个,均匀略低密度4个,不均匀低密度2个,混杂密度3个。4个病灶周围环以低密度假包膜,包膜完全2个,不完全2个。2个病灶诊断为急性出血,1个为亚急性出血,4个病灶中心可见坏死,2个病灶内可见脂肪变性。增强扫描:动脉期病灶除出血、坏死和脂肪变性部分呈均匀明显强化8个,有2个病灶肿瘤实质部分呈不均匀强化。门脉期和延迟期病灶呈等密度或略低密度。4个病灶周围包膜平扫和动脉期呈低密度,门脉期或延迟期呈轻度强化。结论螺旋CT特别是三期增强扫描对肝腺瘤的定性诊断及鉴别诊断有重要意义。     

腰大肌神经纤维瘤一例

患者男,46岁。左下腹不适1个月余。体检:左下腹有深压痛,未触及肿块。B超提示左下腹膜后一大小约5.8cm×5.9cm肿块。CT表现:S1平面左腰大肌后内侧可见一大小约6.0cm×4.5cm的肿块,边缘光整,密度不均匀,平扫CT值20~34HU(图1),增强扫描肿块呈轻至中度强化,CT值20~48HU(图2),内见小片状无强化坏死区,腰大肌前缘呈“新月”形,肿块与脊柱之间脂肪图1CT平扫:左腰大肌后内侧见一大小约6.0cm×4.5cm肿块,边缘光整,密度不均匀图2增强扫描肿块呈轻至中度强化,内见小片状不强化区隙存在。CT拟诊:左腰大肌良性肿瘤。手术所见:左腰大肌深面见一大…     

肝结核的螺旋CT动态增强扫描表现及诊断价值

目的 探讨各型肝结核的螺旋CT动态增强扫描表现及其诊断价值. 资料与方法 18例肝结核患者行螺旋CT平扫和动态增强扫描,均经手术病理或穿刺活检证实.结果 (1)浆膜型1例:肝包膜呈梭形增厚低密度影,增强扫描病灶内有分隔样强化,邻近肝实质动脉期明显强化.(2)粟粒型8例(病灶最大径<2.0 cm):表现为肝内散在多发(6例)或单发(2例)粟粒小结节状低密度灶,增强扫描动脉期和静脉期病灶边缘轻度强化.(3)结核瘤型7例(病灶最大径≥2.0 cm):表现为单发或多发较大结节或肿块,4例病灶内有斑点状钙化,1例结核性肝脓肿有环形钙化,增强扫描动脉期病灶边缘轻度强化,周围肝组织明显强化,静脉期病灶边缘明显环形强化或病灶内蜂窝状强化.(4)胆管炎型1例:表现为肝门部肝内胆管扩张,增强扫描胆管壁强化,合并有腹膜后和肠系膜根部肿大淋巴结环形强化.(5)混合型1例:表现为肝包膜及邻近肝组织内低密度灶,同时具有浆膜型和结核瘤型的CT表现.结论 将肝结核分为浆膜型、粟粒型、结核瘤型、胆管炎型和混合型5种类型较合理.螺旋CT动态增强扫描能显示肝结核的一些特征性表现,如病灶"边缘强化征"、"蜂窝征"等,有助于该病的定性诊断.     

肾毛细血管瘤1例

患者女,53岁,体检发现左肾占位性病变4 d入院.查体无阳性体征,血、尿生化检查未见异常. 双肾CT平扫:左肾中上极可见稍低密度影,其内密度不均匀,与肾实质分界不清,大小约7 cm×6.5 cm×5 cm(图1).CT动态增强扫描:左肾病变于增强扫描各期呈不均匀强化,病变大部分为逐渐增强,动脉期CT值30 HU,至延时12 min扫描,CT值升至71 HU,仅病变前内上部分各期均无明显增强(图2,3).诊断:左肾中上极占位,血管瘤可能性大,不除外肾癌.MR平扫:左肾中上极见一较大不规则异常信号影,T1WI呈稍低信号,T2WI压脂呈高信号,内可见网状等信号影(图4).     

脾血管肉瘤1例

患者 女,53岁.既往有脾大、血小板减少6个月.近日腹痛,以中上腹为著,出现恶心、腹泻,偶有里急后重,腹肌略紧,脾于左季肋下约6 cm. CT检查:示肝脏轮廓不光整,肝内弥漫分布低密度影,增强扫描无明显强化;脾脏异常增大,增强扫描脾脏动脉期"斑马"状强化消失,静脉期、延迟期呈逐渐强化(图2~4),其内可见多发点片样低密度区,下部可见椭圆形高密度影,约33 mm×16 mm,CT值约63 HU,无强化(图1);肝脾外围见大量液性密度影,CT值34 HU.术后MRI检查示肝实质可见多个类圆形稍长T1信号,压脂T2呈稍高信号,增强检查其边缘见环形强化,椎体多发小圆形影,增强检查环形强化(图5).免疫组化:LCA(-),CD31(+),Vim(+),CD34(+),CK(-),Ki-67约10%(+).病理诊断:(脾脏)血管肉瘤(图6) .     

黄色肉芽肿性肾盂肾炎一例

患者女,62岁.右侧腰部胀痛不适1个月,食欲不振,时有尿频.体检:右侧肾区压痛,叩击痛.实验室检查:血常规白细胞10×109/L,中性粒细胞计数0.65,血沉50 mm/h,肝肾功能、肿瘤标志物均未见异常,尿红细胞、白细胞和尿蛋白阳性. CT平扫示右肾外形增大,肾脏下缘见类圆形低密度灶,边界模糊,大小约3.8cm ×5.0 cm,内见囊状低密度区,CT值10～ 24 HU,肾周筋膜增厚(图1),增强扫描动脉期病灶较清晰,病变区局部皮质变薄,边缘实性部分中度强化,CT值约45～ 75 HU,中央可见分隔强化,囊性部分无强化,内壁光滑,无壁结节,肾后筋膜受累增厚(图2);实质期仍见边缘强化,中央低密度无强化,邻近腰大肌略增厚(图3),冠状位可清晰显示病灶范围,右肾形态饱满,肾脏下极见低密度病灶,肾周筋膜内见"絮"状密度增高影(图4).     

肾脏黏液瘤合并出血一例

患者女,43岁.体检发现左肾占位性病变2 d而于2010年2月18日入院.体检:腹部未见阳性体征.尿潜血呈弱阳性.彩超示左肾实质内一实质性肿物,大小为31 mm×34 mm,肿物内部及周边可见少许血流信号.MSCT平扫见左肾形态不规则,内上部实质内有一不规则形异常密度影,边界尚清,最大层面为4.9 cm×3.1 cm,向肾轮廓外突出,其内密度不均,似有分隔,CT值为20～48 HU.增强扫描病灶呈不均匀强化并以边缘为著,其内可见强化的间隔,病变内侧与腰大肌分界不清(图1,2).MSCT拟诊左肾癌而行腹腔镜下切除术.     

肝脏孤立性坏死结节的CT、MRI表现与病理对照研究

目的:探讨肝脏孤立性坏死结节(SNN)的CT、MRI表现及其分型诊断价值和病理基础.方法:分析经临床和病理证实的肝孤立性坏死结节29例(所有病例均行MR检查,其中15例行CT检查),探讨SNN的CT、MRI表现及其分型诊断价值和病理基础.结果:①单纯凝固性坏死型(14例),T1WI、T2WI上均呈低或低-等信号,增强扫描病灶内凝固性坏死无强化,周围包膜呈延迟强化.其中8例行CT检查,CT平扫呈低或等密度,增强扫描无强化,5例可见包膜呈延迟期环形强化.②伴液化性坏死型(5例),T1WI上呈低信号,较大病灶内可见更低信号;T2WI上病灶呈低-等信号,其内液化性坏死呈点片状更高信号;增强后病灶无强化,周围包膜呈轻-中度强化.CT检查3例,CT平扫呈低或等密度,增强扫描无强化,2例周围包膜呈延迟期环形强化.CT不能反映病灶内液化性坏死.③多结节融合型(10例),T1WI呈低信号,其内可见低-等信号分隔;T2WI病灶以等-稍高信号为主,其内可见等或略高信号分隔,其中6例合并液化性坏死还可见裂隙状高信号.增强扫描病灶无强化,其内分隔及周围包膜呈轻-中度强化.CT检查4例,其中3例为低或等密度融合结节,增强扫描内部分隔及周围包膜呈延迟期强化.CT不能显示内部液化性坏死和病灶全部分隔.结论:CT、MRI能较好反映肝脏孤立性坏死结节的分型及各型的病理特征,MRI在多结节融合型和伴液化坏死型的诊断价值明显优于CT.     

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.