骨肉瘤的X线平片、CT、MRI诊断

目的:评估X线平片、CT、MRI诊断骨肉瘤的价值.材料和方法:回顾性分析20例经手术病理证实为骨肉瘤的X线平片、CT、MRI表现.结果:20例X线平片均能清楚显示骨肉瘤的基本表现,术前正确诊断17例,误诊3例;CT显示骨肉瘤的骨质破坏及瘤骨优于X线平片11例;MRI显示骨肉瘤的早期骨破坏及周围软组织、病变范围及骨骺(骺板)侵袭、瘤周水肿优于X线平片及CT14例.结论:X线平片是诊断骨肉瘤的首选及基本方法,CT或MRI对提高骨肉瘤的诊断、分期及临床治疗提供全面、准确的影像学资料,尤其MRI对于指导保留骨骺的保肢术的选择具有重要意义.     

儿童骨骼尤文肉瘤的影像学诊断和鉴别诊断

目的 探讨儿童骨骼尤文肉瘤在X线平片、CT和MRI上的影像学征象，以提高对其诊断和鉴别诊断能力。资料与方法 回顾性分析经临床病理证实的儿童骨骼尤文肉瘤11例，其中X线平片检查7例，单行MRI扫描2例，单行CT扫描4例，同时行MRI及CT扫描者4例。结果 11例尤文肉瘤中发生于骨盆4例，股骨3例，胫骨、肋骨、趾骨和脊柱各1例，其中胫骨和髂骨各1例术后出现颅骨转移。X线平片上6例表现为虫蚀状或溶骨性破坏，2例病灶略呈膨胀性改变，骨皮质破坏伴单层、多层或放射状骨膜反应，邻近软组织层次欠清；发生于肋骨的1例以硬化为主，CT像上髓腔密度增高，骨质鼠咬状或斑片状破坏伴骨皮质裂隙状或不规则破坏；2例骨皮质呈膨胀、变薄、中断，周围见不完整的层状骨膜反应及较大软组织肿块；MRI上表现为大片长T1长T2信号的骨质破坏和巨大的软组织肿块；1例肿块呈跨关节生长。结论 X线平片、CT和MPI在骨尤文肉瘤的评估方面有重要作用。X线平片可有助于肿瘤的定性和定位；MRI平扫T1WI像及短反转时间反转恢复技术(STIR)能清晰显示肿瘤的范围，在显示肿瘤对骨骺及邻近软组织的侵犯方面尤为敏感；CT在显示骨及骨皮质破坏等方面优于MRI。     

软骨母细胞瘤MRI及X线平片和CT的表现特征

目的 研究软骨母细胞瘤的影像表现,探讨其MRI与X线平片、CT征象的对应关系.方法 分析16例经手术、病理证实的良性软骨母细胞瘤的影像资料,总结其MRI表现与X线平片、CT征象的对应关系.结果 16例软骨母细胞瘤均位于骨骺,大小为0.9 cm×0.8 cm×1.0 cm～4.8 cm×4.3 cm×5.1 cm,呈不同程度的分叶状.在T1WI上以等、低信号为主,T2WI上呈混杂信号,CT上为软组织密度,内见钙化和更低密度区.边缘呈长T1、短T2信号,在CT上表现为硬化边.MRI可见病灶周围有骨髓水肿,在X线和CT上表现为骨质硬化区.病灶邻近软组织肿胀.MRI显示骨膜异常9例,8例与病灶不相邻;X线和(或)CT显示骨膜新生骨6例.MRI显示关节积液12例,CT显示6例.MRI上病灶均呈不均匀强化,骨髓水肿、骨膜反应和软组织肿胀均见强化.软骨母细胞瘤在扩散加权成像(DWI)上呈等、高信号,在MR平扫中的等T1、等T2成分和长T1、长T2成分,以及骨髓水肿、骨膜反应和软组织肿胀在DWI上均呈高信号.结论 MRI和X线平片、CT从不同方面反映软骨母细胞瘤的病理改变,联合应用不同检查手段可更全面显示软骨母细胞瘤的特点.     

成人骨肉瘤的影像诊断(附21例报告)

目的 探讨成人骨肉瘤的影像学表现,提高该病的影像诊断准确性.方法 回顾性分析本院1999-10-2006-03收治的21例成人骨肉瘤患者的影像学资料.结果 21例中发生在膝关节周围8例,骨盆4例,胸椎1例,股骨上段及股骨颈4例,桡骨远端1例,上下颌骨各1例,肋骨1例.19例原发,2例分别继发于骨巨细胞瘤和骨纤维结构不良.X线平片显示病变区骨质破坏或增生,可显示不同的骨膜反应,显示瘤骨8例,软组织肿块14例,病理性骨折3例,发生在长管状骨的13例中显示髓腔扩大8例.CT表现与X线平片基本相似,但对于瘤骨和骨膜反应的显示更清晰.MRI主要表现为T1WI不均匀低信号或以低、等低信号为主的混杂信号,T2WI不均匀高信号或混杂信号,软组织肿块的大小及范围显示更清楚,CT及MRI增强扫描显示肿瘤中等至明显强化,以边缘强化更显著.8例行DSA检查,显示病灶中等至明显强化,有紊乱幼稚的肿瘤血管,同时行经动脉化疗栓塞.结论 X线平片、CT、MRI三者结合能为本病的诊断治疗提供更全面的影像信息,DSA不仅提供诊断信息,也是重要的治疗手段.     

原发性骨恶性纤维组织细胞瘤的影像学分析

目的:探讨原发性骨恶性纤维组织细胞瘤(BMFH)的影像学表现,以提高该病的诊断水平。方法:回顾性分析经病理证实的原发性骨恶性纤维组织细胞瘤21例患者的X线摄片、CT和MRI的影像学特征,探讨影像学的诊断价值。结果:21例中长骨BMFH 18例,扁骨或不规则骨BMFH 3例。X线平片均有不规则溶骨性骨质破坏,相邻骨皮质破坏,9例病灶边缘有轻度骨硬化,5例伴有膨胀性改变,14例骨质破坏区周围出现弥漫性软组织肿胀;CT表现为不规则、无结构溶骨性骨质破坏,局部被软组织密度肿块所替代,邻近骨皮质呈不规则虫噬样破坏,同样可以看到有软组织肿胀,5例病灶内部见少许残留致密骨嵴和骨质破坏边缘断续性硬化,另有4例肿块内可见单发或多发囊状低密度区,未见钙化及残留骨结构;MRI表现:8例骨质破坏区均呈不均匀长T1长T2异常信号,其中夹杂斑片状或囊状更长T1长T2信号,均有骨皮质破坏并突破皮质形成软组织肿块。结论:原发性BMFH的影像学表现有一定的特征,X线平片、CT和MRI的结合有助于诊断。     

毛细血管扩张型骨肉瘤的影像表现及其与病理的关系

目的:分析毛细血管扩张型骨肉瘤影像学表现与病理的关系,以提高诊断准确性.方法:回顾性分析经手术病理证实的毛细血管扩张型骨肉瘤9例,术前分别经X线平片、CT平扫、MR SE T1WI、T2WI和T1WI增强扫描,仔细复习影像征象并和手术病理作对照.结果:9例毛细血管扩张型骨肉瘤中,位于股骨5例,胫骨3例和髂骨1例.位于长管状骨者,5例位于干骺端,2例位于骨干,1例接近骨端.肿瘤直径6.3～11.8 cm.所有肿瘤均为溶骨性骨质破坏,破坏区呈椭圆形5例,不规则地图形4例.病灶呈囊状9例,7例病灶境界不清,7例病变见骨膜增生,伴软组织肿块8例,所有病例软组织肿块境界清楚.5例行CT检查,病灶密度低于肌肉或与肌肉相仿,CT显示骨膜增生及软组织肿块较平片清楚,增强扫描软组织明显强化.4例行MR检查,T1WI为混杂信号3例,低信号1例;T2WI为低、等和高信号混杂4例.T2WI 4例均可见明显囊状改变和液-液平面,均可见软组织成分,软组织构成囊壁和分隔,部分呈不规则肿块结节,T2WI软组织信号高于肌肉.结论:毛细血管扩张型骨肉瘤好发于长管状骨干骺端,呈卵圆形或地图样溶骨性破坏,容易呈多囊状坏死,但肿瘤内常见软组织成分,常伴骨膜增生和骨外软组织肿块,CT增强扫描和MR有助于显示病灶的软组织成分.     

Ewing肉瘤的X线平片、CT与MRI影像学分析

本文对36例Ewing肉瘤的X线平片、CT与MRI影像学表现进行了回顾性分析，认为X线平片在Ewing肉瘤的病变部位、骨质破坏、瘤骨、骨膜反应及软组织肿块等方面有一定特殊性。CT对显示髓腔内及软组织肿块等方面较X线平片清晰，但X线平片与CT常常低估病变的范围，MRI对早期检出病变致确定病变范围有明显优势。     

骶骨骨巨细胞瘤X线、CT及MRI表现

目的分析骶骨骨巨细胞瘤(GCT)的X线、CT和MRI表现特点,探讨三种影像检查方法的临床应用价值。资料与方法 21例骶骨GCT均经手术病理证实,所有病例均行X线、CT和MRI检查,分析骶骨GCT的X线平片、CT、MRI表现特点,将影像学表现与手术病理结果进行对照,并经双盲法分析确认。结果 21例中,X线和CT显示囊性膨胀性骨质破坏18例,溶骨性骨质破坏15例,骨包壳不完整14例,MRI显示骨质破坏10例。X线显示侵犯骶髂关节及髂骨5例,CT显示16例,MRI显示11例。CT平扫显示软组织肿块12例,CT增强显示16例,MRI显示16例,其中巨大囊实性软组织肿块12例,10例可见液平面,病灶周围可见软组织水肿及骨髓水肿。骨质破坏在MR SE T1WI上呈等低信号,T2WI呈等信号。骨包壳在MRI上表现为低信号,X线和CT上表现为硬化环。软组织肿块实性部分在T1WI为等信号,T2WI及短时反转恢复(STIR)呈等高信号。囊性部分在T1WI为低信号,T2WI及STIR呈等高信号。软组织水肿及骨髓水肿在T2WI及STIR呈高信号。CT和MRI增强软组织肿块实性部分明显强化,囊性部分不强化。结论 X线、CT和MRI从不...     

Ewing′s瘤的X线、CT和MRI影像学表现及其意义

目的　探讨Ewing′s瘤的X线、CT及MRI影像表现及其意义。资料与方法　回顾性对比分析 2 1例经穿刺及手术病理证实Ewing′s瘤的X线、CT及MRI的影像学改变。结果　管状骨骨质破坏主要表现为筛孔样、虫蚀样溶骨性破坏 ,并出现层状、葱皮样骨膜新生骨 ,放射样针状骨 ,具有一定的特征性。 13例管状骨外骨及 1例骨外Ewing′s瘤骨质破坏表现多样 ,仍以溶骨为主 ,且 2 0例骨Ewing′s瘤均伴有周围软组织肿块。结论　Ewing′s瘤在不同部位有不同的影像学表现 ,具有相对的特征性表现 ;CT及MRI在确定Ewing′s瘤软组织肿块的大小、骨皮质的破坏、骨髓腔的完整性、骨膜反应及病理性骨折优于X线平片 ,有助于选择治疗方案     

下颌骨骨肉瘤影像学分析

目的:分析下颌骨骨肉瘤影像学表现,评价不同影像检查方法的优劣。方法:7例下颌骨肿块患者中均经X线和MRI检查,6例行CT并经手术病理证实为下颌骨骨肉瘤。所有病例的影像学特点和诊断价值均被分析比较。结果:X线检查有7例病变显示不清;6例呈棉絮状和不规则高密度,1例呈低密度,内有间隔;3例见骨膜反应呈“日光放射状”和“花边状”。CT平扫显示2例呈高密度,4例呈混合密度伴有骨皮质破坏、中断;5例见“日光放射状”骨膜反应;CT增强显示所有病例均有不均匀强化表现,4例伴有软组织肿块形成。平扫MRI显示5例病变T1WI上呈等、低信号,T2WI上呈高信号;2例在T1WI和T2WI上均呈等、低信号;增强MRI显示2例病灶轻度强化;2例呈边缘强化,其内强化不均。结论:CT和MRI均可清晰显示下颌骨骨肉瘤的形态和内部结构,MRI显示髓内病变范围方面优于CT。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.