Ⅰ、Ⅱ期子宫内膜癌MRI表现与病理对照研究

目的:分析Ⅰ期和Ⅱ期子宫内膜癌的MRI表现,评价MRI对子宫内膜癌肌层和宫颈侵犯的价值。方法:回顾性分析30例经手术病理证实的Ⅰ、Ⅱ期子宫内膜癌的T1WI、T2WI和动态增强图像,观察肿瘤的类型、信号、强化特点及结合带与内膜下强化的显示情况,将MRI判断肌层和宫颈侵犯的结果与病理比较。结果:弥漫型子宫内膜癌14例,表现为子宫内膜广泛增厚;局灶型子宫内膜癌16例,表现为宫腔内结节状病灶或较大肿块。与子宫肌层相比,肿瘤T1WI多为等信号,T2WI多为高信号。动态增强早期13例弥漫型子宫内膜癌呈轻至中度强化,15个局灶型肿瘤呈明显或中度强化。T2WI显示结合带18例,动态增强早期显示内膜下强化17例。以手术病理结果为标准,MRI判断深肌层侵犯的敏感度、特异度和诊断符合率分别为87.5%、95.5%和93.3%,判断宫颈侵犯的敏感度、特异度和诊断符合率分别为75%、95.5%和90%。结论:MRI评价子宫内膜癌肌层和宫颈侵犯准确可靠,应列为术前常规检查。     

子宫内膜癌的MRI诊断及分期研究

目的探讨子宫内膜癌的MRI表现,评价MRI对子宫内膜癌术前分期的价值. 资料与方法 24例经手术病理证实的子宫内膜癌患者术前均行MRI检查,横断位、矢状位、冠状位 SE T1WI, 横断位、矢状位、冠状位TSE T2WI,Gd-DTPA增强后T1WI横断位、矢状位、冠状位扫描.在MRI上观察肿瘤位置、信号特征及侵犯肌层的深度.MRI所见与手术病理对比. 结果子宫内膜癌的表现:子宫增大,子宫内膜弥漫性不规则增厚,T1WI呈低信号,T2WI为相对高信号,有强化,侵犯肌层时,则T2WI上子宫肌层信号增高,结合带中断,显示不清.MRI对子宫内膜癌分期总的准确度为83.3%. 结论 MRI能多方位清晰地显示子宫内膜癌瘤灶及侵犯范围和深度,明显优于其他影像检查方法;MRI对术前子宫内膜癌分期也明显优于其他影像检查方法,故MRI应成为子宫内膜癌术前常规的影像检查方法.     

子宫内膜癌的磁共振表现及分期

目的:探讨子宫内膜癌的MRI表现,评价MRI在子宫内膜癌的诊断及术前分期中的价值.方法:23例子宫内膜癌患者术前行MRI检查,按照1998年FIGO修订分期原则将所有病例分期,并与术后病理结果进行对照分析.采用列联表的x2检验及配对资料的x2检验.结果:子宫内膜癌的癌灶在T2 WI上表现为子宫内膜不规则增厚,信号不均匀且高于肌层,并有不均匀强化.本组显示MRI对子宫内膜癌分期准确率为87%(20/23),对肌层浸润深度判断的准确率为76.9%(10/13).结论:MRI能多方位清晰显示子宫内膜癌瘤灶及侵犯范围,对子宫内膜癌的诊断及术前分期具有很高的价值.     

矢状面SPIR结合动态增强技术在子宫内膜癌分期中的价值

目的:探讨矢状面SPIR结合动态增强技术在子宫内膜癌分期中的价值。方法:85例经手术病理证实的子宫内膜癌患者均行MRI横断面T1WI、T2WI,矢状面T2WI SPIR、Gd-DTPA动态增强及常规横断面T1WI增强扫描,观察肿瘤、结合带及肌层侵犯情况,将矢状面SPIR结合动态增强与其它序列比较。结果:对明确肿瘤性质、判断子宫结合带中断及肌层侵犯,矢状面SPIR结合动态增强序列明显优于其它序列。结论:矢状面SPIR结合动态增强技术对子宫内膜癌术前分期有重要价值,应成为子宫内膜癌术前常规的一种检查技术。     

FIGOⅠ Ⅱ期子宫内膜癌MRI征象分析与评价

目的:按照FIGO2009分期标准,分析ⅠⅡ期子宫内膜癌的MRI征象及其病理基础,评价MRI对子宫内膜癌肌层和宫颈侵犯的诊断价值。方法:43例ⅠⅡ期子宫内膜癌患者术前均行MRI检查,采用双盲法,描述肿瘤的MRI表现特征,并将MRI术前分期及判断肌层和宫颈浸润结果,与术后病理结果对照分析。结果:Ⅰa 26例,Ⅰb 8例,Ⅱ期9例。Ⅰ期MRI主要表现为子宫内膜增厚、腔内局限型或弥漫性软组织肿块呈中等强化、T2WI低信号结合带中断及肌层侵犯等,其病理基础为癌细胞呈腺样乳突状结构,突破粘膜层,向肌壁间浸润性生长。Ⅱ期以宫颈内出现与宫体肿瘤相连续的异常信号影及宫颈纤维间质破坏为特征。MRI评价肿瘤浸润肌层深度的诊断准确性为86%,判断宫颈侵犯的敏感性、特异性、准确性分别为78%、91%、88%,与病理结果比较无显著性差异(P0.05)。结论:MRI对Ⅰ、Ⅱ期子宫内膜癌的早期诊断、肌层和宫颈侵犯的判断及术前分期准确性高,具有较高的临床应用价值。     

MRI扩散加权成像ADC值在子宫肉瘤诊断中的应用价值

目的 探讨MRI扩散加权成像(DWI)表观扩散系数(ADC)值在子宫肉瘤诊断中的应用价值.方法 回顾性分析24例(包括3例平滑肌肉瘤、5例子宫内膜间质肉瘤、4例腺肉瘤、12例癌肉瘤)经手术病理证实的子宫肉瘤DWI及MRI表现,判断肿瘤的位置、大小、信号特点、强化方式、浸润深度、远处转移及分期情况,测量肿瘤实质部分及相应正常子宫肌层、内膜的ADC值.结果 肿瘤多表现为信号不均伴肌层浸润的软组织肿块,T1WI呈等或稍低信号,T2 WI为中等或高信号,增强多呈明显强化,DWI呈高信号,ADC值减低,本组子宫肉瘤ADC值0.87×10-3mm2/s,显著低于正常子宫肌层(1.59×10-3mm2/s)、内膜(1.73×10-3mm2/s),也显著低于文献报道良性病变的ADC值(1.44～ 1.55×10-3mm2/s).结论 ADC值在子宫肉瘤的诊断与鉴别诊断中具有重要价值,结合MRI平扫及动态增强扫描能进一步提高对该病的诊断及术前分期中的准确性.     

MRI成像对子宫内膜癌术前分期的研究

目的:通过对子宫内膜癌患者术前MRI检查的回顾性分析并与手术病理结果相对照,探讨MRI成像在对宫内膜癌术前分期的价值.方法:研究对象为36例在手术前接受了MRI检查的子宫内膜癌患者.检查采用SIEMENS 1.5T超导型成像仪,体部线圈;扫描序列包括T1WI、T2WI横断面、矢状面扫描,静脉注射对比剂Gd-DTPA后动态增强扫描.将MRI诊断分期与手术病理分期对照.结果:子宫内膜癌的MRI表现为宫腔内肿块或子宫内膜的弥漫性增厚;MRI术前分期的准确率达94.4％ (34/36).结论:MRI子宫内膜癌的术前分期准确可靠,应作为术前常规检查.     

子宫内膜息肉与早期子宫内膜癌的MRI信号特征分析

目的 分析子宫内膜息肉与早期子宫内膜癌的特征性MRI平扫表现,以期在无需静脉注射对比剂的情况下,提高两者术前鉴别诊断的准确性。方法 回顾性分析经手术病理证实的39例子宫内膜息肉和32例早期子宫内膜癌病人的MRI资料。采用独立样本t检验比较2组病人病变大小及DWI相对信号强度值。采用Pearson卡方检验分析2组病人MRI平扫信号特征,包括T2WI上病变内部信号特征(低信号纤维核心和高信号小囊),DWI上病变与正常肌层的信号强度差值,T2WI和DWI上病变周围线样高信号。结果与子宫内膜癌相比,子宫内膜息肉T2WI上有高信号小囊和低信号纤维核心表现者更多(P<0.05)。DWI上病变与子宫肌层信号强度差值比较,子宫内膜息肉(36.4±61.7)低于子宫内膜癌(229.8±94.8)(P<0.05)。子宫内膜息肉在T2WI、DWI上的病灶周边线样高信号表现均多于子宫内膜癌(P<0.05)。结论 子宫内膜息肉的MRI表现具有特征性,T2WI及DWI上病变周围线样高信号有助于鉴别子宫内膜息肉与子宫内膜癌。     

子宫腺肌症离体标本低场MRI研究

目的:分析子宫腺肌症离体标本的低场MRI表现,探讨子宫腺肌症的低场MRI诊断.材料和方法:采用OUTLOOK PROVIEW 0.23T MR对17例子宫腺肌症离体标本行采用矢状位T1WI、T2WI及irT2WI平扫并与病理进行对照分析.结果:子宫体积增大呈类球形,结合带增厚,厚度为10.4～28.6mm,平均15.2mm.病变主要位于子宫后壁肌层14例和前壁3例.所有标本,T2WI与irT2WI示子宫肌层内低信号区内夹杂斑片状高信号影,TIWI示子宫肌层内散在斑点状低信号影,6例标本肌层内少许斑点状高信号.T2WI/irT2WI呈高信号而T1WI呈低信号的病理上为异位的内膜岛,在T2WI与TIWI均呈高信号的为异位内膜出血灶.结论:低场MRI对子宫腺肌症诊断有重要价值,其能真实有效的反映出病变的病理特征,T2WI与irT2WI是病灶显示的敏感序列.     

3.0 T MRI对早期子宫内膜癌的诊断及分期价值

目的 探讨3.0 T MR T2WI及容积加速肝脏采集扫描(LAVA)技术对早期子宫内膜癌的诊断价值.方法 回顾性分析经手术病理证实的27例子宫内膜癌患者资料.MR检查包括横断面T1WI、矢状而脂肪抑制T2WI;横断而或欠状面LAVA动态增强扫描(包括动脉早期、晚期、实质期和延迟期).记录肿瘤的部位、信号,对子宫肌层浸润深度进行术前分期并与手术病理结果对照,评价T2WI和LAVA序列对子宫内膜癌诊断的敏感度、特异度、准确度,并采用配对卡方检验Fisher's确切概率法比较2种序列对深肌层浸润的准确性.结果 经手术病理证实的27例子宫内膜癌,按国际妇产科联盟标准分为:Ⅰ期22例,Ⅱ期5例.T2WI判断肿瘤深肌层浸润的敏感度、特异度、阳性预测值、阴性预测值分别为70.0%(7/10)、94.1%(16/17)、87.5%(7/8)和84.2%(16/19),准确度为85.2%(23/27);LAVA判断肿瘤深肌层浸润的敏感度、特异度、阳性预测值、阴性预测值分别为80.0%(8/10)、94.1%(16/17)、88.9%(8/9)和88.9%(16/18),准确度为88.9%(24/27).2种序列对深肌层浸润的准确度差异无统计学意义(P=1.00).结论 3.0 T MR T2WI对早期子宫内膜癌的诊断具有重要作用,LAVA动态增强扫描对早期子宫内膜癌肌层浸润术前诊断及分期有指导价值.     

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.