MRCP诊断术后胆管结石:2D、3D FASE序列对照

目的评价磁共振胰胆管成像(MRCP)二维高级快速自旋回波(2D FASE)序列和三维高级快速自旋回波(3D FASE)序列对胆道术后残余对胆道术后病变的诊断价值.方法对72例胆道术后出现不明原因发热、黄疸、肝功能异常、右上腹痛等症状患者同时进行MRCP 2种序列检查,结果分别与手术、直接胆道造影对照.结果MRCP 2D FASE序列、3D FASE序列诊断肝内胆管结石的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为43.5%、100%、100%、79%、81.9%以及69.6%、95.9%、88.9%、87%、87.5%.2种序列诊断有显著性差异(P＜0.05).MRCP 2D FASE序列和3D FASE序列诊断胆总管及吻合口结石的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为77.8%、96.3%、87.5%、92.9%、91.7%以及83.3%、98.1%、93.8%、94.6%、94.4%.2种序列相比无显著性差异(P＞0.05).结论MRCP 2种序列对胆系结石均有很高的检出率.3D FASE序列较2DFASE序列能检出更细小的结石.     

3.0T MRI内插扰相快速梯度回波T1WI联合MRCP对胆系结石的诊断价值

目的 探讨3.0T MRI的内插扰相快速梯度回波T1WI(LAVA-Flex)联合磁共振胰胆管造影(MRCP)对胆系结石的诊断价值.方法 127例临床可疑胆系结石患者行上腹部磁共振检查(LAVA-Flex+ MRCP);回顾性分析胆系结石的LAVA-Flex序列的信号特点及MRCP的表现,比较分析MRCP、LAVA-Flex+ MRCP 2种方法对胆系结石的阳性检出率.结果 MRCP发现结石110例,阳性检出率为86.6％;增加LAVA-Flex序列后发现结石121例,阳性检出率为95.3％;LAVA-Flex序列新发现的结石均为直径≤5 mm的小结石和泥沙样结石;LAVA-Flex序列联合MRCP诊断结石的阳性检出率高于常规的MRCP,其统计学比较有差异(P＜0.05).结论 LAVA-Flex序列可以发现微小的胆系结石,MRCP增加LAVA-Flex序列后能够提高胆系小结石阳性检出率,LAVA-Flex序列可以作为MRCP的重要补充.     

磁共振2D和3D MRCP技术对胆道疾病的诊断效能评价

目的 探讨磁共振2D和3D MRCP 2种成像技术对胆道系统疾病的诊断效能.方法 回顾性分析102例均行3.0T 2D和3D MRCP成像的胆管疾病的病例,其中结石37例,肿瘤30例,炎症12例,胆肠吻合术后复查病例23例.依据图像评价标准对102例2D和3D MRCP图像质量进行评价,比较2种成像方法对胆管结石和肿瘤性病变诊断效能.结果 102例中,2D MRCP图像优、良、差的病例数分别为67例、30例和5例;3D MRCP图像优、良、差的病例数分别为54例、40例和8例,经统计学处理2D和3D MRCP图像优良率之间没有显著性差异.37例胆管系统结石的病例中,2D MRCP诊断结石符合率为91%,3D MRCP诊断结石符合率为78%;30例各种肿瘤中,2D MRCP诊断肿瘤符合率为70%,3D MRCP诊断肿瘤符合率为87%.在P=0.05的显著性水平上,2D和3D MRCP在诊断结石和肿瘤效能上没有显著差异.结论 3.0T MRCP 2D和3D 2种成像技术图像质量和对结石和肿瘤的显示上并不存在很大的差异性.     

MRI-FIESTA成像序列对胆道结石的诊断价值

目的：评价FIESTA成像序列对胆道系统结石的诊断价值。方法：30例CT诊断为肝内胆管结石患者,其中14例伴肝外胆管结石（肝总管6例,胆总管结石8例）,均行磁共振胰胆管水成像MRCP检查,同时对感兴趣区分别行薄层FRFFSE-T2WI脂肪抑制序列及FIESTA脂肪抑制序列扫描检查,比较其对结石的诊断符合率。所有病例后均经手术或ER-CP证实。结果：30例胆内胆管结石,MRCP＋FRFFSE组阳性19例,符合率63%;MRCP＋FIESTA组阳性26例,符合率87%,两者肝内结石符合率差异有统计学意义（P〈0.05）;而肝外胆管结石,MRCP＋FRFFSE组阳性15例,其中假阳性1例,MRCP＋FIESTA组阳性14例,两者符合率均近100%,肝外结石符合率无明显差异性。结论：FIESTA序列对胆道结石尤其是肝内结石有极高的临床诊断价值。     

磁共振胰胆管成像对恶性胆道梗阻的诊断价值

目的：评价磁共振胰胆管成像（MRCP）对恶性胆道梗阻性疾病的临床诊断价值，探讨肝外恶性胆道梗阻的MRCP、MRI诊断及鉴别诊断。方法：回顾性分析69例恶性胆道梗阻患者的MRI及MRCP表现，并与CT、US、直接胆道造影和手术病理结果对照。MRCP采用二维（2D）和／或三维（3D）屏气半傅立叶转换快速自旋回波（FASE）序列T2加权成像技术。结果：69例MRCP检查均一次成功，全部病例胰胆管显示满意，与直接胆道造影对照，二者所获图像极其相似。MRCP对恶性胆道梗阻定位诊断准确率为98．5％定性诊断准确率为95．6％。结论：MRCP对恶性胆道梗阻定位及定性诊断优于CT和US，是诊断恶性胆道梗阻的一种有效的非侵袭性的检查方法。     

单激发放射状MRCP在胆道梗阻中的应用价值

目的:探讨单次激发放射状磁共振胰胆管水成像(SSH/MRCP/RAD)在胆道梗阻中的应用价值。方法:对55例经病理证实的胆道梗阻性疾病的MRCP成像资料进行回顾性的分析,MRCP采用单次激发放射状自旋回波序列技术。其中肝癌2例,肝门转移癌4例,肝门胆管癌12例,肝内外胆管结石2例,胆管癌7例,胰头癌7例,壶腹癌5例,十二指肠降部腺癌2例,胆总管结石10例,炎症3例,先天胆管囊肿1例。结果:55例MRCP检查均一次成功,肝内外胆管显示率100%,主胰管显示率85%。定位诊断100%,定性准确率86.8%,良性为85.7%,恶性92.3%。结论:SSH/MRCP/RAD是较为理想的成像技术,结合源图定性诊断特异性高,在临床有较大的应用价值。     

MRCP结合薄层T2WI-STIR序列对胆总管泥沙样结石的诊断准确性

目的比较上腹部常规磁共振成像(MRI)结合磁共振胰胆管成像(MRCP)与薄层T2WI-STIR序列结合MRCP对胆总管泥沙样结石的诊断准确性。方法 58例经临床手术或内镜逆行胰胆管造影(ERCP)证实的胆总管泥沙样结石患者均经上腹部常规MRI、MRCP及薄层T2WI-STIR序列扫描。随后,对常规MRI+MRCP与薄层T2WI-STIR序列+MRCP探测胆总管泥沙样结石的检出率进行比较。结果与手术或ERCP所见相对照,常规MRI+MRCP在58例胆总管泥沙样结石患者中检出33例,符合率为56.9%;而薄层T2WI-STIR序列+MRCP检出胆总管泥沙样结石44例,符合率为75.9%。两种方法对胆总管泥沙样结石的检出率有显著性差异(P<0.05)。结论与常规MRI+MRCP比较,薄层T2WI-STIR序列+MRCP对胆总管泥沙样结石有更高的诊断准确性。     

MRCP对诊断良恶性胆道梗阻的临床应用

目的 评价磁共振胰胆管成像(MRCP)对良恶性胆管梗阻的诊断价值。方法25例经病理证实的良恶性胆道梗阻包括胆囊及胆道结石10例,单纯胆囊结石3例,胆总管囊肿合并结石1例,壶腹及胰头癌6例,肝门癌3例,以及胆囊癌2例的MRCP表现进行了回顾性分析。MRCP检查是以PHILIPS GYROSCAN NT 1．0磁共振成像仪并用3D-FSE序列和常规SE序列进行的。结果在所有病人中成功地进行了MRCP检查。其表现随病变性质与部位不同而异,如肝内胆管明显扩张且呈软藤状见于肝门癌。胆总管横行截断,断端形态规则见于胆管上段腺癌。胆总管明显增宽呈壶腹状,胆囊明显增大见于胆总管囊肿。结论MRCP应成为诊断良恶性胆道梗阻的推荐方法。     

胆管癌的MRI与MRCP诊断

目的探讨磁共振成像(MR I)及磁共振胰胆管成像(MRCP)对胆管癌的诊断价值。方法对27例有完整临床资料的胆管癌病例行常规MR I平扫,病变部薄层扫描,及三期轴位动态增强扫描,并用2种不同方法行磁共振胰胆管成像(MRCP):①HT2-FSE不屏气二维多平面薄层采集;②单次激发快速自旋回波技术(SSFSE)单平面厚层采集。结果几种成像方法对病变局部的显示率分别为T1W I 52%(14/27)、T2W I 70%(19/27)、局部薄层扫描85%(23/27)、增强扫描100%(27/27);定位诊断率:HT2-FSE二维多平面薄层采集为100%(27/27),SSFSE单平面厚层采集为89%(24/27)。结论胆道薄层扫描及动态增强扫描对恶性胆道肿瘤的定位及定性诊断有较大的帮助,MRCP可无创显示胆道形态,有助于诊断。     

先天性胆管扩张的鉴别诊断

目的探讨磁共振胆胰管造影(MRCP)诊断儿童先天性胆管扩张的临床价值。方法回顾性分析78例先天性胆管扩张患儿的MRI和MRCP表现,并与手术病理结果进行对照分析。结果先天性胆管囊肿76例,Ⅰ型33例,Ⅱ型2例,Ⅲ型0例,Ⅳ型41例,Ⅴ型0例,囊肿型胆道闭锁2例;先天性胆管囊肿常合并胆囊扩大(53.9%),胆汁淤积(75%)和结石(42.1%);囊肿型胆道闭锁其胆管扩张局限,肝门部及门静脉周围可见局限斑片状长T_2信号,无胆囊扩大,胆汁淤积和结石等合并症。结论 MRCP能正确诊断先天性胆管扩张,可有效鉴别诊断先天性胆管囊肿和囊肿型胆道闭锁。     

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.