肝胆管囊腺瘤的影像学表现

目的 探讨肝胆管囊腺瘤CT、MRI及B超表现,提高其诊断准确率.方法 回顾性分析9例经病理证实的肝胆管囊腺瘤患者,螺旋CT检查7例,MRI检查4例,B超检查5例.结果 7例患者CT平扫表现为多房囊性病变,囊内可见线状分隔,囊壁均匀增厚,壁光滑;MRI检查4例患者中,病变T1WI呈低信号多房囊性占位,T2WI病灶呈高信号为主混杂信号,囊内分隔呈低信号,增强后动脉期囊壁及分隔轻度强化,门脉期及延迟期继续强化.B超检查5例患者表现为肝内无回声暗区,边界清楚,内见多条强回声带,可见分隔或乳头状隆起.结论 平扫加动态增强CT、MRI及B超能够特征性反映肝胆管囊腺瘤的影像学特点,提高该疾病的诊断准确率.     

儿童颈肩部淋巴管瘤的MRI表现

目的:探讨儿童颈肩部淋巴管瘤的MRI影像表现,以加深对该疾病的认识.方法:26例经手术病理证实的淋巴管瘤MRI数据纳入回顾性研究,分析病灶的部位、结构形态与边缘、信号特征以及增强表现等.结果:病灶全部位于组织间隙内,其中80.8%位于肌间隙内,其余位于皮下间隙.病变由多个囊性结构构成,可以分为单囊为主型(55%)和多囊型(45%),25例病灶内有分割,88.5%的病灶形态不规则.87%的病灶T_1WI呈等低信号且不均匀,全部病灶在T_2WI呈高信号,多囊者各囊内信号可不同.增强后半数有分隔强化.结论:儿童颈肩部淋巴管瘤典型MRI表现是位于组织间隙内的、不规则的多囊性病灶,呈长T_1长T_2信号,常有分隔,分隔可强化或不强化,不同的囊内信号可不同.     

肝胆管囊腺癌影像学表现

目的 探讨肝胆管囊腺癌的CT、MRI及B超表现,提高其诊断准确率.方法 回顾性分析18例经病理证实的肝胆管囊腺癌患者,螺旋CT检查6例、MRI检查5例,B超检查7例.结果 18例肝胆管囊腺癌患者中多囊性病灶2例,16例为单囊性病灶.CT平扫及MRI T1WI均表现为囊性占位,囊内可见分隔和乳头样、条状实性突起,囊壁不均匀增厚,T2WI病灶呈高信号为主,囊内分隔及乳头样、条状实性突起呈低信号,增强后动脉期囊壁、分隔及实性部分轻度强化,门脉期进一步强化,延迟期减退但仍有强化.B超均表现肝内液性为主的囊实性混合回声团块,边界较模糊,边缘高低不平,囊内有棉絮状或乳头状赘生物.结论 平扫加动态增强CT、MRI及B超能够一定程度反映肝胆管囊腺癌的影像学特点,对于提高该疾病的诊断具有一定参考价值.     

小儿淋巴管瘤的CT和MRI诊断

目的 探讨儿童淋巴管瘤的CT和MRI表现及其诊断价值.方法 回顾性分析经手术病理证实的43例淋巴管瘤的CT和MRI影像资料,CT检查37例,MRI检查6例.结果 病变发生于颈部21例,其中同时累及纵隔和/或腋窝6例;肠系膜7例;腹膜后7例;大网膜3例;胸腹壁3例;四肢2例.主要表现为:(1) 边缘清楚或不清楚的单房性(n=5)或多房囊性(n=38)薄壁肿块;(2) 沿疏松组织间隙生长(n=22);(3) 5例出血者瘤内密度增高,其中2例可见液-液平面;(4) 2例合并感染者,囊壁增厚;(5)增强扫描囊壁及分隔轻度强化,囊内不强化;(6) T2WI均呈高信号影,T1WI呈低信号或等信号影,合并出血者T1WI呈高信号影.结论 淋巴管瘤的CT、MRI表现具有特征性,对临床治疗有重要价值.     

腮腺间隙原发病变的CT和MRI影像诊断及鉴别诊断

目的:提高腮腺间隙原发病变影像诊断及鉴别诊断能力。方法:回顾性分析32例腮腺间隙原发病变的影像特征,包括25例良性肿瘤及肿瘤样病变,7例原发恶性肿瘤。结果:CT和MRI能显示病变累及的范围。多形性腺瘤局部含有丰富的纤维粘液样基质,在T2WI上呈高信号以及增强后明显强化。腮腺腺淋巴瘤多位于腮腺浅叶下极,表现为边界清楚的双侧或单侧多发的囊实性肿瘤,增强扫描早期明显强化。基底细胞瘤呈T1WI、T2WI低信号,增强后呈早期及延迟强化。1例血管淋巴管瘤和1例淋巴管瘤表现边界较清的弥漫性软组织肿块,具有"钻缝生长"特征。神经鞘瘤在MRI上信号不均匀,可见斑片状T2高信号,增强后不均匀明显强化。恶性肿瘤边界不清,浸润生长,T2WI呈低信号,增强后不均匀强化。其它病变缺乏影像学特征。结论:腮腺间隙原发病变有一定的临床及影像特征,术前CT和/或MRI检查,有利于病变的诊断、鉴别诊断和治疗方法的选择。     

肝脏胆管囊腺癌影像学诊断的价值

目的:探讨彩色多普勒超声和介入超声技术及其他影像学检查在肝脏胆管囊腺癌(HBCAC)诊断中的价值。方法:回顾性分析1995年~2005年6例临床材料完整且经病理证实的HBCAC。结果:HBCAC患者的临床表现和实验室检查缺乏特异性;影像学表现为肝内单发或多发囊性病灶,囊壁明显增厚,囊壁上可见结节回声,囊内探及分隔回声,囊壁及囊内分隔探及血流信号,囊壁结节探及血流信号,无肝内外胆管扩张。二维及彩色多普勒超声和介入超声技术结合CT及MRI对HBCAC的诊断符合率较高。结论:彩色多普勒超声技术应作为诊断HBCAC的首选方法,增强CT、MRI检查、超声引导下穿刺或病灶囊液抽吸涂片检查具有确诊断值。     

胰腺实性假乳头状瘤的影像学诊断

目的:研究胰腺实性假乳头状瘤的影像学表现,提高对该病的认识诊断水平.方法:回顾性收集7例经手术病理证实的胰腺实性假乳头状瘤,5例女性,2例男性,发病年龄为17~46岁.3例行CT和US检查,1例行CT和MR检查,2例单独行CT检查,1例单独行US检查.分析其临床特征及CT、MR、US表现.结果:7例胰腺实性假乳头状瘤中,1例诊断为恶性,6例诊断为未定性.6例未定性中,1例于术后半年复查发现肿瘤复发及肝转移.CT均表现为巨大的囊实性肿块,其中2例可见钙化,增强扫描后,肿块囊壁与实性成分不均匀强化,出血坏死区无强化.MR可见肿块在T1WI、T2WI上呈不均匀混杂信号,能识别肿瘤内部的坏死囊变及出血等特异性征象.US可见肿块呈孤立性、囊实性结构,边界清楚锐利,有包膜回声.肿块周边及实质内可探及血流信号,以静脉血流为主.结论:胰腺实性假乳头状瘤影像学表现较具特征性,结合临床特征对术前诊断很有帮助.     

肝胆管囊腺癌的MRI表现

目的:探讨肝胆管囊腺癌(HBCAC)的MRI表现,提高肝胆管囊腺癌的诊断准确性.方法:回顾性分析9例经病理证实的肝胆管囊腺癌的MRI表现,所有患者均行MR平均和三期动态增强扫描.结果:9例中单囊性病灶8例,多囊性病灶1例.T1WI上6例表现为囊状低信号影,囊内分隔和囊壁厚薄不均,可见壁结节或乳头状突起;3例囊壁光滑,囊内呈稍高信号影,可见结节状软组织信号影.T2WI上病灶以高信号为主,囊内分隔、壁结节及软组织呈低信号.增强扫描动脉期示囊内分隔、壁结节和软组织明显强化,门脉期及延迟期强化仍较明显.结论:平扫及动态增强MRI能较好反映肝胆管囊腺癌的影像学特点,对本病的诊断及鉴别诊断有重要价值.     

钙化性纤维性肿瘤的影像学特征

目的钙化性纤维性肿瘤(CFT)术前诊断正确率较低,本研究旨在探讨CFT在各个部位的影像学特点,以提高对本病的认识。资料与方法回顾性分析18例经病理诊断为CFT瘤患者的临床资料及CT与MRI表现,包括肿块大小、密度、信号、强化方式等。所有患者行CT检查,其中14例行增强扫描,4例行MRI检查。结果 18例中,17例为单发软组织肿块,1例为多发软组织肿块。17例边界清楚,1例位于实质性脏器的病灶与实质分界相对欠清。CT平扫病灶均呈等或稍高密度,且较均匀,无明显坏死囊变,增强扫描后呈轻度缓慢强化。肿块内可见粗大条状钙化或散在不规则点状钙化。4例MRI表现为T1WI等信号,T2WI等或稍低信号,扩散加权成像呈稍低信号。1例胃黏膜下肿块行超声内镜检查呈中等回声,胃镜检查可见胃黏膜隆起,表面粗糙,但未见明显破坏或糜烂。结论 CFT的影像学特征为:CT平扫呈均匀等、稍高密度,MRI呈等T1等或稍短T2信号,扩散加权成像稍低信号,增强扫描呈渐进性轻度强化或不强化,肿块中心出现粗大条状钙化或散在点状钙化时则比较典型。     

胚胎发育不良性神经上皮瘤的CT和MRI表现

目的:探讨胚胎发育不良性神经上皮瘤(DNET)的CT和MRI表现。方法:回顾性分析6例经手术病理证实的DNET的MRI和CT资料。6例均行常规MRI检查,其中4例行液体衰减翻转恢复(FLAIR)序列和扩散加权成像(DWI),3例行MR波谱检查。6例中5例行CT平扫。结果:6例中5例为单发,1例为弥漫性。病灶均位于或主要位于皮层区,单发者呈倒三角型表现。肿瘤以囊性成分为主,于CT平扫上均为低密度影,1例可见钙化;其MRI表现为T1WI低信号,T2WI高信号,FLAIR序列上病灶边缘和分隔呈高信号改变,增强扫描示病灶实质结节或分隔有轻度强化,病灶周围均未见水肿。结论:瘤周无水肿、倒三角征和瘤内分隔为PNET的特异性影像学表现,其影像学表现有助于临床诊断和治疗。     

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.     

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.     

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）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme     

改进的定位技术在胸部肿瘤穿刺活检中的应用

目的：探索CT-SIM三维定位系统、体模固定技术和PET-CT融合影像导引定位技术在胸部肿瘤经皮穿刺活检中的应用价值。方法：对380例胸部肿瘤患者行改进的CT定位技术下的经皮穿刺活检术。根据肿瘤的大小、深度、毗邻关系、活动度以及患者的心肺功能状态,综合运用CT-SIM系统、体模固定技术和PET-CT融合影像导引技术,为患者进行穿刺前定位。统计穿刺定位时间长度、成功率、确诊率、并发症发生情况,并与210例采用传统铅栅定位下胸部肿瘤穿刺活检的相应资料进行比较。结果：采用改进的CT定位技术的380例患者穿刺定位精确,平均定位时间（9.5 min）较传统方法（16.8 min）缩短7.3 min,活检成功率和确诊率分别是98.7%和95.3%,高于传统定位方法的93.3%和83.3%,两者差异均具有统计学意义（P〈0.05）。穿刺并发症发生率相似,气胸发生率分别为2.8%和2.9%,咯血发生率分别为11%和12.8%。结论：根据患者状态及肿瘤特点,在CT-SIM系统快速精确定位技术的基础上,综合运用体模固定技术和PET-CT融合影像导引技术,能显著缩短经皮穿刺活检的定位时间,提高活检成功率。