扩散张量成像在脑环形强化病变中的鉴别诊断价值

目的评价 MR 扩散张量成像(DTI)在环形强化病变鉴别诊断中的应用价值。方法搜集经病理或临床证实的脑脓肿9例、胶质母细胞瘤12例、单发转移瘤10例,行常规 MR 平扫、增强扫描及 DTI 检查。构建表观扩散系数(ADC)图和各向异性分数(FA)图,并测量病灶中心及周围水肿区的 ADC、FA 值。结果脓肿腔 DTI 表现为高信号,水肿区呈等或低信号;胶质母细胞瘤和转移瘤中心坏死区呈低信号,水肿区呈等信号或稍低信号。在 ADC 图上,脓肿呈低信号,平均 ADC 值为(0.66±0.07)×10~(-3)mm~2/s,水肿区呈高信号;胶质母细胞瘤和转移瘤均呈高信号,平均 ADC 分别为(2.50±0.11)×10~(-3)mm~2/s、(2.37±0.52)×10~(-3)mm~2/s,其周围水肿区亦呈高信号。脓肿与胶质母细胞瘤、转移瘤坏死区 ADC 值差异有统计学意义(F=108.80,P<0.05)。在 FA 图上,病灶坏死区与水肿均表现为低信号,脓肿与胶质母细胞瘤、转移瘤坏死区 FA 值分别为0.15±0.04、0.07±0.01、0.06±0.01,差异有统计学意义(F=34.52,P=0.000);水肿区3组间 FA 值分别为0.15±0.01、0.20±0.05、0.13±0.04,差异有统计学意义(F=8.82,P=0.001)。结论在 DTI 上,脓肿表现为较特异的高信号,ADC 值较低,有助于和囊变、坏死性肿瘤鉴别。     

表观扩散系数和各向异性分数在星形细胞瘤良恶性鉴别中的作用

目的 评价磁共振扩散张量成像(DTI)参数表观扩散系数(ADC)与各向异性分数(FA)在星形细胞瘤良恶性鉴别中的作用.方法 回顾性分析经病理证实的32例星形细胞瘤.根据分级将其分为良性组(Ⅰ+Ⅱ级)15例与恶性组(Ⅲ+Ⅳ级)17例.对照术前T2WI与增强T1WI,在DTI上测量肿瘤实质区、肿瘤坏死区、水肿区.DTI测量参数包括:ADC与FA.比较不同区域的DTI参数问的差异以及与良性与恶性组间的差异.获得数据用均数±标准差表示,使用单因素方差检验.以P＜0.05为具有统计学差异.结果 肿瘤实质、中心坏死区、瘤周水肿区在ADC图上为高信号,FA图上为低信号.2组间肿瘤实质区[分别为(1363.21±361.02)×10-6mm2/s和(1053.72 ±212.81)x 10-6mm2/s,F=9.06,P=0.005]与瘤周水肿区[分别为(1535.50±163.21)×10-6mm2/s和(1785.00 ±124.65)×10-6mm2/s,F=22.79,P=0.000]的ADC值则有统计学意义.2组问中心坏死区的ADC值无统计学差异[分别为(1995.30±497.51)× 106mm2/s和(1630.22±633.43)×10-6mm2/s,F=0.27,P=0.61].FA值则仅在瘤周水肿区(分别为0.17±0.04和0.12 ±0.02,F=17.79,P=0.000)具有差异.结论 ADC、FA值可用来鉴别星形细胞瘤的良恶性,ADC值有较好的鉴别能力.瘤周水肿在DTI鉴别良恶性星形细胞瘤中具有重要作用.     

脊髓肿瘤的扩散张量成像研究

目的：探讨磁共振扩散张量成像(DTI)在评估脊髓肿瘤患者神经功能方面的应用价值。方法对22例脊髓肿瘤患者和22例健康志愿者进行脊髓常规磁共振成像(MRI)和 DTI 扫描,分析各向异性分数(FA 值)、表观扩散系数(ADC)值和纤维束比值(FTR)的组间差异,及其与 McCormik 评分的相关性。结果2组病灶层的 FA 值(t =-5.587,P =0.000)、ADC 值(t =7.232, P =0.000)有显著差异;病灶上层的 FA 值(t=-0.438,P =0.666)、ADC 值(t =0.303,P =0.765)无显著差异;病灶下层的 FA 值(t=-1.777,P =0.090)无显著差异,ADC 值(t=2.113,P =0.047)有显著差异;2组的 FTR 值(t =-7.902,P =0.000)有显著差异。髓外肿瘤与髓内肿瘤的 FA 值、ADC 值和 FTR 值均有显著差异(P <0.05)。脊髓肿瘤组病灶层 FA 值、ADC 值、FTR 值与McCormik 分级均存在直线相关关系。结论DTI 能够直观地反映脊髓肿瘤患者的脊髓神经功能和损伤情况。     

脑梗死继发皮质脊髓束Wallerian变性的DTI动态研究

【摘要】目的：探讨磁共振扩散张量成像（DTI）监测脑梗死后皮质脊髓束Wallerian变性的可行性。方法: 45例符合纳入标准的脑梗死患者分别于发病10天内及发病后第30和90d时进行3次全脑常规MRI和DTI数据采集,利用Fiber Track工具测量双侧大脑脚底的ADC和FA值,并计算相对ADC值（rADC）和相对FA值（rFA）。结果：MR DTI显示脑梗死发病(5.3±2.6)d后患侧大脑脚底的FA值降低,发病后首次及第30和90d时梗死侧大脑脚底FA值较对侧分别降低9.90%、23.7%和20.7%,差异均具有统计学意义（P<0.05）。梗死侧大脑脚底ADC值随时间延长而轻度升高,但与对侧比较差异均无统计学意义（P>0.05）。结论：DTI定量参数（ADC和FA）可以反映皮质脊髓束Wallerian变性的动态病理变化。DTI在脑梗死发病后5天左右即可检测出皮质脊髓束Wallerian变性,是监测脑白质微观结构早期改变的敏感方法。     

DTI对致痫性局灶性皮质发育不良病灶定侧意义的初步探讨

目的:探讨致痫性局灶性皮质发育不良(FCD)患者丘脑DTI参数的变化及其临床相关性。方法:选取致痫性FCD患者和正常对照组各15例,行DTI扫描,并手动测量2组双侧丘脑DTI参数,即ADC值及各向异性分数(FA)。2组丘脑ADC值及FA值比较行Levene检验,2组双侧丘脑各参数比较行配对t检验。结果:FCD组患侧丘脑FA值(0.249±0.034)低于对照组(0.268±0.037),差异有统计学意义(F=2.663,P=0.010);患侧丘脑ADC值[(8.727±0.420)×10~(-3)mm~2/s]低于对照组[(8.956±0.505)×10~(-3)mm~2/s],差异无统计学意义(F=1.817,P0.05)。FCD组患侧丘脑的FA值与ADC值均低于对侧,差异均有统计学意义(t=5.473,P0.001;t=3.212,P=0.006)。结论:致痫性FCD患者中双侧丘脑的DTI参数有着特殊改变,DTI在致痫性FCD的临床定侧及神经影像学机制的研究上具有一定的临床应用价值。     

DTI在布氏杆菌性脊柱炎中的诊断价值及其相关参数与血清凝集试验滴度的相关性

【摘要】目的：探讨扩散张量成像（DTI）在布氏杆菌性脊柱炎（BS）中的诊断价值,分析DTI相关参数与该病血清凝集试验滴度的相关性。方法：对37例BS患者及37例健康志愿者(对照组)的脊柱进行螺旋CT、MRI常规及DTI扫描,并测量表观扩散系数（ADC）值和各向异性分数(FA)值,对急性期(10例)、亚急性期（13例）、慢性期（14例）、正常对照组的ADC值及FA值进行统计学分析,比较保守治疗前、后的ADC值和FA值;对所有BS患者的ADC值、FA值与血清凝集试验滴度进行相关性分析。结果：CT共发现病变椎体65个,常规MRI共发现病变椎体99个,常规MRI对病变椎体的检出率明显优于CT。急性期、亚急性期、慢性期、对照组的ADC值差异有统计学意义（F=270.04,P=0.000）,FA值差异亦有统计学意义（F=7.12,P=0.000）。急性期与亚急性期的ADC值差异无统计学意义（P=0.714）。急性期、亚急性期、慢性期ADC值明显高于对照组,差异均有统计学意义（P值均<0.05）;慢性期ADC值较急性期、亚急性期有所降低,差异有统计学意义（P值分别为0.024、0.043）。对照组、急性期、亚急性期的FA值差异均无统计学意义（P值均>0.05）;慢性期FA值较对照组、急性期、亚急性期FA值低,差异均有统计学意义（P值均<0.05）。急性期、亚急性期、慢性期治疗后ADC值低于治疗前,差异均有统计学意义（P值均<0.05）。急性期、亚急性期治疗后FA值低于治疗前,差异有统计学意义（P值分别为0.002、0.013）,慢性期治疗后FA值高于治疗前（P=0.043）。ADC值与血清凝集试验滴度呈正相关性（r=0.837,P=0.007）;FA值与血清凝集试验滴度不相关（r=-0.197,P=0.16）。结论：DTI检查通过测量FA值和ADC值能够量化分析BS椎体的改变情况,指导临床治疗,为进一步评估BS患者预后提供相关依据。     

创伤性脑白质损伤的扩散张量成像研究

目的:评价扩散张量成像(DTI)在创伤性脑白质损伤(WMI)中的应用价值。方法:16例创伤性脑外伤后经临床诊断有WMI的患者通过Philips 1.5TIntera Achieva MR扫描仪行常规MRI和DTI。后处理获得部分各向异性指数(FA)、表观弥散系数(ADC)和纤维示踪成像三维图。根据T2WI及T2快速场回波图像,分别于WMI区域、同侧同名或对侧同名纤维束正常区域取感兴趣区,测量FA值和ADC值并进行比较。结果:脑外伤患者损伤脑白质中挫伤和出血、仅挫伤和仅出血区域三者之间的FA值(F=0.68,P>0.05)和ADC值(F=0.53,P>0.05)均未见明显不同。除仅出血区域的ADC值与对照区域相比差异无统计学意义(t=1.36,P>0.05),挫伤和出血(t=9.72,P<0.05)、仅挫伤(t=8.28,P<0.05)和仅出血(t=5.44,P<0.05)区域的FA值较正常对照区域明显降低,挫伤和出血(t=4.71,P<0.05)、仅挫伤(t=4.81,P<0.05)的ADC值较正常对照明显增高,纤维示踪成像显示损伤区域脑白质较正常区域稀疏、分离、缺失。结论:DTI技术能够显示患者WMI区域的异常改变,但ADC值对出血的判断有局限性。     

磁共振弥散张量成像在无骨折脱位型颈脊髓损伤的临床应用研究

目的 探讨磁共振弥散张量成像(MR-DTI)技术在无骨折脱位型颈脊髓损伤临床应用的可行性及其诊断价值.方法 收集病例组21例无骨折脱位型颈脊髓损伤患者和对照组27例健康志愿者行常规MR及MR-DTI检查,分别测定各向异性分数(fractional anisotropy,FA)值、表观弥散系数(apparent diffusion coefficient,ADC)值.结果 正常人颈髓MR-DTI的FA值=0.645±0.016,ADC值=(0.919±0.017)×10-3mm2/s.无骨折脱位型颈脊髓损伤MR-DTI的FA值=0.501±0.022,ADC值=(1.008±0.287)×10-3 mm2/s;与对照组对比:无骨折脱位型颈脊髓损伤中FA值明显降低,两者的差异具有统计学意义(P＜0.05),而ADC值略增高,两者的差异无统计学意义(P＞0.05).结论 DTI可以更加敏感的探测到无骨折脱位型颈脊髓损伤的发生,可为颈髓损伤程度的评估提供有价值的信息.     

扩散张量成像对慢性肾脏病早期肾损害的评价

【摘要】目的：探讨MR扩散张量成像（DTI）评价慢性肾脏病（CKD)早期肾损害的临床应用价值。方法：A组,健康对照组12例;B组CKD危险因素组,13例;C组 1～3期CKD患者18例。所有受试者均行1.5T MR DTI,测量各向异性分数（FA）和表观扩散系数（ADC）。搜集各组的临床指标：估算肾小球滤过率 (eGFR）和血清胱抑素C（CysC）、血肌酐(Scr）。分析三组间的DTI参数差异及其与临床指标的相关性。结果：A组、B组和C组肾脏皮质FA分别为0.18±0.04,0.17±0.03,0.16±0.03,髓质FA分别为0.37±0.04,0.34±0.06,0.30±0.03,差异有统计学意义（P＜0.05）。皮质ADC值分别为（2.38±0.19）×10-3mm2/s,（2.26±0.16）×10-3mm2/s,（2.17±0.24）×10-3mm2/s,差异有统计学意义（P＜0.05）。肾脏皮质FA、髓质FA与eGFR呈正相关（r=0.373、0.418,P<0.05）。髓质FA与CysC呈负相关（r=-0.427,P<0.05）。皮质ADC与eGFR呈正相关（r=0.401,P<0.05）。皮质ADC与Scr呈负相关（r=-0.388,P<0.05）。受试者操作特征（ROC）曲线分析,以髓质FA≤0.327为界值,诊断早期CKD的敏感度为78.57%,特异度为94.44%,曲线下面积（AUC）为0.891,诊断效能较好。皮质FA诊断CKD肾损害的效能一般,AUC为0.774。结论：肾脏DTI可以早期发现CKD患者和CKD危险因素患者的肾损害,髓质FA值诊断早期CKD的效能较高。     

大鼠眶下神经结扎损伤磁共振弥散张量成像

目的:对正常和眶下神经结扎损伤大鼠模型的三叉神经进行弥散张量成像(DTI),与神经形态学表现进行对照,探讨两者的关系和评价意义。材料和方法:30只成年大鼠三叉神经进行DTI检查后随机分为两组:眶下神经结扎组(20只)和假手术组(10只)。术后1周、2周、3周、4周、5周、6周进行DTI检查,测量双侧神经干的ADC及FA值。DTI检查结束处死大鼠取双侧神经干进行形态学检查。结果:术前大鼠三叉神经干ADC值为1.42±0.17,FA值为0.41±0.12。与假手术组比较,结扎侧神经干ADC信号先升后降;FA信号明显减低,FA值判断神经干是否为结扎侧的敏感度为80%,特异度为85%。早期受损神经纤维变性、脱髓鞘;慢性期神经纤维变形、走行扭曲、交叉。结论:FA值对神经干慢性损伤的判断具有较好的敏感性和特异性。结扎损伤导致神经干水分子弥散状态改变的基础除早期神经纤维变性、脱髓鞘外,慢性期神经纤维扭曲变形、交叉排列等也可能是重要因素。     

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).     

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.     

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