口服胃肠道造影对比剂在MRI中的应用

目的：研究应用口服胃肠道对比剂后，腹部MRI检查图像质量的改善。材料和方法：以葡萄糖酸亚铁糖浆溶液为对比剂，经体外试验确定适宜的浓度；并进行临床试验，将50例受检者随机分为2组，分别口服葡萄糖酸亚铁糖浆溶液和水作为胃肠道对比剂，采用FSE序列，横断面T1WI，PWI，T2WI，所得图像与水作为对比剂时的图像对比研究。结果：以葡萄糖酸亚铁糖浆溶液作对比剂时，在T1WI，PWI，T2WI上，胃肠道均呈现高信号，胃肠道结构及腹部实质脏器显示清晰，优于以水作为胃肠道对比剂时的图像。结论：使用合适的胃肠道对比剂，可以使腹部脏器得到更好显示。     

MRI特异性对比剂铁羧葡胺对肝脏局灶性病变检出的比较研究

目的 通过比较MR平扫、应用对比剂钆喷替酸葡甲胺（Gd—DTPA）增强MRI及MRI特异性对比剂铁羧葡胺增强MRI对肝脏局灶性病变的检出，验证铁羧葡胺在病灶检出方面的优势。方法 2003年12月至2004年7月，选择怀疑为肝脏局灶性病变的病例59例，根据相对金标准判定共133个病灶。所有病例均先行梯度回波（GRE）T1WI、去脂快速自旋回波（FSE）序列T2WI、动态梯度回波Gd—DTPA增强MRI，48h后行铁羧葡胺动态GRE增强扫描及去脂FSE T2WI与GRE TW^＊W延迟扫描。统计各序列对局灶性病变检出的敏感性。结果 铁羧葡胺延迟增强去脂FSE T2W序列、动态GRE增强扫描、GRE T2^＊W延迟增强扫描检出病灶数分别为130、115、127个；平扫GRE T1WI序列、去脂FSE T2WI检出病灶分别为84和106个；Gd—DTPA动态GRE增强检出123个病灶。对于其中44个的微小病灶（〈1cm），铁羧葡胺延迟增强去脂FSE T2WI检出率达到932％（41/44），铁羧葡胺动态增强检出率为727％（32/44），铁羧葡胺延迟增强GRE T2^＊WI检出率为886％（39/44），Gd—DTPA动态增强检出率为795％（35/44），平扫去脂FSE T2WI检出率为545％（24/44），平扫GRE T1WI检出率为34.1％（15/44）。铁羧葡胺延迟增强去脂FSE T2WI及GRE T2WI显著提高了对于微小病灶（〈1cm）的检出率，与平扫MR（包括去脂FSE T2WI和GRE T1WI）及Gd—DTPA动态增强MR相比差异有统计学意义（P〈005）。结论 铁羧葡胺延迟增强去脂FSE T2WI及GRE T2^＊WI序列优势主要为提高肝微小病灶（〈10cm）的检出率。     

增强FLAIR T2WI诊断脑膜转移瘤的价值

目的:探讨脑膜转移瘤的MRI表现及增强后FLAIR序列T2WI的诊断价值。方法:回顾性分析20例脑膜转移瘤患者的病例资料,其中硬脑膜转移瘤5例,软脑膜转移瘤15例。所有病例行常规MRI平扫及SE T1WI和FLAIR序列T2WI增强扫描并进行对比分析。结果:MRI平扫检出6例,病灶边界均显示不清;MRI增强扫描检出所有病例,SE-T1WI上病变主要表现为脑膜的线状和/或结节状强化,FLAIR T2WI对软脑膜转移瘤病灶范围的显示更清楚,可鉴别强化的血管与病变。结论:MRI增强扫描是诊断脑膜转移瘤的重要检查方法,增强后FLAIR序列T2WI与SE T1WI同时使用,可提高对软脑膜转移瘤的检出率及诊断准确性。     

膝关节MRI平扫与直接法造影诊断半月板损伤准确性分析

目的:比较分析MRI平扫与造影MRI对半月板损伤诊断的准确性。方法:100例疑似半月板损伤患者,行MRI矢状位T1WI、T2WI GRE、STIR、PD+Fatsat,冠状位T2WI GRE,平扫后立即在直接关节腔内注射对比剂行矢状位、冠状位、轴位T1WI,层厚4mm、层距1mm。结果:94例经关节镜或手术确诊为半月板撕裂,其中,MRI GRE序列诊断撕裂84例,膝关节MRI造影诊断83例。6例经关节镜或手术确诊为正常或变性,MR GRE序列和膝关节MRI造影也为正常或变性。结论:MRI平扫与MRI造影对半月板损伤的诊断准确性差异无统计学意义(P>0.05)。     

乙二胺四乙酸铁钠作为MRI口服胃肠道对比剂的实验研究

目的:研究乙二胺四乙酸铁钠溶液作为MRI口服胃肠道对比剂的可行性.方法:以乙二胺四乙酸铁钠溶液作为对比剂进行体外试验,根据浓度不同分10个等级进行T1 WI、T2 WI、PDWI和单次激发厚层水成像扫描,所得图像与水为对比剂时得到的图像作对比研究.结果:乙二胺四乙酸铁钠溶液浓度在7.5～10 mmol/l时各个序列增强效果均较佳,在T1 WI、PDWI表现为高信号,在T2 WI表现为低信号.结论:乙二胺四乙酸铁钠溶液可以作为MRI口服胃肠道对比剂.     

预饱和脂肪抑制技术在乳腺MRI检查中的临床应用

目的 探讨预饱和脂肪抑制技术在乳腺MRI检查中的临床应用价值。资料与方法 对58例乳腺疾病患者进行常规MRI平扫、脂肪抑制MRI平扫和脂肪抑制动态增强MRI扫描，对比分析SE TlWI、FSE T2WI、脂肪抑制SE T1WI、脂肪抑制FSE T2WI和脂肪抑制SE T1WI增强扫描5种图像对病变的检出情况及病变形态和内部信号的显示效果。结果 (1)对病变的检出，脂肪抑制增强扫描明显优于平扫各图像，检出率达100％，平扫各图像对病变的检出无显著性差别，其中以脂肪抑制T2WI为最好，检出率为93．1％，脂肪抑制T1WI最差，检出率为85．06％；(2)在病变形态的显示上，虽然脂肪抑制T2WI效果较好，但与常规T2WI相比并无显著性差别，而脂肪抑制的增强扫描则明显优于平扫各图像；(3)在病变内部信号的显示方面，脂肪抑制的平扫(包括T1WI、T2WI)明显优于常规平扫，而脂肪抑制的增强扫描明显优于平扫各图像。结论 乳腺MRI平扫中脂肪抑制的应用对病变的检出及内部信号的显示具明显优势，以脂肪抑制T2WI效果更好；在脂肪抑制基础上进行动态增强扫描不仅对病变强化的形态学特征显示良好，明显提高病变的检出率，而且能准确判断病变强化程度，观察病变血流灌注的动态变化过程．明显提高了MRI对乳腺疾病诊断的准确性，因此预饱和脂肪抑制技术在乳腺MRI增强扫描中的应用具有重要价值。     

脑静脉窦血栓形成的MRI表现

目的 :探讨脑静脉窦血栓形成的MRI表现。方法 :回顾性分析23例脑静脉窦血栓形成患者的影像学资料,包括MRI平扫、3D Bravo序列增强扫描及DSA。结果:23例中发病部位为上矢状窦10例,乙状窦6例,直窦3例,横窦4例。其中多个静脉窦同时受累12例,占52.17%;上矢状窦受累10例,占43.48%;横窦受累4例,占17.39%。MRI平扫示脑静脉窦流空效应消失,T1WI及T2WI呈不同信号改变,其中4例T1WI呈等信号,T2WI呈低信号;14例T1WI及T2WI均呈高信号;5例T1WI呈不均匀低信号,T2WI呈高信号。23例均行3D Bravo序列增强扫描,静脉窦呈环形、圆形或三角形强化,静脉窦内血栓无强化,呈充盈缺损状;11例行DSA检查受累静脉窦表现为不规则显影、静脉窦狭窄影或不显影,且与3D Bravo序列增强扫描检出的发病部位及血栓数量一致。结论:MRI平扫联合3D Bravo序列增强扫描是诊断脑静脉窦血栓形成快速、无创且准确的检查方法。     

非增强磁共振对无肠道准备结肠癌的诊断价值

目的探讨非增强磁共振序列组合(DWI联合T2WI)诊断无肠道准备结肠癌的价值。方法采用3.0T MRI对36例无肠道准备的结肠癌患者行全腹部扫描,两名影像医师独立分析所有受检者的常规MRI序列(T2WI),DWI联合T2WI序列及DCE-MRI序列的图像,评判各个序列诊断无肠道准备结肠癌的读者间一致性,并两两对比评估各序列的诊断准确性、敏感性、特异性、阳性预测值及阴性预测值。结果 DWI联合T2WI获得了很好的读者间一致性(κ0.85),常规MRI及DCE-MRI序列仅获得了较好的读者间一致性(κ0.64,κ0.74);对于诊断无肠道准备的结肠癌,DWI联合T2WI的各组参数值明显高于常规MRI及DCE-MRI序列(P0.05),DCE-MRI的各组参数值高于常规MRI(P0.05)。结论非增强磁共振序列组合(DWI联合T2WI)可以较准确有效地诊断无肠道准备的结肠癌。     

联合应用多种MR成像技术对胰腺癌的诊断价值

目的:探讨MRI多种成像技术对胰腺癌的诊断价值,确定胰腺MRI的最佳扫描组合序列。方法:回顾性分析经手术病理证实的43例胰腺癌的MRI图像,扫描序列包括:平扫FS FLASH T1WI、TSE T2WI、True FISP T2WI、HASTE-MRCP和动态增强3D VIBE序列等。测量正常胰腺与病灶的信号强度,计算胰腺/肿瘤的CNR,对各序列图像质量进行评分。将各序列MRI诊断和评价结果与手术病理对照。结果:胰腺/肿瘤CNR:多时相动态增强3D VIBE序列,以胰腺实质期的胰腺/肿瘤的CNR最高(9.7),其同期所获得的图像质量最优(3.54±0.64),均优于平扫各序列(P<0.05)。对胰腺肿瘤的评价:动态增强3D VIBE序列在检出胰腺癌及评价癌肿胰周血管受累、邻近器官受侵及转移灶方面均为最优(P<0.05);MRCP对胰腺癌导致的胰胆管受侵最敏感,其次是True FISP序列;综合各序列诊断的敏感性和准确性均优于任何单一的平扫、水成像或动态增强扫描序列。结论:胰腺癌的MR检查,多种扫描序列各有优缺点,联合应用能发挥最大潜力。理想的检查组合应包括:平扫屏气FS FLASH T1WIT、SE T2WI、高分辨率的厚层及薄层MRCP、屏气的三维梯度回波序列多时相动态增强扫描。     

脑室内星形细胞瘤的MRI诊断

为探讨脑室内里形细胞瘤的MRI表现及其对该病的诊断价值。对经过手术病理证实的15例脑室内星形细胞瘤的临床资料及MRI表现，其中男9例，女6例，年龄3—57岁平均23．7岁，所有病理术前均行MRI平扫及增强扫描。扫描序列为：SE序列的矢状位T1WI和轴位T1WI；FSE序列的轴位T2WI。有8例里类圆形囊变，7例呈分叶状。平扫病灶呈等或长T1。等或长T2信号。增强扫描瘤体多明显强化，且不均匀。     

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.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

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.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

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.