肝细胞癌和发育不良结节的MRI与病理对照研究

比较肝细胞癌（HCC）和发育不良结节（DN）的磁共振信号，形态学改变与组织病理学的关系。材料和方法：收集21例HCC（≤5．0cm），7例DN。全部病例均做MR检查进行病理分级及观察结节内铁沉积。结果：21例HCC中，T1WI上为稍低信号T2WI上为稍高信号者17例，占80．95％，组织学为梁索型，病理分级为Ⅰ－Ⅲ级。7例DN中，T1WI上为稍高信号T2WI上为等信号者6例，占85．71％，病理上为多结节聚集，可见核不典型增生改变，二者信号差异有统计学意义（P＜0．001）。21例HCC中仅2例见铁沉积，均出现在瘤内出血区，7例DN中3例有铁沉积，以间质及窦除为多。少数高分化癌（Ⅰ级）者不易与DN区分，应作增强扫描。结论：大部分HCC与DN在中场强MR检查时凭信号可以区分二者，但少数高分化癌中，二者鉴别有一定困难。     

实验性肝细胞癌T1WI成像与铁含量的关系

目的探讨铁含量对肝细胞癌T1WI信号的影响.材料和方法用0.2%DEN(Sigma产品)灌喂Wistar大鼠80只,诱癌成功后行常规SE序列T1WI、T2WI,对照组20只不灌喂DEN,余同实验组.扫描后处死动物取肝组织与肝癌组织作HE、普鲁士蓝染色,并测定组织内水、铁含量.结果肝癌组织与癌周肝组织含水量无差异,肝癌组织中铁含量低于癌周肝组织,但在呈低信号的肝癌内含铁血黄素含量明显高于呈其它信号强度类型的肝组织.结论水含量不是影响肝癌MR表现的主要因素,含铁血黄素是导致肝癌T1WI呈低信号的因素之一.     

大鼠肝癌MRI、DSA与病理对照研究

目的探讨大鼠肝癌和诱发肝癌模型MRI、DSA的成像技术及影像特点,建立肝癌实验模型.材料和方法将CBRH3癌组织块接种在大白鼠肝脏不同部位和二乙基硝胺诱发肝癌模型,分别在癌肿形成后,行MRI、DSA检查及癌组织镜检,观察其影像学表现并和病理进行对照分析.结果接种癌T1WI呈低信号,T2WI呈较均匀高信号,DSA表现为环形异常血管染色;诱发癌T1WI呈均匀或不均匀低信号(10例),T2WI呈等或略高信号8例,呈低信号2例.结论接种癌影像学表现和人体转移性肝癌相类似,可作为转移性肝癌之实验模型;而诱发癌影像表现和人体原发性肝癌相类似,可作为原发性肝癌之实验模型.     

高场强原发性肝癌MR表现及分析

目的：分析高场强下原发性肝癌的MRI表现。方法：收集经手术或尸检病理证实的原发性肝癌MR资料43例，其中巨块型肝癌32例，其中伴子灶3例，结节型5例，小肝癌6例。设备为GE1．5T超导signa advantage MR。应用SET1WI，FSEPDWI，T2WI进行轴位扫描，所有病均行增强扫描。结果：肝癌在T1WI呈高、等、低信号，在T2WI呈高信号，部分肿瘤内部信号不均，肝癌的强化程度主要取决于肿瘤血供的多少，肝癌的包膜由纤维组织构成，表现为低信号环，无包膜的肿瘤门静脉侵犯发生率高，肿瘤的信号及包膜与其病理分级有一定的相关性。结论：MRI对反映原发性肝癌的病理特征有其独特的优越性。     

肝细胞癌的低场MR征象分析(附33例报告)

目的分析肝细胞癌在低场MR的征象.方法收集33例手术病理证实的肝细胞癌的术前低场MR资料进行分析.结果1.肿瘤实质信号均匀区的信号配对主要分为三类1T1WI稍低、T2WI稍高信号18例;2T1WI等、T2WI稍高信号13例;3T1WI稍高、T2WI稍高信号2例.2.肿瘤实质内MR异常信号区1T1WI低、T2WI高信号(斑点状24例,片状9例,条状5例);2T1WI稍低、T2WI高信号(斑点状8例,片状2例,条状3例);3T1WI高、T2WI高信号(斑点状4例,片状2例);④T1WI低、T2WI低信号(斑点状5例,片状6例,条状2例).3.肿瘤边缘在T2WI上分三种1边缘清楚无分叶21例,其中11例可以见到"包膜征”;2边缘清楚伴分叶5例;3边缘不清7例.结论1低场MR中,肝细胞癌的肿瘤实质在T1WI可以是多种信号,缺乏特征性,但在T2WI均为稍高信号.2MR诊断肝细胞癌一定要有瘤内异常信号.3肝细胞癌的MR边缘部的形态应以T2WI为准,肿瘤边缘可以光滑清楚,也可以分叶状或边缘不清,"包膜征”有诊断意义.     

结节性甲状腺肿的MR表现与病理对照

目的 探讨MR对结节性甲状腺肿(NG)的诊断价值.方法 回顾性分析55例NG患者的MR表现,观察结节的大小、数量、形态、边缘、信号类型、强化方式,结果与手术病理对照.结果 55例NG共见110个结节,其中单个结节19例(34.5%),多个结节36例(占65.5%);边界清晰、规则101个(91.8%),边缘模糊、不规则9个(8.2%);实性结节64个(58.2%),囊性结节46个(41.8%);结节 有4种信号类型:(1)T1WI等或稍高信号、T2WI高信号58个(52.7%);(2)T1WI和T2WI均高信 号37个(33.6%);(3)T1WI稍低、等或高信号、T2WI低信号9个(8.2%);(4)T1WI和T2WI均等信号6个(4.5%);绝大多数实性结节强化明显,幅度高于背景甲状腺;囊性结节呈周围环形强化、壁结节明显强化和囊内不强化.结论 NG在MR像上具有一定的形态学和信号特征,了解其MR表现有助于明确诊断.     

1.5 T MR导向下肝脏恶性肿瘤射频消融治疗技术初探

目的 探讨1.5 T MR引导下对肝脏恶性肿瘤射频消融治疗的可行性.方法 23例44个经病理证实、不能或不愿手术的肝脏恶性肿瘤病灶,其中11例为原发性肝癌、12例为肝转移癌,肿瘤最大径平均(3.3±1.8)cm,均采用MR兼容多极射频针在1.5 T MR引导下进行射频消融治疗.术后MR扫描观察消融情况,消融灶完全覆盖原病灶、范围超出病灶边缘0.5～1.0 cm为消融完全.结果 所有消融均顺利完成,平均手术时间(93±33)min,消融灶均完全覆盖病灶,无胆瘘、膈肌穿孔、黄疸、气胸等并发症发生.射频电极针在MR图像上呈低信号.消融灶在T2WI序列上呈低信号,周围可见薄层高信号环绕;T1WI序列上消融灶呈明显高信号,边界清晰;DWI上消融灶呈等低信号,周围呈环状稍高信号.结论 1.5 T MR引导下肝脏恶性肿瘤射频消融是安全、有效的技术.     

肝硬化结节与小肝癌的MRI研究

目的:回顾性分析肝硬化合并小肝癌、再生结节(RN)及肝不典型增生结节(DN)的MR表现,探讨其MR诊断与鉴别诊断。方法:收集50例结节性肝硬化病例MR检查资料,患者行正反相位T1WI、脂肪抑制T2WI、动态增强扫描和弥散加权(DWI)扫描,总结肝内结节的信号特点。结果:RN在T1WI脂肪抑制上多为等信号或稍高信号,T2WI多为低信号,增强后与周围正常肝组织强化相似或信号稍低;DN在T1WI多为较高信号,T2WI多为稍低或等信号,增强后强化不明显;癌结节T1WI多为稍低或等信号,偶有稍高信号,T2WI多为较高信号,DWI为高信号,强化多为动脉中晚期强化,门静脉期以后强化减退。结论:磁共振平扫加动态增强能对大多数RN、DN和小肝癌结节做出明确诊断和鉴别。     

继发性淋巴瘤骨浸润的影像学表现

目的 总结继发性淋巴瘤骨浸润的影像学表现特点.方法 回顾性分析39例经病理证实为继发淋巴瘤骨浸润的CT、MR和全身骨显影影像资料.39例均行CT检查,其中14例行MR检查,10例行SPECT检查,1例行PETCT检查.结果 病变主要发生于脊柱、股骨及骨盆,以多骨受累多见.CT表现为溶骨性或以溶骨性为主的骨质破坏22例(56.5%),成骨性7例(17.9%),混合性10例(25.6%).14例MR检查中T1WI 呈低或等信号,T2WI呈等或稍高信号,以T2WI脂肪抑制序列显示最为清楚,呈中～高信号,另外DWI序列对淋巴瘤也显示清楚,呈高信号.病灶周围出现软组织肿块者17例(43.6%),且增强扫描后呈轻中度均匀强化.11例全身骨显影中,10例显示病变局部放射性浓聚灶,1例见放射性缺损区并局部见"冷"、"热"混合型改变.结论 综合分析CT、MR及骨显影的影像学表现,在临床中对于确定病灶存在、病变范围以及随访具有重要的临床指导价值.     

诱发性大鼠肝硬化性肝癌超顺磁性氧化铁增强MRI与电镜表现

目的 研究诱发性大鼠肝硬化性肝癌超顺磁性氧化铁(SPIO)增强MRI与电镜表现. 材料与方法 16只由二乙基亚硝胺(DENA)诱导的肝硬化性肝癌大鼠行肝脏SPIO增强前后MR扫描,再行肝脏病理学及电镜检查. 结果 肝癌在T1WI上为低或等低信号,T2WI为较高信号.SPIO增强T2WI上,正常肝实质、肝硬化组织信号强度(SI)较增强前明显下降,肝癌SI较增强前无明显下降,其对比噪声比(CNR)升高,病变显示清晰.SPIO增强T1WI上正常肝实质及硬化肝组织SI无明显下降,肝癌SI较增强前升高,其CNR较增强前降低,病变显示不清楚.电镜下正常肝组织枯否细胞(KC)内溶酶体丰富,可见较多黑色颗粒状SPIO粒子,胞浆内可见大的SPIO簇.肝硬化组织细胞间隔增宽,胶原纤维明显增多,KC数量无明显减少,其内溶酶体有所减少,可见散在SPIO粒子,胞浆内可见较大的SPIO簇.肝癌组织KC数量减少或消失,癌细胞内细胞器基本消失,核异型. 结论 诱导性大鼠肝硬化性肝癌MR信号表现与人类肝癌相似.SPIO增强肝脏信号改变和KC数量及吞噬功能有一定关系.SPIO增强T2WI不仅能提高肝癌的对比,且能间接反映KC数量,可以预测肝癌组织学分级.     

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.