磁共振扩散加权成像ADC值和eADC值与肝细胞癌血管生成的关系

目的 分析不同b值时肝细胞癌(hepatocellular carcinoma, HCC)的表观扩散系数(apparent diffusion coefficient, ADC)值和指数化表观扩散系数(exponential apparent diffusion coefficient, eADC)值、灌注ADC值和eADC值 (ADCperf值和eADCperf值)在评价肿瘤血管生成的价值.方法 选取行手术切除并经病理证实的肝细胞癌病例31例,手术前行DWI扫描并计算低、中、高b值时的ADC值、eADC值、ADCperf值和eADCperf值.利用免疫组化技术检测HCC边缘和中心VEGF、Flk-1的表达情况、PCNA指数及微血管和成熟血管的数目、平均面积、总面积、周长、直径、异型指数以及动脉数、静脉数、血管成熟指数和平均灌注分数等.将DWI各测量指标与以上血管参数进行对照分析.结果 在肝脏与HCC之间,中、高b值组ADC值和eADC值,及ADCperf值和eADCperf值存在统计学差异(P＜0.05).在病灶边缘与中心之间ADCperf值及eADCperf值均存在统计学差异(P＜0.05).在病灶边缘,低、中b值组内的ADC值与微血管平均面积均为正相关(P＜0.05),eADC值则与成熟血管平均面积负相关(P＜0.05).另外,病灶边缘的eADCperf值与动脉数呈正相关(P=0.048, r=0.558),在病灶中心,ADCperf值与微血管平均面积正相关(P=0.038, r=0.628).结论 低、中b值时ADC值和eADC值易受血管因素的影响,eADCperf值可作为评价HCC的动脉情况的简便的指标.     

扩散加权成像在慢性血吸虫肝病中的应用价值

目的研究DWI不同b值的表观扩散系数(apparent diffusion coefficient,ADC)值、指数化表观扩散系数(exponential apparent diffusion coefficient,eADC)值、灌注ADC值、灌注eADC值在慢性血吸虫肝病中的应用价值。方法对经临床及病理证实的慢性血吸虫肝病患者35例和无肝病组38例行常规肝脏MR检查后,进行DWI扫描,设b值为0,50、600s/mm~2,测量肝ROI得到ADC值和eADC值,并计算出灌注ADC值和灌注eADC值,将其数据与病理结果进行对照分析。结果慢性血吸虫肝病组的ADC值及灌注ADC值较无肝病组低,而eADC值较无肝病组高,且均有统计学意义(P0.01);慢性血吸虫肝病组灌注eADC值与无肝病组差异无统计学意义(P0.05)。慢性血吸虫肝病组表现为不同程度的纤维组织增生和假小叶形成,均可见虫卵纤维化及钙化结节。结论扩散加权成像对诊断慢性血吸虫肝病有重要价值。     

MR扩散加权成像使用不同b值测量腹部脏器ADC值的比较

目的:探讨不同b值对MR扩散加权成像(DWI)时腹部实质性器官和肝脏病灶表观扩散系数(ADC)值测量结果的影响。方法:29例研究对象行DWI检查,包括正常对照组17例,恶性病变组12例(肝细胞癌6例,胆管细胞癌2例,转移癌4例)。对每例受试者分别采用2种扫描方案行DWI扫描,方案A采用b值为0、500和1000s/mm2,方案B采用b值为0、200和400s/mm2。测量并比较两种方案DWI扫描时腹部各器官及肝脏病灶的ADC值。结果:采用A方案时正常肝脏的ADC值为(1.50±0.11)×10-3mm2/s,采用B方案时为(1.13±0.19)×10-3mm2/s,两者差异有极显著性意义(t=6.058,P<0.001)。采用这2种扫描方案其它器官的ADC值测量结果:脾脏分别为(0.94±0.08)×10-3mm2/s和(0.86±0.08)×10-3mm2/s,胰腺分别为(1.43±0.13)×10-3mm2/s和(1.36±0.15)×10-3mm2/s,肾皮质分别为(2.19±0.15)×10-3mm2/s和(2.21±0.19)×10-3mm2/s,肝内恶性病灶分别为(1.11±0.14)×10-3mm2/s和(1.02±0.13)×10-3mm2/s;除肾皮质外,脾脏、胰腺和肝脏病灶的两次ADC值测量结果间的差异均有显著性意义(P<0.05),b值差大时的测量结果均明显高于b值差小者。结论:DWI成像时b值的不同会影响ADC值的测量结果,大b值差时的测量结果较小b值差时更准确且稳定。     

应用DWI鉴别系统性淋巴瘤与淋巴结转移瘤

目的 探讨扩散加权成像(DWI)对系统性淋巴瘤与淋巴结转移瘤的鉴别诊断价值.资料与方法 对36例系统性淋巴瘤及26例恶性肿瘤腹腔淋巴结转移患者行常规MRI及多b值的DWI.观察DWI信号强度,并测量病变淋巴结的表观扩散系数(ADC)值及指数表观扩散系数(eADC)值,应用独立样本t检验分析两种病变间的ADC值、eADC值差异.结果 淋巴瘤与淋巴结转移瘤在DWI上均呈高信号,但各b值组二者间ADC值及eADC值均存在统计学差异(P<0.05).其中b=1000 s/mm2时,其间差异最显著,淋巴瘤与淋巴结转移瘤的ADC值分别为(0.67±0.14)×10-3 mm2/s和(1.03±0.14)×10-3 mm2/s,eADC值分别为(0.52±0.07)×10-2和(0.36±0.05)×10-2,应用受试者工作特征(ROC)曲线得出鉴别二者的ADC值及eADC值的诊断阈值分别为0.834×10-3mm2/s和0.439×10-2,敏感性和特异性分别为96.2%、94.4%和91.7%、96.2%.结论 DWI的ADC值及eADC值有助于区分系统性淋巴瘤与淋巴结转移瘤.     

3.0 T MRI扩散加权成像ADC值与SD大鼠肝癌分化程度的相关性研究

目的 探讨3.0 T MRI扩散加权成像(DWI)表观扩散系数(ADC)值与SD大鼠小肝癌分化程度的相关性.方法 取SD大鼠80只,注射肝癌诱导试剂,3个月后建立SD大鼠肝癌模型40只,行MRI.常规行T1WI和T2WI定位,DWI采用单次激发自旋回波-回波平面成像(SE-EPI),取b=50 s/mm2和b=100 s/mm2两组,在DWI像上取直径＞5 mm高信号结节在相应ADC图上分别测量其ADC值;检查完毕取相应部位结节行HE染色.结果 40个小肝癌病灶中,27个病灶的组织分化类型单一,其中高分化5个,中分化11个,低分化11个,b=50 s/mm2时其对应ADC值分别为(2.31±0.13)×103mm2/s、(2.03±0.18)×103 mm2/s、(1.64±0.24)×103 mm2/s;b=100 s/mm2时其对应ADC值分别为(2.25±0.04)×103mm2/s、(2.11±0.27)×103mm2/s、(1.89±0.20)×103 mm2/s;余13个病灶具有中、低分化两种不同的组织分化类型,其中5个病灶主要以低分化为主,另8个病灶主要以中分化为主.不同肝癌等级之间的ADC值比较差异具有统计学意义(P＜0.05).b=50 s/mm2组中,中分化组ADC值高于低分化组(P＜0.05),高分化组ADC值均高于低分化组与中分化组(P ＜0.05);b=100 s/mm2组中,中分化组与高分化组ADC值均高于低分化组(P＜0.05),而高、中分化之间差异无统计学意义(P＞0.05).b=50 s/mm2时其相关系数r值为0.863,b=100 s/mm2时其相关系数r值约0.696.结论 DWI ADC值与SD大鼠肝癌的病理分级之间有明显相关性,且b=50 s/mm2时相关性更高.     

不同b值下前列腺外周带癌灶ADC值的初步定量分析

目的:探讨DWI在不同b值下前列腺外周带癌灶ADC值的参考值范围。方法:对28例前列腺外周带癌(PCa)的DWI在b值分别为300、600、8001、000 s/mm2时所得前列腺外周带癌灶和正常外周带ADC值进行定量分析。结果:b值分别为300、600、800、1000s/mm2下外周带癌灶的平均ADC值分别为(1.12±0.24)×10-3、(0.95±0.19)×10-3(、0.88±0.14)×10-3(、0.81±0.17)×10-3mm2/s,外周带非癌区平均ADC值分别为(1.93±0.39)×10-3、(1.78±0.23)×10-3、(1.61±0.21)×10-3、(1.53±0.21)mm2/s,同b值下2者比较有统计学意义(P<0.05)。b值分别为300、600、8001、000 s/mm2下外周带癌灶ADC值参考范围分别为(0.63～1.61)×10-3(、0.56～1.34)×10-3(、0.59～1.17)、(0.46～1.16)×10-3mm2/s。结论:前列腺外周带癌区和非癌区ADC值随b值变化而变化,通过ADC值测量可以定量分析前列腺外周带癌,提高前列腺癌诊断的准确率。     

ADC值及eADC值在卵巢肿瘤定性诊断中的应用

目的 :探讨DWI中的ADC值及指数化表观扩散系数(eADC)值在卵巢肿瘤定性诊断中的应用价值。方法 :收集行MRI检查并经手术病理证实的65例卵巢癌患者,另选择卵巢良性肿瘤48例,比较2组的ADC值及eADC值。结果:65例卵巢癌的ADC值为(1.115±0.250)×10~(-3)mm~2/s,eADC值为(0.475±0.110) mm~2/s;48例卵巢良性肿瘤的ADC值为(1.673±0.310)×10~(-3)mm~2/s,eADC值为(0.271±0.150) mm~2/s。结论:卵巢癌与卵巢良性肿瘤的ADC值及eADC值差异有统计学意义,结合两者常规序列的MRI表现,可作出相对准确的诊断。     

扩散加权成像鉴别肺恶性肿瘤与实性良性病变的初步研究

目的探讨扩散加权成像(diffusion-weighted imaging,DWI)对肺恶性肿瘤与实性良性病变的鉴别诊断价值。资料与方法62例肺内恶性肿瘤和实性良性病变(共66个病灶)行常规MRI和DWI检查,b值为500s/mm2,观察病变区DWI信号特点并测量其表观扩散系数(apparent diffusion coefficient,ADC)值。结果不同病变组DWI信号虽有一定特点,但不具特征性。恶性病变组和良性病变组ADC值分别为(1.256±0.320)×10-3mm2/s、(1.648±0.416)×10-3mm2/s,两者差异有统计学意义(t=-3.637,P=0.001),ADC值鉴别肺内良恶性病变的最佳诊断阈值为1.400×10-3mm2/s,敏感性和特异性分别为83.3%和74.1%;小细胞肺癌ADC值为(1.064±0.196)×10-3mm2/s,非小细胞肺癌ADC值为(1.321±0.335)×10-3mm2/s,两者差异亦有统计学意义(t=2.967,P=0.007);原发性肺癌ADC值为(1.255±0.328)×10-3mm2/s,肺转移瘤ADC值为(1.263±0.280)×...     

局灶性结节增生与肝细胞癌MR扩散加权成像表现特征的比较

目的 探讨肝局灶性结节增生(FNH)和肝细胞癌在MR DWI上的表现特征.方法 同顾性分析2008年8月至2010年11月间,有MR检查资料并经手术病理证实的FNH和小肝癌患者资料,共有24例26个FNH病灶和36例39个小肝癌病灶.行b值=500 s/mm2DWI和常规动态增强扫描,对病灶DWI的信号特点进行记录和分析,对病灶的ADC值,病灶对周围肝实质ADC值比进行测量.对两组病灶信号特点分布行Fisher确切概率法检验,两组病灶ADC值及病灶与周围肝实质ADC值比采用独立样本t检验,并用ROC曲线评价ADC值和病灶与周围肝实质ADC值比对两种病灶的鉴别价值.结果 多数(23/26)FNH病灶在DWI上表现为等或略高信号,多数(25/39)HCC病灶表现为高信号,两者信号特点分布差异有统计学意义(P=0.000).FNH病灶的平均ADC值、病灶与周围肝实质ADC值比分别为(1.76±0.62)×10-3mm2/s和1.06±0.18,均高于HCC的平均值(1.26±0.46)×10-3mm2/s(P=0.001)和0.79±0.12(P=0.000).ADC值和病灶与周围肝实质ADC值比的ROC曲线下面积(Az)分别为0.79±0.05和0.85±0.05,差异无统计学意义(P=0.270);特异度分别为69.23%和97.44%,差异有统计学意义(P=0.001).结论 FNH在DWI上表现为等或略高信号,病灶ADC值和病灶与周围肝实质ADC值比高于HCC,应用ADC参数分析有助于FNH与HCC的鉴别.     

Application of Diffusion Weighted Imaging in Differential Diagnosis of Benign and Malignant of Stomach Neoplasm

目的 探讨扩散加权成像(diffusion-weighted imaging,DWI)及其表观扩散系数(apparent diffusion coefcient,ADC)在胃良、恶性肿瘤鉴别中的价值,确定ADC值在良恶性肿瘤鉴别中的最佳临界点.方法 39例经手术或胃镜活检病理证实的胃肿瘤性病变患者,进行常规MRI及DWI,b值采用800 s/mm2,以病理结果为金标准,统计分析胃良性和恶性占位之间的ADC值差异.结果 当b值为800 s/mm2,良性组ADC平均值为(2.200±0.959)× 10-3mm2/s,恶性组ADC平均值为(1.89±0.463)× 10-3mm2/s,两组间有显著差异(F=25.12,P＜0.05).受试者工作特征(ROC)曲线显示,区别良恶性胃部肿瘤的最佳临界点为1.915×10-3mm2/s,其敏感性为88.7％,特异性为91.1％,约登指数为0.798.结论 DWI在胃肿瘤诊断中具有可行性.b值为800 s/mm2时,胃良性和恶性肿瘤之间的ADC值存在显著统计学差异,区别胃部良恶性肿瘤的最佳临界点为1.915×10-3mm2/s,ADC值对于鉴别胃良恶性肿瘤有辅助诊断价值.     

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.