MRI在脑干血管母细胞瘤的诊断价值

目的:分析脑干血管母细胞瘤的MRI表现特点,讨论MRI诊断价值及鉴别诊断。材料和方法:经手术和病理证实7例,其中男性2例,女性5例,年龄19~45岁,平均28.7岁;均经MRI平扫及增强扫描。结果:7例脑干血管母细胞瘤1例位于延髓,2例位于延髓与脑桥交界处,4例位于脑桥。6例为单发囊性,呈大囊小结节,囊液呈长T1长T2信号,瘤结节呈不规则形,T1WI为稍低或等信号强度,T2WI呈较高信号强度。瘤旁无水肿或水肿较轻。增强扫描瘤结节明显强化,部分囊壁呈环形强化。1例为实质性,T1WI呈中等偏低信号,T2WI呈中等偏高信号,增强扫描肿瘤显著增强。肿瘤实质内及肿瘤旁可见迂曲的血管流空影。结论:MRI对脑干血管母细胞瘤的诊断具有较高的准确性,尤其是增强扫描对定性诊断及鉴别诊断具有重要价值。     

色素沉着绒毛结节性滑膜炎的MRI表现

目的 探讨色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis，PVNS)的MRI表现。方法 23例PVNS中膝关节9例，髋关节9例，踝关节3例，肘关节1例，腕关节1例，均经手术和病理证实。23例PVNS均行X线和MR检查，其中4例行CT检查。分析PVNS的影像学表现，着重总结PVNS的MR影像学特点。结果 X线表现：23例均可见关节及软组织肿胀，7例关节内外可出现较致密结节状或分叶状软组织肿块影，19例可见邻近关节骨质侵蚀性小缺损。CT表现：4例中3例可见关节内外结节状或分叶状软组织肿块，增强扫描可见结节样强化，1例CT仅显示关节囊增厚，关节内积液。MRI表现：23例病变部位增生肥厚的滑膜在T1WI上呈中等或中等稍低信号，在T2WI上呈中等稍高信号，其内可见多发散在结节，呈T1WI、T2WI低信号灶；增生肥厚的滑膜在快速梯度回波(FFE)T2WI序列上呈明显结节样低信号。23例病变关节均可见不同程度的关节积液。19例有骨质破坏，表现为凹陷性类圆形骨质缺损，骨缺损区T1、T2WI呈中等信号灶，周围有硬化边，呈T1WI、T2WI低信号。相邻骨髓腔内可见弥漫性反应性水肿灶，呈片状高T2信号。结论 MRI能准确显示PVNS的病变范围和程度，对PVNS有定性诊断价值。     

胃肠道外间质瘤的CT和MRI表现

目的 分析胃肠道外间质瘤(EGIST)的CT和MRI表现.方法 回顾性分析经手术或病理证实的16例EGIST患者的CT和MRI表现,所有16例均行CT扫描,8例行MRI扫描.分析肿瘤的位置、大小、形态、密度、信号特征及强化方式.结果 发生于大网膜3例,小网膜1例,肠系膜7例,腹膜后间隙4例,腹壁1例.圆形或类圆形3例,不规则形13例,病灶单发者13例,多发者3例.CT平扫均显示密度不均,其内见大小不一斑片状囊变、坏死区,增强肿瘤实质部分动脉期轻度强化,平衡期多为中等度强化,1例病灶内有钙化,1例伴肝转移.肿块最大径线4.8～ 18.2 cm(平均9.7 cm).MRI多表现为较大的分叶状软组织肿块,T1WI呈等低信号,T2WI呈稍高信号,DWI呈高信号,增强肿瘤实质部分中度到明显不均匀强化.结论 EGIST的CT和MRI表现具有一定特征性,CT和MRI在EGIST的诊断与鉴别、观察肿块与周围消化道的关系方面扮演重要角色.     

滑膜软骨瘤病的MRI诊断

目的 探讨滑膜软骨瘤病的MRI特征.方法 搜集经病理证实的26例滑膜软骨瘤病MRI影像资料,分析其MRI表现.结果 滑膜软骨瘤病的MRI表现为关节滑膜肥厚、关节内悬垂体及游离体、关节腔积液和骨性关节炎改变.26例中,Milgram病理分期Ⅰ期5例,3例表现为关节滑膜的不规则结节状肥厚,2例滑膜均匀肥厚,2例增强扫描肥厚的滑膜及结节明显强化;Ⅱ期9例,Ⅲ期12例,表现为既有关节滑膜的结节状肥厚,又有关节内悬垂体和游离体的形成,悬垂体呈中等T1、中等T2信号,增强扫描呈明显强化或环形强化,游离体于T1WI及T2WI上呈低信号,表现为大小不一、数目不等、形态不同的圆形、卵圆形钙化或骨化结节影,其中11例游离体中央呈短T1信号,脂肪抑制序列PDWI上呈低信号,增强扫描无明显强化.10例继发骨性关节炎改变.结论 滑膜软骨瘤病具有典型的MRI特征,当游离体钙化或骨化时可明确诊断,对较早期病变的诊断亦具有重要价值.     

结节性硬化症脑部CT和MRI表现(附12例报告)

目的:分析结节性硬化症脑部CT和MRI表现,以提高对本病的认识。方法:回顾性分析12例经临床证买为结节性硬化症患者的CT和MRI脑部影像学表现。结果:TSC脑部主要影像学改变包括:①室管膜下结节(12例),CT 上表现为多发高密度钙化结节,MRI上表现为T1WI高信号、T2WI低信号7例,T1WI和T2WI上均为低信号1例,T1WI 上呈等信号、T2WI上呈低信号4例;②皮层及皮层下结节(9例),其CT表现为高密度钙化灶3例、低密度灶6例,MRI上呈T1WI低信号、T2WI高信号9例;③脑白质异常(6例),CT上表现为多发低密度灶4例,MRI上表现为T1WI低信号、 T2WI高信号6例。5例行MRI增强扫描,示室管膜下结节呈中等强化,皮层及皮层下结节和脑白质异常信号均未见强化。结论:CT和MRI能较好显示结节性硬化脑部改变,CT对显示钙化结节较敏感,MRI对显示皮层及皮层下结节和脑白质改变较敏感。     

原发性输卵管癌的磁共振征象分析

目的:探讨原发性输卵管癌(PFTC)的MRI影像特征.方法:回顾性分析15例经手术及病理证实的原发性输卵管癌的临床资料和MRI表现,总结其MRI影像特征.结果:病灶表现为附件区肿块,单侧14例,双侧1例.9例为囊实性肿块,其中6例肿块呈腊肠形,3例呈不规则形;5例伴不同程度输卵管积水;8例囊性成分于T1WI呈低信号、T2WI呈高信号;1例囊性成分于T1WI、T2WI均呈高信号;实性成分均呈T1WI等或低信号、T2WI不均匀高信号.4例为实性肿块,其中2例呈腊肠形,1例呈卵圆形,1例呈不规则形;呈T1WI低信号、T2WI稍高信号.2例为管状囊性肿块伴管壁乳头状软组织结节,囊液呈T1WI低信号、T2WI高信号,管壁结节呈T1WI稍低信号、T2WI稍高信号.增强后各种实性成分呈明显不均匀强化.伴腹水5例、直肠转移性肿块1例.结论:附件区腊肠形囊实性肿块伴输卵管积水或腊肠形实性肿块是输卵管癌较具特征性的MRI征象.     

鼻道、鼻咽恶性黑色素瘤的MRI诊断

目的 分析鼻道、鼻咽恶性黑色素瘤的MRI表现,探讨其诊断要点.方法 回顾性分析经病理证实的8例鼻道、鼻咽恶性黑色素瘤的MRI特征及临床资料,所有患者均行MR平扫、增强及动态增强检查.结果 肿瘤位于中鼻道1例,鼻咽部2例,鼻腔、上颌窦及同侧筛窦5例.5例可见明显骨质破坏并侵犯邻近结构,累及翼腭窝3例、颞下窝2例、眼眶4例、前颅底2例、咽旁间隙1例.MRI表现:3例直径＜2 cm,呈类圆形肿块,T1WI为高信号,T2 WI为低信号,呈明显均匀强化.5例直径＞3 cm,不规则肿块,MRI表现为混杂信号,T1WI以等、低信号为主,其内有斑片状高信号;在T2WI,1例以等低、信号为主,4例以稍高信号为主,增强扫描呈轻度不均匀强化.动态增强扫描时间-信号强度曲线平台型、流出型各4例.结论 鼻道、鼻咽恶性黑色素瘤MRI信号特征与肿瘤大小相关.肿瘤较小时T1WI呈高信号,T2WI呈低信号;肿瘤较大时MRI信号混杂,轻度不均匀强化为其特征.     

泪腺良性上皮性肿瘤及肿瘤样病变影像学分析

目的:总结分析泪腺良性上皮性肿瘤及肿瘤样病变的CT和MRI表现.方法:回顾性分析63例经病理学证实的泪腺良性上皮性肿瘤及肿瘤样病变的CT和MRI影像资料.结果:①60例良性混合瘤中,50例位于眼眶外上象限泪腺窝内,6例位于眶缘前,2例位于眼球外侧,1例位于眼球上方,1例为多发;53例呈类圆形,7例形态不规则;45例可见邻近眶壁骨质受压改变; MRI示T1WI呈低信号或等信号,T2WI呈高信号或等信号,增强扫描可见明显强化;②1例嗜酸细胞瘤CT示肿瘤呈类圆形,密度不均匀,中央密度略低,泪腺窝骨质受压;③2例上皮囊肿均位于眶缘前,CT呈均匀低密度,MRI T1WI呈低信号,T2WI呈等信号,增强后无强化.结论:CT及MRI可显示泪腺良性上皮性肿瘤及肿瘤样病变的特征,有助于病变的诊断及鉴别诊断.     

手部常见软组织肿瘤的MRI表现

目的 :探讨手部常见软组织肿瘤的MRI特点。方法 :对53例经病理确诊的手部常见软组织肿瘤的临床资料及MRI特点进行回顾性分析,53例均行MRI平扫,其中38例行MRI增强扫描。结果:53例中腱鞘巨细胞瘤17例,血管瘤12例,血管球瘤11例,腱鞘囊肿8例,脂肪瘤5例。MRI表现:腱鞘巨细胞瘤T1WI多呈等低信号,T2WI呈高低混杂信号,边缘多可见低信号包膜影,增强扫描多明显强化;血管瘤T1WI多呈以稍高信号为主的混杂信号,PDWI多呈不均匀高信号,瘤内多可见出血,增强扫描不均匀明显强化;血管球瘤T1WI呈等低信号,PDWI呈高信号,增强扫描明显均匀强化;腱鞘囊肿T1WI呈稍低信号,PDWI呈高信号,部分瘤内可见线状低信号分隔影,增强扫描包膜强化;脂肪瘤T1WI呈高信号,PDWI及STIR呈低信号。结论 :手部常见软组织肿瘤多具有典型的MRI表现,MRI可作为诊断手部软组织肿瘤的首选方法。     

肝硬化再生结节和退变结节的MRI表现：初步研究结果

目的研究肝硬化再生结节和退变结节的MRI表现.资料与方法前瞻性地研究26例肝硬化再生结节和退变结节的MRI表现,其中合并肝癌8例.26例中有12例行CT平扫,6例行CT增强扫描;26例均行MRI平扫,18例行Gd-DTPA增强MRI,10例行超顺磁性氧化铁(菲立磁)增强MVI.临床实验室检查中,除8例合并有肝癌的患者甲胎蛋白显著增高外,其余18例甲胎蛋白均正常.结果26例中12例结节灶直径＜1 cm，8例在1～3 cm，6例＞3 cm.MRI表现：12例直径＜1 cm的结节灶在T1WI呈等信号，T2WI呈低信号，Gd-DTPA和菲立磁增强与正常肝实质呈同步强化，在CT上呈高密度改变.结节灶直径1～3 cm的8例中,5例结节在T1WI呈高信号,T2WI呈低信号,强化同前;另3例在T1WI呈低信号的结节,在T2WI呈高信号,其强化与正常肝实质不同步,在菲立磁增强扫描中呈高信号;CT平扫均呈等密度.6例直径＞3 cm的结节中2例在T1WI、T2WI均呈等高信号,菲立磁增强扫描呈高信号,Gd-DTPA增强MRI示巨大结节较周围邻近正常肝组织信号高;4例在T1WI呈高信号,在T2WI呈低信号，菲立磁增强扫描呈低信号,Gd-DTPA增强扫描巨大结节无强化，较周围邻近正常肝组织信号低,有时可见血管经过巨大结节表面.CT显示6例呈等或稍高密度.在MRI上可见1例“结中结”征.结论肝硬化再生结节在MRI上能较好地与肝细胞癌鉴别,但较难与退变结节鉴别.退变结节在T2WI不呈高信号,而肝细胞癌呈高信号,以此可作区别.此外,良性退变结节菲立磁增强T2WI呈低信号.     

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.