成人股骨头缺血坏死并软骨下骨折:平片、CT与MRI和病理结果的对照研究

背景:软骨下骨折是成人股骨头缺血坏死的重要合并症,对患者的治疗和预后有重要影响,然而有关软骨下骨折的病理及影像学表现尚缺乏深入的研究。目的:比较X射线平片、CT和MRI对诊断股骨头缺血坏死并软骨下骨折的敏感性。方法:选择临床确诊的股骨头缺血坏死患者82例(132髋),依次行X射线、CT和MRI检查,并对其中手术切除的16个股骨头标本进行切片、脱钙和苏木精-伊红染色,然后在显微镜下进行观察。结果与结论:132髋中,平片或CT确诊软骨下骨折72髋,X射线平片51髋,CT60髋,MRI33髋。与CT相比,MRI敏感性和特异性分别为36%和100%,平片敏感性和特异性分别为70%和96%。CT诊断股骨头缺血坏死并软骨下骨折优于MRI(χ2=10.95,P0.05)。本组16个股骨头大体标本与影像学对照研究显示,软骨下骨折区可见液体积聚和纤维肉芽组织增生,对应于X射线和CT上软骨下裂隙状透亮影,与上述病理过程是一致的。结果说明CT显示股骨头缺血坏死并软骨下骨折优于平片或MRI;MRI有助于观察股骨头缺血坏死后软骨下骨折的伴随征象,尤其T2WI+脂肪抑制,可评价骨折处的液体。CT检查实属X射线的更精细断层扫描。     

早期股骨头缺血性坏死的影像学诊断方法选择

股骨头缺血性坏死（avascular necrosis of the femoral head,ANFH）又称无菌性坏死,是骨科常见病。对于该病的诊断目前主要依靠影像学诊断,常用的方法有X线平片、CT扫描及MRI等检查。为了探讨如何选择合适的检查方法才能既节约费用又提高检出率，本文作者收集了我院近3年检查诊断为ANFH的32例患者资料，分析总结如下。     

股骨头缺血性坏死的影像学研究现状及进展

成人股骨头缺血性坏死是常见疾病,早期诊断和疗效评估是其重要的诊疗行为,多种影像学技术的应用为其诊疗提供了重要依据。本文对成人股骨头缺血性坏死不同影像学技术的相关文献进行综述,包括X射线,计算机断层扫描（CT）,核磁共振成像（MRI）技术。分析在股骨头缺血性坏死的诊断中不同影像学技术的优缺点、对临床诊疗的作用以及研究现状和进展。     

脊柱胸腰段骨折的影像学表现

目的：探讨常规X线平片、CT及MRI三种影像学检查手段在脊柱胸腰段骨折中的诊断价值。方法：对131例脊柱胸腰段骨折患的X线平片、CT和MRI资料进行回顾性对比分析。结果：本组131例，151个椎体骨折，共198个骨折部位，其中83例合并椎管狭窄，73例合并脊髓损伤。结论：在脊柱胸腰段骨折影像学检查中，常规X线平片能同时检出多段椎骨骨折，并对脊柱稳定性有初步预测；CT扫描能清晰显示骨折细节，准确判断骨折类型和椎管狭窄程度；MRI检查对脊髓损伤显示最佳。三种检查方法互补性强。     

脊柱创伤的影像学诊断价值分析

目的 探讨X线平片、CT、MRI对重症脊柱创伤诊断的优缺点,为创伤外科合理选择检查方法提供理论依据.方法 采用回顾性分析方法对患者的X线平片、CT、MRI影像资料进行对比分析,比较三种检查的优缺点.结果 CT检查骨折的阳性率为100%;平片检查单纯椎体压缩骨折阳性率为83%,附件骨折阳性率为90%;MRI检查单纯椎体压缩骨折阳性率为92%,附件骨折阳性率为80%,对脊髓、神经根受压情况显示清晰.结论 CT尤其螺旋CT应成为重症脊柱创伤的首选检查方法.MRI可作为其重要的补充检查手段,脊柱平片仅可作为一般的补充检查手段.     

膝关节自发性骨坏死MR诊断及鉴别诊断研究

目的：探讨膝关节自发性骨坏死(SONK)的影像学表现。方法在临床和影像学资料,对20例确诊患者膝关节自发性骨坏死。均行膝关节MRI检查,行CT检查4例,行平片检查4例。结果MRI显示软骨病变,位于股骨髁负重的地方14例。这表明2例软骨下骨折裂隙综合征；显示软骨状长T1短T2信号,2例骨髓水肿在信号；显示软骨下焦稍长T1长T2信号10例。CT检查45例,清晰显示病变2例；X线平片检查4例,仅1例病变。结论MRI能显示膝关节自发性骨坏死病变比CT,X射线敏感。结合临床表现和MRI诊断可以。     

胸椎黄韧带骨化的影像学研究及其临床意义

目的:探讨胸椎黄韧带骨化的影像学表现,评价X线、CT和MRI的诊断价值.方法:回顾性分析23例经手术病理证实的胸椎黄韧带骨化的X线、CT和MRI影像学资料.结果:所有病例的X线平片显示胸椎退行性改变,仅其中3例的侧位片显示椎间孔处模糊骨化影.CT扫描显示胸椎椎板前缘凸向椎管的高密度影,椎管变窄,外侧型7例,弥漫型8例,结节增厚型8例.MRI显永黄韧带骨化病变呈低信号影,脊髓不同程度受压.23例患者共发现黄韧带骨化节段57个,骨化节段为单发病灶6例,多发病灶17例.病变累及上胸段(T1-4)3例,中胸段(5-8)7例,下胸段(T9-12)16例.合并后纵韧带骨化6例,合并胸椎间盘突出2例.结论:胸椎黄韧带骨化有典型的CT和MRI影像学表现,但在X线平片上容易漏诊;CT结合MRI检查是确诊胸椎黄韧带骨化的蕈要诊断手段.     

影像学检查对急性脊柱损伤的诊断价值分析

目的 探讨、分析急性脊柱损伤的影像学检查特征,评估常规X线平片、CT及MR在诊断中的应用价值.方法 回顾性分析71例经X线平片、螺旋CT扫描及MR检查的脊柱损伤患者的病例.结果 CT与MR在显示椎间盘病变与椎体内细小骨折线优于X线平片,CT在显示椎弓与椎板骨折上优于X线平片与MR,MR在显示脊髓损伤上优于X线平片与CT.结论 X线平片是脊柱损伤的首选方法,但最好同时辅以CT检查,明确脊柱损伤的类型.对于怀疑有脊髓损伤的患者应及时进行MR检查.     

小转速髓芯减压结合自体红骨髓组织工程复合物治疗早中期股骨头缺血性坏死

目的探讨小转速髓芯减压结合自体红骨髓组织工程复合物治疗早中期股骨头缺血性坏死的临床疗效。方法选取2010年6月至2015年6月在我院住院的股骨头缺血坏死患者47例(52髋),采用随机数字表法分为2组:A组采用小转速髓芯减压+自体红骨髓组织工程复合物的方法治疗25例(28髋),B组采用髓芯减压+人工骨治疗22例(24髋),所有患者术前行髋关节X线片、CT及MRI检查,术后6、12、18个月行髋关节X线片、CT、MRI检查观察股骨头修复及坏死进展情况。结果所有病例平均随访34个月(18~60个月)。经过治疗,两组患者的临床坏死体积对比,影像学稳定率,股骨头生存率,有统计学差异(P0.05),两组患者的性别、年龄、病因基础资料差异无统计学意义(P0.05)。结论小转速髓芯减压+自体红骨髓组织工程复合物治疗早中期股骨头缺血性坏死操作简单,临床疗效满意,早期患者术后优良率更高。     

周围型肺癌行X线平片与CT诊断的临床价值对照

目的 对比周围型肺癌行X线平片与CT诊断的临床价值.方法 回顾性分析本卫生院2012年7月～2014年7月收治的63例经病理学确诊的周围型肺癌患者X线平片与CT检查资料,并对比两种检查方式影像学表现.结果 本组患者行CT检查的毛刺、肿块、棘样突起、空泡、胸膜凹陷、支气管气象、肺门及淋巴结肿大、血管聚集及厚壁空洞等影像特征阳性检出率显著高于X平片检查,对比差异有统计学意义(P＜0.05);X线平片确诊周围型肺癌49例,确诊准确率为77.78％(49/63),CT确诊周围型肺癌60例,确诊准确率为95.24％(60/63),两者对比差异具有统计学意义(P＜0.05).结论 相较于X线平片,周围型肺癌行与CT检查可显著提升影像学特征检出率与诊断准确率.     

局灶型Castleman病的MDCT和MRI表现特征及其病理学基础

为了探讨局灶型Castleman病(CD)的多层螺旋CT(MDCT)和磁共振成像(MRI)表现特征及其病理学基础,收集经手术病理证实的13例患者的临床资料,回顾分析其MDCT和MRI表现特征。所有患者均行MDCT平扫,11例行MDCT增强扫描,而另外2例行MRI平扫和增强扫描。13例患者共有14个病灶且均为透明血管型,MDCT平扫病灶均为等密度软组织肿块影;4个病灶中心有钙化,其中斑点状钙化2个,分支放射状钙化及分支放射状钙化伴病灶边缘弧形钙化各1个。MDCT增强扫描均有明显强化,其中均匀强化11个,另外3个为不均匀强化,表现为中心有星芒状低密度无强化区2个,局灶性无强化影1个;病灶周围显示较多迂曲血管影8个。行MRI扫描者T1WI信号稍高于肌肉,T2WI为明显高信号,增强亦有明显强化;同时右肩部病灶中心显示流空血管影,增强显示粗大的供血动脉及周边许多小血管影。总之,局灶透明血管型CD在MDCT或MRI上多表现为孤立性软组织肿块,以明显均匀强化为主、少数伴有不规则钙化或星芒状瘢痕为特征。     

Clinical characteristics and treatment of angiomatous meningiomas: a report of 27 cases

Angiomatous meningioma (AM) is a rare histological variant of meningioma. Twenty seven patients (14 male and 13 female) with angiomatous meningioma were treated in our institution. Their clinical presentation, neuroimaging studies, treatment and follow-up were investigated. The age of patients ranged from 24 to 72 years with a mean of 51.8 years. The clinical presentation was non-specific and depended on the location of the tumor and was mainly due to the mass effect. On computed tomography (CT) scanning, AMs showed slightly hyperintensity. On magnetic resonance imaging (MRI), AMs demonstrated hypointensity on T1-weighted images (T1WI), hyperintensity on T2-weighted images (T2WI), slight hypointensity on diffusion-weighted images (DWI), enhancement on postcontrast T1WI, peritumoral edema, and rich signal voids of vessels in the tumor. On histology, all tumors exhibited abundant blood vessels with at least focal classic meningothelial differentiation. Thirteen, eight, and six cases were achieved Simpson grade I, II and III-IV resection respectively. Nineteen cases were followed for 8 to 125 months with a mean of 47.9 months. Four patients with residual tumor were treated with postoperative radiation therapy and all of them had stable disease. One patient with Simpson grade II resection was not treated with radiation therapy and developed recurrent tumor in 5 years. In conclusion, angiomatous meningiomas have relative high male to female ratio, more frequent peritumoral edema, and rich blood vessels. Gross total resection is still the treatment of choice. These patients with residual tumor after surgery can benefit from radiation therapy. Overall, the prognosis of AMs are as good as other benign meningiomas.     

Long-term biodistribution in vivo and toxicity of radioactive/magnetic hydroxyapatite nanorods

Although nanoscale hydroxyapatite [Ca₁₀(PO₄)₆(OH)₂; HA] has been widely investigated as a carrier in the delivery of drugs, genes, or siRNA, the in vivo toxicity of nanoscale HA is not clear and the long-term dynamic distribution in vivo has not hitherto been visualized. In this work, gadolinium-doped HA nanorods (HA:Gd) with an r₁ value of 5.49 s⁻¹ (mm)⁻¹ have been prepared by a hydrothermal method. Samarium-153 (¹⁵³Sm) was then effectively post-labeled onto the HA:Gd (¹⁵³Sm-HA:Gd) with a labeling rate of ∼100% and a radio-labeling stability in vitro of ∼100% over 48 h. The product could serve as a new dual-modality probe for SPECT and MR imaging in vivo. By means of SPECT and MRI, the HA:Gd nanorods were found to be quickly taken up by the mononuclear phagocyte system, especially the liver and spleen. The nanorods in the liver and lung tended to be eliminated within 24 h, but nanorods in the spleen behaved differently and proved difficult to excrete. In vitro studies by cell transmission electron microscopy (TEM) and methyl thiazolyl tetrazolium (MTT) assay showed good biocompatibility of the HA:Gd nanorods with HeLa cells, even at a high concentration. The indicators of body weight, histology, and serology demonstrated that the HA:Gd nanorods exhibited excellent biocompatibility in vivo for at least 61 days. Therefore, ¹⁵³Sm-HA:Gd nanorods with excellent relaxivity, γ-emission, and biosafety offer clear advantages and potential for bioapplications.     

C-1 root schwannoma with aggressive lateral mass invasion

Schwannomas are relatively common, benign tumors that are thought to arise from the nerve sheath cell. Schwannomas of the C1 root are extremely rare and seldom invade lateral masses because they gradually increase in size and can extend through the wide space behind the lateral mass instead of the intervertebral foramen. We present here an unusual case of a benign schwannoma that aggressively invaded the lateral mass of C-1.     

College of Radiology, Academy of Medicine of Malaysia position on whole body screening CT scans in healthy asymptomatic individuals (2008)

To date, the College of Radiology (CoR) does not see any clear benefit in performing whole body screening computed tomography (CT) examinations in healthy asymptomatic individuals. There are radiation risk issues in CT and principles of screening should be adhered to. There may be a role for targeted cardiac screening CT that derives calcium score, especially for asymptomatic medium-risk individuals and CT colonography when used as part of a strategic programme for colorectal cancer screening in those 50 years and older. However, population based screening CT examinations may become appropriate when evidence emerges regarding a clear benefit for the patient outweighing the associated radiation risks.     

Polyphosphoric acid capping radioactive/upconverting NaLuF4:Yb,Tm,Sm nanoparticles for blood pool imaging in vivo

Nanoparticles that circulate in the bloodstream for a prolonged period of time have important biomedicine applications. However, no example of lanthanide-based nanoparticles having a long-term circulation bloodstream has been reported to date. Herein, we report on difunctional radioactive and upconversion nanoparticles (UCNP) coated with polyphosphoric acid ligand, that is ethylenediamine tetramethylenephosphonic acid (EDTMP), for an application in single-photon emission computed tomography (SPECT) blood pool imaging. The structure, size and zeta-potential of the EDTMP-coated nanoparticles (EDTMP-UCNP) are verified using transmission electron microscopy and dynamic light scattering. Injection of radioisotope samarium-153-labeled EDTMP-UCNP (EDTMP-UCNP:¹⁵³Sm) into mice reveal superior circulation time compared to control nanoparticles coated with citric acid (cit-UCNP:¹⁵³Sm) and ¹⁵³Sm complex of EDTMP (EDTMP-¹⁵³Sm). The mechanism for the extended circulation time may be attributed to the adhesion of EDTMP-UCNP on the membrane of red blood cells (RBCs). In vivo toxicity results show no toxicity of EDTMP-UCNP at the dose of 100 mg/kg, validating its safety as an agent for blood pool imaging. Our results provide a new strategy of nanoprobe for a long-term circulation bloodstream by introducing polyphosphoric acid as surface ligand.     

Acceptance Test of a Commercially Available Software for Automatic Image Registration of Computed Tomography (CT), Magnetic Resonance Imaging (MRI) And 99mTc-methoxyisobutylisonitrile (MIBI) Single-Photon Emission Computed Tomography (SPECT) Brain Images

This note describes a method to characterize the performances of image fusion software (Syntegra) with respect to accuracy and robustness. Computed tomography (CT), magnetic resonance imaging (MRI), and single-photon emission computed tomography (SPECT) studies were acquired from two phantoms and 10 patients. Image registration was performed independently by two couples composed of one radiotherapist and one physicist by means of superposition of anatomic landmarks. Each couple performed jointly and saved the registration. The two solutions were averaged to obtain the gold standard registration. A new set of estimators was defined to identify translation and rotation errors in the coordinate axes, independently from point position in image field of view (FOV). Algorithms evaluated were local correlation (LC) for CT-MRI, normalized mutual information (MI) for CT-MRI, and CT-SPECT registrations. To evaluate accuracy, estimator values were compared to limiting values for the algorithms employed, both in phantoms and in patients. To evaluate robustness, different alignments between images taken from a sample patient were produced and registration errors determined. LC algorithm resulted accurate in CT-MRI registrations in phantoms, but exceeded limiting values in 3 of 10 patients. MI algorithm resulted accurate in CT-MRI and CT-SPECT registrations in phantoms; limiting values were exceeded in one case in CT-MRI and never reached in CT-SPECT registrations. Thus, the evaluation of robustness was restricted to the algorithm of MI both for CT-MRI and CT-SPECT registrations. The algorithm of MI proved to be robust: limiting values were not exceeded with translation perturbations up to 2.5 cm, rotation perturbations up to 10° and roto-translational perturbation up to 3 cm and 5°.     

生物磁光声联合成像的研究现状

超声(US)成像、光学相干断层(OCT)成像和磁共振成像(MRI)是临床常用的医学成像手段。此外,光声层析(PAT)和磁声(MA)成像是近年来新兴的多物理场耦合功能成像手段。将两种或者两种以上的成像手段结合起来形成多模态联合成像,可以使各成像模态的优点得到充分展现,对目标进行高精度和高分辨率的成像,精确识别病变组织,并对其功能成分进行定性和定量的分析。对US-PAT、US-OCT、PAT-OCT、US-PAT-OCT、磁光以及磁光声(MPA)联合成像,特别是对血管内联合成像的研究进展和临床应用前景进行综述,总结目前存在的问题,并展望未来可能的发展方向。     

CONTRAST STUDY ON BA AND CT IN PATIENTS WITH BRAIN TRAUMA

目的:探讨脑电地形图与脑CT在脑外伤诊断中的应用价值。方法:脑电地形图和脑CT在124例脑外伤患者中被检查了,并且进行了对比。结果:在硬膜内和外血肿等器质病变中,BA和CT的定性和定位诊断是一致的,在脑震荡和脑外伤后综合征等功能性病变中,BA是阳性而CT是阴性。结论:脑电地形图在脑外伤的诊断中有重要应用价值。     

Multimodal Nanoprobes to target cerebrovascular amyloid in Alzheimer's disease brain

Cerebral amyloid angiopathy (CAA) results from the accumulation of Aβ proteins primarily within the media and adventitia of small arteries and capillaries of the cortex and leptomeninges. CAA affects a majority of Alzheimer's disease (AD) patients and is associated with a rapid decline in cognitive reserve. Unfortunately, there is no pre-mortem diagnosis available for CAA. Furthermore, treatment options are few and relatively ineffective. To combat this issue, we have designed nanovehicles (nanoparticles-IgG4.1) capable of targeting cerebrovascular amyloid (CVA) and serving as early diagnostic and therapeutic agents. These nanovehicles were loaded with Gadolinium (Gd) based (Magnevist^®) magnetic resonance imaging contrast agents or single photon emission computed tomography (SPECT) agents, such as ¹²⁵I. In addition, the nanovehicles carry either anti-inflammatory and anti-amyloidogenic agents such as curcumin or immunosuppressants such as dexamethasone, which were previously shown to reduce cerebrovascular inflammation. Owing to the anti-amyloid antibody (IgG4.1) grafted on the surface, the nanovehicles are capable of specifically targeting CVA deposits. The nanovehicles effectively marginate from the blood flow to the vascular wall as determined by using quartz crystal microbalance with dissipation monitoring (QCM-D) technology. They demonstrate excellent distribution to the brain vasculature and target CVA, thus providing MRI and SPECT contrast specific to the CVA in the brain. In addition, they also display the potential to carry therapeutic agents to reduce cerebrovascular inflammation associated with CAA, which is believed to trigger hemorrhage in CAA patients.