原发性肺黏膜相关淋巴组织淋巴瘤的18F-FDG PET/CT影像学表现

目的 分析原发性肺黏膜相关淋巴组织（MALT）淋巴瘤的18F-FDG PET/CT影像学表现,提高对原发性肺MALT淋巴瘤的认识及诊断能力。 方法 回顾性分析2006年11月至2017年4月经病理确诊的9例原发性肺MALT淋巴瘤患者（男性6例、女性3例,中位年龄59岁）的临床资料及18F-FDG PET/CT显像资料,记录病灶的部位、数量、密度、大小、形态及最大标准化摄取值（SUV_max）,以及纵隔及肺门淋巴结等情况;分析影像信息并同时进行相关文献复习。 结果 9例原发性肺MALT淋巴瘤患者18F-FDG PET/CT表现分为3型:实变型4例、肿块型3例、弥漫肺炎型2例。实变型表现为大小、受累范围不等的实变影;肿块型表现为单发或多发、边缘毛糙的实性肿块影;弥漫肺炎型表现为肺叶内或双肺弥漫的斑片、团块样软组织密度影。在9例患者中可见支气管充气征8例（部分伴有支气管扩张）、三角型灌注征3例、病灶向中心聚拢4例、钙化2例、胸腔积液2例、肺门及纵隔淋巴结肿大2例。所有病灶18F-FDG 代谢不均匀增高,中位SUV_max为6.0（2.6~8.3）;2例弥漫肺炎型纵隔及肺门淋巴结18F-FDG摄取异常增高,SUV_max分别为13.0、4.7。 结论 原发性肺MALT淋巴瘤的18F-FDG PET/CT表现常为斑片状致密影,多见实变影,内部常见支气管充气征,18F-FDG轻度摄取,结合相对缓慢的病程,可考虑为原发性肺MALT淋巴瘤。     

^18F-FDG PET-CT对多发性骨髓瘤的诊断价值

目的探讨^18F-FDG PET-CT对多发性骨髓瘤（MM）的诊断价值。方法回顾分析经病理证实的27例MM患者的PET-CT资料,分别记录病灶骨质破坏的部位并按骨质破坏形态进行分类,同时测量其最大SUV值（SUVmax）。结果 27例MM患者中有26例PET-CT检出病灶（阳性率为96.3%）,共检出病灶354个。PET和CT同时检出60.2%（213/354）的病灶,34处病灶仅在PET检出（34/354,9.6%）,而107处病灶仅在CT检出（107/354,30.2%）。PET-CT表现分三型：①骨质疏松型（4例）,表现为骨质密度减低,骨皮质变薄或断续不连,可合并胸腰椎压缩骨折,肋骨病理性骨折,PET示轻度代谢异常增高,SUVmax均值为3.5±1.0。②骨质破坏型（20例）,表现为骨质破坏、病理性骨折、软组织肿块等,PET示大部分为中低代谢,SUVmax均值为3.1±1.0,合并软组织肿块时为高代谢,SUVmax均值为5.3±1.7。③骨质硬化型（3例）,表现为骨质密度增高,破坏与硬化混合存在或骨质破坏周围有硬化缘,PET示轻度代谢异常增高,SUVmax均值为3.5±1.2。结论 PET-CT对于MM的诊断及评价全身累及范围具有一定价值。     

继发性骨淋巴瘤的18F-FDG PET/CT影像学表现

目的 探讨继发性骨淋巴瘤在18F-FDG PET/CT显像中的影像学特点。 方法 对2012年4月至2015年6月行全身18F-FDG PET/CT显像的46例继发性骨淋巴瘤患者的PET/CT影像学表现进行回顾性分析。并将骨髓穿刺结果分为阳性和阴性两组,对两组显像相应穿刺部位（髂棘）SUV进行独立样本t检验,同时绘制穿刺部位SUV诊断继发性骨淋巴瘤的受试者工作特征曲线（ROC）。 结果 46例继发性骨淋巴瘤患者中,霍奇金淋巴瘤6例、非霍奇金淋巴瘤40例;单发10例,多发18例,全身弥漫分布18例。46例患者骨质异常表现多样,其中,骨髓浸润型31例（67.40%）、混合型10例（21.74%）、硬化型3例（6.52%）、溶骨型2例（4.34%）。46例患者中肱骨或股骨受累32例（69.57%）,均为骨髓浸润型表现。骨髓穿刺阳性组及阴性组SUV独立样本t检验结果显示t=4.036,P < 0.001,提示两组差异有统计学意义。穿刺部位SUV诊断继发性骨淋巴瘤的ROC曲线结果显示SUV诊断界值为2.35,其诊断继发性骨淋巴瘤的特异度和灵敏度分别为83.3%和80.0%。 结论 继发性骨淋巴瘤的18F-FDG PET/CT影像学表现存在一定的特征性,在该病的诊断与鉴别诊断中具有重要的临床价值,且对骨髓穿刺部位的选择具有指导意义。     

神经淋巴瘤病的^18F—FDG PET／CT影像特征分析

目的分析神经淋巴瘤病^18F—FDGPET／CT影像特征,并探讨其在评估神经淋巴瘤病中的应用价值。方法回顾性分析经病理检查证实的8例神经淋巴瘤病患者（男3例,女5例,年龄35～82岁）^18F—FDGPET／CT影像学资料,比较神经淋巴瘤病受累周围神经与健侧周围神经PET／CT表现的异同,并利用SPSS12．0软件对两者SUVmax行配对t检验。结果8例神经淋巴瘤病患者PET／CT共发现病灶11个,PET示病灶均沿神经丛、神经束或椎问孔走行,表现为束条形、根块状或结节状FDG代谢异常增高,SUVmax为6．54±3．23;病灶CT表现为沿神经束或神经根管走行的束条形、根块状或结节状软组织密度影,与周围软组织及邻近脂肪间隙分界不清。健侧对应部位周围神经在^18F-FDG PET／CT上未见明确显影,其SUVmax为1．15±0．48。神经淋巴瘤病受累神经与健侧周围神经SUVmax比较,差异有统计学意义（t=9．357,P〈0．001）。结论神经淋巴瘤病^18F—FDG PET／CT主要表现为沿神经丛、神经束或椎间孔走行的束条状、根块状或结节状FDG异常摄取灶,PET／CT可以准确反映肿瘤细胞对周围神经的浸润,显示病灶的大小、形态、分布及肿瘤活性。     

肺外结核18F-FDG-PET/CT误诊分析

目的 探讨肺外结核的18F-FDG-PET/CT表现并分析肺外结核误诊原因.方法 回顾性分析25例18F-FDG-PET/CT误诊为恶性肿瘤的肺外结核患者资料.结果 25例18F-FDG-PET/CT误诊恶性肿瘤中23例经病理证实结核,2例经临床诊断性治疗最终诊断为结核,包括8例骨关节结核,10例胸腹膜结核,7例淋巴结结核.8例骨关节结核中4例为胸椎结核,2例关节结核,另2例全身骨骼广泛受侵.4例胸椎结核呈溶骨性破坏,邻近软组织肿胀及软组织肿块,18F-FDG-PET示病变椎体呈明显放射性浓聚影,标准摄取最大值(SUVmax)=3.56 ～ 12.58.2例全身广泛骨质破坏,CT示全身多发骨质破坏,软组织肿块不明显,PET是全身骨骼弥漫性放射性浓聚影.关节软组织结核2例:CT示左侧腰大肌脓肿,1例左侧腰大肌脓肿向下延伸至左侧髋关节,骨盆左侧及左侧髋关节软组织肿块,PET呈大片状不均放射性浓聚影,SUVmax=4.36～ 8.23.胸膜腹膜结核10例中有1例为胸膜腹膜结核,9例为腹膜结核,CT表现为腹膜及胸膜均匀增厚并伴有不同程度的胸腹腔积液.增厚的腹膜及胸膜呈条状放射性浓聚影,SUVmax=2.56 ～ 6.23,9例腹膜结核患者肠系膜内可见多发软组织密度结节及小斑片影,即“污秽征”.淋巴结结核7例:CT表现为对称性两侧纵隔、肺门多发淋巴结增大,最大径1.5 ～8.0 cm,SUVmax=10.5.结论 肺外结核的18F-FDG-PET/CT表现没有特征性,与恶性肿瘤鉴别困难.在充分分析PET/CT征象的基础上结合临床及实验室检查,才能最大限度地减少肺外结核的误诊.     

子宫肌瘤~(18)F-FDG PET/CT显像高代谢机制的初步探讨

目的探讨18F-2-氟-2脱氧-D-葡萄糖(18F-FDG)正电子发射体层摄影术(PET)/CT显像上子宫肌瘤的高代谢表现及机制。资料与方法回顾性分析2007年7月至2010年8月接受PET/CT检查的受检女性(共1785例)的PET/CT图像,以18F-FDG摄取高于肝脏作为代谢增高的标准,子宫出现高代谢病灶者共147例,其中9例经病理证实为子宫肌瘤。结果 9例子宫肌瘤表现为18F-FDG代谢增高的受检者年龄34~57岁,平均46岁,子宫肌瘤18F-FDG代谢的18F-FDF最大标准摄取值(SUVmax)为4.4~20.4。绝经前期子宫肌瘤的18F-FDG摄取多见,且SUVmax高于绝经后期。绝经前期子宫肌瘤的18F-FDG摄取与月经周期无明显相关,但增殖期子宫肌瘤的SUVmax低于分泌期。结论子宫肌瘤可以表现为18F-FDG代谢增高,不应一概视为恶性。认识子宫肌瘤的高代谢表现有助于减少假阳性,提高诊断准确性。     

骨盆原发性非霍奇金淋巴瘤的临床及影像表现分析

目的探讨骨盆原发性非霍奇金淋巴瘤的临床及影像表现。方法经手术病理证实的20例骨盆原发性非霍奇金淋巴瘤,19例行X线检查,8例行CT检查,14例行MRI平扫加增强扫描。结果 1)临床表现:男性14例,女性6例,发病年龄15-74岁,平均年龄39岁。15例位于髂骨(其中10例同时累及髋臼,另外5例同时累及髋臼及耻骨),4例累及髋臼及耻骨,1例为骨盆多部位受累。临床症状主要为髋部疼痛及髋关节活动受限;2)影像表现:X线及CT表现为溶骨性骨质破坏19例,其中13例表现为单纯溶骨性骨质破坏,6例表现为溶骨性骨质破坏合并骨质硬化。8例行CT检查病例均表现为骨皮质破坏合并软组织肿块。14例行MRI检查病例均表现为正常的骨髓信号被肿瘤信号取代并形成软组织肿块。T_1WI上病变表现为等信号10例,稍高信号4例,T_2WI上均表现为高信号,增强扫描病灶均明显强化;3)病理类型:弥漫大B细胞淋巴瘤17例,T细胞淋巴瘤、滤泡性淋巴瘤及间变性大细胞淋巴瘤各1例。结论当患者年龄30岁,骨盆出现单纯溶骨性破坏或溶骨性骨质破坏合并骨质硬化,伴周围软组织肿块,且软组织MRI信号较均匀,无瘤骨及钙化,需考虑为非霍奇金淋巴瘤。     

原发性肺弥漫大B细胞淋巴瘤18F-FDG PET/CT显像一例

笔者报道了一例原发性肺弥漫大B细胞淋巴瘤的18F-FDG PET/CT显像病例,从临床症状、实验室检查、18F-FDG PET/CT影像学等方面分析该病特点,并通过文献回顾了原发性肺弥漫大B细胞淋巴瘤鉴别诊断要点。研究结果显示,本例原发性肺弥漫大B细胞淋巴瘤18F-FDG PET/CT影像学表现为巨大软组织团块影、边缘光滑、内见多发点状钙化灶,18F-FDG代谢团块状增高,SUV_max为26.2。18F-FDG PET/CT显像能够为原发性肺弥漫大B细胞淋巴瘤的诊断提供参考依据。     

炎性肌纤维母细胞瘤的~(18)F-FDG PET/CT表现

目的探讨炎性肌纤维母细胞瘤(IMT)的~(18)F-FDG PET/CT表现,以提高对该病的认识。方法回顾性分析经病理证实的7例IMT患者的临床资料及~(18)F-FDG PET/CT显像资料,男2例,女5例,年龄16～79岁,中位年龄57岁。结果 7例IMT中,5例单发,2例多发,共20个病灶。5例单发病灶,位于肺部3例,小腿1例,盆腔1例; 2例多发病灶中,1例累及纵隔、腹部及盆壁,1例位于腹壁及盆壁。15个病灶呈圆形或椭圆形软组织密度结节或肿块,5个病灶形态不规则,可见分叶;大部分病灶边界清楚、密度均匀。~(18)F-FDG摄取不同程度增高,SUVmax为13. 1(5. 9,19. 5),病灶最大径为2. 6(2. 0～4. 4) cm,病灶最大径与SUVmax无相关性(r=0. 411,P=0. 072)。5例患者行Ki-67检测,Ki-67与病灶SUVmax呈正相关(r=0. 794,P=0. 001)。结论 IMT的~(18)F-FDG PET/CT表现缺乏特异性;肿瘤~(18)F-FDG摄取的高低,在一定程度上能反映肿瘤细胞的恶性程度。     

惰性淋巴瘤大细胞转化的~(18)F-FDG PET/CT影像研究(附8例分析)

目的:探讨~(18)F-FDG PET/CT对惰性淋巴瘤大细胞转化的诊断价值.方法:回顾性分析8例惰性淋巴瘤转化前后~(18)F-FDG PET/CT影像,其中男性5例,女性3例,平均年龄53.5岁;8例转化前后均经病理及免疫组化染色证实.结果:8例惰性淋巴瘤最终均转化为弥漫大B细胞型淋巴瘤;其中6例由黏膜相关淋巴组织边缘区B细胞淋巴瘤(MALT)转化;1例由滤泡性淋巴瘤(FL)转化;1例由霍奇金结节性淋巴细胞为主性淋巴瘤(NLPHL)转化.转化前病灶~(18)F-FDG摄取呈轻度增高或无增高,平均SUV为2.2±1.0;转化后病灶~(18)F-FDG摄取明显增高,平均SUV为4.7±1.9;转化后病灶平均SUV明显高于转化前(P<0.01).结论:惰性淋巴瘤以小细胞为主,其增殖活性低,核分裂不明显,葡萄糖代谢水平较低,在PET/CT上病灶呈低摄取;转化成大细胞淋巴瘤增殖活性高,核分裂明显,葡萄糖代谢水平明显增高,提示~(18)F-FDG PET/CT随访可帮助判断惰性淋巴瘤发生大细胞转化.     

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.     

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).     

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.     

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.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme