胰头部肿块型慢性胰腺炎与胰头癌的影像鉴别诊断

目的 :分析胰头部肿块型慢性胰腺炎与胰头癌的CT、MRI表现及鉴别要点,以提高影像鉴别诊断水平。方法 :回顾性分析15例经手术病理证实的胰头部肿块型慢性胰腺炎与15例胰头癌患者的临床及影像学资料。结果:15例胰头部肿块型慢性胰腺炎CT表现为肿块钙化1例,胰管钙化13例,呈等低密度10例,肝门、腹主动脉旁可见钙化淋巴结6例,肝内胆管扩张6例,增强扫描CT值增高20 HU;MRI时间-信号强度曲线呈平台型及持续型,MRCP可见枯藤征10例、胰管贯通征12例。15例胰头癌CT表现为胰腺体尾部萎缩14例,增强扫描门脉期病灶可见强化12例、病灶处胆管截断15例;MRI时间-信号强度曲线呈缓慢流出型及平台型,MRCP可见双管征、不相交征、软藤征13例。结论:CT、MRI对胰头部肿块型慢性胰腺炎与胰头癌的鉴别诊断有一定价值;在MRCP表现上胰头部肿块型慢性胰腺炎与胰头癌存在较大差异。     

胰头部肿块型慢性胰腺炎与胰头癌的CT分析与鉴别

目的 探讨胰头部肿块型慢性胰腺炎与胰头癌的CT特征及鉴别诊断.方法 对30例胰头部肿块型慢性胰腺炎与30例胰头癌患者的CT资料进行回顾性分析.结果 胰头部肿块型慢性胰腺炎与胰头癌主要CT鉴别点及其例数.①肿块形态密度:分叶(3例,25例),肿块内伴钙化(17例,0例).②增强:门脉期相对低密度(2例,30例),相对等密度(28例,0例).③胰管扩张(18例,25例),串珠样扩张(15例,4例),平滑扩张(3例,21例),病灶处胰管截断(4例,12例),病灶处胰管贯通(14例,1例).④胆管扩张(25例,12例),胆管病灶处截断(2例,21例),病灶处逐渐变细(10例,4例).⑤双管征(10例,20例),不相交征(0例,20例).⑥胰周大血管:周围脂肪间隙模糊(23例,2例),血管包埋受侵(0例,22例).结论 CT检查对胰头部肿块型慢性胰腺炎与胰头癌的诊断与鉴别诊断具有重要意义.     

3.0TMR LAVA增强扫描在胰头癌和肿块型胰腺炎的鉴别诊断价值

目的探讨3. 0TMR LAVA增强扫描在胰头癌和肿块型胰腺炎的鉴别诊断价值。方法回顾性分析病理证实的胰头癌18例和肿块型胰腺炎13例的临床及影像学资料,31例术前均接受LAVA增强扫描,计算病灶的信噪比(SNR)与对比噪声比(CNR)。结果 18例胰头癌中16例LAVA增强动脉期显示病变与正常胰腺实质相比呈显著低信号,2例呈稍低信号,18例均在门静脉期可见边缘轻度环形强化,18例病灶均可见延迟强化; 13例肿块型胰腺炎LAVA增强各期显示病变与正常胰腺实质相比呈稍低信号8例,等信号5例。胰头癌SNR及CNR低于肿块型胰腺炎(P 0. 05)。结论胰头癌和肿块型胰腺炎在LAVA增强扫描时所表现的强化方式差异显著,3. 0TMR LAVA增强扫描对两者的鉴别具有重要的临床意义。     

多层螺旋CT在胰头部肿块型慢性胰腺炎诊断中的价值

目的：探讨胰头部慢性肿块型胰腺炎的MSCT表现。方法：回顾性分析30例经手术、针吸细胞学及CT随访证实的胰头部肿块型慢性胰腺炎患者的病例资料,总结其CT特征。结果：胰头部肿块型慢性胰腺炎主要CT征象：①胰头部肿块。CT平扫7例为单纯胰头增大,6例肿块内伴有假囊肿,14例肿块内伴钙化,3例肿块内同时伴有钙化和假囊肿。20例行增强扫描,其中15例表现为渐进性强化,3例为动脉期明显强化、静脉期与胰腺体尾部强化程度相似,2例各期未见明显强化;②胰管扩张。18例伴有胰管扩张,串珠样扩张15例,病灶处胰管贯通10例,13例伴有胰管钙化;③胆管扩张。12例胆总管扩张,远端自上而下逐渐变细10例;④胰周大血管。23例胰周大血管周围脂肪间隙欠清晰,未见包埋侵犯现象。⑤15例肾前筋膜增厚。结论：胰头部肿块型慢性胰腺炎MSCT表现具有一定特征性,MSCT检查对胰头部肿块型慢性胰腺炎的诊断及鉴别诊断具有重要的临床价值。     

磁共振DWI并3D-VIBE序列对胰头慢性胰腺炎与胰头癌的鉴别诊断

目的探讨磁共振DW（I弥散加权成像）并3D-VIBE（三维梯度回波容积内插法）序列在胰头慢性胰腺炎与胰头癌鉴别诊断中的应用价值。方法 17例经临床、手术和病理证实的胰头疾病患者（胰头慢性胰腺炎4例,胰头癌13例）,分别行常规MRI检查、DWI、3D-VIBE序列平扫及动态增强扫描,对所获得的图像资料主要观测以下内容：肿块形态学特点,DWI肿块信号特征,肿块多期强化特征,胰管、胆管的改变,胰周血管显示情况,胰周器官受累情况及有无远处转移病灶等。结果 DWI肿块的信号特征：三组不同高b值（400、600、800s/mm3）的图像均显示胰头慢性胰腺炎呈较高信号,且信号近似于胰体、尾组织信号;胰头癌肿块信号明显高于正常胰腺组织信号者。3D-VIBE序列胰腺肿块强化特征分析结果：胰头慢性胰腺炎组中胰头部肿块动脉期几乎无强化,其强化程度明显低于正常胰腺组织,门脉期、延迟期肿块逐渐强化;而胰头癌组中胰头部肿块动脉期强化程度低于正常胰腺组织,门脉期、延迟期肿块强化效应逐渐减退。结论 DWI结合3D-VIBE动态增强扫描技术能较全面的显示胰头肿块的影像学特征,有助于胰头慢性胰腺炎与胰头癌的鉴别诊断。     

胰头肿块型慢性胰腺炎的CT诊断与鉴别诊断

目的:分析胰头肿块型慢性胰腺炎(MTCP)的CT表现,以提高其诊断与鉴别诊断的准确性。方法:回顾性分析26例胰头MTCP的临床资料,所有患者均行平扫和增强扫描。结果:26例主要CT表现:(1)平扫肿块密度均匀10例,等低密度夹杂点状或小斑片高密度钙化灶16例。增强扫描动脉期轻度强化、静脉期及延迟期渐进性强化21例;动脉期明显强化2例;3期扫描均未见明显异常强化3例。(2)主胰管连续21例,截断5例;主胰管呈串珠样扩张14例,平滑扩张2例;胰管走行区钙化3例。胆总管轻中度扩张8例,明显扩张2例;胆总管末端呈渐进性变细7例,突然中断1例;肝内胆管明显扩张2例,呈枯枝状轻中度扩张8例。双管征10例,无不相交征。(3)胰周脂肪间隙正常8例,脂肪间隙模糊16例,2例胰周脂肪间隙消失,可见血管轻度受压,但无明显管腔变形。肾前筋膜增厚17例。结论:胰头MTCP表现具有一定特征性,CT检查对胰头MTCP的诊断及鉴别诊断具有重要价值。     

CT及MRI多模态参数对鉴别胰头部肿块型慢性胰腺炎与胰头癌的价值

目的分析胰头部肿块型慢性胰腺炎(MFCP)与胰头癌的CT以及MRI定性及定量表现,总结二者有效的影像鉴别特点。方法选取我院16例胰头部MFCP及16例胰头癌临床及影像资料进行回顾性分析。结果胰头部MFCP与胰头癌影像表现:1)肿块形态密度:分叶状(2例,11例),假性囊肿(11例,0例),肿块内钙化(6例,0例);2)DWI高信号:(2例,14例);3)静脉期相对低密度(3例,15例);ROC曲线分析示静脉期CT差值鉴别二者的AUC=0.852;4)胰胆管表现:主胰管扩张(9例,12例),胰管病灶处截断(1例,10例),胆总管扩张(6例,12例),胆总管病灶处截断(2例,10例),双管征(7例,11例),不相交征(1例,12例),肝内胆管扩张(2例,11例);5)周围组织表现:肾周筋膜增厚(9例,3例),胰周血管包绕受侵(1例,2例)。结论胰头部MFCP与胰头癌的影像学表现具有特异性,肿块的形态、DWI信号、胰胆管扩张程度及二者的血供特点有助于二者诊断及鉴别诊断。     

十二指肠恶性肿瘤的CT诊断与鉴别诊断

目的　探讨十二指肠恶性肿瘤的CT诊断与鉴别诊断。方法　回顾性分析 2 0例手术病理证实的十二指肠恶性肿瘤的CT平扫和增强资料。结果　原发十二指肠恶性肿瘤 8例 ,其中十二指肠腺癌 3例 ,恶性淋巴瘤 2例 ,恶性间质瘤 3例 ;十二指肠继发性恶性肿瘤 12例 ,其中壶腹癌 3例 ,胰头癌 8例 ,胰腺无功能性神经内分泌癌 1例。十二指肠腺癌CT表现为肠腔局限性不规则环状狭窄伴软组织肿块 ,增强扫描肿块有中度强化 ;恶性淋巴瘤的特点是长范围的肠壁增厚或肠腔外肿块 ,增强扫描肿块有轻度强化 ;恶性间质瘤的特点是巨大软组织肿块伴明显、不均匀强化 ,肠梗阻不明显。壶腹癌表现为十二指肠降部内侧壁的局限性肿块 ,增强有轻中度强化 ,伴肝内外胆管扩张 ;胰头癌累及十二指肠表现为十二指肠内侧壁凹凸不平 ,邻近的胰头部肿块 ,增强扫描不强化 ,伴肝内外胆管扩张 ;胰腺无功能性神经内分泌癌侵及十二指肠表现为胰头部巨大肿块伴明显强化 ,肝内外胆管不扩张 ,肿块与十二指肠分界不清。结论　CT检查对十二指肠恶性肿瘤有重要的诊断和鉴别诊断价值。     

螺旋CT双期增强扫描对可疑胰头癌的鉴别诊断

目的：探讨螺旋CT双期增强扫描对可疑胰头癌的鉴别诊断价值。方法：对49例经超声和临床拟诊的胰头癌行胰腺的螺旋CT双期增强扫描,动脉期和门静脉期延迟扫描时间分别为25秒和60秒,所有病例经病理或临床追踪诊断。结果：49例中,胰头变异例,胰头周围淋巴结病6例,慢性胰腺炎7例,胰头癌31例。其中46例（94%）诊断正确,1例胰头周围淋巴结结核和 2例慢性胰朱炎误诊为胰头癌。结论：螺旋CT双期增强扫描对可疑胰头癌的鉴别诊断有很高的价值。     

周围型肝内胆管癌的多层螺旋CT动态扫描观察

目的 分析肝内周围型胆管细胞癌(IHPCC)多层螺旋CT动态增强扫描的CT表现.方法 经手术病理证实的25 例IHPCC 病人,均行 CT 平扫及三期动态增强扫描,回顾性分析其CT表现.结果 所有病例CT平扫病灶均表现为大片状低密度影,病灶内或病灶周围可见胆管扩张.增强扫描动脉期病灶无强化8例,轻度强化17例;延迟扫描均有不同程度强化表现.结论 CT动态增强扫描是肝内周围型胆管细胞癌诊断和鉴别诊断的重要方法.     

Mistakes in the diagnosis and treatment of the complete dislocation and fractures of the acromial end of the clavicle

The analysis of the mistakes in the operative treatment of the sick with such a trauma was conducted. Two typical examples were given. The mistakes were stipulated non-diagnosis of the simultaneous break of the coracoclavicular ligament and not taking measures for its recovery. The radiodiagnosis based on N. Z. Shmidt's method is considered to be inevitable for this category of the sick. After the confirmation of the diagnosis the operation of choice can be the operation of Yotkins-Leochuk for the sick with the complete dislocation of the acromial end of the clavicle, and the operation of Yotkins for the sick with fractures of the acromial end of the clavicle with the break of the coracoclavicular ligament. By means of these methods 43 sick men with the dislocation and 7 sick men with fractures of the acromial end of the clavicle have been operated since 1973. No cases had complications, relapses or unsatisfactory results.     

Quantitative evaluation of the echo intensity of the median nerve and flexor muscles of the forearm in the young and the elderly

Objectives

Musculoskeletal structures often appear brighter on imaging in the elderly, which makes it difficult to accurately delineate a peripheral nerve during ultrasound-guided regional anaesthetic procedures. The echo intensity of skeletal muscles is significantly increased in the elderly. However, there are no data comparing the echo intensity of peripheral nerves in the young and the elderly, which this study was designed to evaluate.

Methods

13 healthy, young volunteers (aged <30 years) and 11 elderly patients (aged >60 years) who were scheduled to undergo orthopaedic lower limb surgery were recruited. The settings of the ultrasound system were standardised and a high-frequency linear array transducer was used for the scan. A transverse scan of the median nerve (MN) and the flexor muscles (FMs) at the left mid-forearm was performed and three video loops of the ultrasound scan were recorded for each subject. Still images were captured from the video loops and normalised. Computer-assisted greyscale analysis was then performed on these images to determine the echo intensity of the MN and the FMs of the forearm.

Results

The echo intensity of the MN and FMs of the mid-forearm was significantly increased in the elderly (p<0.005). There was also a reduction in contrast between the MN and the adjoining FM in the elderly (p=0.04).

Conclusion

Under the conditions of this study, the MN and the FMs in the forearm appeared significantly brighter than those in the young, and there was a loss of contrast between these structures in sonograms of the elderly.Recently, there has been an increase in interest in the use of ultrasound to guide peripheral nerve blocks [1-3]. We have observed during such procedures that musculoskeletal structures often appear significantly brighter and that there is loss of contrast between the nerve and its adjoining muscles in the elderly, which often makes it difficult to accurately delineate a peripheral nerve using ultrasound in this age group. There are published data showing that the echo intensity (EI) of skeletal muscles is significantly increased in the elderly [4]. However, there are no data comparing the EI of a peripheral nerve in the young and the elderly, which this study was designed to evaluate.     

Sonography of the wrist and the hand

Sonographic examination of the hand requires high-frequency linear transducers. As the relevant structures are located very close to the surface, water stand-off pads are mandatory. Owing to the high sensitivity of sonography in the detection of fluid, exudative synovitis, tenosynovitis and ganglia can be easily diagnosed. Sonographic information on muscle atrophy and alterations of the shape and echogenicity of the median nerve in patients with carpal tunnel syndrome may be useful in evaluating the extent of disease. Further indications for the sonographic examination of the hand include suspected tumors, foreign bodies and synovial proliferation. Osseous destruction can be visualized in patients with rheumatoid disease, but the precise extent is hard to determine.     

Aspects of the venous drainage of the pons and the mesencephalon

Summary After a brief resumé of the morphology of the pontomesencephalic veins, the authors demonstrate the drainage dynamics of these veins in normal and pathlogical vertebral angio-seriograms. The repercussions of drainage impairment are illustrated.

---

Untersuchungen über die Venen-Drainage von Pons und Mesencephalon

Zusammenfassung Nach kurzer Beschreibung der Morphologie der pontomesencephalen Venen wird die Drainagedynamik dieser Venen anhand normaler und pathologischer Vertebralisangiogramme demonstriert. Die unterschiedlichen Mechanismen einer Drainagebehinderung werden erläutert.

---

A propos du drainage veineux du pont et du mésencéphale

Résumé Après un bref résumé de la morphologie des veines ponto-mésencéphalques, les auteurs décrivent les modalités de drainage de ces veines en sérioangiographie vertébrale normale et pathologique. Ils illustrent les répercussions de drainage défectueux.

     

高原彝汉成年人血红蛋白、红细胞值调查分析

目的了解高原地区彝汉成年人血红蛋白、红细胞及相关指标的基础水平，探讨其与国家参考值指标是否存在差异。方法选择健康成人规范采集静脉血，用美国COULTERAC·Tdiff2血球分析仪检测，对数据进行统计学处理。结果川西南高原彝汉成人的血红蛋白、红细胞水平及相关指标与国家参考值比较差异有非常显著的意义，P〈0．001；当地彝汉民族比较差异无显著意义，P〉0．05。结论有必要制定高原地区成人血红蛋白、红细胞及相关指标的正常参考值，为临床提供更科学实际的参考依据。     

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulner nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.