胃癌16层螺旋CT术前分期与术后病理对比研究

目的:通过研究16层螺旋CT对胃癌述前TNM分期的诊断与手术病理比较,探索其在确定胃癌术前TNM分期中的应用价值。材料和方法:研究对象为72例不同年龄、临床症状及辅助检查疑诊胃癌患者,行常规16层CT平扫加增强三期薄层扫描,扫描后数据经过图形工作站进行二维、三维容积重建处理,多方位显示胃癌病变的部位、范围、大小、侵犯胃壁程度及侵犯周围组织器官的范围,周围各组淋巴结大小及范围,按照国际统一的TMN分期法进行TNM的CT术前分期,并与手术后病理TNM分期对照。结果:16层CT检查结果与手术后病理对照,T分期的准确性94.4%,能够显示黏膜和黏膜下层、肌层、浆膜层侵犯程度;N分期:N0准确性100%、N1准确性90.5%、N2准确性100%。CT多期增强可区别血管与淋巴结,可显示5mm直径的淋巴结影,特别是动脉期及门静脉期扫描特异性较高,有显著差异,淋巴结检出水平明显提高,但直径小于10mm淋巴结敏感性减低;M分期准确性达100%,清晰显示肺转移、肝转移、腹膜后及肠系膜淋巴结转移程度及大小。16层CT对胃癌诊断的敏感性95%,特异性80%,准确性92%,阳性预测值98%。结论:16层CT常规平扫加三期增强扫描合并图像后处理分析,可提高胃癌TNM分期的准确性,是胃癌术前准确分期的可靠方法,对合理制定手术前计划有较高价值。     

MSCT三期增强扫描和后处理技术对胃癌术前分期的评价

目的:探讨多层螺旋CT(MSCT)对胃癌的影像学诊断及其对术前分期的价值。方法:对49例胃癌患者行16层螺旋CT三期增强扫描后,用多平面重建(MPR)和CT仿真内镜(CTVE)等后处理技术对胃癌CT图像进行术前分期评价,并与术后病理分期对照,以术后病理分期为金标准。结果:MSCT T分期:T1期诊断准确率75.00%(6/8),T2、T3、T4期准确率分别为70.59%(12/17)、68.42%(13/19)、80.00%(4/5);N分期:N0期68.75%(11/16),N1期准确率为59.10%(13/22),N2期63.64%(7/11)。M分期中除1例左锁骨上淋巴结转移未行该部位的CT扫描不计入统计之列外,其余48例M分期的准确率为M0为90.91%(40/44),M1为50.00%(2/4)。结论:16层螺旋CT三期增强扫描结合多平面重建和CT仿真内镜等后处理技术对胃癌分期的准确率较高,值得临床推广。     

16排螺旋CT胃癌术前T分期的诊断价值

目的利用16排螺旋CT双期增强扫描对胃癌进行T分期并与病理对照,确定多排螺旋CT(multi-detec-tor row CT,MDCT)在术前T分期中的作用。资料与方法经胃镜证实的62例患者(63个病灶),术前采用16排螺旋CT平扫和动脉期、门静脉期双期增强扫描,随后根据5 mm层厚横断面图像情况重组薄层动脉期和门静脉期多平面重组(multiplanar reconstruction,MPR)图像,由两名资深放射科医师共同完成T分期,术后与病理对照。结果 MDCT结合MPR技术后对胃癌的检出率为96.7%,其中对早期胃癌的检出率为66.7%,进展期胃癌的检出率为100%。胃癌的MDCT大体分型准确率为88.9%。63个胃癌MDCT术前T分期总体准确率为71.4%,其中早期胃癌准确率为33.3%,进展期胃癌准确率为75.4%。结论采用MPR后处理技术的MDCT配合动态增强扫描对进展期胃癌的检出、大体分型和T分期准确率明显提高。     

螺旋CT三期增强扫描对胃癌TNM分期的研究

目的　评价螺旋CT三期增强扫描对胃癌TNM分期的诊断价值。方法　胃癌 10 1例进行低张水充盈螺旋CT三期增强扫描。结果　 (1)螺旋CT三期增强扫描对胃癌T -分期、N -分期和TNM分期的准确性分别为 81.8%、72 .9%和 80 .2 %。 (2 )动脉期—门脉期胃壁呈多层结构有利于判断胃癌浸润胃壁的深度 (Ρ <0 .0 5 )。 (3 )平衡期肿瘤强化完全有助于判断有无邻近器官受侵。(4 )以淋巴结直径 >5mm为转移标准 ,螺旋CT诊断转移淋巴结的敏感性明显高于以 10mm为转移标准 (Ρ <0 .0 5 )。结论　螺旋CT三期增强扫描能提高胃癌TNM分期的准确性。     

水脂分离增强序列在3.0T磁共振直肠癌术前分期中的应用

目的:将水脂分离增强扫描序列应用于直肠癌磁共振术前分期检查,探讨其在直肠癌术前分期中的应用价值。方法:选择经肠镜活检证实为直肠癌患者46例,随机盲法均分为两组,一组序列采用常规序列及T1脂肪抑制增强扫描序列;另一组序列采用常规序列及水脂分离增强扫描序列,结果与病理分期对照,比较两组序列图像信噪比及T、N分期。结果:组一T分期总敏感度为74%,特异度为78%。N分期总敏感度为74%,特异度为74%;N0分期敏感度78.6%,特异度66.7%,准确率为78%;N1分期敏感度57%,特异度81%,准确率为71%;N2分期敏感度100%,特异度100%,准确率为100%。组二T分期总敏感度为83%、特异度为83%;N分期总敏感度91%,特异度为91%;N0分期敏感度94%,特异度83%,准确率为94%;N1分期敏感度75%,特异度95%,准确率为75%;N2分期敏感度100%,特异度94.5%,准确率为100%。结论:水脂分离序列可提高图像信噪比,脂相有助于提高N分期,此序列在直肠癌术前分期中具有一定的临床应用价值。     

多层螺旋CT后处理技术在喉癌分期中的应用

目的探讨16层螺旋CT各种后处理技术在喉癌术前分期中的应用。资料与方法37例拟诊喉癌患者术前行准直为0．625mm螺旋CT扫描,利用扫描获取的容积资料行薄层1mm冠状、矢状、轴位多平面重组（MPR）、仿真喉镜（CTVL）、容积再现（VR）重建肿块与颈部邻近血管关系以及喉腔透明显示（RSP）等多种后处理技术,综合对喉癌术前TNM作出评估,并将影像分期结果与手术病理结果对照,评价该方法的准确性。结果16层螺旋CT术前对喉TNM分期与临床最终手术病理结果对照,其中TI期符合率为50％,T2期为60％,T3期为75％,T4期为81．25％。总体分期符合率为72．9％。尤其是1mm薄层MPR图像可明显提高对前联合、喉旁间隙、声门下有无受累以及喉软骨微浸润的判断。结论16层螺旋CT0．625mm层厚各向同性容积扫描,各种后处理技术的综合应用,在喉癌术前临床评估中具有很高的实用价值,值得推广应用。     

MSCT对胃癌术前TN分期的临床应用价值

目的探讨MSCT检查在胃癌TN分期的临床应用价值。方法回顾性分析我院2011年1月~2014年12月经病理或手术证实的50例胃癌患者的MSCT平扫及双期增强扫描资料,并与术后病理结果对照,评价MSCT在胃癌TN分期的临床应用价值。结果 MSCT胃癌T分期诊断的总体准确率为74%(37/50),其中对T1、T2、T3和T4期判断的特异度分别为75.0%、73.3%、71.4%、80.0%,敏感度分别为75.0%、68.5%、75.0%、80.0%。MSCT胃癌N分期诊断的总体准确率为71.7%(33/46),其中对N0、N1、N2期判断的特异度分别为73.3%、71.4%、70.0%,敏感度分别为73.3%、68.2%、77.8%。结论 MSCT对胃癌术前TN分期的诊断具有较高准确性,可以为临床选择治疗方案、评估预后提供重要的参考价值。     

多层螺旋CT 增强扫描在进展期胃癌诊断的应用分析

目的：探讨多层螺旋CT增强扫描对进展期胃癌 TNM 分期的诊断价值。方法35例经胃镜及病理证实为进展期胃癌患者,进行多层螺旋CT平扫及三期增强扫描,扫描方法采用大螺距,根据胃镜提示的病变部位采用不同的扫描体位。对扫描图像行胃癌的TNM 分期（淋巴细胞短径、长径、CT值、胃癌侵及范围）并与术后病理分期对照,分析多层螺旋CT在诊断进展期胃癌TNM分期的诊断敏感性和特异性。结果35例患者按照上述体位扫描,进展期胃癌的检出率为100％,胃底贲门癌13例,胃体部癌9例,胃窦部胃癌11例,全胃癌2例;T分期与病理分期符合率为73．44％,N分期与病理分期符合率为53．73％,M分期与病理分期符合率为91．32％。结论多层螺旋C T增强扫描在进展期胃癌诊断中及对临床手术指导具有重要价值。     

多层螺旋CT胃癌术前TNM分期

目的 评价多层螺旋CT（MSCT）三期动态增强扫描在胃癌术前TNM分期中的作用，资料与方法 32例胃癌患者均在术前6天内行MSCT扫描，检查前20min饮水1000-1200ml，扫描前10min肌注盐酸山莨菪碱20mg。平扫后行三期动态增强扫描，动脉期开始于注射对比剂后30s,60s后为实质期，2min后为平衡期。32例中16例在同期行腔内超声检查，术前CT检查结果由2名资深放射科医师双盲法进行评定TNM分期，评定时根据需要行MPR重建；腔内超声检查由1位内科和1位外科医师分别完成；MSCT及超声分期结果均与手术后病理结果进行比较。结果 对于T分期，MSCT分期T1-T2者敏感性为75%，准确性为68%，T3-T4者敏感性为98%，准确性为88%；特异性淋巴结N分期N1检出敏感性为60%，准确性为50%，N2-N3敏感性为82%，准确性为78%；远处转移本研究中出现较少，敏感性为75%，准确性为75%；综合评价TNM分期提示准确性为75%，腔内超声检查T分期敏感性为95%，准确性为90%；N分期敏感性为30%，准确性为21%；远处转移几乎无法显示，综合TNM分期准确性仅50%。结论 三期动态增强MSCT薄层扫描可在很大程度上提高微小病变的检出率，可较准确地显示正常胃壁结构及胃癌侵犯胃壁的深度，同时可反映淋巴结转移情况及远处脏器的转移和播散，作出准确的TNM分期。MSCT和超声内镜检查两者相结合可有效地为临床手术方案的选择提供指导。     

MDCT多平面重建技术在胃癌术前T、N分期中的应用

目的:利用16排螺旋CT多平面重建(MPR)后处理技术对胃癌进行术前T、N分期并与病理相对照,确定MPR后处理技术在胃癌术前T、N分期中的作用.方法:经胃镜证实的70例患者,术前采用16排螺旋CT平扫和动脉期、门静脉期双期增强扫描,由两位资深放射科医师对常规5mm层厚横断面图像及重建出的薄层MPR图像中的肿瘤进行定位及T、N分期,并与病理结果对照.结果:常规5mm层厚横断面与MPR图像对胃癌的检出率分别为88.6％和95.7％,其中MPR图像对进展期胃癌的检出率为100％.常规5mm层厚横断面与MPR图像的术前T分期总体准确率分别为60％和74.3％,差异具有显著性意义;两种方法的术前N分期总体准确率分别为78.6％和81.4％,MPR图像术前N分期的敏感性提高至98.1％,特异性降低至72.2％.结论:和常规横断面相比,采用MPR后处理技术能提高病变的检出率,又能提高病变的T、N分期.     

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.     

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.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

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).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

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）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.