MRI特殊序列对梗阻性黄疸定性诊断的价值

目的 探讨MR胆胰管成像( MR cholangiopancreatography,MRCP)和容积式插入法屏气检查(volume imaging body exam,VIBE)序列在梗阻性黄疸中定性诊断的价值.方法 对119例梗阻性黄疸病人的MRCP结合MRI VIBE序列诊断与最终诊断[经皮穿刺胆道造影术(PTC)或内窥镜逆行性胰胆管造影术(ERCP)及手术、病理结果]进行回顾对照分析,评价MRI特殊序列对梗阻性黄疸定性诊断的价值.结果 梗阻性黄疸MRCP和VIBE诊断与最终诊断的定性诊断符合率为94.1%;分类比较符合率为:结石性梗阻100.0%,除结石外良性梗阻83.9%,恶性梗阻94.3%.恶性梗阻组与除外结石良性梗阻组符合率的差异有统计学意义.结论 MRI特殊序列对梗阻性黄疸定性诊断特异性较高.     

MRCP及LAVA联合应用在癌性梗阻性黄疸鉴别诊断中的价值

目的探讨磁共振胰胆管造影（MRCP）联合动态增强扫描（LAVA）对癌性梗阻性黄疸鉴别诊断的价值。方法106例癌性梗阻性黄疸患者行MRI、MRCP和LAVA检查,进行诊断及鉴别诊断,并与病理结果进行对比分析。结果106例癌性梗阻性黄疸中,胆管癌45例,胰头癌22例,胆囊癌18例,壶腹癌12例,十二指肠癌9例。不同来源的肿瘤引起胆管系统的改变及强化方式有一定的差异。本组癌性梗阻性黄疸MRI诊断与手术病理结果符合率约为92．5％。结论MRCP和LAVA的联合应用对癌性梗阻性黄疸的鉴别诊断具有重要价值,其影像学结果对临床治疗决策有指导意义。     

梗阻性黄疸的低场强磁共振胰胆管成像

目的:评价磁共振胰胆管成像对梗阻性黄疸的诊断价值。方法:回顾性分析50例经手术病理及临床证实的胆道梗阻性疾病患者的MRCP及MRI表现。结果:MRCP对胆道梗阻定位诊断符合率为100%,定性诊断符合率为86%。结论:MRCP结合MRI是诊断胆胰管疾病非常有效和准确的方法。     

MRCP联合MRI在胰胆管梗阻性疾病中诊断的价值

目的:探讨MRCP联合MRI对胰胆管梗阻性疾患定位和定性诊断的价值.方法:对2000年9月～2007年9月842例梗阻性黄疸患者的MRCP及MRI的图像进行分析,并与CT、US、直接胆道造影和临床手术病理结果对照.结果:全部病例MRCP 检查均一次成功,其中320例行直接胆道造影,与MRCP 对照,二者所获图像极其相似.MRCP 对梗阻定位诊断准确率为96.79%,MRCP联合MRI可提高到100%;MRI对梗阻定性诊断准确率为89.19%,联合MRCP可提高至97.74%.CT对梗阻的定位、定性诊断率分别为78.61%,77.59%;US对梗阻的定位、定性诊断率分别为89.73%,82.47%.结论:MRCP联合MRI作为无创性检查技术,对胆胰管梗阻性疾病的定位与定性诊断准确率均高于CT及US;可作为胆系梗阻性病变诊断的首选检查.     

The Preoperative Evaluation of Plain MR and Coronal LAVA Technique in Low Level Biliary Obstruction

目的 探讨磁共振平扫[包括磁共振胰胆管造影(MRCP)]及冠状面快速三维容积动态增强(liver acquisition with volume acceleration,LAVA)在低位胆管梗阻诊断中的应用价值.资料与方法 64例低位胆管梗阻患者进行MR平扫、MRCP及冠状面LAVA检查,并将检查结果按三种方法分组:(1)平扫(包括MRCP);(2)冠状面LAVA;(3)MR平扫+冠状面LAVA.对检查结果进行判读与分析,包括病变的定位及定性诊断,并与手术病理、经内镜逆行性胰胆管造影术(ERCP)或经皮肝内胆管造影术(PTC)结果对照,诊断结果进行McNemar检验,数据不足时采用精确概率法.结果 依据最终诊断结果将所有病例分为三组:(1)肿瘤性低位胆管梗阻;(2)除结石外良性低位胆管梗阻;(3)结石性低位胆管梗阻.第一组病例中三种方法的定位诊断符合率无统计学差异,而MR平扫的定性诊断符合率低于冠状面LAVA及MR平扫+冠状面LAVA两种方法(P值分别为0.039,0.021).第二组病例定位及定性诊断符合率无明显统计学差异.第三组冠状面LAVA诊断符合率低于其他两种方法(P=0.031).结论 冠状面LAVA对于肿瘤性低位胆管梗阻的定性诊断具有较大优势,MRCP在胆管梗阻疾病中,简便易行,可用于筛选检查,对于胆管结石的诊断有明显优势.     

MR平扫及冠状面LAVA技术在低位胆管梗阻中的诊断价值

目的探讨磁共振平扫[包括磁共振胰胆管造影(MRCP)]及冠状面快速三维容积动态增强(liver acqui-sition with volume acceleration,LAVA)在低位胆管梗阻诊断中的应用价值。资料与方法 64例低位胆管梗阻患者进行MR平扫、MRCP及冠状面LAVA检查,并将检查结果按三种方法分组:(1)平扫(包括MRCP);(2)冠状面LA-VA;(3)MR平扫+冠状面LAVA。对检查结果进行判读与分析,包括病变的定位及定性诊断,并与手术病理、经内镜逆行性胰胆管造影术(ERCP)或经皮肝内胆管造影术(PTC)结果对照,诊断结果进行McNemar检验,数据不足时采用精确概率法。结果依据最终诊断结果将所有病例分为三组:(1)肿瘤性低位胆管梗阻;(2)除结石外良性低位胆管梗阻;(3)结石性低位胆管梗阻。第一组病例中三种方法的定位诊断符合率无统计学差异,而MR平扫的定性诊断符合率低于冠状面LAVA及MR平扫+冠状面LAVA两种方法(P值分别为0.039,0.021)。第二组病例定位及定性诊断符合率无明显统计学差异。第三组冠状面LAVA诊断符合率低于其他两种方法(P=0.031)。结论冠状面LAVA对于肿瘤性低位胆管梗阻的定性诊断具有较大优势,MRCP在胆管梗阻疾病中,简便易行,可用于筛选检查,对于胆管结石的诊断有明显优势。     

良性梗阻性黄疸的MRCP影像分析

目的　探讨MRCP对良性梗阻性黄疸的临床定性诊断价值。方法　用Philips 1.5T超导型磁共振成像仪对 12 8例良性梗阻性黄疸患者进行常规MRI及MRCP检查。 12 3例经手术或ERCP病理证实 ,5例临床随访证实。结果　MRCP对良性梗阻性黄疸定位诊断准确率 10 0 % ,定性诊断准确率 90 .6%。枯枝征在良性梗阻性黄疸中特异性 10 0 %、准确性 95 .3 %、敏感性 85 .7%。结论　MRCP在良性梗阻性黄疸中的定性诊断中枯枝征可作为一种特异性征象     

MRCP、FIESTA序列和LAVA序列动态增强扫描诊断肝外胆道梗阻的对比研究

目的:评价FSE序列MRCP、FIESTA序列和LAVA动态增强扫描诊断肝外胆道梗阻的临床价值。方法:对50例经超声诊断肝外胆道梗阻的患者,以1.5T HD MR行FSE序列MRCP、FIESTA序列冠状位扫描,并以LAVA序列行冠状动态增强扫描,分别在注射Gd-DTPA后10、30和60s行3期冠状位扫描,将FIESTA序列图像及LAVA序列动态增强图像、MRCP诊断结果与手术病理进行对比。结果:MRCP可以显示梗阻的部位以及可能的病因,但对病变的侵犯范围显示能力有限;FIESTA序列可以显示梗阻的部位、胆管与门静脉的关系,显示胆管结石有较大的价值,但对胆管的肿瘤、胰头部肿瘤显示能力不足;LAVA序列动态增强扫描对恶性肿瘤所致的梗阻有较强的诊断能力,尤其是在诊断肿瘤的侵犯范围方面有较大的临床意义。结论:肝外胆道梗阻的MRI检查可先行FIESTA序列扫描及MRCP扫描,对疑诊断肿瘤的患者可行LAVA序列动态增强扫描。     

磁共振胰胆管造影对梗阻性黄疸诊断价值

目的:探讨研究MRCP对梗阻性黄疸的诊断价值。方法:对43例经手术病理证实的结石、良性狭窄、壶腹癌、胰头癌、胆管癌的梗阻性黄疸患者进行MRCP检查。结果:结石11例,良性狭窄2例,先天性胆总管囊肿1例,壶腹癌5例,胰头癌7例,胆管癌15例,胆囊癌2例。MRCP能清晰地显示正常胰胆管树的结构,能直观显示胰胆管扩张和梗阻的部位、形态、范围,其检出率和定位率为100%,定性诊断率为98%。结论:MRCP对梗阻性黄疸定位、定性诊断准确,特别对结石的诊断,结合原始图像有特异性,能清楚显示梗阻部位、梗阻原因、病变形态、病变与周围关系及病变性质。     

3.0T MR平扫及LAVA技术在恶性低位胆道梗阻术前诊断中的价值

目的 评价3.0T MR平扫[包括磁共振胰胆管成像(MRCP)]及肝脏快速容积采集(LAVA)技术在恶性低位胆道梗阻术前诊断及评估中的价值.资料与方法 将52例经手术与病理证实为恶性低位胆道梗阻患者的MRI资料分为3组:(1)平扫(包括3D MRCP);(2)LAVA;(3)平扫+LAVA.在不知病理结果的情况下对3组资料进行判读与分析,包括病变的定位诊断、定性诊断及手术可切除性预测,并进行统计学检验.结果 MR平扫(3DMRCP)、LAVA、平扫+LAVA 3组对肿瘤的定位诊断准确率分别为96.2%、98.1%、100%;定性诊断准确率分别为71.2%、88.5%、94.2%,第一组与第二组、第三组间P值分别为0.028、0.002,差异有统计学意义,第二组与第三组间P=0.488,差异无统计学意义.3组资料手术可切除性预测的准确率分别为75.0%、90.4%、90.4%,第一组与第二、三组间差异有统计学意义(P=0.038).结论 3D MRCP可准确判断梗阻部位,对于病变的定位诊断具有较大的优势;LAVA技术由于可以提供更多病变的直接征象和强化特征,因此在肿瘤的定性诊断及可切除性评估中具有重要作用.     

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,     

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.     

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.     

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.