^31P磁共振波谱回顾及其在肝脏等脏器中的临床应用

常规方法检测肝脏ATP需要大量组织标本，在同一批动物或人体的重复检测是不可能的，并且不能监测早期或可逆性细胞损伤中的轻微新陈代谢变化。^31P MILS是活体检测高能磷酸盐的唯一手段。无机磷(H)与磷酸单酯(PME)比率(细胞生存和代谢的标志)以及各种ATP可以重复定量检测。在细胞死亡和随后的器官病变之前，利用^31P MRS，可检测到早期轻微能量变化引起的β-ATP明显减少，Pi／β-ATP比率减少以及PME／β-ATP比率的显著升高。在正常肝脏的波谱中，含磷总量的PME波峰为4．77％(可信区间CI：4．11～5．42)，在轻度肝硬化[5．80％(95％CI：5．46～6．14)，P=0．0051，对正常肝]和重度肝硬化[9．64％(95％CI：8．71～10．57)，P=0．0002，对正常肝和P=0．001，对轻度肝硬化]明显升高_2_2。在对所有原发或继发肿瘤患者的研究中，PME／PDE比率是增加的，作者认为^31P MRS是检测肝脏疾病进展和治疗效果的有效方法。     

31P-MRS在评估肝硬化及其分级中的价值

目的 探讨31P-磁共振波谱(MRS)无创评估肝硬化及其分级的价值.资料与方法 分别对53例肝硬化患者及28名正常对照组进行单体素31P-MRS扫描,计算肝细胞内pH值(pHi)、磷酸单酯(PME)、磷酸双酯(PDE)、无机磷(Pi)、磷酸肌酸(PCr)、γ-ATP、β-ATP、α-ATP、PME/ATP、Pi/ATP、PCr/ATP、PME/PDE、PME/Pi、PDE/Pi、PDE/ATP比值和低能磷酸盐(LEP)等代谢指标.探讨以上各参数在肝硬化及其Child-Pugh分级中的异同.结果 在肝硬化组,PME、PME/ATP、PME/PDE及PME/Pi均大于正常对照组(P<0.05);而Pi则相反(P=0.023;t=2.340).肝硬化Child-Push分级A、B、C级的PME分别为424.23±127.74、468.32±156.10、497.52±169.84,Pi分别为418.02±108.29、353.80±98.81、302.11±74.37,PME/Pi分别为1.03±0.45、1.41±0.59、1.82±0.62,均存在统计学意义(P值分别为0.047、0.038、0.042;F值分别为3.425、4.489、3.811),而其他代谢物在肝硬化及其分级中差异无统计学意义(P>0.05).结论 肝硬化时PME相关参数明显升高,PME、Pi和PME/Pi可对肝硬化的程度进行评估.     

Gd-DTPA增强对于肝脏及肝脏疾病31P-MRS代谢参数的影响

目的 探讨Gd-DTPA增强对于肝脏及肝脏疾病31P-MRS代谢参数的影响.方法 分别对肝内良、恶性病变(分别为31例和54例)及肝硬化和正常肝脏(分别为34例和21例)进行单体素31P-MRS扫描.计算肝细胞内pH值(pHi)、磷酸单脂(PME)、磷酸双脂(PDE)、无机磷(Pi)、γ-ATP、β-ATP、α-ATP、PME/ATP、Pi/ATP、PME/PDE、PME/Pi、PDE/Pi、PDE/ATP和低能磷酸盐(LEP)等参数.分析Gd-DTPA增强前、后肝内病变的显示情况,以及以上代谢物参数的差异.结果 Gd-DTPA增强前在体线圈定位图像上,肝癌、转移瘤和胆管癌显示欠佳或其边界欠清者分别占该病总数的47.8%(11/23)、13.6%(3/22)和66.7%(6/9);增强后则分别为13.0%(3/23)、4.5%(1/22)和22.2%(2/9);增强前肝脓肿、海绵状血管瘤、局灶性结节增生及腺瘤显示欠佳或其边界欠清的分别占该病总数的11.1%(1/9)、29.4%(5/17)、80%(4/5),增强后分别为0%(0/9)、5.9%(1/17)、0%(0/5).在增强前和增强后,正常肝脏,肝硬化,肝脏良、恶性病变的31P-MRS各代谢物参数均未见统计学差异(P>0.05).结论 Gd-DTPA增强技术可增加31P-MRS定位的准确性,钆对比剂不影响肝脏及其疾病代谢物检测的准确性.     

31P MR波谱成像在肝脏的初步临床应用研究

目的探讨31P MRS成像技术在肝脏的初步临床应用。方法对5例健康志愿者、5例乙型肝炎肝功能正常病例、5例慢性活动性肝炎肝硬化、5例原发性肝细胞癌病例行常规MR扫描、31P MRS成像。采用GE公司波谱分析软件(spectroscopy analysisGE)校正,并计算细胞内pH值,分析各峰峰值及各比值变化特征。结果正常组5例中4例肝脏31P波谱提供的6种代谢物峰从左至右为:磷酸单脂(PME)、无机磷(P i)、磷酸二脂(PDE)、三磷酸腺苷(γ-ATP、α-ATP、β-ATP)6种。其中1例出现7种峰,多出一种因受腹壁肌肉影响产生的磷酸肌酸(PCr)峰。轻度肝炎组,PME轻度升高,PDE轻度减低,PME/PDE值较正常组略高。慢活肝-肝硬化组6个共振峰中仅PME明显升高。原发性肝细胞癌病例中,PME均明显增高,细胞内pH值呈碱性。结论31PMRS对检测肝脏代谢变化具有重要价值。     

~(31)P MR波谱在犬顿抑心肌实验中的应用

目的　评价 3 1PMRS在犬顿抑心肌研究中的应用价值。方法　 10条健康杂种犬开胸阻断左冠状动脉前降支 2 0min后 ,解除阻断予以再灌注 ,分别在术前、术后 2、4、6、8h ,1、2、3、12d不同时间点进行心肌3 1PMRS的动态检测。结果　正常对照组结果显示 ,心肌组织磷酸肌酸 /β -三磷酸腺苷 (PCr/β -ATP)和无机磷酸盐 /磷酸肌酸 (Pi/PCr)的比值分别是 1.70± 0 .6 1与 0 .2 0± 0 .0 8,pH值为 7.19± 0 .2 0。顿抑心肌再灌注后 2h ,PCr/β -ATP和 pH值下降 (Ρ <0 .0 5 ) ,Pi/PCr比值提高 (Ρ <0 .0 1) ;PCr/β -ATP在再灌注后 4h时接近正常 ,之后无明显差异 ;而Pi/PCr比值上升持续到再灌注后第 3d ,在第 12d恢复至正常水平。pH值在再灌注后 6～ 8h逐渐恢复正常。结论　心肌缺血再灌注后 ,Pi/PCr比值的变化能较早且准确地反映心肌的代谢状态 ,为临床早期诊断顿抑心肌提供了一种无创性连续观测的新方法。     

~(31)P MR波谱在扩张性心肌病的临床应用

目的　对扩张性心肌病(DCM)进行MRI和31PMR波谱(31PMRS)研究,观察DCM的形态学改变和心肌细胞能量代谢特点。方法　8例健康志愿者为正常对照组,5例DCM病人作为检测组,进行心脏MRI扫描和31PMRS测定。结果　DCM病人的心肌普遍变薄,左心室射血分数下降,平均为33%;心肌细胞磷酸肌酸/三磷酸腺苷(PCr/ATP)和pH值下降,无机磷/磷酸肌酸(Pi/PCr)上升。结论　DCM的心肌代谢异常与心衰程度相关;MRI和31PMRS能够对DCM的形态学和心肌能量代谢作出初步诊断。     

肝脏CT灌注成像技术及其在肝硬化中的初步应用

目的　采用单层CT动态成像测定肝脏血流量 ,探讨CT灌注成像测定肝血流量的技术原理。资料与方法　 15例经临床及实验室、B超检查诊断为肝硬化患者 ,其中ChildB级者 10例 ,ChildC级者 5例。对照组为 13例无肝脏疾病者。所有患者均选取同时含有肝脏、脾脏、主动脉和门静脉的层面进行单层CT动态增强扫描 ,绘制感兴趣区时间 密度曲线计算肝脏血流量各参数。结果　正常组肝动脉灌注量 (HAP)为 0 .2 82 3± 0 .0 96 9ml·min-1·ml-1,门静脉灌注量 (PVP)为 (1.1788± 0 .4 0 0 4 )ml·min-1·ml-1,总肝血流量 (THBF)为 (1.4 5 6 3± 0 .4 4 39)ml·min-1·ml-1,肝动脉灌注指数 (HPI)为 (19.73± 5 .81) %。肝硬化时PVP为 (0 .6 12 1± 0 .2 5 4 4 )ml·min-1·ml-1,较正常组降低 ;THBF也减低 ,为 (0 .84 2 6± 0 .32 4 2 )ml·min-1·ml-1。肝硬化患者的HPI较正常组略有升高 ,为 (2 7.16±12 .75 ) % ,但无统计学差异 (P =0 .0 6 5 )。结论　肝脏CT灌注成像可定量测定肝脏血流量参数     

3.0T31P-MRS对骨与软组织肿瘤的诊断价值

目的 探讨超高场31P-MRS对骨与软组织肿瘤的成像特点.方法 对病理证实的骨与软组织肿瘤41例用磷表面线圈进行31P-MRS分析,测量波谱中各代谢产物的峰下面积,分别以三磷酸腺苷β峰(β-ATP)、三磷酸核苷(NTP)、磷酸肌酸(Pcr)为参照计算各代谢产物的相对比值,根据无机磷(Pi)相对于Pcr化学位移的变化计算细胞内pH值,进行相对定量分析.根据峰下面积计算各代谢产物与β-ATP、三磷酸核苷(NTP=ATP+Pi+Pcr)、Pcr的相对值PME/β-ATP、PDE/β-ATP、β-ATP/Pi、PME/NTP、PDE/NTP、Pcr/Pi及Pcr/PME.并运用SPSS11.5 for Windows软件包进行统计学处理,采用多个独立样本的非参数检验.结果 良、恶性肿瘤组的Pcr/PME、PME/NTP较对照组均有显著性差异(P<0.05).良、恶性肿瘤组PME/β-ATP、PME/NTP的差异有显著性意义(P<0.05).与正常组比较,良、恶性肿瘤组的PME和PDE及Pi峰升高,Pcr峰降低.结论 31P-MRS测得的Pcr/PME、PME/NTP与骨、软组织肿瘤相关,PME/β-ATP、PME/NTP在骨与软组织肿瘤的诊断和鉴别诊断中发挥重要的作用.     

慢性实验性帕金森病模型猴多巴胺转运蛋白显像研究

目的　探讨多巴胺系统功能显像对帕金森病 (PD)的诊断价值。方法　对 5只正常猴及 6只经颈动脉注射 1 甲基 4 苯基 1,2 ,3,6 四氢吡啶 (MPTP) 30个月的PD模型猴进行99Tcm 2 β [N ,N′ 双 (2 巯乙基 )乙撑二胺基 ]甲基 ,3β (4 氯苯基 )托烷 (TRODAT 1)SPECT显像 ,经图像处理 ,计算正常及PD模型猴纹状体特异摄取比值 (SURs)。结果　正常猴纹状体在 30 ,6 0 ,12 0 ,15 0 ,180及 2 4 0minSURs分别为 0 5 4 9,0 792 ,0 84 8,0 96 5 ,0 96 9和 0 96 4 ;MPTP模型猴 3h双侧纹状体比值 [健侧 (左侧 ,L) 损毁侧 (右侧 ,R) (L R) =1 32 8± 0 30 8]明显高于对照猴 (L R =1 0 16± 0 0 12 ,t=9 87,P <0 0 5 ) ;损毁侧纹状体 枕叶摄取比值为 0 385± 0 32 6 ,明显低于对侧 (0 795± 0 4 2 6 )及对照猴 (R :0 790± 0 2 4 4 ,L :0 819± 0 2 4 9;t分别为 8 5 6 ,9 4 2和 8 93,P均 <0 0 5 )。结论　99Tcm TRODAT 1SPECT脑显像能反映PD模型猴脑多巴胺能突触前功能的变化。     

CT灌注成像对肝硬化血流动力学的临床研究

目的　采用单层CT动态成像测定肝脏血流量 ,研究肝硬化程度与肝脏血流量动态变化的关系。方法　对 2 7例肝硬化患者及 13例对照者选取同时含有肝脏、脾脏、主动脉和门静脉的层面进行单层CT动态增强扫描 ,绘制感兴趣区时间 密度曲线 ,计算肝脏血流量各参数。结果　正常组肝动脉灌注量为 (0 2 82 3± 0 0 96 9)ml·min-1·ml-1,门静脉灌注量为 (1 1788± 0 4 0 0 4 )ml·min-1·ml-1,总肝血流量为 (1 4 5 6 3± 0 4 4 39)ml·min-1·ml-1,肝动脉灌注指数为 (19 73± 5 81) %。肝硬化程度不同时 ,肝动脉灌注量、门静脉灌注量、肝脏总血流量及肝动脉灌注指数变化间差异存在显著性意义。ChildA、B级患者肝动脉灌注量 [(0 16 85± 0 10 6 8)ml·min-1·ml-1,(0 192 1± 0 0 986 )ml·min-1·ml-1]降低 ,而ChildC级患者肝动脉灌注量 [(0 30 72± 0 114 5 )ml·min-1·ml-1]比ChildA、B级患者增加 ,肝动脉灌注指数 [(37 4 8± 16 6 5 ) % ]也增加。ChildB、C级患者门静脉灌注量 [(0 6 331± 0 2 0 70 )ml·min-1·ml-1,(0 5 70 2± 0 35 6 2 )ml·min-1·ml-1]及总肝血流量 [(0 82 5 2± 0 2 95 2 )ml·min-1·ml-1,(0 8774± 0 4 118)ml·min-1·ml-1]下降。结论　肝脏CT灌注成像可定量测     

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).     

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     

改进的定位技术在胸部肿瘤穿刺活检中的应用

目的：探索CT-SIM三维定位系统、体模固定技术和PET-CT融合影像导引定位技术在胸部肿瘤经皮穿刺活检中的应用价值。方法：对380例胸部肿瘤患者行改进的CT定位技术下的经皮穿刺活检术。根据肿瘤的大小、深度、毗邻关系、活动度以及患者的心肺功能状态,综合运用CT-SIM系统、体模固定技术和PET-CT融合影像导引技术,为患者进行穿刺前定位。统计穿刺定位时间长度、成功率、确诊率、并发症发生情况,并与210例采用传统铅栅定位下胸部肿瘤穿刺活检的相应资料进行比较。结果：采用改进的CT定位技术的380例患者穿刺定位精确,平均定位时间（9.5 min）较传统方法（16.8 min）缩短7.3 min,活检成功率和确诊率分别是98.7%和95.3%,高于传统定位方法的93.3%和83.3%,两者差异均具有统计学意义（P〈0.05）。穿刺并发症发生率相似,气胸发生率分别为2.8%和2.9%,咯血发生率分别为11%和12.8%。结论：根据患者状态及肿瘤特点,在CT-SIM系统快速精确定位技术的基础上,综合运用体模固定技术和PET-CT融合影像导引技术,能显著缩短经皮穿刺活检的定位时间,提高活检成功率。