肾脏体积与性别和年龄及体重参数的关系分析

目的：探讨肾脏体积与性别、年龄及体重参数的关系,确定正常成人肾脏体积CT测量的参考范围。方法：连续选取160例无肾病,无服用肾脏损害药物史,无高血压和糖尿病病史者的腹部CT资料,分为20～40岁、4l～60岁、6l～80岁3个年龄组,采用阈值法对320个肾脏体积进行测量。统计学分析肾脏体积与年龄及体重参数的相关性,各年龄组、性别及左右间的差异有无显著性意义。结果：160例全肾、右肾和左肾的平均体积分别为（325.871±46.211）ml、（159.793±24.221）ml和（166.078±24.734）ml,男、女全肾平均体积分别为（340.232±47.604）ml和（306.933±36.795）ml;肾脏体积与各体重参数有一定的相关性,其中相关性最强的指标是肾脏体积与体表面积的相关性（r=0.676）;3个年龄组间肾脏体积均数的差异有显著性意义（F=7.234,P〈0.01）男女性别间肾脏体积的差异有显著性意义（P〈0.01）;左、右肾体积的差异有显著性意义（P〈0.01）。结论：体表面积可以作为临床粗略估计肾体积大小时的参考指标。     

SPECT/CT直接测量肾脏深度在肾小球滤过率测定中的应用

目的 探讨在以SPECT/CT测定GFR时用CT直接测量肾脏深度代替传统的Tonnesen公式法的必要性和可行性.方法 49例患者在接受肾动态显像的同时进行腹部CT平扫,测量两侧肾的深度.将所测值与传统的Tonnesen公式值和SPECT侧位平面图像测量值进行比较,然后将CT和SPECT测得的肾脏深度数据代入到Gates法GFR测量软件中,观察肾脏深度改变对GFR测定值的影响.采用配对t检验对Tonnesen公式法和SPECT测量法测得的肾脏深度值及各自深度值对应的GFR与CT法测得的相关数据间差异进行比较,对Tonnesen公式误差、SPECT测量误差与肾脏深度的关系采用直线相关分析.结果 CT测得的肾脏深度分别为右肾(7.04±1.15) cm,左肾(7.18±1.15) cm.与CT测量值相比,Tonnesen公式法低估了肾脏深度[右肾:(5.77±0.90) cm,t=- 11.50,P＜0.01;左肾:(5.74±0.88) cm,t=12.20,P＜0.01],而SPECT测量值则高估了肾脏深度[右肾:(7.40±1.15) cm,t=5.19,P＜0.01;左肾:(7.49±1.19) cm,=5.14,P＜0.01].Tonnesen公式法误差与肾脏深度呈正相关(右肾:r =0.62,P＜0.01;左肾:r=0.73,P＜0.01),而SPECT测量误差与肾脏深度不相关(右肾r =0.26,P＞0.05;左肾r=0.38,P＜0.01).Tonnesen公式法得到的两侧肾脏深度差为0.03 ～0.05 cm,而SPECT和CT得到两侧肾脏深度差分别为0.54±0.33(0.01～1.28) cm和0.62±0.45(0.01～1.60) cm.Gates法采用Tonnesen公式肾脏深度低估了GFR,与CT所测肾脏深度对应的GFR相比,误差百分比分别为右肾(-20.92±11.28)％(t=-6.99,P＜0.01),左肾(-23.71±7.71)％(t=-8.73,P＜0.01);采用SPECT测量则高估了GFR,对应误差百分比为右肾(5.23±9.64)％(t=2.72,P＜0.01),左肾(8.93±9.29)％(=5.21,P＜0.01).结论 采用SPECT/CT的CT功能精确测量两侧肾脏深度,有助于提高Gates法GFR测定的准确性.     

不同检查者间应用三维超声测量成人肾脏体积的重复性研究

目的探讨不同检查者间应用三维超声测量成人肾脏体积的重复性。资料与方法通过三维超声获得31名健康成人的肾脏图像,2名检查者通过图像软件手动描记得出肾脏体积,比较2名检查者所获得肾脏体积的范围、平均值和标准差,比较两者间的相关性,评估其测量的一致性。结果 2名检查者测量左、右肾脏体积的相关性均较好(r=0.976,95%CI 0.950~0.988;r=0.991,95%CI 0.981~0.996);两者测量左、右肾体积的一致性较好(ICC=0.924、0.991);Bland-Altman分析显示,两者测量左、右三维肾脏体积的平均差值分别为(-3.08±7.27)ml和(0.31±6.32)ml,左、右肾体积一致性95%CI分别为-17.61~11.45和-12.33~12.95。结论三维超声测量肾脏体积的检查者间的重复性较好,可作为临床测量肾脏体积的优选方法。     

Tonnesen公式计算肾脏深度的准确性与BMI的关系

目的 探讨Tonnesen公式计算肾脏深度的准确性与BMI的关系.方法 利用单纯随机抽样法抽取接受99Tcm-DTPA肾动态显像以测定GFR的患者123例,按照Tonnesen公式计算肾脏深度.计算BMI(kg/m2),并根据WHO对亚洲成人的体质量标准分组:偏瘦组(BMI＜ 18.50),正常组(18.50≤BMI＜ 22.99),超重组(22.99≤BMI＜ 27.50)和肥胖组(BMI≥27.50).行肾脏局部CT扫描,并测量肾脏深度.利用配对t检验,分析在不同BMI范围内CT测量肾脏深度与Tonnesen公式计算结果间的差异.结果 123例患者中,只有30例BMI正常的患者CT测量肾脏深度与Tonnesen公式计算值[CT左肾:(5.20 ±0.29) cm,公式左肾:(5.06±0.29) cm,=1.88,P＞0.05;CT右肾:(5.22±0.28) cm,公式右肾:(5.09±0.29) cm,t=1.69,P＞0.05]间差异无统计学意义.其他各组CT实测肾脏深度与公式计算值间差异均有统计学意义.偏瘦组29例,肾脏深度:CT左肾为(5.38±0.58) cm,公式左肾为(4.43 ±0.26) cm,=9.82,P＜0.001;CT右肾为(5.32±0.32) cm,公式右肾为(4.43±0.47) cm,t=6.58,P＜0.001.超重组34例,肾脏深度:CT左肾为(7.40±0.94) cm,公式左肾为(6.10 ±0.34) cm,=7.89,P＜0.001;CT右肾为(7.30 ±0.88) cm,公式右肾为(6.10±0.35) cm,t =7.41,P＜0.001.肥胖组30例,肾脏深度:CT左肾为(8.06±1.14) cm,公式左肾为(7.28 ±0.55) cm,=4.18,P＜0.001;CT右肾为(8.11±1.07) cm,公式右肾为(7.18±0.58) cm,t =4.76,P＜0.001.结论 BMI在正常范围者,Tonnesen公式计算肾脏深度的准确性较好;不在此范围者用Tonnesen公式计算准确性降低,可借助CT图像测量肾脏深度.     

多层螺旋CT测量肝体积在活体肝移植中的应用

目的 评价多层螺旋CT测量肝体积在活体肝移植的应用价值.方法 亲体肝移植供体和受体各18例接受了多层螺旋CT扫描,所有病例联合应用阈值法和层切法测量受体的全肝、供体的右半肝和左半肝叶体积,测量结果与术中实际肝体积进行对比.结果 多层螺旋CT测量的受体平均肝脏体积为1232.4 cm3 ,术中平均肝脏体积为1220.1 cm3;多层螺旋CT测量供体肝左叶及右叶平均体积分别为392.9 cm3、836.59 cm3,术中肝左叶及肝右叶平均体积分别为389.9 cm3、832.84 cm3 2种方法测量结果差异无统计学意义(P>0.05).结论 MSCT可以准确评价肝体积,为活体肝移植术前提供重要依据.     

Cine-MRI测量健康成年人肾脏运动幅度

目的 通过电影磁共振成像(Cine-MRI)技术观察健康成年人平静规律呼吸状态下双肾运动幅度.资料与方法 选取57名健康成年志愿者(男28名,女29名),于平静规律呼吸状态下进行与双肾长轴平行的斜冠状面Cine-MRI检查,测量一次完整呼吸过程中双肾下极运动幅度,比较双侧肾脏及不同性别间肾脏运动幅度的差异.结果 Cine-MRI测得健康成年人平静规律呼吸状态下右肾运动幅度为5.6～16.5 mm,平均(9.5±2.1) mm;左肾运动幅度为4.5～13.9 mm,平均(8.1±2.0) mm;双侧肾脏运动幅度比较,差异有统计学意义(t=9.30,P＜0.05);男性左、右侧肾脏运动幅度分别为(8.7±2.0) mm和(10.3±2.2) mm,均大于女性对应侧肾脏运动幅度[分别为(7.5±1.8) mm和(8.8±1.7) mm],差异有统计学意义(t=2.82、4.41,P＜0.05).结论 平静规律呼吸状态下斜冠状面上右肾运动幅度大于左肾,在进行功能磁共振成像时宜选用左肾数据作为参照标准,尤其是当受检者为男性时.     

MR血氧水平依赖成像评价兔肾缺血再灌注损伤的实验研究

目的 探讨MR血氧水平依赖成像(blood oxygen level-dependent,BOLD)对兔肾缺血再灌注损伤(IRI)的诊断价值.方法 健康新西兰大白兔30只,完全随机分成IR 1 ～3组,建立左肾缺血再灌注模型,3组左肾动脉夹闭时间分别为40、60、80 min,夹闭后松开动脉夹均再灌注48 h.分别于IRI前后行双肾MR冠状位%wI及BOLD扫描,检查完成后立即取左肾行病理学检查.分别测量双肾肾皮质(cortex,C)层、外髓(outer medulla,OM)层的R2*值,再将左肾与右肾相同区域的R2*值做比值(rR2*),并计算IRI前后左右肾rR2*的差值(△rR2*).IRI前后IR1～3组每组组内兔肾C层和OM层△rR2*比较采用配对样本t检验;IR 1～3组C层和OM层△rR2*组间两两比较采用LSD检验.结果 肾IRI后,IR 1 ～3组OM层△rR2*分别为0.27 ±0.04、0.47 ±0.01、0.49±0.01.IR 2、3组OM层△rR2*明显高于IR 1组(P＜0.01),而IR 2组OM层△rR2*与IR 3组差异无统计学意义(P＞0.05);IR 1～3组C层△rR2*分别为0.12±0.02、0.10 ±0.02、0.11±0.03,组间两两比较差异均无统计学意义(P＞0.05).3组OM层△rR2*均高于C层(P＜0.05).结论 肾脏缺血时间越长,再灌注后损伤越重;肾脏缺血时间超过60 min后,肾脏IRI的程度已经达到最大程度.BOLD通过无创地检测肾脏外髓质血氧水平,能间接地反映肾脏IRI随缺血时间变化的趋势特点,有助于肾脏IRI的检出.     

MSCT肝脏体积测量研究

目的 评价MSCT测量肝脏体积(LV)各种方法的优劣及在肝移植中的应用价值.资料与方法 对18例肝移植受体术前行MSCT多期扫描.用手动法及半自动法测量LV,与术后即刻水测法所得LV进行相关分析、单因素方差分析及Bland-Altman检测,并分别记录两种方法测量LV所需时间.结果 手动法所测LV为(1369.8±186.7) cm3,半自动法所测体积为(1416.3±192.1) cm3,实际体积为(1383.1±196.1) cm3;术前CT手动法、半自动法测量体积与术后实际体积均有明显的相关性(r分别为0.969、0.978,P＜0.05);各方法所测体积与实际体积差异无明显统计学意义(F=0.016<0.05,P=0.985>0.05);手动法所测LV数值更接近实际体积,但平均时间为(24.5±5.7) min,较半自动法(9.6±1.8) min长.结论 MSCT半自动法LV测量减少了放射科医师的工作量,是一种较好的测量肝脏体积的方法.     

多层螺旋CT在正常成人活体肾的影像解剖研究

目的通过测量正常活体肾的各径线值和位置,获得正常成人活体肾的影像解剖数据,为临床、科研及教学提供依据。方法 157例非肾脏疾病患者(男101例,女56例,年龄22～77岁,平均44.18岁)其中55例为肾移植供体,均经SIEMENS16层螺旋CT腹部平扫与增强后动脉期和静脉期扫描检查。对源像应用MPR、MIP及VR后处理。测量项目包括肾脏的长径、宽径、厚度以及肾动脉的直径等。为了比较男、女间和左侧与右侧之间的差异,对所获数据应用SPSS13.0软件包统计分析。结果左肾的长径、宽径及厚度分别为102.51±10.05 mm、54.13±5.87 mm、49.16±5.12 mm,右肾的长径、宽径及厚度分别为99.95±12.80 mm、50.50±4.68 mm、46.51±5.2 mm,两者比较有统计学意义(P<0.05)。男性的双肾长径、宽径及厚度均大于女性的(P<0.01)。左侧肾动脉直径为5.39±0.74 mm,右侧肾动脉直径为5.24±0.69 mm,二者比较有统计学差异(t=3.557,P<0.0001)。男性的双侧肾动脉直径均大于女性的(P<0.01)。结论多层螺旋CT后处理功能强大,图像三维立体感强,能够明确肾脏与周围组织的解剖关系,可作为活体肾解剖测量的有用方法。     

3.0 T血氧水平依赖功能MRI技术对注入碘对比剂后肾脏损害评价的实验研究

目的 探讨3.0 T血氧水平依赖功能MRI(fMRI-BOLD)技术在碘对比剂大鼠肾脏损害评价中的应用价值.方法 29只SD大鼠分别于注入碘对比剂前、注入碘对比剂碘普胺后20 min、24 h、48 h、72 h不同时间点进行常规MR序列及BOLD序列扫描;注入碘对比剂前作为对照组.BOLD序列扫描图像在工作站处理后,测量大鼠肾脏皮质、外髓及内髓的T2*值,计算表观自旋-自旋弛豫率(R2*值)(R2*值=1/T2 *值).对照组大鼠双肾不同部位R2*值的比较采用方差分析,对照组和实验组不同时间、不同部位右肾和左肾R2*值的比较采用t检验.结果 对照组大鼠左、右肾脏外髓R2*值[分别为(31.76±2.73)/s和(32.77±3.07)/s]均高于相应皮质[分别为(30.20±3.48)/s和(28.84±3.11)/s]及内髓[分别为(29.54±2.42)/s和(28.37±2.80)/s],F值分别为3.357和14.961,P值均＜0.05.左肾和右肾内髓、外髓和皮质的R2*值差异均无统计学意义(P值均＞0.05).注入碘对比剂后不同时间点,以外髓R2*值变化明显.在注射对比剂20 min时,肾脏外髓R2*值最高[右肾和左肾分别为(44.58±3.13)/s和(43.57±3.84)/s],24 h后R2*值逐渐降低[右肾和左肾分别为(42.89±3.40)/s和(42.07±4.82)/s].内髓及皮质R2*值仅表现为轻微改变.结论 R2*值能反映出大鼠肾脏皮、髓质氧分压的变化,判断髓质缺血缺氧程度.BOLD成像技术能反映肾脏皮髓质氧代谢情况,评估肾脏损害程度,是一种简单、可行及重复性较好的方法.     

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.     

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.     

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）