经皮骶髂螺钉内固定治疗骶髂关节脱位

目的 分析经皮骶髂螺钉内固定治疗骶髂关节脱位的临床疗效.方法 对2002年6月-2006年8月16例骶髂关节脱位患者的临床资料进行回顾性分析,其中男10例,女6例;年龄10～58岁,平均34.3岁.所有患者均在C形臂X线机监测下经皮骶髂螺钉内固定.结果 手术时间为30～90 min,平均50.5 min.术后行骨盆正位、侧位、人口位、出口位X线片和CT扫描,螺钉均位于S1、S2椎体内.16例均获得12～36个月(平均18.3个月)随访.14例骨折复位良好,无切口感染,无术中血管神经损伤,无内固定松动及断裂,腰骶及下肢活动、感觉均正常.结论 经皮骶髂螺钉内固定治疗骶髂关节脱位具有固定可靠、手术创伤小、并发症少、有利于患者康复等优点,是治疗骶髂关节脱位的一种安全、有效的治疗方法.术中需行骨盆正位、侧位、人口位和出口位的透视以保证螺钉置人的准确性.     

T_2~*-mapping用于青年志愿者骶髂关节软骨成像的初步研究

目的通过优化扫描参数及后处理技术,定量分析正常骶髂关节(SIJ)软骨T2*弛豫时间值,探讨磁共振T2*-mapping成像用于青年健康志愿者SIJ软骨研究的可行性,为下一步AS患者SIJ软骨T2*-mapping研究奠定基础。方法采用3.0T超导磁共振扫描仪,随机选取2013年12月~2014年3月期间青年健康志愿者30名,对其行5回波GRE序列双侧SIJ斜冠状面扫描,运用T2*图测量30例骶侧软骨平均T2*弛豫时间值,并进行统计学分析。结果 30名青年健康志愿者骶侧软骨T2*弛豫时间值平均为(17.15±3.26)ms。30名正常青年健康志愿者中,15名男性和15名女性骶侧软骨T2*弛豫时间值分别约为(18.66±3.17)ms和(15.65±2.62)ms,差异有统计学意义(t=4.005,P0.05)。30名正常青年健康志愿者中,左侧和右侧骶侧软骨T2*弛豫时间值分别约为(17.26±3.51)ms和(17.05±3.04)ms,差异没有统计学意义(t=0.516,P0.05)。结论 T2*-mapping成像可用于测量正常青年人SIJ骶侧软骨的T2*值,可为临床骶髂关节炎(SIS)疾病的诊断和研究提供参考。由于SIJ髂侧面软骨太薄,T2*-mapping成像应用于SIJ髂侧面软骨研究仍面临挑战。     

Assessment of resectability of pancreatic cancer with dynamic contrast-enhanced MR imaging: technique, surgical correlation and patient outcome

The aim of our work was to investigate the use of a dynamic contrast-enhanced MR (DCEMR) technique for staging apparently localised pancreatic cancer, and to determine the patterns of tumour and vascular enhancement with this technique. Thirty-five consecutive patients were examined. The MR findings were correlated with surgical findings in 13 patients and with clinical outcome in 22 patients. Breath-hold gradient-echo fast low angle shot (TR = 100, TE = 4, flip angle 80 °) acquisitions were obtained at 10 and 40 s (right anterior coronal oblique plane) and at 90 s (axial plane) following intravenous gadolinium. Mean contrast-to-noise ratio was higher on the first than the second acquisition (p < 0.001) and higher on the second acquisition than the third (p < 0.005). Tumour conspicuity was greatest and arterial anatomy was best demonstrated on the first acquisition and the portal venous anatomy on the second. Small tumours were isointense by the third acquisition. Maximal intensity projections were helpful. The MR findings correctly predicted the surgical findings in 11 of 13 cases (85 %) and the clinical course in the other 22 patients. The DCEMR imaging technique is valuable in the staging of patients with pancreatic cancer. Capillary and portal venous phase images are both required for complete local staging. Received 5 November 1996; Revision received 24 March 1997; Accepted 21 April 1997     

核素骨显像对骶髂关节、髋关节及 脊柱关节病的诊断

目的 建立国人骶髂关节／软组织、骶髂关节／骶骨、髋关节／软组织、髋关节／股骨放射性比值的正常参考值,探讨其在脊柱关节病（ＳｐＡ）中的诊断价值,方法 对无腰腿症状、ＣＴ检查骶髂关节正常的不同年龄者１３０例２６０组关节分为４组：１５～１９岁、～２４岁,～３９岁,≥４０岁,进行全身骨骼及骶髂关节、髋关节周围结构的ＳＰＥＣＴ显像,取得４组不同部位放射性比值,同时对临床诊断为ＳｐＡ的４５例患者进行骨显像,计     

CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks.     

Non-contrast MR imaging of the glenohumeral joint. Part I. Normal anatomy

MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved.     

改良髋关节磁共振成像扫描方法在发现骶髂关节病变中的应用价值

目的：通过对髋关节磁共振成像（MRI）冠状位扫描的改良,从而发现骶髂关节病变,弥补临床医生判断失误,提高疾病的检出率。方法对265例申请髋关节MRI检查的患者增加冠状位扫描层数,使每例患者双侧骶髂关节均能大部分显示。结果发现骶髂关节病变的共计20例,发现率为7．5％,年龄11-65岁,其中强直性脊柱炎16例,退行性骨关节炎2例,骶髂关节结核1例,外伤导致骨挫伤1例。结论骶髂关节病变,尤其是强直性脊柱炎是一种以危害年轻人为主的慢性炎性疾病,起病隐匿,临床部分患者以髋关节为主述症状,引起误诊,MRI在检查髋关节时适当在冠状位上增加扫描层数,能发现7．5％的遗漏病变,方法简便易行,值得推广。     

正常胃的MRI表现与扫描技术

目的：研究正常胃的MRI表现和扫描技术。方法：在胃不同充盈状态下，采用单次屏气快速扫描序列，共进行72人次MRI平扫和7次增强检查，分析正常胃的MRI表现和图像质量。结果：按充盈程度不同，胃壁形态可分为扩张不良，适度扩张、充分扩张3型表现。MRI能较好显示胃及其与邻近器官的关系。胃壁厚度平均值在适度扩张下为2．7mm，在充分扩张下为2.4.T2WI图像均无运动伪影，79％的T1WI图像在使用解痉剂后无运动伪影。结论：采用单次屏气快速扫描序列，MRI能获得满意的胃部图像，较好显示胃及其与邻近解剖关系。     

Contrast media in MR arthrography of the glenohumeral joint: intra-articular gadopentetate vs saline: preliminary results

The purpose of this investigation was to compare gadopentetate and saline as contrast media in MR arthrograms of the glenohumeral joint. In 60 consecutive patients MR arthrograms with either gadopentetate (n = 26) or saline (n = 34) were performed. After injection of gadopentate, 3D gradient-echo (GE) images were obtained (TR 32 ms, TE 10 ms, flip angle 40 °). With saline, double-echo steady-state images (heavily T2-weighted 3D GE images) were obtained (TR 40 ms, TE 9/45 ms, flip angle 40 °). In the last 14 of these patients T2-weighted turbo spin-echo (SE) images were added (TR 2900 ms, TE 96 ms). Contrast-to-noise ratios standardized for imaging times proved to be superior for the gadolinium arthrograms compared with GE and SE saline arthrograms (intra-articular fluid vs subacromial fat: p = 0.0001 and 0.0008; intra-articular fluid vs supraspinatus tendon: p = 0.0001 and 0.046). Using a qualitative scoring system gadolinium arthrograms were superior to saline arthrograms (p < 0.0001 and p < 0.0001). Saline arthrograms in combination with GE and SE sequences are inferior to gadopentetate arthrograms with GE sequences. Received 24 May 1996; Accepted 30 August 1996     

Transarticular invasion of bone tumours across the sacroiliac joint

Purpose The purpose of this study was to evaluate the pattern of tumour spread across the SI articulation, correlating with cadaveric anatomic observations, in order to better understand the local spread of tumour and to assist in the assessment of local staging. Material and methods Twenty-four consecutive patients (14 male, 10 female; age range 22–89 years, mean 52 years) with primary bone tumours of the iliac bone or sacrum abutting the SI joint, in whom surgical resection of the SI joint was performed, were studied following institutional ethics approval. In all patients, preoperative magnetic resonance (MR) imaging studies of the pelvis and SI joint were reviewed for imaging evidence of transarticular extension across the SI joint. Gross pathologic and histologic assessment of possible transarticular SI joint tumour extension was performed in all patients. Nine cadaveric pelvic specimens without pelvic neoplastic disease (4 male, 5 female; age range 20–84 years, mean 59 years, median 58 years) were anatomically dissected and the articular anatomy of the SI joint examined macroscopically. Results Twelve of the twenty-four patients demonstrated imaging and histological evidence of transarticular SI joint invasion. Eight tumours infiltrated only the interosseous ligamentous aspect of the SI joint. In the remaining four cases, extensive tumour infiltrated both the cartilaginous and ligamentous aspects of the joint. No case showed tumour involvement isolated to the cartilaginous aspect of the joint. Among the cadaveric specimens studied, degenerative changes were found involving the majority of cases (6/9), with cartilage thinning and fibrillation and antero-superior marginal osteophytes seen involving the cartilaginous portion of the SI joint articulation. Four of the nine specimens demonstrated central ossification bridging the iliac and sacral aspects of the ligamentous (interosseous) SI joint. Conclusion Tumour invasion across the SI articulation favours its interosseous ligamentous portion. Factors influencing transarticular tumour extension and its preferential course across the interosseous component of the articulation have been discussed. It is particularly important to assess the interosseous ligamentous portion of the SI articulation when locally staging primary pelvic bone tumours subjacent to the SI articulation, as this will have a significant impact on planning surgical management.     

磁共振DWI联合DCE序列诊断早期强直性脊柱炎骶髂关节改变

目的：探讨磁共振 DWI 联合 DCE-MRI 诊断早期强直性脊柱炎的临床应用价值。方法：回顾性搜集48例临床早期活动性强直性脊柱炎患者影像资料,分析其 DWI 及 DCE 序列图像,分别测量骶侧髂侧关节面下骨髓的 ADC 值,并与21例健康志愿者的资料进行对比分析,计算增强因子 Fenh、增强斜率 Senh 和达峰时间 Tmax,并与正常组对照,绘制病例组时间-信号曲线（TIC）,对 ADC 值与 Fenh、Senh 值之间关系进行统计学分析。结果：病例组髂骨侧关节面下骨髓区 ADC 平均值为（5．05±1．10）×10－4 mm2／s,骶骨侧为（4．63±0．79）×10－4 mm2／s,均较对照组增高;病例组骨髓区Fenh、Senh 高于对照组,Tmax 低于正常值;病例组 TIC 表现为Ⅱ型,Ⅲ型;病变区 ADC 值与 Fenh 值之间呈高度直线相关关系（P ＜0．05）,相关系数 r＝0．705。结论：磁共振 DWI 及 DCE-MRI 对早期 AS 患者骶髂关节骨髓异常改变显示敏感;病变区 ADC 值与 Fenh 值相结合,增强了早期诊断本病的信心,提供了影像诊断的新思路。     

强直性脊柱炎骶髂关节病变的CT诊断

目的：探讨CT对强直性脊柱炎（AS）患骶髂关节病变的早期诊断价值。方法：收集33例AS患的临床及CT资料进行分析。 参考相关献将骶髂关节病变分为：0、Ⅰ、Ⅱ、Ⅲ级。结果：33例AS患的64个骶髂关节受累，其中双侧受累31例，单侧2例。2个骶髂关节表现正常为0级；19个关节表现为轻度受侵破坏，关节面模糊，骨质疏松定为I级；22个关节表现为明显破坏，关节面呈锯齿状或串珠状参差不齐或皮质中断，关节面下可见囊状吸收区，周围骨硬化，关节间隙假性增宽定为Ⅱ级；23个关节表现为关节强直，关节间隙变窄，可见骨小梁通过关节，严重关节呈骨性融合定为Ⅲ级.结论：根据骶髂关节的CT表现，结合临床资料，可准确诊断早期AS。     

正常成人骶髂关节ADC值测量研究

目的:探讨健康成人骶髂关节的DWI特征,测量b值=500s/mm2时骶髂关节ADC值范围,为进一步研究DWI在骶髂关节病变中的应用提供依据。方法:应用Siemens Avanto 1.5T MRI扫描仪对100例随机选取的健康成人志愿者共200个骶髂关节行常规序列及DWI序列扫描。分别测量双侧骶骨面、髂骨面ROI的ADC值,比较同一b值不同部位ADC值的差异。按年龄分为3组(≤30岁;31~50岁;≥51岁),比较不同年龄组骶骨及髂骨ADC值的差异。结果:在b值=500s/mm2时,髂骨和骶骨的ADC值分别为(311.95±55.32)mm2/s、(362.64±72.16)mm2/s;成像条件相同时,骶骨的ADC值大于髂骨的ADC值,差异有统计学意义。不同年龄组骶骨、髂骨ADC值比较,差异有统计学意义。结论:本研究得到了1.5T MRI正常人骶髂关节的ADC值范围,为DWI在骶髂关节相关疾病的研究提供了一定的参考价值。     

正常骶髂关节软骨MRI成像分析

目的 探讨MRI显示正常骶髂关节软骨的最佳序列.方法 收集40例健康志愿者80侧骶髂关节软骨MRI扫描资料,其中男28例,女12例,年龄18~45岁,平均为29.36岁.均使用Philips Intera Achieva 1.5T 双梯度扫描仪,扫描序列包括轴位T1WI、T2WI、STIR、3D-WATS及斜冠状位T2WI.由2名资深医生对每侧骶髂关节软骨在不同序列显示情况进行分组评价,分为清晰、基本清晰、不清晰3组,统计处理各组间显示率差异.结果 40例健康志愿者80侧骶髂关节软骨在T1WI、T2WI、STIR、3D-WATS序列均可不同程度的显示,其中清晰组在各个序列的显示率为18.75%、0.00%、8.75%、93.75%,其中3D-WATS与T1WI、T2WI、STIR序列比较P＜0.05;T1WI、T2WI、STIR序列各组间比较P＞0.05.结论 3D-WATS序列是显示骶髂关节软骨的最佳序列.     

强直性脊柱炎骶髂关节病变早期的CT特征研究

目的：研究强直性脊柱炎（AS）骶髂关节病变早期的CT特征。方法：对23例AS患骶髂关节病变的CT征象进行了分析。结果：23例AS患中，骶髂关节双侧受累18例，单侧受累5例；14例为早期病变的CT表现，其中4例为可疑病变，10例CT表现为骨皮质限局性硬化， 关节面模糊不清或斑点状脱钙，软骨下微小囊变，这些表现多见于骶髂关节中下部髂骨面，关节间隙基本保持正常或略增宽。结论：CT能清晰地显示早期AS骶髂关节病变并作出早期诊断。     

骶髂关节角度扫描与轴位扫描技术的比较

目的：评价骶髂关节角度CT检查技术的优势。方法：选择45例骶髂关节,全部采用轴位、角度扫描两种方法检查,对两种扫描方法及其显示效果进行对照分析。结果：只需要轴位扫描一半的层面,角度扫描就可以完整地显示骶髂关节纵断面及其邻近解剖结构,图像更为直观。两种技术显示异常征象的信息量（病灶大小、形态、数量）基本无差别。结论：角度CT扫描技术可以成为骶髂关节CT检查的首选方法。     

强直性脊柱炎骶髂关节MRI及临床应用研究

目的 研究强直性脊柱炎（ankylosing spondylitis，AS）骶髂关节MRI表现及其临床应用价值。方法 收集符合1984年修订的纽约标准的强直性脊柱炎患者23例，男19例，女4例，行双侧骶髂关节MR平扫及增强扫描。均采用SE、短时反转恢复（STIR）序列。同时收集患者的临床症状、体征、化验指标与MRI对比分析。结果 23例患者，骨髓水肿11例，骨质侵蚀16例，脂肪沉积20例。骨髓水肿组、骨质侵蚀组、脂肪沉积组分别与无相应表现组在血沉（ESR）、血小板计数（PLTC）、Bath强直性脊柱炎疾病活动指数（BASDAI评分）、患者的整体评估方面差异有显著意义，P值均小于0.05。骨髓水肿组与无骨髓水肿组的骨质破坏差异有显著性。结论 MRI能够显示强直性脊柱炎的早期病理改变，并且MRI表现在评价疾病预后方面有一定临床价值。     

强直性骶髂关节炎的42例CT诊断

目的：回顾性分析强直性脊柱炎的骶髂关节CT表现及诊断价值。方法：分析42例临床诊断为强直性脊柱炎的骶髂关节的CT征象,进行分级,并与临床分期对照。结果：临床早期CT级表现骶髂关节的面呈对称性或不对称受累,关节面毛糙。皮质白线消失．骨关节面皮质中断．关节面下小囊变。临床中期CT级,表现为骶髂关节面局呈锯齿状或毛刷状改变．关节面下小囊状骨质破坏及其周围增生硬化。关节间隙假性增宽或不规则狭窄,关节间隙内含气征。晚期CT级为临床稳定期,可见韧带钙化,关节骨性强直和关节间隙消失。明显骨质疏松,为临床稳定期。结论：CT能够清晰显示骶髂关节的细微结构．作出正确的分级诊断,为临床分级提供依据。