CT and MRI Manifestations and Differential Diagnosis of Intraductal Papillary Mucinous Neoplasm in Pancreas

目的 探讨胰腺导管内乳头状黏液性肿瘤的CT及MRI表现特点及鉴别诊断.资料与方法 回顾性分析经手术病理证实的26例胰腺导管内乳头状黏液性肿瘤的CT及MRI表现.结果 主胰管型4例,主要表现为主胰管扩张,其中1例伴胰管内多发结节影且均匀强化;分支胰管型20例,呈单房或多房样囊性病灶,部分有分隔;混合型2例,表现为胰头及钩突囊性肿块影呈多房样改变,轻度强化,并可见主胰管扩张.结论 CT及MRI在胰腺导管内乳头状黏液性肿瘤的诊断及鉴别诊断中具有重要意义.     

肝内胆管乳头状黏液性导管腺癌合并胰腺导管内乳头状黏液性肿瘤1例

导管内乳头状黏液性肿瘤多发生于胰管、胆管内。该文报道了1例肝内胆管乳头状黏液性导管腺癌合并胰腺导管内乳头状黏液性肿瘤。CT和MRI示肝内外胆管弥漫扩张, 肝左外叶扩张胆管内延迟强化小结节, 以及胰腺钩突囊性灶伴主胰管轻度扩张。病理结果为肝左叶胆管乳头状黏液性高-中分化导管腺癌, 胰腺导管内乳头状黏液性肿瘤伴上皮轻度异型。     

胰腺导管内乳头状黏液性肿瘤CT与MRI表现及鉴别诊断

目的探讨胰腺导管内乳头状黏液性肿瘤的CT及MRI表现特点及鉴别诊断。资料与方法回顾性分析经手术病理证实的26例胰腺导管内乳头状黏液性肿瘤的CT及MRI表现。结果主胰管型4例,主要表现为主胰管扩张,其中1例伴胰管内多发结节影且均匀强化;分支胰管型20例,呈单房或多房样囊性病灶,部分有分隔;混合型2例,表现为胰头及钩突囊性肿块影呈多房样改变,轻度强化,并可见主胰管扩张。结论 CT及MRI在胰腺导管内乳头状黏液性肿瘤的诊断及鉴别诊断中具有重要意义。     

胰腺导管内乳头状黏液性肿瘤的MRI诊断

目的 探讨胰腺导管内乳头状黏液性肿瘤的MRI表现特点及诊断价值.资料与方法 回顾性分析经手术病理证实的10例胰腺导管内乳头状黏液性肿瘤的MRI表现.结果 (1)主胰管型3例,分别为导管内乳头状黏液腺癌、腺瘤癌变和腺瘤;MRI表现为主胰管弥漫性扩张,扩张的主胰管内见实性成分的肇结节.(2)6例分支胰管型,除l例为导管内乳头状黏液腺瘤伴不典型增生外,其余均为腺瘤;MRI表现为与主胰管相通的胰腺内囊性病灶,囊性病灶多呈"葡萄"样外观,其内可见索条形分隔及乳头状突起的壁结节.(3)混合型1例,MRI表现为主胰管及分支胰管内乳头状黏液腺瘤.结论 MRI在胰腺导管内乳头状黏液性肿瘤的诊断中具有重要作用.     

胆管乳头状腺瘤的CT和MRI诊断

目的 探讨胆管乳头状腺瘤的CT和MRI影像特点,提高其诊断正确率.方法 回顾性分析10例经手术及病理证实的胆管乳头状腺瘤,10例均行CT平扫和增强扫描,其中8例同时行MR平扫和增强扫描检查,对其影像表现进行研究分析.结果 10例中发生于左侧肝内胆管6例,右侧肝内胆管2例,胆总管2例.CT上6例表现为乳头状、颗粒状或结节状肿块,呈低密度或等密度,增强后5例呈轻、中度强化,1例未见明显强化.4例CT未发现肿瘤占位,仅发现肝内胆管扩张伴胆管壁增厚,增强后胆管壁轻度强化.MRI上4例表现为等或稍长T1、稍长T2信号肿块,MRCP中发现胆管腔内类圆形或不规则形充盈缺损; 2例常规扫描中未见明显肿瘤,仅在MRCP上显示不规则充盈缺损; 2例仅表现为胆管壁增厚和胆管扩张.10例均伴有局限性或广泛性胆管扩张.结论胆管乳头状腺瘤CT、MRI表现具有一定特征性,可以做到术前正确诊断.     

胆管导管内乳头状黏液性肿瘤的影像表现和形态分型

目的 探讨胆管导管内乳头状黏液性肿瘤(IPMN-B)的CT、MRI特征及其形态分型.方法 回顾性分析经病理证实的IPMN-B患者18例,16例行CT平扫+增强扫描,13例行MR增强扫描,其中11例同时行CT和MR检查.观察分析其影像和病理表现,结合影像及病理表现将IPMN-B分为典型IPMN-B、囊性IPMN-B、无肿块型IPMN-B和侵袭性IPMN-B共4种类型,确定其分型.结果 典型IPMN-B 9例,表现为沿胆管壁的肿瘤灶,肿瘤上游、下游胆管均明显且广泛扩张.囊性IPMN-B5例,胆管呈动脉瘤样扩张,内可见单发或多发瘤灶.无肿块型IPMN-B 2例,胆管呈广泛明显扩张,未见明确肿瘤病灶,胆管壁光滑.侵袭性IPMN-B 2例,病灶所在节段胆管扩张,肿瘤突向胆管腔内使胆管壁呈锯齿状,伴随胆管外异常密度或信号灶.18例均有胆管扩张,其中16例可见扩张胆管内肿瘤病灶,2例未见明确瘤体显示,仅表现为胆管扩张.CT扫描可见肿瘤密度低于肝实质,并高于胆汁和胆管内黏液.MR T2WI可见肿瘤信号高于结石,并低于胆汁和黏液.DWI肿瘤均表现为高信号.增强扫描肿瘤呈轻中度强化,三期增强扫描可见肿瘤的密度或信号均低于肝实质.结论 IPMN-B的CT和MRI表现具有一定特征性并有助于分型.     

胰管内乳头状黏液性肿瘤的CT表现与临床、病理对照

目的 探讨胰管内乳又状黏液性肿瘤的CT特点，并与临床、病理对照，提高该病的诊断正确率。方法 回顾性分析经手术病理证实的8例胰管内乳头状黏液性肿瘤的CT表现，其中男6例，女2例，平均54岁。术前8例均行CT平扫及增强检查，5例行内镜逆行胰胆管造影（ERCP）检查，8例患者亦进行了B超检查，1例行MR检查。结果 CT检查发现胰头部囊实性混合肿块6例，胰头颈体部低密度肿块1例，胰腺体积增大1例，肿块最大径5．6～9．5cm不等，增强后表现为不均匀强化，6例肿块边界尚清晰，1例病灶与胃后壁紧密粘连。8例均有不同程度的胰管扩张，无一例出现远处转移。5例ERCP检查，发现十二指肠乳头增大和黏液溢出者3例，胰头体部胰管中断1例，4例全程胰管扩张。结论 胰腺导管内乳头状黏液性肿瘤的CT表现有一定的特点；CT结合ERCP有助于该病的诊断和指导治疗。     

胰管内乳头状黏液性肿瘤的影像学诊断

目的探讨胰管内乳头状黏液性肿瘤影像学诊断的价值、特征，以及临床特点。方法搜集36例手术证明的胰管内乳头状黏液性肿瘤患者，所有患者术前都接受了CT、MR平扫和增强检查。回顾性分析主胰管型（8例）和分支型（28例）肿瘤的临床特点和影像学表现。结果（1）主胰管型肿瘤的影像表现：主胰管扩张管径〉9mm，呈弥漫或节段性扩张，可伴有壁结节，增强后壁结节不同程度强化；MR胰胆管成像（MRCP）主胰管呈中～重度扩张，其中4例胰管内有扁平状和（或）乳头状的充盈缺损，2例近端胰管明显扩张。（2）分支型肿瘤的影像学表现：肿瘤胰头钩突部多见，呈单房或多房囊状肿瘤，可伴有分隔、壁结节，伴有主胰管扩张；MRCP显示24例内有分隔，15例内有充盈缺损的壁结节，同时清楚地显示19例分支型肿瘤和主胰管之间的交通，以及8例不同程度扩张的主胰管。结论术前正确地诊断胰管内乳头状黏液性肿瘤对手术方式的选择极为重要。MRCP是1种无创、有效地发现和诊断胰管内乳头状黏液性肿瘤的方法。     

胰腺导管内乳头状黏液性肿瘤的CT诊断

目的:探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的螺旋CT诊断价值。材料和方法:回顾性分析经手术病理证实的14例胰腺IPMN的螺旋CT表现。结果:主胰管型IPMN3例,表现为主胰管扩张伴管壁结节样突起;分支胰管型IPMN5例,表现为分叶状单发囊性病变或葡萄串样多发囊性病变伴腔内分隔或结节样突起;混合型IPMN6例,表现为主胰管扩张和囊性病变合并存在。CT诊断IPMN恶变6例,病理诊断导管内乳头状黏液腺癌7例。结论:螺旋CT能够显示胰腺IPMN的病理特征,并可做出分型。     

胰胆管十二指肠连接区小肿瘤的MRI表现

目的：探讨胰胆管十二指肠连接区（ PDDU）小肿瘤的MRI表现特点,进一步提高MRI诊断的准确性。方法对连接区22例经病理证实的小肿瘤MRI图像资料进行分析。结果MRI诊断PDDU小肿瘤22例（胰头癌11例,壶腹癌5例,胆总管下端癌4例,乳头绒毛管状腺癌以及导管内乳突状粘液瘤各1例）,主要表现为软组织肿块,十二指肠腔内充盈缺损,胆总管下段狭窄和肝内外胆管、胰管、胆总管扩张。结论 MRI能清晰显示PDDU小肿瘤的直接及间接征象并具有一定的特征性,是一种优良的无创伤性检查方法。     

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.     

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.     

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).     

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.