能谱CT碘浓度鉴别肾透明细胞癌病理Fuhrman分级

目的 评价应用能谱CT的能谱曲线及碘浓度值鉴别肾透明细胞癌(ccRCC)病理Fuhrman级别的可行性.方法 回顾性分析62例经病理证实的ccRCC 64个病灶的常规CT表现及增强皮髓质期(CMP)能谱CT表现,能谱CT主要参数包括能谱曲线斜率、标准化能谱曲线、碘浓度及标准化碘浓度(NIC),其中Fuhrman分级低级别(Ⅰ～Ⅱ级)35例,病灶37个,高级别(Ⅲ～Ⅳ级)27例,病灶27个,依据不同病理Fuhrman级别对肿物常规CT表现及能谱CT各参数进行统计学分析,并应用受试者工作特征曲线(ROC)和二项Logistic回归分析评价单独使用能谱CT或联合常规CT特征鉴别高级别和低级别ccRCC的能力. 结果 CMP高级别ccRCC的碘浓度值和NIC值显著低于低级别ccRCC(碘浓度36.57±9.62 mg/ml和49.65±11.42 mg/ml,P＜0.001;NIC 0.61 ±0.13和0.92±0.16,P＜0.001).碘浓度和NIC诊断高级别ccRCC ROC曲线下面积分别为0.811、0.935.最佳阈值、敏感度和特异度分别为:碘浓度0.811 mg/ml、81.1％、77.8％;NIC 0.745、86.5％、92.6％.采用二项Logistic回归分析,肿瘤大小(P=0.011)和肾周脂肪浸润(P =0.002)等常规CT影像学特征能作为鉴别高级别ccRCC的独立危险因素,将NIC列入Logistic回归模型可显著提高诊断高级别ccRCC的准确率(P =0.001).结论 高级别ccRCC的碘浓度值和NIC值显著低于低级别ccRCC,结合常规CT表现,可以提高鉴别高级别和低级别ccRCC的准确率,有助于治疗方案的选择和制定.     

宝石能谱CT能谱参数与透明细胞肾癌分化程度的相关性分析

目的 探讨能谱CT能谱分析对判断透明细胞肾癌分化程度的价值.方法 回顾性分析23例经手术病理或穿刺活检病理证实透明细胞肾癌的能谱参数,包括碘含量、标准碘浓度、能谱曲线斜率.所有病例分为两组：A组与B组.A组,即高分化组,包括核分级Ⅰ级及Ⅱ级;B组,即中低分化及未分化组,包括核分级Ⅲ级及Ⅳ级.其中A组13例,B组10例.结果 两组之间皮质期及实质期的标准化碘浓度、皮质期与实质期碘含量、标准化碘浓度的差值之间的差异具有统计学意义;两组之间的各期碘含量及能谱曲线斜率的差异不具有统计学意义.结论 宝石能谱CT能谱分析可初步判断透明细胞肾癌的分化程度.     

CT能谱成像与MR扩散加权成像评价肾透明细胞癌病理分级的价值比较

目的比较能谱CT与MR扩散加权成像(DWI)评价肾透明细胞癌病理学分级的能力。方法 26例经手术及病理证实的肾透明细胞癌患者,根据病理学分级分为低级别组和高级别组各13例,术前均行能谱CT和MR-DWI检查,比较两组间各能谱CT参数及表观扩散系数(ADC)的差异,绘制受试者工作特征曲线(ROC),根据相应阈值进行诊断试验,通过一致性分析评价诊断效能。结果两组ADC值分别为(1.93±0.23)×10~(-3)mm~2/s、(1.63±0.32)×10~(-3)mm~2/s,两者差异有统计学意义(P0.05)。两组病变肾脏实质期的标准化碘浓度分别为(0.85±0.17)、(0.62±0.17),能谱曲线斜率分别为(4.25±1.15)、(2.87±0.94),差异有统计学意义(P均0.05)。标准化碘浓度、能谱曲线斜率及ADC值的ROC曲线下面积分别为0.82、0.82、0.75,一致性检验结果诊断效能Kappa值分别为0.61、0.53、0.46。结论在评估肾透明细胞癌的病理学分级方面,能谱CT成像优于MR-DWI。     

肾透明细胞癌CT征象与病理Fuhrman分级相关性研究

目的探讨肾脏透明细胞癌CT特征与Fuhrman病理分级的相关性。方法选择肾脏透明细胞癌患者60例,根据病理分级分为低级别组(Ⅰ级+Ⅱ级)46例和高级别组(Ⅲ级+Ⅳ级)14例,分析肿瘤CT影像学特征与病理核分级的相关性。结果低级别组与高级别组肿瘤比较,CT值在平扫、皮质期、髓质期及排泄期无统计学差异(P0.05)。高级别肾癌组肿瘤长径大于低级别肾癌组,易于坏死,且假包膜不完整,静脉癌栓和肿瘤累及肾盂的发生率高于低等级肾癌组(P0.05)。低级别组与高级别组包膜最厚处、包膜最薄处、包膜厚度差均没有统计学差异性(P0.05)。结论肾脏透明细胞癌各期CT值与Fuhrman核分级无关联,但假包膜特征,静脉癌栓和累及肾盂与核分级有密切关联,可用于临床治疗方案及预后。     

双能CT单期扫描碘值测量对直径≤3cm的肾脏透明细胞癌和血管平滑肌脂肪瘤的鉴别诊断价值

目的探讨双能CT单期扫描(皮髓交界期或实质期)碘值测量对直径≤3 cm的肾脏透明细胞癌(clearcell renal cell carcinoma,ccRCC)和血管平滑肌脂肪瘤(angiomyolipoma,AML)的鉴别诊断价值。方法对2010年10月至2011年10月间经手术病理证实的23例直径≤3 cm的ccRCC和14例AML患者资料进行回顾性分析,通过双能量后处理软件Liver-VNC对实质期图像进行处理,测量感兴趣区(region of interest,ROI)的碘值,包括病灶、邻近肾皮质和同层面腹主动脉,定义标准化碘值(NIC)为病灶内碘值/腹主动脉碘值,病灶-肾实质碘值比(LNR)为病灶碘值/肾实质碘值。对两组肿瘤患者的性别采用卡方检验,应用独立样本t检验对两组肿瘤患者的年龄、病灶的大小、NIC值和LNR值进行分析,同时应用受试者工作特征(ROC)曲线评价NIC值和LNR值的诊断性能。结果两组肿瘤的大小差异无统计学意义,而年龄和性别均有统计学意义,ccRCC组的平均年龄为56.3岁(32～73岁),AML组的平均年龄为47.7岁(34～58岁)(P=0.046);ccRCC多见于男性(男∶女为3.6∶1),而AML多见于女性(男∶女为1∶13)(P<0.001);ccRCC的NIC值和LNR值均较AML高,两者间差异有显著统计学意义(P<0.001)。皮髓交界期NIC值和LNR值的ROC曲线下面积(AUC)分别为0.995、0.937,诊断准确性分别为97%、86.7%;实质期NIC值和LNR值的ROCAUC分别为0.970、0.957,诊断准确性分别为97%、90.9%。结论双能CT单期扫描(皮髓交界期或实质期)碘值测量可以较准确地鉴别直径≤3 cm的ccRCC和AML,从而降低辐射剂量。     

螺旋CT对肾细胞癌亚型的鉴别诊断价值

目的:探讨CT动态增强扫描对肾细胞癌病理亚型的鉴别诊断价值。方法:87例经手术病理证实的肾细胞癌患者,包括50例透明细胞癌、17例乳头状癌、8例嫌色细胞癌和2例集合管癌,术前行CT平扫和双期动态增强扫描(肾皮髓期和肾实质期),测量肿瘤、腹主动脉及邻近正常肾实质的CT值,并计算肿瘤与主动脉、肾实质的强化比值,同时评价肿瘤的强化方式,对不同病理亚型肿瘤的各项指标进行统计学分析。结果:透明细胞癌在皮髓期和实质期增强扫描时肿瘤与主动脉、肾实质的强化比值均高于乳头状癌和嫌色细胞癌(P<0.01),而乳头状癌和嫌色细胞癌间差异均无统计学意义(P>0.05)。不均匀强化常见于透明细胞癌(92%)、乳头状癌(82.4%)和集合管癌(100%);而均匀强化常见于嫌色细胞癌(62.5%),其与透明细胞癌(P=0.010)和乳头状癌(P=0.017)间差异有显著性意义。结论:CT增强扫描时分析肿瘤与主动脉和肾实质的强化比值及强化的均匀度对肾癌病理亚型的鉴别诊断有重要价值。     

肾细胞癌多层螺旋CT多期扫描:评价皮髓交界早期和皮髓交界期的价值

目的 探讨肾细胞癌多层螺旋CT皮髓交界双期扫描的影像学特征和各自诊断价值。资料与方法 经手术病理证实的肾细胞癌31例,术前均经多层螺旋CT平扫、皮髓交界早期、皮髓交界期和实质期扫描,注射对比剂1．5～2．0ml／kg体重,流率为5ml/s。仔细复习CT扫描结果并和手术病理作回顾性对照分析。结果 31例均为单个肾细胞癌。21个病灶皮髓交界早期强化最为显著,6个病灶皮髓交界期强化最为显著,4个病灶实质期强化最显著;三期扫描强化不均匀依次为23、12和7例。平扫＋皮髓交界早期发现29个病灶,定性诊断26个;平扫＋皮髓交界期发现25个病灶,诊断21个;平扫＋皮髓交界早期＋实质期发现30个病灶,诊断28个;平扫＋皮髓交界期＋实质期发现30个病灶,诊断23个。结论 与皮髓交界期相比,皮髓交界早期可以发现更多的病灶,显示肾细胞癌更多的恶性征象,因而定性价值更高。我们建议采用平扫＋皮髓交界早期＋实质期扫描取代传统平扫＋皮髓交界期＋实质期扫描,而平扫＋皮髓交界早期＋皮髓交界期＋实质期扫描更能充分显示肾细胞癌的血液动力学。     

能谱CT碘定量分析对不同亚型肾细胞癌的鉴别诊断

目的评价应用能谱CT碘定量多参数分析鉴别肾细胞癌(RCC)常见亚型的可行性。方法回顾性分析行能谱CT检查并经病理证实的102例单肾单发RCC病人的影像和病理资料,其中肾透明细胞癌(ccRCC)75例,非ccRCC 27例[肾嫌色细胞癌(cRCC)15例,乳头状肾癌(pRCC)12例]。所有病人行平扫及双期动态增强扫描,测量并计算肿瘤最大径、绝对强化CT值、相对强化CT值、碘浓度值及标准化碘浓度(NIC)值。对每个病灶进行TNM分期和Fuhrman分级。采用卡方检验或Fisher确切概率法比较不同亚型RCC的病理分期分级;独立样本t检验比较肿瘤最大径及其他碘定量参数。采用受试者操作特征(ROC)曲线评价各参数值的诊断效能,计算诊断参数的曲线下面积(AUC)、敏感度、特异度。结果 ccRCC与非ccRCC、cRCC与pRCC间病理学表现差异均无统计学意义(P0.05)。ccRCC的绝对强化CT值、相对强化CT值、碘浓度值、NIC值均高于非ccRCC(P0.05),pRCC的绝对强化CT值、相对强化CT值、碘浓度值、NIC值均高于cRCC(P0.05)。NIC值为0.35时,鉴别ccRCC和非ccRCC的AUC为0.992,敏感度和特异度分别为98.67%、92.59%。NIC值为0.17时,鉴别c RCC和pRCC的AUC为0.978,敏感度和特异度分别为93.33%、91.67%。结论根据能谱CT碘定量参数可以鉴别ccRCC与非ccRCC、cRCC与pRCC,NIC值有助于鉴别不同RCC亚型。     

基于CT肾实质期肾周纹理特征预测肾透明细胞癌分级

目的 探讨基于CT肾实质期肾周纹理特征术前预测低级别(Fuhrman I/Ⅱ)和高级别(Fuhrman Ⅲ/IV)肾透明细胞癌(cc RCC)的有效性。方法 选取病理证实为cc RCC患者118例。从肾实质期的CT图像中提取肾周纹理的组学特征。用组间和组内相关系数(ICC)、特征间线性相关检查和F检验作为特征筛选方式,最终保留13个特征用于模型构建。通过绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)来评估模型的预测能力。结果 训练组和验证组的AUC分别为0.893和0.828。训练组的敏感性和特异性为75.0%和87.9%,对应的验证组的敏感性及特异性分别为71.4%和79.3%。结论 CT肾实质期肾周纹理特征是一种无创性的术前评估cc RCC的Fuhrman分级方法,可以为临床治疗决策提供有利的信息。     

CT能谱成像评价肾透明细胞癌核分级

目的：采用CT能谱成像术前评估肾透明细胞癌核分级,以评估术前肾透明细胞癌的恶性程度,指导手术治疗。资料与方法回顾性分析经手术病理证实的40例肾透明细胞癌肿块的能谱特征,所有患者术前均采用64层CT能谱的能谱扫描模式进行扫描,获得动脉期和髓质期的能谱系列图像。比较不同分级肾透明细胞癌的能谱特征参数及能谱曲线,并与病理结果进行对照。结果40例患者中,I、II、III级分别有13例、15例、12例。肾透明血细胞癌I、II、III级动脉期70 keV CT值比值分别为1.17±0.25、0.84±0.85、0.64±0.19（F=23.697, P<0.05）,髓质期分别为0.83±0.12、0.64±0.07、0.54±0.08（F=30.975, P<0.05）;动脉期碘浓度比值分别为1.19±0.40、0.60±0.10、0.25±0.94（F=32.932, P<0.05）,髓质期分别为0.69±0.18、0.43±0.94、0.26±0.51（F=28.673, P<0.05）。肾透明血细胞癌I、II、III级动脉期能谱曲线斜率分别为4.00±1.24、2.16±0.95、0.92±0.64（F=23.392, P<0.05）,髓质期分别为3.54±1.20、2.70±0.71、1.20±0.44（F=24.272, P<0.05）。各级肾透明细胞癌间动脉期和髓质期水浓度差异均无统计学意义（P>0.05）。结论 CT能谱成像扫描参数单能量CT值、能谱曲线斜率、碘基值在肾透明细胞癌不同核分级间有显著差异,有望为术前治疗方案的选择提供依据。     

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.