功能性便秘患儿24例基础治疗疗效分析

目的了解基础治疗在功能性便秘中的作用。方法24例功能性便秘患儿在给予乳果糖糖浆治疗10天的基础上加以基础治疗6个月,包括合理饮食、足量饮水、排便习惯的训练、增加活动量以及心理治疗等。记录第1个月和第6个月的相关临床症状,根据Bleijenberg便秘评分标准对症状进行评分,积分进行比较。结果第1个月和第6个月的便秘临床评分积分分别为8.25±2.23和7.00±1.78,明显低于治疗前便秘临床评分积分12.50±1.69,且第6个月的便秘临床评分积分也低于第1个月。结论基础治疗安全有效、操作简便且疗效持久,可以从根本上治疗和预防功能性便秘。     

Contrast-enhanced thoracic 3D-MR angiography in infants and children

Purpose: To optimise breath-hold contrast-enhanced MR angiography (MRA) in infants and children with suspected congenital heart or thoracic vessel malformation.Material and Methods: Thirty-nine children (median age 1 year) were examined, using five different ultrafast MRA sequences with a TR between 3.2 and 5.0 ms and the contrast agent meglumine gadoterate. A test injection was used to determine contrast travel time. Different parameters for contrast injection were evaluated. Signal-to-noise ratio (SNR) measurements were performed and image quality and injection timing were evaluated.Results: MRA was successful in all patients and image quality was considered very good in 52%. Adequate SNR was achieved with no significant differences between the MR sequences. SNR decreased only 25-30% between subsequent scans. The mean contrast dose was 0.23 mmol/kg. The mean scan time was 12.5±3.8 s; the shorter scan times made dynamic examinations possible with high temporal resolution. Highest spatial resolution was obtained with TR 4.6/5.0 sequences.Conclusion: A contrast dose of 0.2 mmol/kg b.w. is recommended with an injection rate of 0.5 to 1.2 ml/s, depending on patient size and scan time. The scan delay time should equal the contrast travel time for optimal vessel enhancement. In the future, contrast-enhanced MRA may be a potential alternative to angiocardiography in infants and children.     

Ultrasound elastography and contrast-enhanced ultrasound in infants,children and adolescents

Objective

To describe prerequisites, use, and safety of ultrasound elastography and contrast-enhanced ultrasound in infants, children, and adolescents.

Method

This review deals with two latest developments in ultrasonography in children. The principle of strain elastography, transient elastography, and acoustic radiation force imaging is discussed, including limitations, and advantages of the different techniques in diagnosing focal and diffuse organ disease. The intravesical (contrast-enhanced voiding ultrasonography) and intravascular use of contrast-media to outline blood, and urinary flow is described, with special emphasis on indications, off-label use, and diagnostic gain. Examples of indications for performing the advanced ultrasound techniques are presented.

Summary and conclusion

Latest developments in ultrasound machine engineering, and the availability of contrast-media that interact with ultrasound waves allow for assessment of tissue stiffness/elasticity properties, blood, and urinary flow. Thereby ultrasound is capable not only to depict morphology, but gives the additional information on organ, and focal lesion perfusion, and urinary flow dynamics. The information gap to other cross-sectional techniques such as magnetic resonance imaging, that make potential harmful sedation, and anaesthesia in the youngest children necessary, thereby gets closer.     

Medium dose chloral hydrate for sedation of infants and children undergoing CT

The use of chloral hydrate for paediatric sedation before CT was studied systematically in a limited scale and mainly retrospectively. Chloral hydrate in a dose of 50–75 mg/kg (maximum dose 2 g) was administered per os or per rectum to 378 children for 400 CT examinations. All absolute and relative contraindications had been taken into account. A total of 360 CT examinations (90%) were free of motion artifacts, due to successful sedation. A total of 28 examinations (7%) were less optimal, but still diagnostic, so repetition was unnecessary. A total of 12 examinations (3%) had to be repeated with IV anaesthesia. Adverse reactions that occurred were vomiting in 30 examinations (7.5%), diarrhoea in 4 (1.0%), hyperactivity in 2 (0.5%) and respiratory symptoms in 1 (0.3%). Prolonged sedation (> 2 h) was noted in 71 of 245 children (29.0%). No side effect with simultaneous oral or IV contrast agent was observed. Correspondence to: M. K. Zarifi     

MR排粪造影在女性出口梗阻型便秘研究中的应用价值

目的 利用MR排粪造影研究女性出口梗阻型便秘的肛、直肠形态及功能性病变,同时对前、中盆腔联合性病变进行全面评价.方法 107例临床诊断为出口梗阻型便秘的女性患者,年龄20～84岁,平均55岁,进行MR排粪造影检查,使用自行设计高顺应性球囊模拟大便,分别测量静息、提肛及力排时盆底相关数据.结果 107例出口梗阻型便秘患者中,70例直肠前膨出(65.4%),为女性出口型便秘常见梗阻因素;85例(79.4%)患者为2种及2种以上的联合性病变,并发前、中盆腔病变,包括60例膀胱脱垂(56.1%)、59例子宫或阴道穹窿脱垂(55.1%)、54例会阴体下降(50.5%)、28例盆底疝(26.2%).结论 MR排粪造影不仅能准确评价出口梗阻型便秘女性患者的肛、直肠形态及功能性病变,同时能对前、中盆腔联合性病变进行全面评价.     

Role of MRI in paediatric musculoskeletal conditions

The aim of this review is to discuss the indications and use of MR imaging (MRI) in the paediatric musculoskeletal system. After briefly reviewing basic technical considerations the MRI appearance of the most relevant congenital, inflammatory, infectious, ischemic, and posttraumatic skeletal conditions, as well as benign and malignant bone and soft tissue tumours that are typical for the paediatric age group will be presented.     

婴幼儿运动发育迟缓的头颅MRI表现及病因分析

目的分析婴幼儿运动发育迟缓的发病原因与头颅MRI表现。方法从344例临床确诊为运动发育迟缓的婴幼儿中随机抽取172例和作为对照的正常婴幼儿20例,均经SE序列MRI检查,包括横断面T1WI、T2WI、T2FLAIR,冠状面T2WI及矢状面T1WI平扫。统计分析是以χ2检验并利用统计软件SPSS13.0进行的。P值小于0.05为显著性差异。结果致病原因中的脑白质髓鞘化异常、脑外间隙增宽和脑室增大、缺氧缺血性脑病后遗改变的χ2值均大于等于χ20.01、P值均小于等于0.01,在统计学上有显著性意义,发病危险因素排序依次为脑白质髓鞘化异常、脑外间隙增宽和脑室增大、缺氧缺血性脑病后遗改变。皮层发育异常、胼胝体发育不良、脑畸形的χ2值均大于等于χ20.05、P值均小于等于0.05,在统计学上有意义。结论脑损伤所致的脑白质髓鞘化异常、脑外间隙增宽和脑室增大、缺氧缺血性脑病后遗改变、皮层发育异常、胼胝体发育不良、脑畸形是婴幼儿运动发育迟缓的主要颅内原因,尤其是前四项。头颅普通MRI检查能清晰地显示本病的颅内异常征象,为早期诊断和评估以及疗效随访提供重要信息。对于平扫未见明确异常者,需要深入地查找其他病因。     

小肠出血的影像学检查

目的：分析小肠出血性病变的X线、DSA、核素扫描和CT表现,探讨小肠出血的影像学检查方法。材料和方法：回顾分析45例经临床病理证实的小肠出血性病变的X线、DSA、核素扫描和CT表现。包括小肠平滑肌瘤10例、平滑肌肉瘤8例、小肠憩室5例、小肠血管畸形22例。结果：小肠平滑肌瘤（肉瘤）,小肠钡剂造影检出率为86％（12／14）,DSA为92％（11／12）,核素扫描为50％（5／10）,CT检查为100％（8／8）。小肠憩室,小肠钡剂造影检出率为80％（4／5）,DSA为75％（3／4）,核素扫描为60％（3／5）,CT检查为67％（2／3）。小肠血管畸形,小肠钡剂造影检出率0％（0／20）,DSA为73％（16／22）,核素扫描为44％（7／16）,CT检查为0％（0／4）。结论：小肠出血病人的检查应该以小肠钡剂造影和DSA作为常规,核素扫描是一种补充手段,若发现小肠肿瘤时应加作CT检查。     

Colour flow imaging of the great intracranial arteries in infants

Summary Colour flow imaging was used for the visualisation of the great intracranial arteries in 100 healthy infants. All children were investigated by computersonography with a 5 MHz linear transducer. Simultaneous imaging of brain tissue, displayed in gray scale and flow, displayed in colour was possible. Flow towards the transducer was displayed in red, flow away from the transducer in blue. The following arteries could be shown in sagittal and coronal sections: anterior cerebral artery, both internal carotid arteries, the basilar artery, both vertebral arteries and the posterior cerebral arteries. The middle cerebral artery could only be shown in axial sections through the temporal bone. With the help of colour flow imaging the exact course of the great intracranial arteries can be shown. Precise placement of the sample volume as well as angle correction is possible when absolute flow velocities are measured by pulsed dopplersonography. Congenital vascular abnormalities can be visualised within the image.     

长骨血管瘤的影像诊断

目的 分析长骨血管瘤的影像特征,旨在提高其诊断水平.方法 回顾性分析经手术病理证实的18例长骨血管瘤患者的X线平片(14例)、CT(9例)及MRI(6例).结果 18例长骨血管瘤中髓型10例、骨膜型5例、皮质内型3例.X线表现:髓型8例,其中3例表现为典型的蜂窝状,3例为溶骨性病灶周围骨质硬化明显,单纯溶骨、毛玻璃样密度各1例;骨膜型3例,表现为骨皮质增厚、硬化;皮质内型3例,表现为边界清晰的溶骨性病灶.CT表现:髓型6例,表现为溶骨膨胀型病灶5例,其中3例可见薄厚不一的硬化边,蜂窝状骨嵴影2例,骨皮质呈筛孔状1例,垂直于骨皮质的放射状骨膜增生2例;毛玻璃样密度1例.2例骨膜型表现为骨皮质均匀增厚1例,不规则骨膜增厚1例,局部髓腔狭窄消失.1例皮质内病变表现为病灶呈均匀软组织密度,局部皮质膨胀、增厚.MRI表现:2例显示髓腔内斑片状T1WI稍低信号,T2WI均呈稍高信号,边界清晰;1例T1WI及T2WI均呈等或稍低信号,病灶与正常组织分界不清;1例显示病灶突破局部骨皮质,肿物向外突出,外突肿物及相连髓腔部分T1WI呈稍低信号,T2WI呈高信号;2例显示骨膜增厚,其中1例呈等信号,1例无信号;2例周围肌肉组织内可见不均匀斑片状长T2信号,T1WI与肌肉组织呈等信号.结论 长骨血管瘤的囊性蜂窝状X线表现较为特征型;CT及MRI有助于长骨血管瘤的诊断.

Abstract：

Objective To explore the imaing features of hemangioma in the long bone and improve the diagnostic level of this disease. Methods The X-ray(14 cases), CT(9 cases) and MRI(6 cases)findings of 18 patientswith histologically proven hemangioma in the long bone after surgery were retrospectively reviewed. Results Ten tumors occurred in medullary cavity or bone end(medullary type),6 on the surface of bone (periosteal type) and 3 in cortex (intracortical type). X-ray findings: among 8 cases of medullary type, 3 showed honeycomb appearance, 3 lytic areas with sclerotic borders, one purely osteolyticchanges, and 1 frosted glass; 3 cases of periosteal type showed sclerosis and thickening of the underlying cortex; 3 cases of intracortical type showed well-defined osteolytic foci. CT findings: among 6 cases of medullary type, 5 appeared as expansile lytic lesion with uneven selerotic rim (3 cases)orhoneycomb appearance (2 cases), 1 cribriform appearance in the cortical bone, 2 periostealnew bone formation in vertical radiation pattern; 1 ground-glass appearance; among 2 cases of periosteal typeone showed regular cortical thickening, and the other irregular periosteal proliferation with marrowing of medullarycavity; 1 case of intracorticaltype showed density similar to that of soft tissue, with cortical thickening and expansion . MRI findings: 2 apeared as well-defined lesions with low signal intensity on T1WI and high signal intensity on T2WI; 1 appeared as ill-defined lesion with low to intermediate signal intensity on T1 WI and T2 WI. One showed breakthrogh of cortex and formation of soft tissue mass with low signal intensity on T1 WI and high signal on T2WI. Two showed thickening of periosteumwith intermediate signal intensity in one of them and very low signal intensity in the other. Two showed abnormal signal intensity in surrounding muscles, which was high on T2 WI and intermediate on T1 WI. Conclusions The soap-bubble or honeycomb appearance is the typical radiographic finding of hemangioma in long bone. CT and MRI can provide useful information for the diagnosis of hemangioma in long bone.     

非潜水性骨梗死影像学诊断

目的 探讨非潜水性骨梗死的影像学表现。方法 7例患中，平片 CT MRI ECT检查、平片 CT、平片 MRI检查各2例；单纯拍平片1例。结果 7例共累及14骨。早期平片、CT可无异常发现，亦可见病变区密度不均或轻度骨膜反应。MRI示病灶中心T1WI呈等骨髓脂肪信号，边缘呈迂曲的低信号带；该带T2WI可分2层。整个坏死区呈地图样改变。ECT显示为中央放射性缺损，边缘放射性浓聚。晚期平片、CT扫描病灶呈类环形、花边状或条状致密影。MRI、ECT此期表现无特征。结论 对早期病例，MRI是最好的检查手段。晚期病例检查应首选平片和CT。     

胆固醇性肺炎的影像学表现

目的 探讨胆固醇性肺炎的影像学表现。方法 回顾性分析3例经病理证实的胆固醇陛肺炎的胸部X线片及CT表现，并复习相关文献。结果 3例胆固醇性肺炎X线片及CT均表现为肿块样病灶，其中2例伴有空洞和液平面，1例CT增强出现多环状强化。临床病程非常长，抗炎效果差；光学显微镜下可见大量富含胆固醇结晶的泡沫细胞。结论 胆固醇性肺炎是1种罕见的慢性特发性疾病，影像学表现对其诊断有定的价值。     

获得性骨肥大综合征的影像表现

目的 分析获得性骨肥大(SAPHO)综合征的影像表现.方法 回顾性分析11例SAPHO综合征的影像资料,男6例、女5例,年龄28～68岁,平均51岁,X线平片检查9例、CT检查10例、MR检查3例、核索扫描检查3例.结果 9例胸前壁X线平片表现为胸骨上部、第一前肋及锁骨增生、硬化并肥大,相互之间骨桥形成或骨性融合;10例胸前壁CT检查,9例表现为胸、肋、锁骨区骨质增生硬化伴有骨质破坏,胸锁关节和胸肋之间骨性融合,1例仅表现为胸骨柄体关节骨质硬化,2例在轴面像上胸骨柄上缘似"海鸥翅"样改变.11例患者中除1例胸骨病变仪累及胸骨柄体关节外,其余10例胸前壁均多骨受累,其中8例呈对称性,2例为偏侧性(均为右侧).除胸前壁骨病变外,伴有骶髂关节炎、髂骨骨髓炎1例,胸椎骨髓炎2例,腰椎致密骨炎1例和双手掌指关节骨关节炎1例.MR检查3例,分别是胸锁关节、胸椎和骶髂关节,MRI显示锁骨头周围软组织肥厚,胸椎病变表现为椎体内T1WI呈低信号,T2WI呈混杂信号,抑脂像以高信号为主,骶髂关节见软骨下长T1WI短T2WI信号.核素扫描3例,显示胸骨上部及锁骨区呈"T"形异常高浓聚.结论 胸前壁多骨受累是SAPHO综合征主要影像特点,可并发骶髂关节炎、脊椎及髂骨骨髓炎、腰椎致密骨炎和双手骨关节炎.

Abstract：

Objective To explore the imaging characteristics of SAPHO syndrome in 11 cases.Methods Clinical features and imaging findings from 11 patients (6 male,5 female, 28 to 68 years old)with SAPHO syndrome were analyzed retrospectively Including DR in 9 cases, CT in 10 cases, MRI and radioisotope scanning in 3 cases. Results Multi-bones of anterior chest wall disorders were shown in 9cases on DR images including superior sternum , anterior first rib and clavicle hyperostosis. Bony fusion and bony bridge were also seen in these cases. Hyperostosis osteosclerosis, bone destruction and bony fusion of sternoclavicular articulation and first rib were shown on CT images in 9 cases. Osteosclerosis of the joint between manubrium and midsternum was seen in 1 case on CT image. Thc sign of flying sea gull was seen in 2 cases on axial anterior chest wall CT images. The disorders of anterior chest wall were bilateral in 8 cases and unilateral in 2 cases. Sacroiliitis and osteomyelitis of ilium were found accompanied in 1 case.Osteomyelitis of thoracic vertebrae were found in 2 cases, while sclerosing osteitis of lumbar vertebrae and ostearthritis of bilateral hands were observed respectively in 1 case. The thicken soft tissue surround clavicle head, thoracic vertebra disease with long T1 ,jumbly T2 and high fat suppression signal ,long T1 and short T2signal under sacroiliac joint were shown on MRI. Radioisotope scanning displayed higher radioactive uptake of radionuclides, with T shape in sternoclavicular area in 3 cases. Conclusions Multi-bones of anterior chest wall involvement was the common imaging characteristics in 11 patients. Sacroiliitis, osteomyelitis of vertebrae and ilium, sclerosing osteitis, ostearthritis of hand could be seen in some cases.     

孤立性纤维性肿瘤的影像学及病理学分析

目的 探讨孤立性纤维性肿瘤（solitary fibrous tumor,SFT)的影像学及病理学特征。资料与方法 回顾性分析10例胸膜及腹部SFT的影像学表现，并与病理组织学及免疫组化对照观察。结果 （1）SFT多见于胸腔，平片呈边缘光滑的孤立性肿块。（2）CT检查孤立性肿块部分可见囊性退变区，增强扫描肿瘤实质部分明显强化。（3）MRI肿瘤实质在T2WI上呈低信号，较大的肿瘤在T2WI上呈高低混杂信号且可见血管流空信号。（4）病理学检查肿瘤由梭形细胞构成，有多种排列方式，免疫组化CD34阳性。结论 SFT是一种间叶源性软组织肿瘤，影像学上见孤立性，境界清楚的软组织肿块时应考虑到该肿瘤可能，确诊须靠病理学及免疫组化检查。     

原发性甲旁亢的影像学诊断

目的：对原发性甲旁亢的影像学检查方法及诊断价值进行评估。材料和方法：对手术病理证实的５３例原发性甲旁亢病例的影像学资料进行回顾性分析。其中３５例作ＣＴ检查,Ｂ超检查４６例,核素检查５例。结果：５３例甲旁亢手术确诊甲旁腺腺瘤５１例,占９６．２３％。甲旁腺增生２例。ＣＴ检查有２７例诊断为甲旁腺腺瘤（２７／３５）,病灶８１．４８％位于甲状腺下极（２２／２７）,１８．５２％位于甲状腺上极（５／２７）;各病灶增强后通常有明显强化,比平扫时ＣＴ值上升约３０￣４０Ｈｕ。Ｂ超检查有３８例诊断为甲旁腺腺瘤（３８／４６）。核素检查中３例误诊为甲状腺腺瘤。结论：原发性甲旁亢的定性诊断主要依靠临床及生化检查,定位诊断依靠Ｂ超、ＣＴ及核素等影像学检查,Ｂ超和ＣＴ检查的原发笥甲旁亢的诊断中敏感性及特异性无显著差别,两者可互相补充,根据甲旁     

骨包虫病影像学表现及诊断

目的分析骨包虫病的X线、CT及MRI表现，探讨骨包虫病影像学特点。方法回顾性分析7例经手术病理证实的骨包虫病影像学资料。7例均摄常规正侧位X线平片，4例行CT扫描，3例行MR扫描。结果颅骨包虫1例，脊柱包虫3例，髂骨包虫1例，骶骨包虫1例，肋骨包虫1例。X线表现：囊状膨胀性骨破坏5例，其中单囊性改变2例，多囊性骨破坏3例；溶骨性破坏2例，边缘硬化5例，钙化1例，软组织肿块4例。CT表现：4例中囊性膨胀性骨破坏3例，病灶呈多囊性2例，单囊性1例；溶骨性破坏1例；边缘硬化3例，钙化2例，软组织肿块4例。MRI表现：3例均为脊柱病变，共累计7个椎体，单囊性改变1例，多囊性改变2例，软组织肿块3例。病灶在T1IW呈低信号，T2WI呈高信号，囊内容物呈高信号，簇集呈“葡萄串样”，椎体压缩楔形变。结论影像学检查对骨包虫病的诊断具有重要意义，联合应用X线平片、CT、MR检查并密切结合流行病学史能进一步提高对骨包虫病的诊断及鉴别诊断。     

胰岛素瘤的影像学评价(附28例报告)

目的：探讨多种影像学方法在胰岛素瘤术前定位诊断中的价值。资料与方法：28例经手术病理证实的胰岛素瘤患者于术前做B超和DSA检查，22例行胰腺CT扫描，10例行MRI检查。结果：4种影像学方法对胰岛素瘤术前定位诊断准确率分别为：DSA 82％（23／28），超声57％（16／28），CT 41％（9／22），MRI90％（9／10）。DSA与超声。MRI相结合使本组术前定位诊断准确率达93％（26／28）。结论：MRI和DSA是胰岛素瘤术前定位诊断准确率高而有效的方法。对临床有Whipple三联征患者，应首先选用超声和MRI或螺旋CT检查，特别是MRI或螺旋CT薄层快速动态增强扫描。当上述无创检查方法仍不能明确诊断时，可进一步行胰血管造影，多种影像技术联合应用可以提高本病的诊断准确率。     

幼儿暴发性亚急性硬化性全脑炎的MRI诊断

目的提高对暴发性亚急性硬化性全脑炎（SSPE）的MRI表现的认识。方法报告2例经病理证实的暴发性SSPE的MRI所见，并作文献复习。结果1例表现为弥漫性脑组织肿胀、脑沟变浅、大脑皮髓质分界不清，呈大片稍长T1、长T2信号。1例表现为双侧额颞叶、双基底节多处散在的长T1、长T2信号灶，有占位效应及强化。结论暴发性SSPE的MRI特征表现为不同程度的持续性脑肿胀，与一般SSPE患者以脑萎缩表现为主不同。MRI能显示其病变弥漫、灰白质均受累的特征。     

Magnetic resonance imaging of knee injuries in children

The appearances of knee injuries on MR imaging are less well documented in children than adults. Some patterns of injury are shared by both groups of patients, e. g. meniscal damage. The frequency of specific injuries may differ, e. g. anterior cruciate ligament (ACL) tear. Congenital abnormality, coexistent pathology and previous treatment of the knee appear to be associated with meniscal problems. Discoid menisci are seen most frequently in children and have unique features on MR scans. Cruciate ligament tears are difficult to diagnose in the smallest children. The ACL may not be identified due to its small size. Normal bone marrow signal may be confused with marrow infiltration or bone microfracture. Radiographically occult fractures around the knee appear to be strongly associated with ligamentous injury as in adult patients. Osteochondral fractures, osteochondral lesions and articular cartilage damage are revealed on MR scans, but their long-term effects are uncertain. It is possible to diagnose a range of knee injuries on MR scans in children. The biggest diagnostic challenge is in pre-school children. Received 13 December 1996; Revision received 13 March 1997; Accepted 14 March 1997     

多层螺旋CT在小儿肺静脉畸形引流诊断中的价值

目的　探讨多层螺旋CT(MSCT)对小儿肺静脉畸形引流的诊断价值。方法　对20例MSCT诊断为小儿肺静脉畸形引流的病例进行回顾性分析。年龄11d至12岁,MSCT采用对比增强容积扫描,层厚1 250mm,层间距0 625mm,均行多平面重建(MPR)、薄层最大密度投影(STS MIP)、容积再现(VR)及表面阴影成像法(SSD)重建。所有病例均行超声心动图(US)检查,其中12例行心血管造影(CAG)检查, 14例尚有手术结果对照。结果　MSCT诊断完全型肺静脉畸形引流9例,部分型肺静脉畸形引流11例。心上型5例、心脏型10例、心下型4例、混合型1例。MSCT均清晰显示异常连接肺静脉的数目、分布和位置。CAG漏诊3例,US漏诊10例。14例有手术对照者,MSCT对肺静脉畸形引流的定性、定位诊断全部正确。结论　MSCT较常规CAG及US可明显提高小儿肺静脉畸形引流的检出率,对本病有重要的诊断价值。