颈动脉体瘤的MRI诊断

目的:提高对颈动脉体瘤MRI表现的认识。方法:回顾性分析经手术病理证实的16例颈动脉体瘤(18个肿块)的MRI表现,所有病例常规行FSE T1WI和T2WI,12例行MRA检查,其中5例行3D PCA,8例行增强后MRA检查。结果:16例中14例(14/16)为单侧性,2例(2/16)为双侧性;右颈部病变7个(7/18),左颈部11个(11/18);肿瘤呈纺锤形或不规则形,其内信号欠均匀,1例有显著坏死区,13个(13/18)肿块在MR平扫出现“盐和胡椒征”,以“胡椒”表现最为显著;15个肿块(15/15)均有明显强化,其中8个肿块出现“盐和胡椒征”。12例患者(13个肿块)行MRA检查,显示颈总动脉分叉均有不同程度扩大。结论:根据肿瘤的部位、颈总动脉分叉角度的扩大和血管流空等表现,MRI可在手术前正确诊断颈动脉体瘤。     

头颈部副神经节瘤的影像学诊断

目的:结合头颈部副神经节瘤的发生部位,分析其影像学表现和特点.材料和方法:回顾性分析23例头颈部副神经节瘤患者的影像学资料(5例鼓室球瘤,12例颈静脉球瘤,3例迷走体瘤和3例颈动脉体瘤),21例行CT检查(其中1例行动态增强检查),15例行MRI检查.结果:鼓室球瘤较小,多发生于鼓岬区;颈静脉球瘤以颈静脉孔为中心,较大的肿瘤侵犯咽旁间隙、中耳、外耳道、乳突和(或)颅内;颈动脉体瘤位于上颈部颈内外动脉分叉处,伴上述动脉明显分离移位;迷走体瘤位于咽旁颈动脉鞘区,血管移位不一.以上四类肿瘤CT平扫呈中等密度,强化显著,部分肿瘤内见强化的血管和囊性改变;MRI T1WI中低信号,强化显著,T2WI中高信号,部分肿瘤内见囊变,多数肿瘤中可见血管流空"盐和胡椒征"(鼓室球瘤和较小的颈静脉球瘤中不见).鼓室球瘤和颈静脉球瘤边缘不规则,后者侵犯咽旁间隙部分边缘光滑,骨质呈虫咬状破坏;颈动脉体瘤和迷走体瘤边缘光滑,无骨质破坏.结论:多数头颈部副神经节瘤具有特定的发生部位和特征性的CT和MRI表现,可据此确诊;发生于不同部位的肿瘤的影像学表现有所差别.     

颈静脉球瘤的MRI及DSA表现

目的总结颈静脉球瘤的MRI及DSA表现,提高对该肿瘤的认识。资料与方法回顾性分析经手术、病理证实的18例颈静脉球瘤的MRI及DSA表现。结果18例颈静脉球瘤,其中位于颈静脉孔区10例,位于鼓室2例,另有6例同时累及颈静脉孔和鼓室。肿瘤呈实质性,境界多清楚,强化明显,T2WI和Gd—DTPA增强扫描可见肿瘤实质内点状、条状及曲线状血管流空影,即“盐和胡椒征”,该征象具有一定的特征性。DSA显示颈静脉球瘤为富血供肿瘤,肿瘤染色明显,由颈外动脉分支供血。结论颈静脉球瘤具有特定的发病部位和较典型的MRI及DSA表现,MRI具有较高的病变检出率及定性能力,DSA能准确地显示肿瘤的供血动脉和肿瘤血管的细节,对进一步行介入栓塞治疗、外科手术治疗具有重要意义。     

迷走神经副神经节瘤的MRI诊断(附6例报告及文献复习)

目的 分析迷走神经副神经节瘤的MRI表现。方法 对6例迷走神经副神经节瘤（良性4例，恶性2例）进行回顾性分析，重点分析其部位、信号、大血管移位和转移情况。结果 6例肿瘤中，4例位于上颈部，中、下颈部各1例；右颈部病变4例，左颈部2例；肿瘤类似纺锤形或不规则形；6例信号均欠均匀，其中4例出现“盐和胡椒征”，以“胡椒”表现最为显著；6例病变均有明显强化。对4例病变行MR血管造影，见颈动脉均向前、内移位，颈内静脉向后、外移位。2例恶性肿瘤中，1例破坏颈静脉孔区域骨质并颈部淋巴结和双肺内转移，1例出现颈部淋巴结的转移。结论 迷走神经副神经节瘤有其特定的部位和MRI信号，手术前可以进行定性诊断。     

颈静脉球瘤影像学诊断

目的 探讨颈静脉球瘤的影像学表现及其诊断价值。方法 8例颈静脉球瘤均经病理证实，均行MRI平扫，其中，6例行MRI增强扫描，MRA和MRV检查各2例，CT平扫2例，分析其影像学表现。结果 CT显示肿瘤密度均匀，周围骨质呈侵蚀性破坏；MRI肿瘤呈等T1长T2信号，“盐-胡椒”征为颈静脉球瘤特征性表现；MRA显示肿瘤区畸形血管及供血动脉，MRV显示静脉窦受压变细。结论 CT对显示骨性结构改变有明显优势，MRI，MRA和MRV对显示病变特征、诊断和鉴别诊断有明显意义。     

颈静脉孔区肿瘤的CT和MRI诊断

目的：探讨CT和MRI对颈静脉孔区肿瘤的诊断及鉴别诊断。方法：回顾性分析了经手术病理证实的34例颈静脉孔区肿瘤的CT和MR影像资料,其中包括颈静脉球瘤12例,神经鞘瘤10例,转移瘤3例,脑膜瘤2例,神经纤维瘤、脊索瘤、软骨瘤、软骨肉瘤、纤维脂肪瘤、纤维血管瘤和先天性囊肿各1例。CT检查21例,其中15例作增强扫描。MRI检查31例,其中24例加作MR增强扫描。结果：肿瘤内纡曲流空的血管即“椒-盐”征是颈静脉球瘤的特征性MRI表现。神经鞘瘤易发生囊变,注射对比剂后肿瘤中度强化。转移瘤骨质破坏不规则。脑膜瘤增强扫描可见脑膜“尾巴”征。软骨瘤和软骨肉瘤可见明显钙化。结论：CT与MRI相结合能更全面地为临床提供诊断、鉴别诊断及治疗所需要的信息,为治疗方法的选择提供可靠的依据。     

颞骨肿块的影像学研究

目的 研究颞骨肿块的CT、MRI和DSA表现及其临床价值。方法 对照分析21例颞骨肿块的CT、MRI和DSA表现与手术病理表现。结果 5例颈静脉球瘤均显示“椒盐征”和肿瘤明显染色。3例鼓室球瘤表现为鼓室内明显强化的软组织影和肿瘤明显染色。4例内淋巴囊肿瘤CT表现为岩骨迷路后前庭水管区和中内耳软组织肿块及骨质破坏，MRI表现为“椒盐征”，T1WI示肿块边缘有环形高信号影，DSA示3例内淋巴囊腺样囊性癌明显染色。4例外中耳鳞癌CT表现为不规则软组织肿块以及中外耳广泛骨质破坏，1例DSA表现有肿瘤染色。2例软骨肉瘤CT表现为含有点片状钙化的软组织肿瘤，1例肿瘤周边可见高密度环。2例鼻咽癌侵犯中内耳，表现为岩部、鼓室、乳突和颈静脉窝不规则肿块和骨质破坏。1例嗜酸性肉芽肿CT表现为岩部、鼓室不规则肿块和骨质破坏。结论 CT和MRI清楚显示肿块的形态、范围和内部结构，能准确定位，CT、MRI和DSA结合有助于肿块的定性诊断，为手术提供依据。     

脊椎转移瘤的MR征象分析（附32例报告）

目的分析脊椎转移瘤的MRI表现,探讨其影像学特征性改变。方法分析32例经病理和临床证实的脊椎转移瘤的MR表现,分别观察其形态改变,椎体骨髓信号特点、类型,骨皮质破坏与椎旁软组织肿块及跳跃征。结果32例脊椎转移瘤共82个椎体受累,19个椎体病理性骨折,16个椎体后缘骨皮质弧形膨隆。MR信号改变椎体局灶型44个,弥漫型36个,斑片型2个,椎旁肿块17例,椎弓破坏13例,跳跃征15例。结论局灶性与弥漫型信号改变是脊椎转移瘤椎体常见信号异常,跳跃征、椎体后缘骨破坏与肿块是其特征性表现,多征象综合分析是正确诊断本病的关键。     

颅颈交界区脊索瘤1例影像表现及误诊原因分析

目的 探讨颅颈交界区脊索瘤影像表现，主要是磁共振成像表现，并分析误诊原因。方法 回顾性分析1例误诊的颅颈交界区脊索瘤影像学表现(主要是磁共振成像表现)，结合文献总结颅颈交界区脊索瘤影像学表现，并对误诊原因进行分析。结果 1例颅颈交界区肿块，病理证实为脊索瘤，病变侵犯广泛，影像学表现与颈静脉球瘤有多处相似之处，以至于造成误诊，但仔细观察肿瘤磁共振成像表现具有脊索瘤表现特征(等或稍长T1信号，明显长T2信号，持续缓慢增强肿块)却不具备颈静脉球瘤的特征性表现。结论 颅颈交界区脊索瘤影像学表现(主要是磁共振成像表现)有其特征性，认真观察分析可以作出正确诊断，避免误诊。     

脊髓室管膜瘤的MR影像诊断

目的 研究脊髓室管膜瘤的MR影像特征.方法 回顾性分析经手术病理证实的15例脊髓室管膜瘤的临床及磁共振表现.结果 15例脊髓室管膜瘤中,12例位于颈髓,1例位于胸髓,2例位于腰髓.全部肿瘤呈中心性生长,平均累及2.1个椎体单位.13例肿瘤边界清.平扫T1 WI大部分肿瘤呈等信号或混杂信号,在T2 WI大部分呈高信号或混杂信号.10例肿瘤实质头端或尾端反应性囊变,4例瘤内囊变,2例肿瘤内出血,2例肿瘤可见”帽征”.7例肿瘤明显均匀强化.结论 肿瘤中心性生长,边界清、明显均匀强化是室管膜瘤与其它脊髓肿瘤的主要鉴别依据.     

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.