肝内胆管错构瘤5例的磁共振成像诊断及鉴别诊断简

目的：探讨成人肝脏胆管错构瘤的影像学表现,以提高对本病的认识。方法回顾性分析5例经手术、病理证实的肝内胆管错构瘤的影像学表现。对所有患者均行磁共振成像（MRI）平扫、磁共振胰胆管造影（MRCP）、增强扫描,并穿刺活检病理证实。结果 T1WI病变呈低于肝实质的信号,呈多发,沿血管胆管树分布, T2WI病灶显示清楚,呈明显的高信号,在MRCP序列上,多数病变显示为高信号,与T2WI比较,显示的病变数量有所减少。MRCP显示肝内多发类囊状高信号病变,与可见的胆管树不相通。增强扫描示各期病灶无强化,在增强扫描60 s,3 min肝实质明显强化,小囊状信号未见明显强化,形成明显的对比。结论成人肝内胆管错构瘤在影像学上无特征性表现,类似于肝转移瘤、肝脓肿、肝海绵状血管瘤等常见的肝囊性占位病变。     

胆管错构瘤的影像学表现

目的探讨胆管错构瘤的超声、CT及MRI影像学表现,并比较三种影像学检查方法对其诊断的价值。方法回顾性分析12例胆管错构瘤的超声、CT及MRI表现及相关临床资料,并与病理结果对照。结果超声检查胆管错构瘤表现为肝实质非均匀性回声增强,可见"彗星尾征"及"等号征";CT平扫表现为点状低密度灶弥漫或局限性分布,增强扫描5例未见增强,3例部分病灶边缘轻度强化。MRI检查T_1WI呈低信号,T_2WI呈高信号,重T_2WI呈更高信号,增强扫描7例可见环形强化。结论超声及CT检查对胆管错构瘤的准确诊断不及MRI敏感、可靠,通过超声检查出可疑的胆管错构瘤,首选的进一步影像学诊断方法是MRI。但超声检查简便易行,经济廉价,因此,是本病检出与随访过程中的重要而首选的检查方法。     

脾脏错构瘤的CT和MRI表现

目的:探讨脾脏错构瘤(SH)的CT和MRI表现.方法:回顾性分析6例病理确诊的SH患者的CT和MRI影像学表现.结果:6例SH中5例为单发,1例为多发.病灶在CT平扫呈等或稍低密度,在T1WI上呈等或稍低信号,在T2WI上呈不均匀低信号(4例)或高信号(2例),其中2例病灶中心出现局灶异常信号.动态增强扫描4例病灶表现为早期弥漫不均匀轻度强化并随时间推移呈渐进性延迟性强化,2例表现为早期均匀较明显强化,2例病灶中心的局灶异常信号呈部分延迟强化.结论:SH的CT和MRI表现具有一定特征性,影像学检查特别是MRI是诊断SH的重要方法.     

周围型肝内胆管细胞癌的影像学表现与病理对照分析

目的探讨周围型肝内胆管细胞癌的影像学表现及病理基础。方法回顾性分析经手术及病理证实的周围型肝内胆管细胞癌25例,所有病例均行B超检查;21例行CT平扫和增强扫描;11例行MRI检查;9例行DSA检查。结果B超显示病灶15例为低回声,10例为略强或强回声,均匀或不均匀;CT平扫病灶均为低密度,边界不清,MRI表现为T1WI低信号,T2WI呈较高信号伴中心低信号,动态CT及MRI检查病灶多表现为渐进性的向心性强化;病灶局部肝包膜可有回缩,周围肝内胆管可有轻度扩张和结石;选择性动脉造影呈乏血管肿瘤改变,超选择性动脉造影显示动脉期肿瘤血管纤细、呈绒球状改变,实质期肿瘤染色明显,轮廓不清;病理表现镜下为低分化或未分化腺癌,血管分布稀少,癌巢之间为大量纤维结缔组织。结论周围型肝内胆管细胞癌的影像学表现有一定的特征性。     

成人多发胆管性错构瘤的CT、MRI表现

目的:探讨成人多发胆管性错构瘤的CT、MRI表现,以提高对本病的认识。方法:回顾性分析经穿刺活检病理证实的3例成人多发性胆管性错构瘤患者的CT、MRI表现,并结合文献,对此病的病理、临床及影像特点进行讨论。结果:CT平扫显示病灶呈多发低密度,增强扫描无强化。MRI平扫显示病灶呈长T1长T 2信号,增强扫描无强化。MRCP显示肝内多发类囊状高信号病灶,与胆管不相通。结论:应用多层螺旋CT及高场磁共振可清楚显示本病特点,能够明确诊断。     

胆管错构瘤的CT及MRI表现

目的:分析胆管错构瘤的CT及MRI特点,以提高对该病的诊断水平。方法:回顾性分析我院经病理证实的肝内胆管错构瘤13例患者的CT或MRI资料,观察病变在CT及MRI图像上的分布、大小、形态及强化特点。结果:CT平扫主要表现为肝内低密度的囊状病变灶,病灶直径小于10mm,CT增强扫描无强化;MRI主要表现为T1WI上病变信号低于肝实质,T2WI病灶显示清楚,呈明显的高信号,增强扫描病灶未见强化,部分病灶出现边缘强化;MRCP显示肝内多发囊性病变与肝内胆管不相通。结论:胆管错构瘤的CT及MRI表现有一定的特征性,有助于对该病的诊断。     

脾脏错构瘤的CT及MRI诊断(附6例报告)

目的 探讨脾脏错构瘤(SH)的CT和MRI特征,以提高对这种罕见病变的认识.方法 搜集经手术病理证实的SH 6例,其中4例同时行CT和MRI检查,单独行CT或MRI检查的各1例,回顾性分析其CT和MRI表现及特点.结果 单发5例,多发1例.CT平扫呈稍低密度4例、等密度1例;MRI成像T1 WI呈低信号1例、等信号4例,T2 WI呈低信号3例、等或高信号各1例.动态增强扫描,表现为早期不均匀轻度强化并随着时间推移呈渐进性延迟强化和早期不均匀明显强化、静脉期持续强化的病灶各3例,延迟期上述病灶均接近或稍高于脾实质密度(信号).结论 SH的CT和MRI表现具有一定的特征性,尤其是MRI的T2 WI,对SH的诊断具有较高的价值.     

肝腺瘤的影像学诊断

目的探讨影像学(US、CT、MRI及DSA)诊断肝腺瘤的价值。方法回顾性分析经手术、病理证实的11例肝腺瘤的影像学表现,其中11例行US和CT检查(有1例行CT灌注成像,CTP),5例行MRI扫描,4例行DSA检查,并与手术病理所见对照。结果11例肝腺瘤均为单发肿块,无肝硬化背景,直径2.0～10.0cm。影像学表现:US检查,10例呈稍低或不均匀稍强回声,边界清晰,6例见低回声晕,彩色多普勒显示肿块内有较丰富的血流;CT检查,10例为稍低或等密度,8/10例动脉期全瘤明显强化,门脉期轻度强化,延迟期呈等密度,1例平扫和延迟期呈等密度,动脉期中度强化,门脉期轻度强化,误诊为血管瘤。1/11例CT灌注成像(CTP)检查,肝动脉灌注量(HAP)=1.08ml/(min.ml),门静脉灌注量(PVP)=0.19ml/(min.ml),肝动脉灌注指数(HPI)=0.85,各参数值与肝癌均有明显不同;MRI检查,5例肝腺瘤均能显示完整包膜,T1WI上2例稍高于肝脏信号,1例呈等信号,2例为稍低信号,T2WI上5例均表现为以稍高信号为主的混杂信号,脂肪抑制像(STIR)1例呈略低信号,4例信号与T2WI相似,行增强扫描的4例病灶动脉期显著强化,门脉期强化减退,平衡期呈等信号。DSA检查,3/4例病灶见粗细不均的异常血管影,实质期可见肿瘤染色表现。结论肝腺瘤的US和DSA表现均缺乏特异性,CT、MRI则具有一定的特点。CTP对肝腺瘤可能具有诊断和鉴别诊断价值。     

婴儿型肝脏血管内皮瘤的影像诊断

目的 总结婴儿型肝脏血管内皮细胞瘤的临床与影像学表现. 资料与方法 回顾性分析6例婴儿型肝脏血管内皮细胞瘤的临床与影像学表现,所有的病例均经穿刺病理证实.5例行CT扫描,1例行MRI平扫. 结果 CT平扫表现为肝内低密度灶,1例出现钙化,增强扫描动脉期肿瘤均呈不均匀环形强化,4例中央部位出现结节样强化;门静脉期全部病例由周边向中心强化,强化范围扩大;延迟期病灶密度稍高于或等于正常肝实质.1例MR表现为肝内多发结节,T1WI低信号,T2WI高信号,增强扫描动脉期部分结节呈环形强化,部分结节呈全瘤均匀强化,延迟期全部结节呈全瘤强化. 结论 本病的CT与MRI表现有一定的特征性,有助于诊断本病.     

小儿肝脏间叶性错构瘤的MRI表现

目的肝脏间叶性错构瘤是1种少见的肝脏良性肿瘤。方法搜集经MRI检查后手术或穿刺病理证实的12例，总结其MRI表现，以其提高对本病的认识和正确诊断。12例患儿，男7例，女5例。年龄1．2个月至12岁，平均6．3岁。主要症状为：腹部包块(5例)，肝大(8例)，腹痛、贫血(3例)。甲胎蛋白阴性。采用Elscint2．0T磁共振装置，SE、快速梯度回波(FSE)序列，横断、矢状、冠状面扫描，有2例为平扫加动态增强扫描。结果单发结节型6例，其中3例为实性为主，T1WI为稍低信号，T2WI为不均匀高信号；1例为囊实混合性，为实性肿块中可见大小不等边界清楚的囊；2例囊性为主，表现为多房分隔的囊性肿块。弥漫及多发结节型5例，结节大小不等、边界清楚信号同实性肿块。弥漫及单发囊性肿块并存者1例。增强扫描早期病灶轻度环形强化，延迟扫描渐向中心强化。肝内血管受压者5例，腔静脉及腹主动脉受压者3例。病理所见：镜下见纤维增生成片，透明变性，其中小胆管增生，小叶状排列；囊性者部分囊壁内衬单层扁平上皮细胞或胆管上皮，部分为结缔组织裂隙，囊内充满液体或胶样物质。结论MR检查是鉴别和诊断小儿肝间叶性错构瘤的较好方法，应该认识其MRI表现。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.