MRI对海绵窦病变的诊断价值

目的分析海绵窦(cavernous sinus,CS)病变的MRI表现及其临床价值。方法回顾性分析经临床或/和病理证实的海绵窦病变患者59例(男30例,女29例,年龄范围6~69岁,平均45.3岁)MRI资料。59例海绵窦病变患者均行MRI平扫及增强检查,分析病变形态、信号及累及范围。结果海绵窦原发肿瘤(脑膜瘤8例,三叉神经鞘瘤5例,多发性神经纤维瘤病1例,胶质瘤1例);海绵窦继发肿瘤(鼻咽癌18例,侵袭性垂体瘤8例,脊索瘤6例);非肿瘤性病变(颈内动脉瘤6例,颈内动脉海绵窦瘘3例,海绵状血管瘤2例,鼻咽部动静脉瘘累及海绵窦1例)。主要MRI征象:1)47例肿瘤性病变,一侧海绵窦受累29例,双侧海绵窦受累18例,其中13例包绕双侧颈内动脉,22例包绕一侧颈内动脉;2)非肿瘤性疾病12例,海绵窦内见异常血管流空信号,其中3例颈内动脉海绵窦瘘同侧眼上静脉扩张扭曲,6例动脉瘤表现为颈内动脉扩张呈类圆形流空信号,2例海绵状血管瘤呈稍长T1、长T2信号,增强扫描明显不均匀强化,延时扫描强化范围增大。结论 MRI能清楚显示海绵窦区病变及其累及范围,了解颈内动脉海绵窦段是否被包绕,对海绵窦病变的诊断及鉴别诊断具有重要意义,为临床治疗方案的选择提供理论依据。     

垂体腺瘤侵袭海绵窦时颈内动脉的MRI表现

目的　研究垂体腺瘤对颈内动脉海绵窦段的影响以及垂体腺瘤侵袭海绵窦时颈内动脉的MRI表现。资料与方法　回顾分析 10 3例经病理证实的垂体腺瘤的MRI资料 ,测量两侧颈内动脉距中线距离、横径、被肿瘤包绕程度、颈内动脉间距 ,并与 15 0例非鞍区病变患者颈内动脉的MRI表现相比较。结果　非鞍区病变患者两侧颈内动脉海绵窦段间平均距离为 (17.0± 3.5 )mm ,而垂体腺瘤患者则为 (2 4 .4± 4 .2 )mm。颈内动脉间距与肿瘤横径明显相关 ,而与肿瘤体积的相关性相对不明显。海绵窦是否受侵犯与同侧颈内动脉被包绕范围明显相关 ,而与颈内动脉距中线距离及颈内动脉横径无关。结论　两侧颈内动脉间距仅能反映垂体腺瘤的大小 ,与侵袭性无关。海绵窦是否受侵与颈内动脉的移位、狭窄情况无关 ,而与颈内动脉的包绕程度相关 ,颈内动脉被肿瘤包绕范围 <1/ 3,海绵窦未受侵犯 ;若 >2 / 3,则海绵窦受侵犯。颈内动脉的包绕程度可作为评价垂体腺瘤是否侵袭海绵窦的指标     

磁共振弥散加权成像在肝海绵状血管瘤中的应用价值

目的:分析肝海绵状血管瘤不同b值的MRI弥散加权成像特性,提高病变检出率和图像质量。方法:对连续的MRI平扫和增强明确诊断的13例肝海绵状血管瘤,比较弥散加权成像b值分别为0s/mm2,100s/mm2和700s/mm2时的特征。结果:MRI平扫和增强分别显示34个(87%)和29个(74%)病变;在弥散加权成像中,b为0s/mm2时显示21个(54%),小的病变与血管和胆管易混淆;b为100s/mm2时显示39个(100%),病变与周围组织界限清晰;b为700s/mm2时显示33个(85%)。正常肝组织的信噪比以b值为100s/mm2最高(19.15±0.85);病变的信噪比以b值为0s/mm2时最高(12.89±0.96);病变与周围正常肝组织的对比度以b为700s/mm2时最低(0.37±0.02)。结论:MRI弥散加权成像进一步提高了对肝海绵状血管瘤的敏感性,以b值为100s/mm2时,病变检出率和图像质量最高。     

永存枕窦和永存镰状窦的MR诊断

目的 探讨永存枕窦(persistent occipital sinus,POS)和永存镰状窦(persistent falcine sinus,PFS)的MRI表现.资料与方法 搜集100名正常成人冠状位二维时间飞跃法(2D-TOF)颅内MR静脉成像资料,统计观察POS和PFS的MRI表现及其发生率.结果 POS是连接窦汇区与乙状窦远端或颈内静脉起始端的硬脑膜内血管,行径、数量、管径和形态变化较大,发生率为5%;PFS是连接上矢状窦后份与大脑大静脉或下矢状窦后端的大脑镰内血管,仅1支,行径相对恒定,管径和形态有差异,发生率为4%.结论 POS和PFS是常见的静脉变异,是某些病理情况下重要的静脉引流通道.     

枕下海绵窦的研究及其临床意义

枕下海绵窦位于枕下区,与海绵窦在胚胎学发育、功能和病理学特征以及动脉壁的过渡类型上都具有相似性。该区位置深在,解剖结构重要而复杂,是很多疾病发生的部位。枕下海绵窦与颅内静脉、椎静脉丛存在交通,在颅内辅助引流静脉及疾病脑转移中起着重要作用。了解枕下海绵窦的解剖学特点对于指导临床外科手术和血管内介入治疗具有重要意义。     

海绵窦侵袭性垂体瘤MRI和术中所见比较及其临床意义

目的了解MRI术前诊断海绵窦侵袭性垂体瘤的准确性及其临床意义.材料与方法采用KnospE的MRI 5级分级标准,符合3、4级的患者视为MRI海绵窦侵袭性垂体瘤.而术中见海绵窦内颈内动脉壁/海绵窦内壁穿通甚至肿瘤包埋窦内的结构,视为术中所见海绵窦侵袭.结果MRI诊断海绵窦侵袭性垂体瘤的敏感性为60.9%,特异性为89.5%,阳性预测值为87.4%.结论MRI术前判断海绵窦侵袭性垂体瘤具有一定的准确性,对确定手术治疗方案及术后处理有一定帮助.     

MRI对颈动脉海绵窦瘘的诊断价值

目的　探讨MR对颈动脉海绵窦瘘的诊断价值。方法　 2 3例经DSA检查证实的颈动脉海绵窦瘘 ,应用Toshiba 0 .5T磁共振扫描仪进行眼部及颅脑常规MRI及 3DTOFMRA扫描 ,回顾性分析其MRI及MRA表现。结果　 2 3例颈动脉海绵窦瘘的主要MRI及MRA表现 :全部病例均可见患侧海绵窦扩大 ,海绵窦主要属支静脉眼上静脉迂曲扩张 ;患侧眼下静脉扩张 3例 ,大脑浅静脉中组扩张 5例 ;海绵窦引流静脉岩上窦显示扩张 3例、岩下窦扩张 2例。吻合支翼静脉丛迂曲扩张 2例 ,对侧海绵窦扩大 3例。大脑动脉环后交通动脉开放 17例 19支。结论　MRI及MRA检查能够明确颈动脉海绵窦瘘的诊断 ,且MRA可同时显示脑供血代偿的情况 ,有助于选择DSA介入治疗时机。     

视交叉的MRI解剖

目的　研究成人正常视交叉的MRI解剖及其毗邻结构。方法　 6 5例受检者 ,男 31例 ,女 34例 ;年龄 18～ 72岁 ,平均 4 2 3岁。均行横断、冠状和矢状面T1W扫描和矢状T2 W扫描 ,2 0例行横断面T2 W扫描 ,2 0例行冠状面T2 W扫描。分别测量视交叉的横径、高度、前后径、视交叉 -鞍结节间距、视交叉与枕骨大孔前后径夹角及颅内段视神经的夹角 ,并观察视交叉的层面形态及其毗邻结构。结果　 (1)横断面上视交叉的横径为 (13 0± 1 7)mm ,冠状面上横径为 (13 5± 1 7)mm。视交叉高度为 (3 1± 0 5 5 )mm。视交叉前后径为 (8 6± 0 93)mm。视交叉 -鞍结节间距为 (3 1± 1 7)mm。视交叉与枕大孔前后径的夹角为 (38 3± 8 4 )°。两侧颅内段视神经夹角为 (6 5 6± 8 5 )°。所有测量结果按男女分组进行统计学分析 ,男女之间没有显著统计学差异。 (2 )视交叉的毗邻 :视交叉上方为第 3脑室 ;两侧为颈内动脉 ;前上方为大脑前动脉 ;前方为额叶直回 ;后方为漏斗、灰结节和乳头体 ;下方为垂体和蝶窦。结论　MR能很好地显示视交叉的形态及其毗邻 ,并能准确地测量视交叉的大小。     

鼻咽癌翼腭窝侵犯的MR影像分析

目的:探讨鼻咽癌翼腭窝侵犯的MRI特征,分析肿瘤组织侵犯翼腭窝及经翼腭窝向周围组织侵犯的途径.方法:回顾性分析61例经病理证实的鼻咽癌伴翼腭窝侵犯患者MRI片,研究其鼻咽部病变、翼腭窝受累情况及其侵犯途径.结果:61例鼻咽癌翼腭窝侵犯中共有65侧病变.最常见翼腭窝受累的MRI表现是翼腭窝破坏、正常形态消失,翼腭窝内异常强化软组织肿块影(39侧),其次为翼腭窝正常或扩大(形态尚在)、翼腭窝正常脂肪信号影消失,被异常软组织影取代(19侧)以及翼腭窝扩大伴上颌神经的异常强化增粗(7侧).61例翼腭窝受累病例中,有33例(54%)合并海绵窦侵犯,17例(28%)侵犯蝶窦,12例(20%)侵犯破裂孔,5例(8%)侵犯眶下裂、2例(3%)卵圆孔受累.7例(11%)出现上颌神经侵犯.结论:翼腭窝受累最易合并海绵窦、蝶窦和破裂孔侵犯.沿上颌神经侵犯是鼻咽癌侵犯翼腭窝的一条重要途径.MRI能有效、准确评价鼻咽癌侵犯翼腭窝及其向周围组织侵犯的情况,对临床治疗方案的选择及预后评估具有重要的价值.     

大鼠急性期缺血再灌注血管原性脑水肿MRI表现及与血管内皮细胞明胶酶B表达的关系

目的　探讨脑缺血再灌注后血管原性脑水肿 (VBE)MRI表现及其与血管内皮细胞明胶酶B表达的相关性。方法　线栓法建立大鼠脑缺血再灌注模型 ,MR连续动态观察缺血区体积与信号变化 ,免疫组织化学方法观察血管内皮细胞明胶酶B表达。结果　缺血后 3h至 7d扫描术侧大脑半球见T2 高信号改变 ,12h至 3d见不同程度同侧侧脑室受压变窄、中线结构向对侧移位。 3h开始上述征象逐渐明显 ,1～ 2d达到峰值 ,3～ 7d则逐渐减轻。显微镜下见随时间推移而明显的血管内皮细胞肿胀、血管周围间隙增宽与无定形嗜酸物质。不同时间点明胶酶B免疫组织化学染色均可见血管内皮细胞胞质着色 ,12h、1d、2d、3d、5d与 7d染色评分分别为 (1 2 0± 0 4 2 )分、(1 70±0 4 8)分、(2 2 0± 0 71)分、(2 87± 0 5 8)分、(3 0 0± 0 0 1)分与 (2 5 0± 0 71)分 ,与MRI上缺血侧大脑半球体积增加、对侧大脑半球压迫、缺血侧T2 WI上异常高信号体积增加、缺血侧额顶叶和基底节区T2 WI信号强度 (SI)增加的相关系数为 0 89～ 0 976。结论　缺血再灌注后VBEMRI表现为脑组织体积增大与T2 WI信号增高。VBE的MRI征象与脑组织明胶酶B的表达有相关性。     

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.