FLAIR和DWI序列对颅内胆脂瘤的诊断价值

目的:分析颅内胆脂瘤的MRI信号特点,探讨FLAIR和DWI序列对颅内胆脂瘤的诊断价值。方法:回顾性分析20例经病理证实的颅内胆脂瘤的MRI资料,比较FLAIR、DWI序列与常规T2WI、T1WI在显示病变范围、边界及对比度方面的特点。结果:20例颅内胆脂瘤T2WI均呈显著高信号,边界、范围显示不清,与周围脑脊液对比度差;18例T1WI呈类似于或稍高于脑脊液的低信号,2例T1WI呈高低混杂信号。总体边界、范围显示模糊,与周围脑脊液对比度较差;20例瘤体均无强化。20例FLAIR序列均呈混杂的不均匀信号,总体信号略高于或与脑实质类似,病变范围、边界显示较清晰,与脑脊液对比度好,与周围脑组织对比度差;DWI序列b=1000时均呈明显高信号,病变边界、范围显示清晰,与周围脑脊液及脑组织对比强烈,极易发现病变及确定范围。结论:颅内胆脂瘤的FLAIR和DWI序列均具有其特点,综合T1WI、T2WI序列可以较准确的诊断胆脂瘤,与颅内其他囊性病变鉴别;在显示病变边界、范围、对比度方面均优于T2WI、T1WI,特别是DWI序列病变范围边界显示清晰,对比度高,具有很高的诊断价值。     

小脑血管母细胞瘤的MRI诊断价值

目的:探讨高场MR对小脑血管母细胞瘤的诊断价值及SWI、DWI序列在其鉴别诊断中的价值。方法:回顾性分析经手术及病理证实的血管母细胞瘤患者18例20个病灶的MRI表现。结果:单发16例,多发2例共4个肿块;小脑半球14例,小脑扁桃体3例,小脑蚓部1例。可分为3型:囊伴结节型12例,实质型5例7个肿块,单纯囊型1例。囊伴结节型囊内壁光整,囊液呈长T1、长T2信号,FLAIR上呈低信号;结节实性成分呈等T2、等T1信号,FLAIR呈稍高、等信号,DWI呈等低信号,SWI多为等信号(11例);增强扫描后囊壁呈轻度强化或不强化,结节瘤体实质部分均明显强化。实质型5例,实质肿瘤呈稍长混杂T2、等T1信号,FLAIR呈等高信号,DWI呈等低信号,SWI呈等信号。1例单纯囊型病灶表现为出血信号。大部分病灶(11例)周围可见轻度水肿带。综上所述,DWI在三型中均表现为等信号或等低信号,SWI大多数为等信号,出血少见。结论:小脑血管母细胞瘤的MRI表现具有特征性,SWI及DWI序列在鉴别诊断中有重要意义。     

MRI FLAIR对脑挫裂伤的诊断价值

目的:探讨MRI FLAIR序列对脑挫裂伤的诊断价值。方法:回顾性分析22例脑挫裂伤的MR表现。结果:脑挫裂伤病变单发性3例,多发性19例。发生于颞叶2例,顶叶1例,双额叶3例,颞、顶叶3例,额、顶叶3例,额、颞、顶、枕复合伤10例。MRI表现为出血性改变8例,FLAIR序列表现为混杂高信号或低信号的病灶;非出血性病灶14例,FLAIR序列表现为高信号。常规T2WI发现病灶共58处,FLAIR上共发现病灶77处。结论:FLAIR序列对脑挫裂伤病变显示优于FSE序列T2WI,有很高的临床使用价值。     

多序列MRI评估脑外伤微出血及弥漫性轴索损伤

目的探讨MR常规序列(T1WI、T2WI、T2FLAIR)、扩散加权成像(diffusion-weighted imaging, DWI)及磁敏感序列(susceptibility weighted imaging, SWI)在脑外伤微出血及弥漫性轴索损伤(DAI)中的应用价值。方法对48例脑外伤患者,应用3.0T MR行常规MRI、DWI及SWI序列成像,比较各序列微出血灶及DAI病灶的检出率差异,并分析病灶在这些序列上的位置分布特点、信号特征。结果联合多种序列共检出547个剪切灶及微出血灶。T1WI检出205个病灶,T2WI检出358个病灶,T2FLAIR检出432个病灶,DWI检出396个病灶,SWI检出471个病灶,SWI病灶检出率高于常规T1WI(χ^2=273.94)、T2WI(χ^2=63.59)、T2FLAIR(χ^2=9.648)、DWI序列(χ^2=31.27),其检出率差异具有统计学意义(P<0.01)。DWI检出的大部分(80%)非出血性剪切灶表现为扩散受限、ADC值减低。SWI图像上微出血灶表现为条状、点状及类圆形低信号,病灶主要分布在皮髓质交界区及深部脑白质区域,位于皮髓交界区病灶排列呈甩鞭样或串珠状,具有特征性。结论 SWI序列对脑外伤微出血的敏感性高,多种序列联合应用对脑外伤微出血和DAI各期的诊断有重要的临床价值。     

磁敏感加权成像对胼胝体损伤的诊断

目的 探讨磁敏感加权成像(susceptibility weighted imaging,SWI)对胼胝体损伤的诊断价值.方法 回顾性分析15例CT检查阴性而MRI检查阳性的胼胝体损伤的MRI图像,所有患者均行高场强1.5T磁共振T1WI、T2WI、FLAIR、SWI横断位及T2WI矢状位扫描,分析各序列胼胝体损伤的信号特征及显示率.结果 胼胝体损伤T1WI为低、略低、稍高信号6例,T2WI、FLAIR为高信号10例,15例SWI均表现为明显低信号,5例患者CT、T1WI、T2WI、FLAIR均未见异常,其中4例SWI诊断为弥漫性轴索损伤,1例诊断为胼胝体等处多发损伤.脑内其他损伤区SWI表现为低信号影.结论 SWI对显示和诊断胼胝体损伤有较高的敏感性和准确性,并能显示常规MRI序列不能显示的微小损伤.     

颅内浆细胞肉芽肿MRI表现及4例误诊分析

目的 探讨中枢神经系统浆细胞肉芽肿(PCG)的MRI表现及误诊原因.资料与方法 对经手术病理证实的4例颅内PCG的临床资料及MRI表现进行回顾性分析.结果 4例病灶分别位于右侧额顶叶、右侧桥小脑角区、右侧中颅窝蝶鞍旁及左侧上矢状窦旁,T1WI、T2WI多表现为等或稍高信号,合并出血时可均呈高信号,扩散加权成像多呈等低信号,液体衰减反转恢复序列(FLAIR)可呈等、低或高信号,增强后多呈明显均匀强化.其中1例位于脑内,术前误诊为转移瘤或胶质瘤伴出血.3例位于脑外,其中2例可见脑膜尾征,术前误诊为脑膜瘤.结论 颅内PCG少见,MRI无特征性表现,确诊有赖于病理检查,免疫组织化学检查有助于鉴别诊断.     

Application Value of Magnetic Resonance Image in the Diagnosis of Cerebral Cavernous Malformations

目的 分析颅内海绵状血管瘤(cerebral cavernous malformations,CCMs)常规MRI序列表现及MRI磁敏感加权成像(susceptibility weighted imaging,SWI)的诊断价值.资料与方法 回顾性分析50例经病理证实的CCMs 患者的MRI资料,比较常规MRI序列(T1WI和T2WI)和SWI表现、检出率和病灶大小,判断其对CCMs的诊断价值.结果 50例共捡出97个病灶,22个病灶可见短T1信号伴出血,常规MRI对出血病灶具有多种表现形式;75个病灶未见短T1信号不伴出血.49个病灶T2WI灶周具有“铁环征”;97个病灶中有48个病灶在T1WI或T2WI上呈“网格”状或“桑椹”状高、低混合信号;8个病灶T1WI、T2WI均呈高信号;6个病灶T1WI、T2WI均呈低信号;3个病灶T1WI呈等信号、T2WI呈稍低信号.SWI显示的病灶范围包括瘤体及灶周含铁血黄素区域,病灶信号不均匀性降低;SWI上90个病灶显示均匀或不均匀黑色信号,7个病灶显示混杂信号影.T1WI、T2WI、SWI对出血性病灶的检出率均为100％,SWI对非出血性病灶检出率为100％,显著高于T1WI和T2WI(18.6％和40.0％,P＜0.05).SWI显示出血性瘤体大小为(3.3±1.2)cm,显著大于T1WI和T2WI[ (2.0 ±0.6)cm和(2.6 ±0.9)cm,P＜0.05];SWI显示非出血性瘤体大小为(3.1 ±1.1)cm,显著大于T1WI和T2WI[(1.7±0.6)cm和(2.3 ±0.8)cm,P＜0.05].结论 MRI是诊断CCMs的首选方法,常规序列结合SWI序列能提供更准确和更全面的诊断信息.     

颅内黑色素瘤MRI诊断

目的 探讨颅内黑色素瘤的MRI特征.方法 回顾性分析11例经手术病理证实的颅内黑色素瘤的MRI表现.结果 11例颅内黑色素瘤,共15个病灶,有14个位于幕上,10个病灶伴有出血,4个病灶局部囊变,大部分病灶有不同程度的水肿.颅内黑色素瘤MRI信号表现为:8个病灶T1WI为高信号、T2WI为低信号,3个病灶以T1WI为等信号、T2WI为低信号表现为主的混杂信号,2个病灶以等T1、等T2为主的混杂信号,2个病灶T1WI为低信号、T2WI为高信号;增强后均有不同程度的强化.结论 颅内黑色素性黑色素瘤MRI具有特征性的表现,对于无黑色素性黑色素瘤MRI表现无明显特征,诊断困难.     

12例继发于桥脑出血的肥大性下橄榄核变性的MRI表现

目的 探讨桥脑出血继发肥大性下橄榄核变性(HOD)的MRI表现.方法 回顾性分析12例桥脑出血后继发HOD的MRI表现,12例均行MRI常规序列和扩散加权成像(DWI)、磁敏感加权成像(SWI)或梯度回波(T2*WI)序列扫描,2例行扩散张量成像(DTI)扫描.结果 MRI表现为同侧或双侧下橄榄核体积增大或无明显变化,T1WI呈等或稍低信号,T2WI呈稍高或高信号,液体衰减反转恢复序列(FLAIR)呈等或稍高信号,DWI呈等或稍高信号,ADC图呈等或稍高信号,SWI或T2*WI呈等或稍高信号,其对原发出血病灶显示最好,DTI示病变侧纤维束稀少,3例并发双侧桥臂变性.结论 HOD多继发于桥脑背盖部出血,有特定的发病部位和较为特征的MRI表现,结合其原发病变可对HOD作出正确诊断.     

颅脑钙化灶的MR磁敏感成像

目的:探讨磁敏感成像技术(SWI)对显示颅内钙化灶的敏感性,并探讨钙化灶在SWI序列中的信号特点。方法:搜13例颅内钙化患者(共56处钙化灶)均进行CT和MRT1WI、T2WI和SWI扫描。结果:钙化灶在T1WI和T2WI上信号多样,没有特异性;在SWI相位校正图上显示为高信号或以高信号为主的混杂信号;在SWI重建图中显示为低信号。98.21%(55/56)的钙化灶DWI上均能显示,且病灶大小和形态与CT所见一致。颅内生理性和病理性钙化灶在SWI序列上检出率和信号特点的差异无统计学意义;脑实质内和脑室系统内钙化灶在SWI序列上检出率和信号特点的差异无统计意义。结论:SWI序列对颅内钙化灶的显示和检出敏感性高,可弥补常规MRI序列对钙化灶显示的不足。     

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.     

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).     

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.     

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.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.