地中海贫血患者心脏、肝脏铁沉积的MRI定量研究

目的 定量评价地中海贫血患者心脏、肝脏铁沉积程度,探讨两者关系及临床用肝铁浓度＞ 15 mg/g干重预测心铁沉积的准确性.方法 连续搜集2010年9月至2011年6月期间103例5岁以上总输血(全血)剂量＞10 U(1 U=200 ml)地中海贫血患者资料,行心脏、肝脏MR检查并测量T2*值,采用Spearman秩相关分析其相关性.以肝脏T2*＜0.96 ms(相当于肝铁浓度＞15 mg/g干重)为标准,将患者分为两组,采用秩和检验比较各组心肌T2*值的差异.以心脏T2*＜10 ms、10 ms≤T2*＜20 ms和T2*≥20 ms为标准,将患者分为3组并采用秩和检验比较各组肝脏T2*值有无差异.绘制用肝铁浓度＞ 15 mg/g干重预测患者心脏铁沉积的ROC曲线.结果 103例地中海贫血患者的心脏T2*值中位数为24.00ms(4.70～51.10 ms),肝脏T2*值中位数为1.16 ms(0.68～14.80 ms),两者呈低度相关(r=0.453,P=0.000),且未见规律性.肝脏T2*＜0.96 ms组25例患者的心脏T2*值中位数为12.10 ms(4.70～41.70 ms),T2*≥0.96 ms组78例患者的心脏T2*值中位数为26.10 ms(4.80～51.10 ms),两组之间差异有统计学意义(Z=-3.566,P=0.000).心脏T2*＜10 ms组20例患者的肝脏T2*值中位数为1.06ms(0.68 ～3.83 ms),T2*≥20 ms组58例患者中位数为1.76 ms(0.74～14.80 ms),差异有统计学意义(Z=-3.553,P=0.000);10 ms≤T2*＜20 ms组25例患者的肝脏T2*值中位数为0.99 ms(0.69 ～ 13.59 ms),与T2*＞20 ms组间差异有统计学意义(Z=-3.951,P=0.000);心脏T2*＜10 ms组与10 ms≤T2*＜20 ms组相比,两组患者的肝脏T2*值之间差异无统计学意义(Z=-0.046,P=0.964).以肝铁浓度＞15 mg/g干重预测心脏铁沉积的ROC曲线下面积为0.771,敏感度为42.2％,特异度为89.7％.结论 多次输血地中海贫血患者的心、肝铁水平之间呈低度相关.肝铁浓度＞ 15 mg/g干重的患者心铁沉积发生率相对较高,用其预测心脏铁沉积的准确度为中等偏低.     

慢性肾脏病患者铁过载的MRI定量研究

目的：通过磁共振HISTO及q-Dixon定量技术对慢性肾脏病患者铁过载情况进行评估，并评价临床常用铁代谢实验室检查对铁过载的预测能力。方法：收集50例慢性脏肾病住院患者行MRI检查，依据患者临床情况分成终末期肾脏病组(ESRD)与非终末期肾脏病组，根据磁共振HISTO定量参数推算的肝脏铁含量(LIC)，将患者分为铁过载组与非铁过载组，进行磁共振铁定量参数及实验室检查结果的组间比较。并使用Spearman相关分析研究各参数与肝脏铁含量的相关性，使用logistic回归分析及受试者工作特征(ROC)曲线评估实验室指标的诊断价值。结果：ESRD组的铁过载患病率47.8%，高于非ESRD组的11.1%，肝脏R2值、R2^*值高于非ESRD组，差异有统计学意义(P<0.05)。铁过载组的血清铁蛋白(SF)值、脾脏R2^*值高于非铁过载组，差异有统计学意义(P<0.05)。Spearman相关分析显示，SF、肝脏R2^*、脾脏R2^*值与LIC呈正相关(P<0.05)，其中SF相关性最好。多重log...     

应用磁敏感加权成像评价肝硬化患者肝脏铁沉积及其与血清铁蛋白含量的相关性

目的 应用磁敏感加权成像( SWI)定量测量肝硬化患者肝脏相位像值,并分析其与血清铁蛋白含量的相关性.资料与方法 32例健康人和42例经临床诊断的乙型肝炎后肝硬化和酒精性肝硬化患者行SWI序列扫描,并检测血清铁蛋白浓度.应用SPIN软件测量健康人肝脏SWI相位值(SPU),将均值减2倍标准差作为相位像测量基线,以此基线为阈值将肝硬化患者相位像感兴趣区划分为高、低含铁区,测量高含铁区SPU,采用相关分析评价其与血清铁蛋白浓度的相关性.结果 32例健康人相位值为(2003±15) SPU,将1973SPU设为阈值对肝硬化患者SWI相位像感兴趣区内高含铁区进行测量,相位值(弧度)=-(0.273±0.142),血清铁蛋白浓度为(165.5±104.4) ng/ml,SWI相位像值与血清铁蛋白浓度呈负相关(r=-0.712,P＜0.001).结论 通过建立肝脏相位像测量基线可以评估肝硬化患者肝脏铁含量.     

采用MRI探究不同输血依赖性疾病患者肝脏铁过载及其影响因素

【摘要】目的：基于MRI R2*技术探究不同病种输血依赖性疾病患者肝脏铁过载情况及铁过载的影响因素。方法：前瞻性搜集输血依赖性疾病患者80例,其中18例再生障碍性贫血(AA),34例急性白血病（AL）,28例骨髓增生异常综合征(MDS)。于3T MRI行多回波Dixon序列扫描,测量R2*值并计算肝脏铁含量（LIC）。搜集患者累计输血量及血清铁蛋白（SF）等临床资料并计算铁摄入量。比较不同病种间临床指标及LIC差异,分析LIC影响因素,并对SF与LIC、铁摄入量进行相关性分析。结果：单因素线性分析显示铁摄入量,病程和病种与LIC线性关系显著（P＜0.01）,多因素线性分析显示仅铁摄入量为LIC的影响因素（P＜0.01）。所有患者SF与LIC及铁摄入量显著相关（r=0.480,P＜0.01）;AA、MDS组SF与LIC及铁摄入量之间均存在显著相关性（P＜0.05）,而AL组SF与LIC及铁摄入量无相关（P＞0.05）。结论：不同输血依赖性疾病均存在肝脏铁沉积,病种间的铁代谢差异对肝脏铁负荷影响较小,可利用铁摄入量评估肝脏铁过载程度。     

β-重型地中海贫血MR定量心脏铁沉积与血清铁蛋白、肝铁浓度相关性研究

目的 使用MR定量重型地中海贫血患者心脏铁沉积,探讨其与血清铁蛋白(SF)、肝铁浓度(LIC)的相关性.方法 对58例10岁以上长期接受输血治疗的β-重型地中海贫血患者行心脏MR检查并测量T2*值,采用Spearman相关分析探讨心脏T2*值和SF、LIC之间关系.分别以SF＞2500μg/L和LIC＞ 15 mg/g干重为界值将患者分组.用完全随机设计两样本秩和检验比较2组患者的心脏T2*值.以T2*＜20 ms为诊断心脏铁沉积参考标准,计算以SF＞ 2500 μg/L或LIC＞ 15 mg/g干重预测心脏铁沉积的敏感度、特异度,分别绘制用SF和LIC预测心脏铁沉积的ROC曲线.结果 58例患者的心脏T2*值范围4.7～51.1 ms,中位数14.o ms; SF范围1345 ～23 640 μg/L,中位数5741 μg/L; LIC范围9.0～ ＞43.0 mg/g干重,中位数41.4 mg/g干重.所有患者的心脏T2*值与SF尚不能认为有线性相关关系(r=-0.240,P =0.070);心脏T2*值和LIC之间呈低度负相关(r=-0.402,P=0.002).SF≤2500 μg/L组7例,心脏T2*值范围6.1 ～47.6 ms,中位数23.7 ms; SF＞2500 μg/L组51例,心脏T2*值范围4.7 ～51.1 ms,中位数13.5 ms,2组心脏T2*值之间差异无统计学意义(Z=-0.489,P=0.625).LIC≤15 mg/g干重组5例,心脏T2*值范围24.4 ～51.1 ms,中位数44.8 ms;LIC＞ 15 mg/g干重组53例,心脏T2 *值范围4.7～45.5ms,中位数13.2 ms,2组心脏T2*值之间差异有统计学意义(Z=-2.895,P =0.004).以SF＞ 2500 μg/L和LIC＞ 15 mg/g干重预测心脏铁沉积的敏感度分别为90.9％(30/33)、100.0％(33/33),特异度分别为16.0％ (4/25) 、20.0％(5/25).以SF和LIC预测心脏铁沉积的ROC曲线下面积分别为0.652、0.775.结论 MRI-T2*可以直接定量重型地中海贫血患者心脏铁沉积,心脏铁浓度与SF无相关,与LIC低度相关.临床用SF或LIC预测心脏铁沉积不可靠,对诊断及治疗提供参考价值不大.     

3.0T MR无创性检测肝脏铁含量:活检验证

目的采用3 T MRI评估R_2*值和信号强度比(SIR)方法定量检测肝脏铁含量(LIC)的效能及局限性。方法这项前瞻性研究共纳入105例病人,行肝脏活检测量组织生化铁含量(LICb)。所有病人均进行3 T MRI屏气多回波梯度回波(mGRE)序列扫描。通过3 T SIR算法(LIC_(SIR))和R_2*(LICR_2*)计算出LIC,并与LICb行相关分析。将数据等分为连续多组对2种方法的比较。结果LICb与R_2*(r=0.95,P0.001)和LIC_(SIR)(r=0.92,P0.001)呈高度相关。以LIC_b为参照,LICR_2*和LIC_(SIR)检测肝脏铁过载的敏感度/特异度分别为0.96/0.93和0.92/0.95,偏倚±标准差分别为(7.6±73.4)μmol/g和(14.8±37.6)μmol/g。LIC_b130μmol/g时,LICR_2*差异性最低,LIC_b130μmol/g时,LIC_(SIR)差异性最低。结论 3 T MRI R_2*在铁过载水平较低时可精确定量LIC,但铁过载水平较高时建议使用SIR方法克服R_2*的局限性。该软件发布在www.mrquantif.org网站,可综合应用2种方法 ,并择优使用。     

磁共振多回波R2*技术无创评估肝硬化铁沉积

目的 探讨磁共振多回波R2*技术评估肝硬化铁沉积的价值.方法 分别对53例肝硬化患者及28例正常对照人群进行磁共振多回波R2*序列扫描.在R2*图和T2*图上测量肝实质、脾及脊柱旁骨骼肌的T2*和R2*值,利用T2*WI图像测量信号强度,再分别计算T2*、R2*值及信号强度的肝/肌、肝/脾及脾/肌各比值.分析肝硬化及其分级对以上MR测量参数的影响.结果 MR各测量值在性别之间未见统计学差异(P>0.05).在肝硬化组,脾R2*值和T2*值与年龄均存在相关性(r值分别 为0.624和-0.616,P值分别为0.017和0.019).肝脏的R2*值最大、肌肉最小.肝硬化组肝脏和骨骼肌的R2*值明显大于对照组,而T2*值则相反(P<0.05);其余测量参数在有、无肝硬化之间未见统计学差异(P>0.05).另外,MR各测量值在ChildPugh分级之间也未见统计学差异(P>0.05).结论 MR多回波R2*技术可对肝硬化铁沉积进行量化,但其不能用于评估肝硬化时肝脏储备功能情况,肝硬化时利用肌肉作为组织铁沉积的参照物并不可靠.     

MR超短回波序列在肝铁和脂肪过载情况下定量分析肝铁浓度的实验研究

【摘要】目的：探讨MR超短回波序列（UTE）对肝铁沉积定量分析的准确性,以及脂肪沉积对肝铁浓度定量测量的影响。方法：将63只雄性新西兰兔随机分为2组,分别用于建立单纯铁过载模型（A组,30只）和铁过载合并脂肪肝模型（B组,33只）。在3.0T磁共振仪上采用UTE序列（包含8个回波时间：0.03、0.08、0.13、0.23、0.43、0.73、1.03和2.03ms）进行扫描,测量实验兔肝脏的R2*值。对兔肝组织标本采用化学法测量肝铁浓度（LIC）,并采用病理方法测量肝脏的脂肪分数。采用Spearman相关性分析评估肝脏R2*值与LIC的相关性,并建立线性回归方程。采用协方差分析法观察肝脏脂肪分数对铁浓度测量的影响。以去铁治疗方案中采用的肝铁含量分级阈值（1.8、3.2、7.0和15.0mg/g）为参考标准,采用受试者工作特征（ROC）曲线评价R2*值对不同铁过载分级的诊断效能。结果：63只新西兰兔中最终存活49只（77.8%）。UTE-R2*值与肝铁浓度呈显著正相关（r=0.947,P<0.0001）。协方差分析结果显示,单纯铁过载组与铁过载合并脂肪肝组之间线性回归方程的斜率无显著差异（P>0.05）。ROC曲线分析显示,肝脏R2*最佳截断值为623、678、1400和2050Hz时,预测不同铁沉积程度（1.8、3.2、7.0和15.0mg/g）的曲线下面积（AUC）分别为0.919、0.968、0.992和0.998。结论：磁共振UTE序列获取的R2*值能够对肝内铁浓度进行精确测量,对铁过载具有很好的分级诊断效能,尤其是对重度铁过载,且不受肝内脂肪沉积的影响。     

磁共振T2* map成像在膝关节骨性关节炎中的应用价值

目的 探讨磁共振T2* map成像在膝关节骨关节炎(OA)中的临床应用价值.方法 41例受检者共41个膝关节分为正常组(n=11)、轻度OA组(n=20)和重度OA组(n=10),采用T2* map成像分别测量股骨内侧、外侧髁,胫骨内侧、外侧髁及髌软骨等5处软骨浅、深层T2*值并对各组间差异进行统计学分析.正常组浅、深层之间T2*值的比较采用独立样本t检验,正常组与轻、重度OA患者浅、深层间T2*值的比较采用q检验.结果 正常成人关节软骨浅层T2*值为19.9～34.0 ms,深层T2*值为16.1～21.9 ms,两者之间存在显著性差异(P＜0.05),轻度OA患者关节软骨浅、深层T2*值分别为27.9～43.7 ms、23.7～31.7 ms,重度OA患者关节软骨浅、深层T2*值分别为27.3～44.4 ms、23.8～31.5 ms,与正常组浅、深层T2*值之间均存在显著性差异(P＜0.05),轻度OA组与重度OA组浅、深层T2*值之间无显著性差异(P＞0.05).结论 MR T2* map成像可用于评价关节软骨生物组织构成的变化,并在早期关节软骨退变的诊断中具有一定的临床应用价值.     

正常人胫股关节软骨T2及T2*弛豫值的比较研究

目的:探讨正常志愿者膝关节软骨的T2及T2*弛豫值范围、影响因素及其内在相关程度。方法:将63名健康人胫股关节按照年龄分为青少年组(<35岁)18人、中年组(36~55岁)28人和老年组(56~78岁)17人,计算体重指数(BMI)并行T2图、T2*图成像,按照全器官磁共振成像评分(WORMS)规定的软骨分区法测量胫股关节软骨10个感兴趣区的T2、T2*弛豫率并取平均值,然后进行统计学分析。结果:健康人胫股关节软骨T2、T2*值分别为(42.98±4.19)ms、(19.75±2.43)ms。左右膝胫股关节T2、T2*值分别为(43.60±4.08 ms,42.37±4.26 ms)、(19.29±2.48 ms,20.21±2.37 ms),经检验两者均无明显统计学差异(P>0.05)。女性及男性胫股关节软骨T2、T2*值分别为(44.28±5.14 ms,41.86±4.09 ms)、(19.36±2.48 ms、20.09±2.42 ms),亦无明显统计学差异(P>0.05)。青少年组、中年组及老年组胫股关节软骨的T2、T2*值分别为(37.45±1.76 ms,41.29±2.13 ms,44.98±4.73 ms)、(17.95±1.58 ms,20.76±1.52 ms,22.30±2.08 ms),三组间有明显统计学差异(P<0.01)。青少年组、中年组及老年组三组内T2、T2*值均呈显著相关(P<0.05,Pearson相关系数分别为0.61、0.63、0.55)。结论:正常人胫股关节软骨T2及T2*弛豫值研究可以为关节软骨早期病变的诊断提供相似的参考价值,定量测定T2*值有望替代传统的T2值用于研究软骨形态学改变之前软骨内生化成分的变化。     

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 role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

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.