骶部硬膜外囊肿的临床影像学表现与病理分析(18例报告及文献综述)

目的探讨骶部硬膜外囊肿的临床影像学与病理特点。方法本组18例均行腰骶部及骨盆X线平片检查,其中17例行CT扫描、11例行MRI检查、7例行脊髓造影、4例行脊髓造影CT(CTM)扫描,结合文献分析其影像学表现。结果本病临床误诊率为78%,X线诊断率17%,CT诊断率72%,MRI检查、脊髓造影、CTM扫描诊断率100%。18例均手术切除,病理报告为硬膜外囊肿,椎管内型13例、椎管外型3例及混合型2例。随访15~32个月,平均24个月,未发现症状加重和复发病例。结论骶部硬膜外囊肿为椎管内或椎管外通过颈口与蛛网膜下腔相通的硬膜外囊性肿物,临床和影像学具有特征性表现。     

骶尾部脊素瘤6例CT观察

作者报导6例骶尾部脊索瘤 CT 检查结果,男性4例,女性3例,年龄5～78岁。均先摄常规 X线片;CT 检查包括口服造影剂小肠显影,结肠造影剂灌注以及静脉内注入造影剂增强或膀胱及病变周围血管造影;并作术前骶部和术后骶部 CT 检查,以便随访对照。6例中5例术前确诊。随访中1例复发,经 CT 证实,2例临床发现骶部及坐骨神经痛等预警性神经压迫症状,CT 复查证实为肿瘤复发。1例常规 CT 复查发现直肠后肿块,手术组织     

骶管蛛网膜囊肿的临床特点及显微手术治疗

目的探讨骶管蛛网膜囊肿的临床特点及治疗方法。方法回顾分析32例经显微手术治疗的骶管蛛网膜囊肿病人的影像学资料,分析其临床特点、手术方法及注意事项。结果骶管蛛网膜囊肿临床症状以骶管内神经受压表现为主,并且与体位有明显关系。X线及CT检查多数没有阳性发现;MRI显示硬膜囊末端为梭形的囊性肿物,且与脑脊液信号相同。本组28例获6个月~3年3个月(平均31.2个月)随访,优:20例,良:6例,可:2例,优良率92.9%。结论MRI是骶管蛛网膜囊肿最好的影像学检查方法,是诊断主要依据。对临床症状重者应考虑手术治疗,显微手术能有效防止术后复发及神经损伤。     

脉络膜裂囊肿的影像学诊断

脉络膜裂囊肿(choroid fissure cyst)为颅内较少见的囊性病变,目前国内外报道较少。为提高对该病的认识水平,本文搜集6例患者的CT及MRI资料分析报告如下。1材料与方法搜集经CT和MRI诊断的6例脉络膜裂囊肿患者资料,其中男4例,女2例,年龄17~41岁,平均29岁。所有患者均因头疼、头晕或其他原因就诊。颅脑CT检查使用HispeedNT双排螺旋CT机,病灶区层厚和层距均为5mm,CT增强扫描采用高压注射器经肘前静脉以2·5~3·0ml/s的流率注射碘海醇100ml后,行轴位横断扫描,MR成像使用Philips Gy-roscan Intera 1·5T超导机,常规扫描T1WI自旋回波…     

CT引导下经皮双针穿刺治疗骶管囊肿

目的 探讨CT引导下经皮双针穿刺注射医用生物蛋白胶(FG)治疗骶管囊肿的安全性和疗效.方法 回顾性分析20例CT引导下经皮双针穿刺注射FG,治疗骶管囊肿患者的临床资料.所有患者术前均有明显的腰骶部疼痛等骶神经丛受压症状,诊断明确后,均在传统的CT引导下单针穿刺注射的基础上,行改良的双针穿刺注射FG治疗.注射量3.0 ～ 15.0 ml,平均(5.9±2.4)ml.治疗后随访1 ～32个月,平均(17±3)个月.疗效评判标准:优:患者症状完全缓解,可以从事正常工作,随访1年以上无复发;良:下肢及会阴部症状完全缓解,仅遗留腰骶部疼痛不适,但不影响患者日常工作,随访6个月以上无复发;中:临床症状无改善,但影像检查提示囊肿缩小;差:临床症状无改善,影像检查提示囊肿大小无变化或术后复发.结果 所有患者均成功实施治疗,无严重并发症发生.疗效优9例、良8例、中2例、差1例,优良率为85％.4例1个月内症状复发,行再次治疗,症状缓解,但其中1例再次复发.其他患者随访期内未见复发.结论 CT引导下经皮双针穿刺注射FG治疗骶管囊肿操作简单、安全可靠.     

Tornwaldt囊肿的MRI诊断

目的:探讨Tornwaldt囊肿的MRI特征。方法:回顾性分析1327例患者的颅脑MRI资料,分析Tornwaldt囊肿的出现率、MRI表现及其与临床症状的相关性。结果:1327例中共发现Tornwaldt囊肿21例,囊肿在T2WI上均呈高信号,在T1WI上较肌肉信号高;15例呈圆形,6例呈椭圆形,横轴面图像上平均最大径6.1mm,最小径5.4mm。21例中2例患者存在持续性鼻分泌物及枕部疼痛,1例仅有枕部疼痛,所有患者均无腺样体切除史。结论:Tornwaldt囊肿的MRI表现有一定特征性,其人群发生率约为1.6%。     

骶部硬膜外囊肿的诊断和治疗

目的探讨骶部硬膜外囊肿临床表现和影像学的特点,以提高该病的诊断和治疗水平。方法回顾18例经手术证实的骶部硬膜外囊肿病例,分析患者的临床症状、体征、影像学表现和治疗方法。结果18例患者均有腰骶部疼痛,5例伴有下肢痛,其疼痛多发生在站起和坐下的过程中,与体位变化有明显关系,站立时疼痛加重,卧位时较轻,头低位时更轻,与腰椎间盘突出症临床表现不尽相同。MRI检查示骶椎管明显扩大,膨胀及椎体后缘被压表现。本组均手术治疗,同时行腰椎间盘髓核摘除术5例。结论MRI是诊断骶部硬膜外囊肿的可靠方法,影像学显示囊肿大且神经症状重者囊肿切除是有效的治疗方法。     

脉络膜裂蛛网膜囊肿的CT、MRI诊断价值

目的:探讨脉络膜裂蛛网膜囊肿的CT、MRI诊断价值。方法:经CT和MRI诊断为脉络膜裂蛛网膜囊肿的患者23例。CT轴位扫描18例,其中增强扫描4例,CT冠状扫描2例,MRI进一步检查14例;单独MRI检查5例。结果:23例病灶均位于两侧脉络膜裂区,发生于右侧15例,发生于左侧8例;均为单发病灶;最大者22mm×28mm,最小者直径5mm。轴位CT上病灶呈长卵圆形、圆形,与环池相连14例,CT值6～26HU,平均为11.4HU。MRI表现:冠状面呈“双凸透镜”形、卵圆形,矢状面呈卵圆形、“箭头样”表现;均呈长T1长T2信号,FLAIR序列示囊肿信号呈低信号。CT、MRI增强扫描均无强化表现。其中CT首次诊断而误诊为其他疾病10例,MRI误诊2例。结论:CT和MRI均可检出脉络膜裂蛛网膜囊肿,但在明确诊断和鉴别诊断方面,MRI优势明显。     

影像学诊断骶神经根囊肿的价值

目的：探讨骶神经根囊肿的影像学特点，提高临床诊断水平。材料和方法：对68例骶神经根囊肿的MRI（35例）、CT（16例）、X线脊髓造影（29例）和X线平片（68例）等影像学特征进行回顾性分析。结果：X线平片一般不能检出骶神经根囊肿。脊髓造影一般能清楚显示神经根囊肿。CT扫描能显示骶管扩大、骶骨椎板变簿、椎体后缘凹陷性侵蚀性改变。MRI能清楚显示骶骶神经囊肿的位置、大小和形态，可做出定性诊断。结论：脊髓造影、MR和CT对本病诊断和鉴别诊断具有重要的临床价值；由于CT受扫描范围的限制和囊肿大小的影响，有时易发生漏诊。     

蝶鞍内囊肿的X线、CT、MRI诊断

目的:提高蝶鞍内囊肿的X线、CT、MRI诊断水平。材料和方法:回顾性分析15例经手术、病理证实的蝶鞍内囊肿的X线、CT、MRI表现。结果:X线平片发现蝶鞍改变7例(含5例X线体层摄影),6例未发现异常,2例行颈动脉血管造影,其中1例大脑前动脉水平段轻度弧形上抬,2例侧位片示颈动脉虹吸部稍张开。CT呈圆形或卵圆形低密度,准确诊断鞍内囊肿6例。MRI表现为蝶鞍内圆形或卵圆形长T1、长T2信号,准确诊断囊肿5例。结论:对蝶鞍内囊肿X线平片和脑血管造影无特异性,CT和MRI术前正确诊断率高。后者为首选的影像学诊断检查。     

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.