Preliminary study of the optimal delay time for liver MR imaging enhanced with Gd-BOPTA

目的:采用对比剂钆贝葡胺(Gd-BOPTA)对肝功能正常志愿者行增强MRI肝胆期扫描,评价不同延迟时相肝实质、胆道系统的信号变化,探讨肝脏功能正常时肝胆期最佳延迟时间的选择.方法:应用对比剂Gd-BOPTA并采用客积式内插值法屏气检查(VIBE)轴面T1WI序列对48例无肝胆疾病的志愿者分别于注射对比剂后40、60和90 min行肝胆期扫描,测量并比较各时相肝脏、左右肝管、胆囊和胆总管的信噪比(SNR),对比率(CR),SNR增长率和CR增长率.结果:全肝、左肝管的SNR和CR均在注射Gd-BOPTA后60 min达到峰值,而胆囊和胆总管在延迟90 min时达到峰值(P＜0.05);胆囊SNR增长率和CR增长率及胆总管SNR增长率在延迟90 min时达到峰值(P＜0.05).结论:正常肝功能者行Gd-BOPTA增强MRI扫描,可在延迟60 min时获得肝脏和左右肝管强化的最佳图像,延迟90 min时获得胆囊和胆总管强化的最佳图像.     

Gd-BOPTA增强MRI肝胆期扫描最佳延迟时间的初步探讨

目的:采用对比剂钆贝葡胺(Gd-BOPTA)对肝功能正常志愿者行增强MRI肝胆期扫描,评价不同延迟时相肝实质、胆道系统的信号变化,探讨肝脏功能正常时肝胆期最佳延迟时间的选择。方法:应用对比剂Gd-BOPTA并采用容积式内插值法屏气检查(VIBE)轴面T1WI序列对48例无肝胆疾病的志愿者分别于注射对比剂后40、60和90min行肝胆期扫描,测量并比较各时相肝脏、左右肝管、胆囊和胆总管的信噪比(SNR),对比率(CR),SNR增长率和CR增长率。结果:全肝、左肝管的SNR和CR均在注射Gd-BOPTA后60min达到峰值,而胆囊和胆总管在延迟90min时达到峰值(P<0.05);胆囊SNR增长率和CR增长率及胆总管SNR增长率在延迟90min时达到峰值(P<0.05)。结论:正常肝功能者行Gd-BOPTA增强MRI扫描,可在延迟60min时获得肝脏和左右肝管强化的最佳图像,延迟90min时获得胆囊和胆总管强化的最佳图像。     

MR对比剂增强扫描长时间延迟技术在肝脏炎性假瘤特异性诊断中的价值

目的 探讨MR对比剂增强扫描长时间延迟技术在肝脏炎性假瘤(inflammatory pseudotumors in liver, IPT)特异性诊断中的价值.方法 对经病理及随访证实的26例IPT进行MR平扫、DWI和动态增强扫描,增强扫描延迟时间均＞20 min,分析病变的MR表现特征.结果 1例为肝脏弥漫性病变,其余25例共发现29个病灶.所有病灶T1WI为低或等信号,T2WI为等、略高或高信号,部分病灶出现"环征".29个病灶中,DWI显示19个中心为高信号;动态增强扫描时,动 脉期、静脉期、3 min、5 min、10 min、15 min、20 min延迟时分别有5、11、25、26、26、28、28个病灶出现边缘强化.延迟期＞20 min(20 min～ 4 h之间)时,所有病灶均显示典型的环形、花边样或多囊样边缘强化,强化边缘厚度一致,内壁光滑;延迟期＞5 min时21个病灶出现纤维间隔.结论 动态对比剂增强扫描长时间延迟(＞20 min)有助于IPT特异性表现的显示.     

组织特异性对比剂--Mn-DPDP的临床应用

目的　探讨肝脏、胰腺病变在Mn -DPDP增强MRI检查中的强化特征。方法　 2 5例Mn -DPDP增强MRI检查 ,其中有15例先行Gd -DTPA增强扫描。常规扫描序列为SET1WI、FSET2 WI、FSET1WI脂肪抑制序列。Mn -DPDP剂量为 0 .5ml/Kg体重 ,肘静脉缓慢滴注 ( 2～ 3ml/min) ,于给药结束后 40min～ 1h扫描 ,序列为SET1WI和FSPGRT1WI ,5例病人 2 4h后复查。结果　原发型肝癌 10例 ,8例为轻度不均匀强化、2例呈半环状强化。肝硬化 2例 ,表现为结节状均匀一致强化且信号高于正常肝组织。肝血管瘤 2例、肝转移瘤 2例、肝囊肿 1例均无强化 ;胰头癌 8例 ,病灶无强化 ,周围胰腺组织明显强化。结论　Mn -DPDP对比剂能使正常肝脏、胰腺显著强化。该药物峰值持续时间长 ,可提供充裕的扫描时间窗     

3.0T MR LAVA序列在上腹部检查的优势

目的 探讨3.0T MR LAVA序列多期动态增强扫描对上腹部病变检出率的优势.方法 对42例临床怀疑肝脏占位患者行MR检查,15例无肝脏病变患者作对照.常规MR T_1WI和T_2WI扫描,包括T1WI 2D和3D FSPGR序列,增强采用LAVA屏气动态多期扫描.分别对2D和3D及LAVA序列图像对病灶检出率进行比较分析,并测量肝、脾的信噪比等情况.结果 LAVA序列对42例肝脏病变患者做多期增强扫描后发现68个病灶,其显示率达100%,对病灶定性诊断准确率达95.6%(65/68).3D T_1WI FSPGR序列增强扫描对病灶显示率为91.2%(62/68),对病灶定性准确率为76.5%(52/68).2D T_1WI FSPGR序列病灶显示率为89.7%(61/68),对病灶定性准确率为70.6%(48/68).15例正常肝、脾组织,使用不同序列测量所得信噪比为:平扫LAVA肝29.68±2.31,脾36.21±3.67,2D肝46.21±5.32,脾58.75±4.68,3D肝19.79±2.23,脾23.36±2.14.增强LAVA肝41.75±5.13,脾57.96±6.13,2D肝56.33±5.63,脾63.21±5.32,3D肝29.05±4.68,脾46.37±5.17.结论 LAVA序列多期动态增强扫描对肝脏病灶的显示及肝血管显示方面较常规2D和3D序列优越.     

MRI特异性对比剂铁羧葡胺对肝脏局灶性病变检出的比较研究

目的 通过比较MR平扫、应用对比剂钆喷替酸葡甲胺（Gd—DTPA）增强MRI及MRI特异性对比剂铁羧葡胺增强MRI对肝脏局灶性病变的检出，验证铁羧葡胺在病灶检出方面的优势。方法 2003年12月至2004年7月，选择怀疑为肝脏局灶性病变的病例59例，根据相对金标准判定共133个病灶。所有病例均先行梯度回波（GRE）T1WI、去脂快速自旋回波（FSE）序列T2WI、动态梯度回波Gd—DTPA增强MRI，48h后行铁羧葡胺动态GRE增强扫描及去脂FSE T2WI与GRE TW^＊W延迟扫描。统计各序列对局灶性病变检出的敏感性。结果 铁羧葡胺延迟增强去脂FSE T2W序列、动态GRE增强扫描、GRE T2^＊W延迟增强扫描检出病灶数分别为130、115、127个；平扫GRE T1WI序列、去脂FSE T2WI检出病灶分别为84和106个；Gd—DTPA动态GRE增强检出123个病灶。对于其中44个的微小病灶（〈1cm），铁羧葡胺延迟增强去脂FSE T2WI检出率达到932％（41/44），铁羧葡胺动态增强检出率为727％（32/44），铁羧葡胺延迟增强GRE T2^＊WI检出率为886％（39/44），Gd—DTPA动态增强检出率为795％（35/44），平扫去脂FSE T2WI检出率为545％（24/44），平扫GRE T1WI检出率为34.1％（15/44）。铁羧葡胺延迟增强去脂FSE T2WI及GRE T2WI显著提高了对于微小病灶（〈1cm）的检出率，与平扫MR（包括去脂FSE T2WI和GRE T1WI）及Gd—DTPA动态增强MR相比差异有统计学意义（P〈005）。结论 铁羧葡胺延迟增强去脂FSE T2WI及GRE T2^＊WI序列优势主要为提高肝微小病灶（〈10cm）的检出率。     

Study of clinical application of hepatic-biliary specific MR contrast agent (Gd-EOB-DTPA) in the diagnosis of focal hepatic lesions

目的:探讨Gd-EOB-DTPA MRI增强扫描时肝局灶性病变的表现及此新型对比剂的诊断效能,提高对肝脏局灶性病变的诊断准确性.方法:已知或怀疑为肝脏局灶性病变的34例患者共90个病灶,病灶性质依次为肝囊肿20个、肝细胞肝癌16个、胆管细胞癌1个、肝脏转移性肿瘤37个、肝血管瘤9个、退变结节1个、肝脏局灶性结节增生1个、肝细胞腺瘤1个、肝脏炎性病变3个及肝脏淋巴上皮瘤样癌1个.所有患者依次行MRI平扫(抑脂TSE T2 WI、抑脂3DVIBE、2D GRE T1 WI)、Gd-EOB-DTPA三期(动脉期、门脉期和平衡期)增强扫描(抑脂3D VIBE)及延迟20min肝实质期扫描(抑脂2D GRET1WI、抑脂TSE T2 WI、抑脂3D VIBE).测量并分析Gd-EOB-DTPA增强前后肝脏和病灶信号变化、病灶-肝脏对比噪声比绝对值(|CNR|)变化情况;并观察病灶Gd-EOB-DTPA增强扫描表现和特征.结果:Gd-EOB-DTPA增强后各期肝实质信号及病灶肝脏|CNR|均显著增加(P＜0.001).动脉期、门脉期和平衡期所有病灶符合应用常规含钆(Gd)对比剂时的强化表现和特征;延迟20min肝实质期扫描时,肝脏局灶性结节增生呈等信号—高信号.1个肝细胞肝癌呈相对高信号,其余肝囊肿、肝细胞肝癌、胆管细胞癌、肝脏转移性肿瘤、淋巴上皮瘤样癌、退变结节、肝细胞腺瘤、肝血管瘤和肝脏炎性假瘤等均呈相对低信号.结论:Gd-EOB-DTPA动态增强扫描与延迟肝实质期扫描联合应用,可以提供病变形态、血供、细胞来源及功能等更多相关信息,从而提高诊断信心及诊断准确性.     

肝胆特异性磁共振对比剂Gd-EOB-DTPA在肝脏局灶性病变诊断中的应用研究

目的:探讨Gd-EOB-DTPA MRI增强扫描时肝局灶性病变的表现及此新型对比剂的诊断效能,提高对肝脏局灶性病变的诊断准确性。方法:已知或怀疑为肝脏局灶性病变的34例患者共90个病灶,病灶性质依次为肝囊肿20个、肝细胞肝癌16个、胆管细胞癌1个、肝脏转移性肿瘤37个、肝血管瘤9个、退变结节1个、肝脏局灶性结节增生1个、肝细胞腺瘤1个、肝脏炎性病变3个及肝脏淋巴上皮瘤样癌1个。所有患者依次行MRI平扫(抑脂TSE T2WI、抑脂3DVIBE、2DGRE T1WI)、Gd-EOB-DTPA三期(动脉期、门脉期和平衡期)增强扫描(抑脂3DVIBE)及延迟20min肝实质期扫描(抑脂2DGRE T1WI、抑脂TSE T2WI、抑脂3DVIBE)。测量并分析Gd-EOB-DTPA增强前后肝脏和病灶信号变化、病灶-肝脏对比噪声比绝对值(|CNR|)变化情况,并观察病灶Gd-EOB-DTPA增强扫描表现和特征。结果:Gd-EOB-DT-PA增强后各期肝实质信号及病灶-肝脏|CNR|均显著增加(P<0.001)。动脉期、门脉期和平衡期所有病灶符合应用常规含钆(Gd)对比剂时的强化表现和特征;延迟20min肝实质期扫描时,肝脏局灶性结节增生呈等信号-高信号,1个肝细胞肝癌呈相对高信号,其余肝囊肿、肝细胞肝癌、胆管细胞癌、肝脏转移性肿瘤、淋巴上皮瘤样癌、退变结节、肝细胞腺瘤、肝血管瘤和肝脏炎性假瘤等均呈相对低信号。结论:Gd-EOB-DTPA动态增强扫描与延迟肝实质期扫描联合应用,可以提供病变形态、血供、细胞来源及功能等更多相关信息,从而提高诊断信心及诊断准确性。     

菲立磁增强MRI检测肝脏占位病变与三期动态增强CT扫描的比较研究

目的　比较菲立磁增强MRI和增强CT扫描在肝脏实性占位病变检测中的应用价值。方法　对 18例肝内局灶性占位患者行MR平扫及菲立磁增强扫描。观察肝脏与病灶信号强度变化 ,形态及数目 ,比较增强前后T2 WI病灶及肝脏的信噪比 (SNR)及对比噪声比 (CNR) ,做出MRI定性诊断 ,并与增强CT扫描诊断进行比较。其中肝细胞肝癌 4例 ,复发性肝癌 4例 ,转移瘤 4例 ,肝血管瘤 6例。结果　菲立磁增强明显降低正常肝组织信号强度 ,而恶性肿瘤的信号强度无强化 ,病灶—肝脏信噪比增加可清晰显示病变 ,并发现新病灶。肝血管瘤的血池效应与增强CT扫描比较有鉴别诊断意义。结论　做为增强CT扫描和Gd -DTPAMR增强的补充方法 ,SPIO增强MRI对肝脏占位病变的显示 ,小病灶发现和定性诊断中有重要的临床意义     

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。     

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     

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.     

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.     

人体中的镭-226、镭-228、钋-210、铅-210

本文报道了广东阳江高本底地区6名、对照地区8名人尸体的骨²²⁶Ra、²²⁶Ra的浓度以及部分居民内脏器官中。²¹⁰Po、²¹⁰Pb的浓度。结果轰明阳江高本底地区和对照地区居民骨镭-226、镭-228的浓度分别为29.9pCi/kg, 26.9pCi/kgl 8.7pCi/kg, 8.2pCi/kg.由此估算出阳江高本底地区屠民骨中²²⁶Ra、²²⁸Ra的负薄璧及对骨衬、骨髓所产生的剂量当量分别为对照地区民民的3.4倍, 3.3倍。两地区居民内脏器官中^{210Po、210Pb的测定分析铡数较少但仍看出, 高本底地区均明显高于对照地区.}     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.