原发性脑淋巴瘤的MRI功能成像和延迟强化特点

目的:探讨原发性脑淋巴瘤的MRI延迟强化方式及弥散加卡义成像、氢质了磁共振波谱、灌注加权成像的特点.方法:同顾性分析23例原发性颅内淋巴瘤的MRI延迟强化以及弥敞加权特点,同时对其中12例磁共振波谱成像和9例灌注加权成像表现进行仔细分析.结果:多发16例,单发7例,共检出50个病灶,T1.WI呈等或稍低信号,T2WI呈等或稍高信号,23例DWI呈高或稍高信号.延迟强化显示15个强化灶范围增大、8个新增强化灶、9个不均匀强化灶趋十均匀、6个强化灶内低信号范围缩小.行磁共振波谱成像的12例中增强后首次扫描即出现强化的病灶表现为Cho升高、NAA下降、出现高Lip峰,其中5个病灶出现Lac峰,另外4个新增延迟强化病灶的MRS表现为NAA轻微下降、Cho稍升高、Iip峰矮小、未见Lac峰.9例灌注加权成像显示脑淋巴瘤呈低灌注趋势.结论:综合分析常规MRI表现及其延迟强化方式、弥散加权成像、磁共振波谱成像及灌注加权成像的特点,能够做出脑淋巴瘤的定性诊断.延迟强化或许可以更充分反映病灶的数量和范围.     

磁共振多技术联合应用对诊断原发性脑内恶性淋巴瘤的价值

目的:探讨常规MRI扫描通过结合DWI、PWI、TDC、MRS多项技术联合应用对原发性脑内恶性淋巴瘤的诊断价值。方法:回顾性分析29例经临床病理证实的原发性脑内恶性淋巴瘤病例,其治疗前常规MRI信号特点与DWI、PWI、TDC和MRS的表现。结果:原发性脑内恶性淋巴瘤T₁WI呈等或稍低信号,T₂WI呈稍高信号,灶周中度水肿,增强后大多呈均匀强化,顶叶病灶可见"压迹征",病变累及胼胝体时呈"蝴蝶征";DWI多呈均匀高信号,ADC值与对侧正常脑实质相比明显降低;PWI示rCBV呈等或等低灌注,与正常脑白质灌注相似,多呈黄绿或蓝色;TDC负性增强上升支与下降支基本对称,信号强度回复前出现一小的再下降波形,增强后基线水平较增强前基线水平呈缓慢上升;MRS示Cho峰明显升高,病灶内NAA中度、Cr峰轻度降低,可见Lip峰、Cho/Cr、Lip/Cr、Lac/Cr均明显升高,NAA/Cr明显降低。结论:原发性脑内恶性淋巴瘤常规MRI具有一定特征性,通过联合应用DWI、ADC、PWI、TDC和MRS表现可提高对其诊断水平。     

多模态MRI对原发性中枢神经系统淋巴瘤的诊断价值

目的探讨多模态MRI在原发性中枢神经系统淋巴瘤(PCNSL)诊断中的价值。方法回顾性分析25例经病理证实的原发性中枢神经系统淋巴瘤的常规MRI平扫和增强的特点,以及在DWI、PWI、1H-MRS上的表现。结果 25例患者共检出42个病灶,单发15例,多发10例,主要分布于深部近中线脑白质处。MRI平扫病灶T_1WI呈等或稍低信号,T_2WI呈等或稍高信号,瘤周水肿多表现为轻中度。增强扫描后病灶实质部分呈结节状、团块状强化,囊变坏死少见。13个病灶出现"脐凹征",8个病灶出现"尖角征",4个病灶累及胼胝体,出现"蝶翼征"。DWI显示42个病灶实质部分呈高或稍高信号,ADC信号明显低于正常脑实质。14例患者共25个病灶进行PWI扫描,17个病灶呈低灌注,8个病灶呈等灌注。4例患者共5个病灶行1H-MRS检查,均表现为肌酸(creatine,Cr)、N-乙酰天门冬氨酸(N-acetyl aspartate,NAA)峰降低,胆碱(choline,Cho)峰升高,并可见高耸的脂质(Lipid,Lip)峰。结论多模态MR成像技术能够提供更多的影像诊断信息,有助于提高PCNSL诊断的准确率。     

MRI多检查序列联合应用对原发性脑淋巴瘤诊断的价值探讨

目的探讨MRI多序列联合应用对原发性脑淋巴瘤的诊断价值。方法回顾性分析18例原发性脑淋巴瘤患者的临床及MRI资料。18例患者均行MRI检查,序列包括:T1WI、T2WI、增强T1WI、DWI、MRS、SWI、DTI。分析并比较不同序列中病灶的表现及信号特征,探讨其在脑淋巴瘤诊断中的作用。结果单发12例,多发6例。共检出病灶29个,其中幕上25个,幕下4个。T1WI呈稍低或等信号,T_2WI呈稍高或等信号。所有病灶强化明显,较均匀一致强化26个,中心坏死3个。瘤体实质区DWI示为高或稍高信号,ADC灰阶图信号与DWI图相反。MRS示Cho峰升高,Cr峰轻度降低,NAA峰降低,出现高耸Lip峰或反向Lip峰。SWI示瘤体内可见微量出血,未见明显显影血管,周围可见受压移位血管。DTI示瘤体实质区的FA值减低,DTT示瘤体区纤维束显著减少。结论 MRI多个检查序列的联合应用可以对原发性脑淋巴瘤做出明确诊断。     

原发性中枢神经系统淋巴瘤的MRI与~1H-MRS研究

目的:探讨免疫功能正常人原发性中枢神经系统淋巴瘤(PCNSL)的常规MRI及多体素质子磁共振波谱(1H-MRS)表现。方法:对15例经病理证实的PCNSL的MRI和1H-MRS表现进行回顾性分析。结果:15例患者共检出24个病灶,其MRI及1H-MRS表现如下:①PCNSL的MRI表现:病灶T1WI呈低或等信号,T2WI呈等或稍高信号;DWI呈高信号;增强后病灶明显均匀强化,"缺口征"、"尖角征"的出现具有特异性;②PCNSL的1H-MRS表现:肿瘤实质区及瘤周近侧水肿区Cho峰升高及NAA、Cr峰降低,肿瘤实质区可见升高的Lip峰。4例病灶在正常组织区可见异常谱线。结论:传统MRI结合1H-MRS表现能够显著提高PCNSL的诊断与鉴别诊断水平;1H-MRS对于肿瘤浸润及多发病灶的显示优于传统MR检查。     

颅内原发性淋巴瘤MRI诊断价值分析

目的分析颅内原发淋巴瘤的MRI征像特点,旨在提高对该病的诊断正确率,降低误诊率。方法回顾性分析苏州大学附属第一医院在2013年～2017年期间收治并经手术病理确诊的32例颅内原发性淋巴瘤患者的MRI资料,并对颅内原发性淋巴瘤患者的病变发生部位、大小、信号等MRI表现进行综合分析。结果本组共检出病灶60个,病灶单发20例,多发12例,以单发为主。病灶分布具有幕上为主,幕下相对少见的特征,其中额顶叶18例,颞叶11例,枕叶2例,小脑半球1例,基底节区4例,丘脑1例,胼胝体5例。多发病灶具有"卫星样"分布的特征。肿瘤周围水肿形态可呈斑片状,指套状。MRI平扫瘤体T_1WI呈等或稍低信号,T_2WI及FLAIR呈等或稍高信号。DWI多表现为高或稍高信号,增强扫描明显强化,多呈握拳样、团块状或开环样强化,"脐凹征""尖角征"及"蝶翼征"也是颅内淋巴瘤较为特异性的影像学表现。颅内原发淋巴瘤的MRS表现为胆碱(Cho)峰升高,N-乙酰天门冬氨酸(NAA)峰降低,脂质(Lip)峰高耸。结论颅内原发淋巴瘤具有特定的MRI征像,对这些征像的综合细致观察分析,有助于提高诊断正确率。     

后颅窝原发性中枢神经系统淋巴瘤的磁共振多模态诊断

目的 探讨磁共振多模态成像在后颅窝原发性中枢神经系统淋巴瘤(PCNSL)中的诊断价值.方法 回顾性分析经病理证实的16例后颅窝PCNSL患者的MR平扫、扩散加权成像(DWI)、动态增强及氢质子磁共振波谱(1H-MRS)影像资料.结果 16例患者共有26个病灶,6例为多发病灶.所有病灶在T1WI呈低或稍低信号;T2WI上21个病灶呈稍高信号,3个呈等信号,2个呈混杂稍高信号;DWI上2例扩散受限呈高信号,13例扩散稍受限呈稍高信号,1例扩散不受限呈等信号.表观扩散系数(ADC)图上测得肿瘤实质与对照侧平均ADC值分别为(0.610 ±0.092)×10-3mm2/s和(0.700 ±0.044)×10-3mm2/s,两者差异有统计学意义(P=0.02,＜0.05,Z=-2.269),rADC为0.884±0.125.增强扫描26个病灶呈明显强化,其中12个病灶可见“尖角征”、“脐凹征”,时间一信号强度(TIC)曲线为Ⅰ型(缓升型).瘤周轻、中度水肿12例.MRS表现为病灶实质区出现高大的Lip峰.结论 多模态磁共振成像有助于后颅窝PCNSL的明确诊断.     

脑内原发性淋巴瘤MRI特征

目的探讨脑原发性淋巴瘤的MRI表现特征,以提高对该病诊断的准确性。资料与方法回顾性分析11例经病理证实为脑原发性淋巴瘤的数目、部位、信号、强化方式、水肿、占位效应、扩散加权成像(DWI)及磁共振波谱(MRS)表现。结果单发3例(27%),多发8例(73%)。21个(63%)病灶位于幕上脑深部白质近脑室旁,7个(21%)病灶位于脑表面,5个(16%)位于幕下。24个(73%)病灶在T1WI上呈稍低信号,18个(55%)在T2WI上呈稍高信号;5个(36%)病灶周围轻度水肿及占位效应,9个(64%)病灶周围有中重度水肿及占位效应;团块状、结节状均匀强化15个(46%),不均匀环状强化8个(24%);3例肿瘤在DWI上呈高信号,氢质子磁共振波谱(1H-MRS)表现为氮-乙酰天门冬氨酸(NAA)峰、肌酸(Cr)峰降低,胆碱(Cho)峰显著升高,见乳酸(Lac)峰和高大脂质(Lip)峰。结论脑原发性淋巴瘤有较为特征的MRI表现,结合DWI、MRS有助于鉴别诊断。     

原发性中枢神经系统淋巴瘤的磁共振表现

目的 探讨中枢神经系统淋巴瘤MRI的表现及诊断价值.方法 回顾性分析11例中枢神经系统淋巴瘤的MR表现,评价不同MR检查方法的诊断价值.结果 11例淋巴瘤均为大B细胞淋巴瘤,4例单发,7例为多发.共有结节24个,其中颞叶8个,顶叶5个,额叶4个,枕叶3个,小脑4个,2个结节灶中央出现坏死,1例伴有脑膜转移.淋巴瘤结节T1WI呈等或略长信号,T2WI以及FLAIR表现为稍高信号,坏死区T2WI以及FLAIR表现为高信号;周围脑白质均有中度水肿,在T2WI以及 FLAIR显示明显;3例有轻度占位效应.淋巴瘤均呈中等强度的均匀增强,1例可见脑膜线样增强.瘤结节在DWI表现为高信号.MRS表现为NAA峰中等程度降低,Cho峰升高,Cr峰降低,并有巨大Lac/Lip复合峰出现.结论 颅内深部单发或多发结节样病灶,在T1WI为等或略低信号,T2WI 或FLAIR为等或稍高信号,中等强度增强,磁共振波谱呈现为巨大Lip/Lac峰,应考虑中枢神经系统淋巴瘤的诊断.     

CT、MRI多模态检查对颅内原发性中枢神经系统淋巴瘤的诊断价值

目的:探讨颅内原发性中枢神经系统淋巴瘤(PCNSL)的CT、MRI多模态成像特点,以期进一步提高PCNSL诊断及鉴别诊断水平。方法:收集经病理证实的PCNSL 35例,术前均行CT及MRI检查,回顾性分析其CT、MRI及功能成像的变化及特点。结果:35例共检出39个病灶,3例多发。CT平扫:38个病灶呈等或高密度,32个呈均匀密度。MRI平扫:38个病灶T1WI、T2WI呈等或稍低信号。27个病灶DWI呈均匀高信号,ADC值降低。多数病灶呈轻至中度水肿和占位效应。CT和MRI增强扫描多为均匀强化,"缺口征"、"尖突征"的出现具有特异性,少数病灶呈环形强化。PWI表现为低灌注,脑血容量(CBV)、脑血流量(CBF)降低,平均通过时间(MTT)、达峰时间(TTP)延长。常出现胆碱(Cho)峰升高、肌酸(Cr)峰降低、N-乙酰天门冬氨酸(NAA)峰明显降低或缺失及高耸的脂质(Lip)峰,肿瘤实质区Cho/NAA、Cho/Cr、NAA/Cr比值均明显高于瘤周水肿区和正常组织(均P0.05)。CT、MRI多模态成像对PCNSL的诊断符合率显著高于单纯应用CT或常规MRI。结论:PCNSL临床表现多变,病理确诊前诊断困难。CT、MRI多模态成像能有效提高PCNSL的诊断和鉴别诊断水平。     

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.     

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     

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.}     

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.     

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.     

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).