颈部神经鞘瘤的CT表现与病理对照

目的 :探讨颈部神经鞘瘤的CT表现及其与病理学之间的关系 ,了解其CT表现的病理学基础。方法 :回顾性分析经手术、病理证实的颈部神经鞘瘤 3 6例 ,增强扫描 2 7例 ,并与手术病理结果进行比较。结果 :CT平扫表现为均匀等密度、略低密度 (和颈部肌肉相比 )肿块 12例 ,增强扫描呈轻度均匀强化 ;2 4例平扫表现为不均匀等密度、略低密度肿块 ,伴中心点状、片状更低密度区 ,增强扫描肿块呈轻度至明显强化 ,中央更低密度区无明显强化。上述表现与病理对照显示更低密度区由疏细胞区 (AntoniB区 )、陈旧性出血及囊性变组成 ,等密度、略低密度区由富细胞区 (AntoniA区 )和胶原组成。不同的细胞区域构成形成不同的CT表现 ,增强表现与AntoniA区增强有关。结论 :颈部神经鞘瘤的CT表现与其病理改变有关 ,对正确诊断具有指导意义。     

胸、腹部恶性神经鞘瘤的CT表现

目的回顾分析胸、腹部恶性神经鞘瘤的CT表现,以提高对本病的认识。方法胸部5例,腹部4例,手术7例,CT引导下经皮穿刺2例,均经病理证实。结果肿瘤位于纵隔5例,腹壁2例,腹膜后2例;孤立性肿块7例,弥漫性2例(位于纵隔);伴胸水4例,伴椎体成骨性转移1例。CT平扫:7例孤立性肿块,呈圆形或椭圆形,中心出现大面积低密度区,CT值5~20HU,6例包膜完整。2例弥漫性病变则呈均匀的密度。注入对比剂后,7例孤立性肿块实质部分及2例弥漫性病变出现不同程度强化。结论CT诊断胸腹部恶性神经鞘瘤孤立性肿块者,具有一定特点,但弥漫性肿块则无特点。     

胸部恶性神经鞘膜瘤的影像表现

目的 分析原发于胸部的恶性神经鞘膜瘤的影像表现,并与手术病理对照,以提高鉴别诊断能力。方法 10例（11个病灶）全部摄正侧位片。8例CT检查,先平扫,再行增强扫描。经手术证实8例,CT导下肺穿刺活检证实2例。6例（7个病灶）行CT与病理对照。结果 肿瘤位于纵隔4例,肺内2例,胸壁3例,横膈1例。病灶呈孤立肿块型8例,多发肿块型1例,弥漫肿块型1例。肺、支气管明显压迫3例;肺浸润1例;肋骨受压变形3例,其中伴骨质破坏2例;胸水4例。CT表现：病灶边缘较光整3个（病理上均有完整包膜）,边缘毛糙4个。病灶呈网格样强化2个（病理见实质肿块内多大小不一的囊腔）,不均匀强化4个（非强化区与病理上出血坏死区相符）,病灶呈均匀液性密度1个（病理示肿瘤囊性变）。结论 胸部良、恶性神经鞘膜瘤的CT诊断有很大限度,肿瘤内低密度我并不是恶性神经鞘膜瘤的特征性表现,肿瘤边界不光整则提示恶性可能,邻近结构受侵破坏是提示恶性病变的重要征象。     

咽旁间隙神经鞘瘤与多形性腺瘤的鉴别诊断

目的探讨咽旁间隙神经鞘瘤和多形性腺瘤的影像学表现,旨在提高对两者的鉴别诊断能力。方法回顾性分析经手术病理证实的12例神经鞘瘤和8例多形性腺瘤的CT和/或MRI表现,分析内容包括病灶部位、最长径、形态与边界、密度或信号特点、强化方式、邻近解剖结构改变情况等。结果咽旁间隙神经鞘瘤及多形性腺瘤发生于左、右侧分别为6/6例和3/5例;两者均表现为类圆形肿块,境界多较清楚。CT表现为软组织密度肿块,可伴有囊变。MRI多表现为长T1长T2信号,伴有囊变者信号不均匀,增强后呈不均匀强化。神经鞘瘤多见于茎突后间隙(10/12,83. 3%),推压二腹肌后腹(10/12,83. 3%)、颈动脉鞘区血管(8/12,66. 7%)及茎突(4/12,33. 3%)向前和/或外侧移位,与腮腺深叶间境界均较清楚。多形性腺瘤多见于茎突前间隙(6/8,75%),推压二腹肌后腹(5/8,62. 5%)、颈动脉鞘区血管(5/8,62. 5%)及茎突(6/8,75%)向内和/或后侧移位。有2例(25%)与腮腺深叶分界不清。结论咽旁间隙神经鞘瘤和多形性腺瘤的影像学表现各具特征性,临床工作中通过仔细分析其起源部位、与周围结构的关系等有助于鉴别诊断。     

少见部位神经鞘瘤的CT影像特征及病理分析

目的探讨少见部位神经鞘瘤的CT影像及病理特征,以提高影像诊断的准确性。方法回顾性分析25例经手术病理及免疫组化证实的神经鞘瘤的影像学资料,并对照病理结果进行分析。结果 1)肿瘤均单发,多呈类圆形,边界清楚。其中15例呈均匀等或稍低密度,4例低密度为主,余6例囊实性混杂密度。增强后肿瘤实性成分延迟强化,中度为主; 2)镜下观:肿瘤由富梭形细胞的Antoni A区和细胞稀疏、伴有囊变或黏液样变性的Antoni B区组成。结论少见部位神经鞘瘤尽管发病部位不同,但有其CT影像学特征表现,确诊仍依赖于病理与免疫组化检查。     

纵隔低密度肿块病变的CT诊断

目的：提高纵隔低密度肿块病变的CT诊断水平。方法：回顾性分析52例经临床、手术及病理确诊的纵隔低密度肿块病例资料。结果：52例中皮样囊肿4例，畸胎瘤6例，胸腺囊肿3例，支气管囊肿5例，心包囊肿4例，脂肪瘤1例，胸内甲状腺肿囊变4例，胸腺瘤囊变5例，淋巴结肿囊变7例(淋巴瘤2例，淋巴结结核5例)，神经源性肿瘤囊变4例(神经节细胞瘤1例，神经鞘瘤2例，恶性神经纤维瘤1例)，纵隔血肿2例，纵隔脓肿6例。CT诊断正功率92．3％(48／52)。结论：纵隔低密度病变种类较多。CT检查可清楚显示病变的部位与特点，结合临床表现一般能作出准确的术前诊断。     

胃神经鞘瘤的MSCT误诊原因分析

目的探讨胃神经鞘瘤的MSCT表现特征并分析其误诊原因。方法回顾性分析我院2008年6月~2012年3月16例经手术病理和免疫组化确诊但CT检查误诊的胃神经鞘瘤临床资料。结果胃体8例,胃窦部3例,胃底5例,CT主要表现为胃壁起源的边界清楚的圆形或类圆形的密度均匀肿块,增强扫描呈持续渐进性强化,无明显钙化及液化坏死,病灶直径平均为(5.5±1.9)cm,其中CT检查误诊为恶性胃间质瘤3例,胃平滑肌瘤6例,胃癌3例,胃外肿瘤2例,良性胃间质瘤2例,均经手术病理及免疫组化检查确诊为胃神经鞘瘤。结论胃神经鞘瘤的MSCT表现有一定特征,当CT表现为边界清楚的均质肿块,与肌肉组织相比呈略低密度,且无出血坏死和囊变时,应考虑胃神经鞘瘤的可能。     

多层螺旋CT诊断腹盆腔神经肿瘤的临床价值分析

目的：探讨多层螺旋CT扫描诊断腹盆腔神经肿瘤的临床应用价值。方法对腹盆腔神经肿瘤7例患者临床资料进行分析。结果6例单发肿瘤均位于S1-3前方偏一侧,其中左前方4例,右前方2例;1例与骶骨广基相连,伴有同侧骶孔扩大,扩大骶孔内有软组织影充填。4例神经鞘瘤为圆形和椭圆形,边缘光滑,密度不均匀,为低/等密度混合肿物,内见囊性病变区,边缘或肿块内见细点状钙化影,增强扫描呈明显不均匀强化。2例单发神经纤维瘤为类圆形,边缘光滑,形态规则或不规则,边界尚清,密度不均匀,1例密度均匀与肌肉密度相近,2例密度不均可见低密度区,囊变1例,钙化1例,平扫中心见高密度影,增强扫描有明显强化。1例神经母细胞瘤,形态不规则,边界上方不清,密度不均匀,平扫密度与肌肉相近,增强扫描肿瘤强化轻微,呈相对低密度。内见囊变区和粗糙、块状钙化灶。增强扫描呈明显不均匀强化。4例神经鞘瘤,2例单发神经纤维瘤,1例神经母细胞瘤。结论多层螺旋CT扫描可以对腹盆腔神经肿瘤作出的定位及定性诊断。     

肾上腺少见肿瘤的CT表现及其病理基础

目的探讨肾上腺少见肿瘤的CT表现特征与病理的相关性,以提高诊断水平。资料与方法对18例经手术病理证实的少见肾上腺肿瘤进行回顾性分析,包括肾上腺节细胞神经瘤5例,髓性脂肪瘤4例,淋巴瘤3例,囊肿、神经鞘瘤各2例以及神经节母细胞瘤、畸胎瘤各1例。在CT图像上,观察病变的位置、大小、形态、密度、内部结构及其与周围结构的关系。结果肾上腺节细胞神经瘤CT表现为均匀软组织密度肿块,1例有点状钙化。髓性脂肪瘤为以脂肪密度为主的肿块。淋巴瘤为软组织密度肿块。良性神经鞘瘤为软组织肿块,有囊变及钙化;恶性神经鞘瘤也为软组织肿块,内见坏死区,伴淋巴结转移。囊肿呈水样密度,壁薄光整,1例有囊壁钙化。神经节母细胞瘤为密度不均匀软组织肿块,内见坏死灶,伴周围淋巴结肿大。畸胎瘤为含钙化、脂肪及软组织成分的肿块。结论CT可揭示肾上腺少见肿瘤的病理基础,它们存在一定的影像表现特点,CT是临床上最常用的影像学检查方法。     

胸壁神经鞘瘤的CT、超声表现和病理对照研究

目的 探讨胸壁神经鞘瘤的CT、超声表现及其与病理组织学间的关系,提高对胸壁神经鞘瘤影像表现的认识.资料与方法 搜集经手术病理证实的胸壁神经鞘瘤11例,回顾性分析其CT、超声表现和病理表现之间的对照关系.结果 10例良性神经鞘瘤,1例恶性神经鞘瘤,均为单发.CT和超声显示病灶位于胸神经走行分布区.良性病变表现为边界清晰的实性或囊实性肿块,呈中低密度或回声区.恶性病变边缘不规整,累及周围组织.肿瘤密度或回声是否均匀取决于瘤内Antoni B型组织的分布以及囊变、骨化或出血和血栓形成等变化.肿瘤强化表现多样,强化幅度一般为20～35 HU,主要由肿瘤内Antoni A型和Antoni B型组织比例决定;无强化或低强化取决于肿瘤囊变出血、胶原沉积、纤维化或钙化和Antoni B型组织分布.彩色多普勒血流显像(CDFI)显示肿瘤多无显著血流信号.结论 了解胸壁神经鞘瘤的病理学特征与CT和超声影像表现的相关性有助于诊断和鉴别诊断.     

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.     

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).     

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）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme     

改进的定位技术在胸部肿瘤穿刺活检中的应用

目的：探索CT-SIM三维定位系统、体模固定技术和PET-CT融合影像导引定位技术在胸部肿瘤经皮穿刺活检中的应用价值。方法：对380例胸部肿瘤患者行改进的CT定位技术下的经皮穿刺活检术。根据肿瘤的大小、深度、毗邻关系、活动度以及患者的心肺功能状态,综合运用CT-SIM系统、体模固定技术和PET-CT融合影像导引技术,为患者进行穿刺前定位。统计穿刺定位时间长度、成功率、确诊率、并发症发生情况,并与210例采用传统铅栅定位下胸部肿瘤穿刺活检的相应资料进行比较。结果：采用改进的CT定位技术的380例患者穿刺定位精确,平均定位时间（9.5 min）较传统方法（16.8 min）缩短7.3 min,活检成功率和确诊率分别是98.7%和95.3%,高于传统定位方法的93.3%和83.3%,两者差异均具有统计学意义（P〈0.05）。穿刺并发症发生率相似,气胸发生率分别为2.8%和2.9%,咯血发生率分别为11%和12.8%。结论：根据患者状态及肿瘤特点,在CT-SIM系统快速精确定位技术的基础上,综合运用体模固定技术和PET-CT融合影像导引技术,能显著缩短经皮穿刺活检的定位时间,提高活检成功率。