CT灌注成像对脑血肿周围组织灌注的动态观察

目的：应用CT灌注成像对高血压脑出血急性期及亚急性期血肿周围组织血流动力学变化进行动态观察。材料和方法：对27例高血压脑出血病人急性期及亚急性期行CT平扫及CT灌注成像扫描，测量血肿周围组织及对侧镜像区脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）、最大层面血肿及周围低灌注区域面积。结果：灌注参数图示急性期血肿周围组织CBF、CBV均较对侧镜像区降低（Z分别为4．213及4．265，P值均小于0．05），MTT较对侧延长（Z=2．631，P〈0．05）；亚急性期血肿周围组织CBF降低，与急性期比较无明显变化（Z=0．024，P〉0．05），亚急性期血肿周围组织CBV亦降低（Z=3．652，P〈0．05），但是与急性期比较CBV有较明显升高（Z=2．21，P〈0．05）。最大层面血肿面积与周围低灌注区域范围及CBF值经Spearman等级相关分析无直线相关关系（r分别为0．262及0．065，P值均〉0．05）。结论：CT灌注成像可以准确地反映高血压脑出血急性期及亚急性期血肿周围低灌注状态。     

脑出血亚急性及慢性期血肿周围组织低灌注损伤的CT灌注成像研究

目的 探讨脑出血亚急性及慢性期血肿周围组织脑血液动力学变化及其相关影响因素。方法 对12例基底节区脑出血患者做了CT常规及灌注成像检查，对其中11例患者血肿体积及血肿周围局部脑血流量（regional cerebral blood flow，rCBF）、局部脑血容量（regional cerebral blood volume，rCBV）、对比剂平均通过时间（mean transit time，MTT）和最大峰值时间（time-to-peak，TTP）的比值（病侧／健侧）进行测量。结果 11例脑出血患者血肿体积最大为72．21ml，最小为13．68ml，血肿平均体积为26．83ml。rCBF参数图显示血肿周围低灌注梯度11例，表现为血肿周围rCBF减低区；rCBV参数图显示血肿周围低灌注梯度10例，表现为血肿周围rCBV减低区；血肿周围高灌注1例，表现为血肿周围rCBV增高区；同侧半球低灌注2例，表现为血肿侧脑组织rCBF、rCBV大面积减低区；时间参数图显示血肿周围TTP延长11例，MTT延长10例；血肿边缘区rCBF显著低于外层区rCBF；边缘区MTT、TTP明显长于外层区MTT、TTP；血肿外层区rCBF、rCBV与血肿边缘区rCBF、rCBV呈线性依从性改变。血肿周围（边缘区和外层区）rCBV与血肿体积有明显的相关性，r边缘区=0．764，r外层区=0．703（双侧），P值均〈0．05。血肿周围rCBF、rCBV、MTT和TTP与症状出现至行CT灌注扫描间期无明显相关性。结论 脑出血亚急性和慢性期，血肿周围脑组织依然存在低灌注梯度，低灌注区脑血流变化与血肿体积密切相关。CT灌注成像可清晰地显示出血肿周围异常的脑血液动力学变化，可为脑出血个体化救治及预后评估提供有价值的信息。     

磁共振灌注加权成像对家兔急性脑出血针刺疗效的评价

目的:探讨磁共振灌注加权成像(PWI)在评价家兔急性脑出血针刺疗效中的价值。方法:雄性健康新西兰兔25只,利用随机数字表法随机分为空白组5只,模型对照组10只,针刺治疗组10只,采用自体血注入法复制急性脑出血动物模型,针刺治疗组造模成功后每隔24 h针刺一次,分别于造模后2 h、3 d和7 d行PWI检查,观察血肿周围及对侧相对脑血流量(rCBF)及对比剂平均通过时间(MTT)的变化,并记录相应数据,采用单因素方差分析及LSD检验进行分析。结果:兔脑出血模型建立后2 h即可观察到脑灌注损伤改变,针刺治疗组较模型对照组血肿周围及对侧血流灌注的改善更加明显,即不同时间点MTT较模型对照组缩短、rCBF较模型对照组增加,两者之间差异有统计学意义(F值均>1,P<0.01)。结论:PWI能够客观评价针刺干预家兔急性脑出血后血肿及其周围组织的血流动力学改变,是研究针刺治疗急性出血性脑中风机制的可靠的影像学方法。     

脑血肿周围组织CT灌注成像研究

目的评价脑CT灌注成像对脑出血患者血肿周围组织血流动力学变化的诊断价值。方法 通过对120例脑出血患者分期单次CT灌注成像检查,分析血肿周围组织血流动力学变化规律以及与神经功能恢复之间的关系。结果四组患者灌注参数图示脑出血后MTT明显延长,7天时达高峰,后逐渐缩短;TTP的变化趋势接近MTT;rCBF7天时最低,后逐渐升高;rCBV的变化趋势接近rCBF。同一参数各组间比较及4个参数各组间经多个样本均数间的两两比较,均得出,P〈O．05,各组数据之间具有统计学差异。结论血肿周围组织血流量呈现出先降低后上升的变化趋势,与临床研究中显示的脑出血患者神经功能恢复过程相一致。脑血流的波动性改变反映了脑出血发生后血肿周围组织继发产生的病理生理学变化。动态CT脑血流灌注定量分析可提供脑组织微循环血液动力学定量信息,是一种比较理想的同时反映形态和功能的检查方法。     

CT灌注成像在急性自发性高血压性脑出血中的应用

目的 应用CT灌注成像(CT perfusion,CTP)对急性自发性高血压出血性脑卒中(acute spontaneously hypertensive intracerebral hemorrhage,shICH)血肿周围脑血液动力学变化进行定量研究,验证血肿周围是否存在缺血半暗带.方法 对26例(男22例,女4例,年龄33～74岁,平均55.08岁)临床及CT确诊为幕上shICH患者行CTP检查,自发病到灌注扫描的时间为8～19h,平均14.88h.以血肿最大层面为参照,测量血肿内部、血肿周围、远隔区及对侧镜像区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT),并计算相对灌注参数值rCBF、rCBV、rMTT(患侧/健侧).结果 shICH血肿灌注参数伪彩图从血肿中心到外周色差呈阶梯样分布.血肿周围组CBV值为(1.61±1.53)ml·100g-1、CBF值为(16.48±17.38)ml·100g-1·min-1),低于对侧镜像区(ZCBV=-2.603、ZCBF=-4.178,P＜0.05);MTT值为(9.12±2.57)s,较对侧镜像区延长(t=4.747,P＜0.05).方差分析显示血肿内部、血肿周围组及远隔区组灌注参数MTT及相对值rCBF、rCBV、rMTT均数间差异有统计学意义(FMTT=9.043、FrCBV=38.031、FrCBF=25.023、FrMTT=12.486,P＜0.05),进一步LSD分析,血肿周围组与远隔区组MTT、rMTT、rCBF差异有统计学意义(P＜0.05),但两组间rCBV值无统计学差异(P＞0.05).且秩和检验显示血肿周围组CBF明显低于远隔区组(Z=2.288,P＜0.05),但两组间CBV均值差异无显著性(Z=-0.357,P＞0.05).结论 CTP可反应shICH血肿周围低灌注状态,但没有证据显示存在缺血半暗带.     

CT灌注观察脑出血后血肿周围组织血流灌注变化

目的:探讨脑出血患者血肿周围组织血流的动态变化规律。方法:脑出血患者59例,分别在入组时、入组后7d、14d、28d应用CT灌注测量血肿周围组织的局部脑血流量(rCBF)、局部脑血容量(rCBV)、对比剂平均通过时间(MTT)、对比剂峰值时间(TTP)参数数值,计算脑岀血侧(患侧)与其健侧镜像部位各参数的比值,并进行对比分析。结果:脑出血后rCBF、rCBV 7d时最低,随后逐渐升高,其患侧与健侧比值各时相点均<1。MTT与TTP 7d时达高峰,随后逐渐缩短,其患侧与健侧比值各时相点均>1。结论:脑出血后血肿周围组织存在持续的低灌注状态,且这种低灌注状态随时间改变呈波动性的变化规律。     

实验性大鼠脑血肿周围脑组织血流变化的CT灌注成像研究

目的 探讨建立大鼠脑血肿周围脑组织血流变化的CT灌注成像方法，并对其可行性进行研究。方法 雄性大鼠70只，采用随机数字抽样法将其分为注血组和对照组。分别将40μl新鲜自体血或生理盐水通过微量注射泵注入大鼠右侧尾状核制备脑出血模型。利用CT灌注成像对各组动物模型血肿周围脑组织血流变化进行观察，并与HE染色和红四氮唑(TTC)染色标本对照。通过计算机辅助CT脑灌注成像软件制作灌注CT参数图，并对血肿周围脑组织局部脑血流量(regional cerebral blood flow，rCBF)、局部脑血容量(regional cerebral blood volume，rCBV)和平均通过时间(mean transit time，MTT)进行相对值(病侧／健侧)测量。结果 注血组血肿周围脑组织存在不同程度低灌注梯度，血肿周围脑组织局部脑血流量(rCBF)呈波动性改变，在注血后1h rCBF降至最低，随后逐渐回升、下降，分别于注血后6h和24h2次回升至峰值。TTC染色血肿呈黑褐色，血肿周围未见白色梗死区。病理学检查显示在出血灶与正常脑组织间存在过渡带即血肿周围区，周围区内组织疏松，细胞不同程度水肿，星形细胞肿胀，神经细胞变性，出血灶周边可见毛细血管增生及炎细胞浸润。对照组CT灌注成像、TTC染色和病理学检查均未见明显异常。结论 大鼠脑血肿周围脑组织血流变化的CT灌注成像方法稳定可靠，能准确反映脑出血周围脑组织异常的血液动力学变化，是活体研究脑出血周围脑组织损伤较为理想的实验方法。     

实验性脑出血周围组织脑血流变化与脑水肿形成的相关研究

目的 探讨血肿周围组织脑水肿形成机制及其与局部脑血流变化间的关系，为脑出血临床救治提供实验基础。方法 雄性大鼠70只，随机数字抽样法分为注血组和对照组，分别将40山新鲜自体血或生理盐水通过微量注射泵注入大鼠脑右侧尾状核制备脑出血模型，利用CT灌注成像对大鼠脑出血模型进行动态增强扫描，通过计算机辅助脑灌注成像软件制作大鼠脑CT灌注参数图，对血肿周围局部脑血流量（regional cerebral blood flow，rCBF）、局部脑血容量（regional cerebral blood volume，rCBV）和对比剂平均通过时间（mean transit time，MTT）脑灌注参数进行相对值（病侧／健侧）测量，并与血肿周围脑组织水含量进行相关性分析。结果 大鼠脑注血后血肿周围组织存在低灌注梯度，血肿周围rCBF呈波动性改变，注血后1h rCBF降至最低，以后逐渐回升，分别于注血后6h和24h2次回升至峰值，并随后再度下降；血肿周围rCBV在注血后1h降至最低，随后逐渐增加，并于注血后24h增加至峰值；血肿周围脑组织水含量在注血后24h最高，并延续至72h；血肿周围脑组织水含量与血肿边缘区rCBV具有明显相关性，r=0．372（单侧），P〈0．05。结论 血肿周围组织脑水肿的形成是血脑屏障破坏、细胞毒性水肿及渗透性活性物质共同作用的结果，脑出血早期rCBF下降以及rCBV代偿性增加在脑出血血管源性脑水肿形成中发挥着重要作用，CT灌注成像是活体下研究血肿周围脑血流变化与脑水肿形成机制较为理想的方法。     

实验性脑血肿周围组织脑血流变化的CT灌注成像与病理学研究

目的探讨血肿周围组织病理发展进程及其与血肿周围局部脑血流变化的关系。方法采用自体血注射法制备大鼠脑出血模型,对70只大鼠于术后1h、3h、6h、12h、24h、48h和72h7个时间点,利用GELightspeed螺旋CT扫描机灌注成像及计算机辅助系统制作大鼠脑CT灌注参数图,对血肿周围局部脑血流量(rCBF)、局部脑血容量(rCBV)和对比剂平均通过时间(MTT)脑血液动力学参数进行定量测量,并与大鼠脑TTC染色、HE-染色以及超微结构改变进行比较。结果大鼠脑血肿周围可见明显的低灌注梯度,血肿周围rCBF和rCBV显著降低,MTT延长。TTC染色血肿周围未见白色梗死区。HE-染色可见血肿周围区星形细胞肿胀,神经细胞变性、坏死,出血灶周边毛细血管增生伴炎细胞浸润。电镜观察显示,注血早期血肿周围组织星形细胞肿胀,神经细胞改变不明显,髓鞘板层松散;随着注血后时间延长,血肿周围组织损伤呈渐进性加重,星形细胞肿胀明显,神经细胞出现变性,髓鞘板层发生局部断裂、崩解。结论大鼠脑注血早期血肿周围局部脑血流的显著降低引发了血肿周围及远隔区脑组织的缺血性损伤,注血后急性期血肿周围组织细胞损伤呈进行性加重,血肿周围存在涉及多种细胞损伤机制的半暗带。     

脑出血患者CT灌注成像的影像学特点

目的探讨脑出血(ICH)患者CT灌注成像(CTP)的影像学特点。资料与方法27例患者于发病后5h～2周行CTP检查,观察其影像学特点。结果上矢状窦的时间密度曲线稳定,能够反映ICH后颅内的总体灌注情况。灌注缺损面积介于血肿与水肿加血肿面积之间;这种现象在基底节区前后侧比左右侧明显,且在某一方向更为显著;血肿周围灌注降低呈阶梯样改变,靠近血肿区达到缺血损伤的程度。ICH并发脑积水患者的灌注明显降低。脑血管畸形继发的出血可见血管影像。结论CTP可以反映ICH患者颅内的血液动力学变化,血肿周围存在缺血性损伤,这种损伤可能与血肿压迫和出血时的机械损伤等有关。CTP能够反映脑积水和颅内高压继发的低灌注。亦可能在鉴别出血的原因和出血方式上有一定的提示作用。     

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.     

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.     

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