多层螺旋CT诊断十二指肠肿瘤的临床价值分析

目的 探讨多层螺旋CT（MSCT）与病理对照对十二指肠肿瘤诊断价值。方法 对79例经病理证实的十二指肠肿瘤MSCT资料及发病机制进行回顾性分析。结果 79例原发性十二指肠肿瘤中十二指肠腺癌57例,间质瘤7例,恶性淋巴瘤7例,类癌4例,脂肪瘤2例,腺瘤2例。十二指肠腺癌CT表现为十二指肠局部软组织肿块影,伴肠腔不规则狭窄;间质瘤CT表现多为较大软组织肿块,有明显强化,肿块多腔外生长;恶性淋巴瘤CT表现肿瘤累及肠管范围较长,肠壁增厚明显,呈轻-中度强化,但肠梗阻症状不明显;类癌CT表现软组织肿块或结节影,强化较明显;脂肪瘤CT表现边界清楚的低密度肿块影（CT值为负值）,强化不明显;腺瘤CT表现等密度的菜花状小肿块影,增强扫描明显均匀强化,边缘有分叶状。结论 MSCT有助于十二指肠肿瘤的定位,定性诊断,对临床制定治疗方案和预后的评估有很大帮助。     

十二指肠恶性肿瘤的CT诊断与鉴别诊断

目的　探讨十二指肠恶性肿瘤的CT诊断与鉴别诊断。方法　回顾性分析 2 0例手术病理证实的十二指肠恶性肿瘤的CT平扫和增强资料。结果　原发十二指肠恶性肿瘤 8例 ,其中十二指肠腺癌 3例 ,恶性淋巴瘤 2例 ,恶性间质瘤 3例 ;十二指肠继发性恶性肿瘤 12例 ,其中壶腹癌 3例 ,胰头癌 8例 ,胰腺无功能性神经内分泌癌 1例。十二指肠腺癌CT表现为肠腔局限性不规则环状狭窄伴软组织肿块 ,增强扫描肿块有中度强化 ;恶性淋巴瘤的特点是长范围的肠壁增厚或肠腔外肿块 ,增强扫描肿块有轻度强化 ;恶性间质瘤的特点是巨大软组织肿块伴明显、不均匀强化 ,肠梗阻不明显。壶腹癌表现为十二指肠降部内侧壁的局限性肿块 ,增强有轻中度强化 ,伴肝内外胆管扩张 ;胰头癌累及十二指肠表现为十二指肠内侧壁凹凸不平 ,邻近的胰头部肿块 ,增强扫描不强化 ,伴肝内外胆管扩张 ;胰腺无功能性神经内分泌癌侵及十二指肠表现为胰头部巨大肿块伴明显强化 ,肝内外胆管不扩张 ,肿块与十二指肠分界不清。结论　CT检查对十二指肠恶性肿瘤有重要的诊断和鉴别诊断价值。     

十二指肠恶性肿瘤的MSCT诊断

目的 探讨MSCT对十二指肠恶性肿瘤的诊断价值.方法 回顾性分析30例经病理证实的十二指肠恶性肿瘤的MSCT表现.结果 十二指肠腺癌27例,间质瘤2例,类癌1例.腺癌以肿块(11/27)或肠壁增厚(16/27)为主;间质瘤2例均呈肿块状;类癌1例为肠壁增厚.30例病变CT平扫均为等密度或稍低密度,23例腺癌(23/26)呈轻中度强化,2例间质瘤明显强化,1例类癌中度强化.9例累及胰头,5例累及肠系膜上动静脉和/或下腔静脉5例腹腔和/或腹膜后淋巴结转移;1例双肺转移.结论 MSCT可对十二指肠恶性肿瘤进行定性诊断,对临床制订治疗方案和预后的评估有很大帮助.     

十二指肠壶腹周围部间质瘤的MSCT表现及其临床意义

目的：探讨十二指肠壶腹周围部间质瘤（GIST）的CT表现及其诊断价值。方法：回顾性分析9例经手术或病理证实的十二指肠壶腹周围部间质瘤的CT表现。结果：9例中良性GIST1例,交界性1例,恶性7例（其中6例为中低度恶性）。病灶大小2.5m×3.0cm～10cm×10cm,平均4cm×6cm。MSCT平扫示瘤内出血2例,无出血7例;分叶8例,无分叶1例。增强扫描示病灶周边部不规则环状强化伴中央坏死6例,明显强化但不伴中央坏死3例;9例均表现为门脉期持续强化。胆总管轻度扩张2例,胰管轻度扩张3例。多种后处理方法相结合可清楚显示十二指肠壶腹部的解剖结构、病灶的位置、形状、大小及所致胰胆管扩张。结论：十二指肠壶腹周围部GIST诊断关键是准确定位和肿瘤强化方式,MSCT三维图像重组更有助于确定诊断和手术方式。     

原发性十二指肠腺癌MSCT表现

_目的：探讨原发性十二指肠腺癌 MSCT 三期增强扫描的影像学特征,总结分析其误诊、漏诊原因。方法：回顾性分析21例经病理证实的十二指肠腺癌的临床、病理及 CT 表现特征。结果：21例十二指肠腺癌中14例呈肿块型,表现为腔内息肉状或菜花状软组织肿块,边界清晰,多呈轻中度均匀强化;6例呈缩窄型,表现为肠壁不规则或环形增厚,肠腔狭窄,常伴有近段肠管扩张,边界清楚或毛糙,可突破浆膜面,呈中度或重度均匀、不均匀强化;1例因图像质量差难以评价。累及十二指肠乳头部的腺癌常伴有肝内外胆管、胰管扩张。21例十二指肠腺癌中正确诊断13例,3例误诊为十二指肠腺瘤,1例误诊为胰头癌,2例误诊为壶腹癌。2例因 CT 检查仅表现为肝内胆管轻度扩张而漏诊。1例肝内转移灶漏诊。结论：MSCT 对十二指肠腺癌的诊断具有重要价值,保证十二指肠的充盈、重视门脉期对肝转移灶的检出以及肝内胆管轻度扩张这一间接征象,有助于更好地发现病变,降低误诊、漏诊率。     

MRI 在原发性十二指肠恶性肿瘤诊断中的应用价值

目的：探讨MRCP、TrueFISP结合3D-VIBE动态增强MR扫描在十二指肠恶性肿瘤诊断中的价值。方法收集资料完整的原发性十二指肠恶性肿瘤29例,回顾性分析 MR 资料,观察病变发生部位、形态、信号特点、周围结构及有无远处转移。结果本组腺癌共21例,黏液腺癌及印戒细胞癌混合1例,印戒细胞癌1例,神经内分泌癌1例,未分化癌1例,恶性间质瘤3例,1例霍奇金氏淋巴瘤。MR 主要表现为十二指肠局部肠壁偏心性或环形不规则增厚,形成软组织结节或肿块,黏膜破坏消失,伴肠腔狭窄,均匀或不均匀持续强化。恶性间质瘤肿瘤较大,合并囊变坏死。淋巴瘤表现为肠壁弥漫增厚,合并腹膜后多发淋巴结肿大。7例侵犯胰头,7例合并淋巴结转移,5例合并肝转移。结论MRCP、TrueFISP 及3D-VIBE 动态增强扫描结合对十二指肠恶性肿瘤诊断具有重要价值。肠壁不规则增厚并肿块形成、黏膜破坏消失是十二指肠恶性肿瘤的重要征象,病灶侵犯周围结构、合并淋巴结肿大或远处转移则有助于定性诊断。     

CT在原发性十二指肠恶性肿瘤诊断中的价值

目的:探讨CT在原发性十二指肠恶性肿瘤中的诊断及鉴别诊断价值。方法:回顾性分析36例经手术病理证实的原发性十二指肠恶性肿瘤患者的CT检查资料,并与手术病理结果进行对照。结果:36例原发性十二指肠恶性肿瘤中十二指肠腺癌30例,恶性间质瘤3例,恶性淋巴瘤1例,神经内分泌癌2例。十二指肠腺癌CT表现为十二指肠局部软组织肿块影,伴肠腔不规则狭窄;恶性间质瘤CT表现多为较大软组织肿块,有明显强化,肿块多腔外生长;恶性淋巴瘤CT表现肿瘤累及肠管范围较长,肠壁增厚明显,呈轻-中度强化,但肠梗阻症状不明显;神经内分泌癌CT表现软组织肿块或结节影,强化较明显。结论:CT检查对原发性十二指肠恶性肿瘤有重要的诊断价值及鉴别诊断价值。     

十二指肠乳头癌的MSCT诊断

目的：探讨MSCT在十二指肠乳头癌诊断中的价值。方法：回顾性分析25例十二指肠乳头癌患者的MSCT及多平面重组（MPR）影像资料,并与手术病理结果对照。结果：25例十二指肠乳头癌MSCT平扫表现为十二指肠乳头区圆形、椭圆形软组织肿块23例,局部肠壁环状增厚2例,多期增强扫描动脉期轻度强化,静脉期强化程度增加,延迟期强化程度减退。胆总管中重度扩张,梗阻端形态呈截断状突然狭窄,肝内胆管轻中度扩张,与肝外胆管扩张程度一致。5例MPR显示十二指肠乳头区软组织肿块突入十二指肠腔内。结论：MSCT不仅能显示十二指肠乳头区肿块及肝内外胆管扩张情况,而且能显示肿块的强化模式,能为十二指肠乳头癌术前诊断提供重要信息。     

小肠常见原发恶性肿瘤的MSCT诊断

目的:探讨MSCT对空回肠常见原发恶性肿瘤的诊断价值,并总结常见恶性肿瘤的临床病理特点。方法:回顾性分析我院36例空回肠常见原发恶性肿瘤的临床资料、病理特点及CT诊断情况。结果:36例中,小肠腺癌18例,位于回肠3例,空肠15例,CT扫描表现为不均匀密度的肿块,病变边界不清,增强扫描显示动脉期及门脉期中度强化,其中14例伴有肠梗阻。小肠恶性胃肠道间质瘤14例,CT扫描显示为圆形或类圆形的肿块,边界较清,增强扫描可见病灶周边部分明显强化。小肠原发淋巴瘤4例,CT扫描显示为结节状或环状肠壁增厚,密度均匀,增强扫描呈轻度强化。结论:通过回顾性分析得出空回肠常见的恶性肿瘤有3种类型:小肠腺癌、恶性胃肠道间质瘤和淋巴瘤。应用CT增强扫描有利于空回肠常见恶性肿瘤的定性诊断,并可以发现病变向外浸润及淋巴结转移征象,为临床手术治疗提供帮助。     

肾上腺占位病变的CT、MRI诊断(附71例报告)

目的探讨肾上腺占位病变的CT、MRI诊断价值,提高对肾上腺间质概念的认识. 资料与方法搜集1994年8月～2001年6月经手术和病理证实的肾上腺占位病变71例,46例行CT平扫,其中31例进行增强扫描;30例行MRI平扫,18例行增强扫描;共有5例行CT、MRI联合检查(平扫+增强). 结果 (1) 皮质占位36例(占50.7%),其中醛固酮腺瘤14例,皮质醇腺瘤11例,无功能腺瘤3例,皮质腺癌2例,皮质增生症6例;有1例伴性变态综合征.(2) 髓质占位29例(40.8%),其中嗜铬细胞瘤16例,成神经细胞瘤3例,节神经细胞瘤2例,转移瘤8例.(3)间质占位6例(8.5%),其中髓样脂肪瘤3例,囊肿2例,纤维脂肪瘤1例. 结论肾上腺占位病变多具有其特定的好发年龄、性别趋向及CT、MRI影像学特征,结合临床及实验室检查有助于提高占位病变诊断的准确性;但部分无功能腺瘤、转移瘤、间质肿瘤的定性诊断仍依赖于组织学检查.     

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).     

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.     

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