多层螺旋CT曲面重建在先天性外耳道闭锁中面神经管异常的研究

目的用多层螺旋CT(MSCT)曲面重建(CPR)技术研究先天性外耳道闭锁中面神经管的异常。方法对15例(17耳)先天性外耳道闭锁患者进行多层螺旋高分辨率CT(HRCT)扫描,图像后处理在Philips Mx8000工作站进行。结果17耳中,外耳道狭窄2耳,外耳道膜性闭锁2耳,骨性闭锁13耳。外耳道先天性胆脂瘤及耳后瘘管1耳。鼓室畸形3耳。听小骨先天畸形7耳。内耳畸形1耳。面神经管异常17耳。其中面神经管总长度变短11耳,面神经管走行异常5耳,面神经管位置异常9耳,面神经管管径变细1耳,面神经管分叉1耳。结论MSCT高分辨率扫描加CPR技术能清晰显示先天性外耳道闭锁患者中面神经管的异常,有利于临床医生术前详尽了解面神经管的行程,减少不必要的面神经意外损伤。     

不稳性寰椎骨折的外科治疗策略

目的 探讨枕颈或寰枢椎内固定融合技术治疗不稳性寰椎骨折的临床疗效和应用价值.方法 对2004年10月-2009年3月收治的不稳性寰椎骨折38例进行回顾性分析,其中6例寰椎爆裂性骨折合并寰枕关节不稳(5例行C0～C2固定融合术,其中1例同时合并有C7椎体压缩性骨折行C0～C3固定融合术),7例典型的Jefferson骨折,3例半环骨折,8例寰椎骨折合并Ⅱ型齿状突骨折,3例寰椎骨折合并Hangman骨折(其中2例Levine-Edwards Ⅲ型行C0～C3固定融合术,1例Ⅱ型行C1～C2固定融合术),3例寰椎骨折合并下颈椎损伤,6例寰椎横韧带断裂(Dickman Ⅰ型)伴寰枢关节不稳,2例寰椎粉碎性骨折合并寰椎侧块内侧骨性结构附着处横韧带撕裂(DickmanⅡ型).5例行C0～C2固定融合术,3例行C0～C3固定融合术,30例行C1～C2固定术并行自体髂骨植骨融合.结果 所有患者术后均获得随访,平均随访时间为28个月(12～46个月).临床症状均得到不同程度的改善.平均手术时间135 min(80～190 min),平均失血量460ml(200～3 300 ml),平均透视时间60 s.38例患者术中均未发生神经、椎动脉和其他手术相关并发症.全部患者均于术后3 d颈托固定后下地行走;术后脊髓损伤症状无加重.3例因电刀灼伤C1～C2间血管静脉丛导致出血,行止血纱布、脑棉片填塞止血,未出现颅脑缺血症状.复查X线片和CT未发现上颈椎失稳或复位丢失,螺钉位置良好,无松动、断钉,寰枢椎或枕颈部均获骨性融合.在晚期随访中,4例(11%)有颈部疼痛和僵硬感,1例枕神经痛.结论 对具有不稳定性寰椎骨折或合并寰椎横韧带损伤的患者,采用枕颈或寰枢椎内固定融合技术及短期外固定对于重建上颈椎永久稳定性是较好的手术方式,并且能阻止神经和脊髓功能的进一步损伤.

Abstract：

Objective To evaluate the clinical effect and safety of the occiput-cervicle or C1-C2 internal fixation and bone graft fusion in treatment of the unstable atlas fracture.Methods A retrospective study was performed in 38 patients with unstable atlas fractures treated by the occiput-cervicle or C1-C2 internal fixation and bone graft fusion from October 2004 to March 2009.Six patients with comminuted atlas fracture combined with instability of the occipito-atlantoid articulations were treated with occiput-C2 fusion(five patients)and with occiput-C3 fusion(one patient).There were seven patients with typical Jefferson fractures,three with semiring fractures,eight with atlas fractures combined with Anderson type Ⅱ odontoid process fractures,three with atlas fractures combined with Hangman's fractures (two patients with Levine and Edwards type Ⅲ Hangman's fractures were treated with occiput-C3 fusion and one patient Levine and Edwards type Ⅱ Hangman's fracture was treated with C1-C2 fusion),three with atlas fracture combined with lower cervicle injury,six with rupture of transverse ligament combined with instability of atlanto-axial joint(Dickman transverse ligament type Ⅰ injury)and two with comminuted fracture of the lateral mass associated with bony avulsion of the medial tubercle and transverse ligament(Dickman transverse ligament type Ⅱ injury).Of all,five patients were treated with occiput-C2 fusion,three treated with occiput-C3 fusion and 30 treated with C1-C2 fusion.Results All the patients were followed up for a range of 12-46 months(average 28 months),which showed improvement of clinical symptoms in some extent postoperatively.The operation time ranged from 80 to 190 min ates(average 135 minates),with intraoperative blood loss for 200-3 300 ml(average 460 ml)and average fluoroscopic time for 60 seconds.There were no neurological deficits,vertebral artery related complications or other complications in all the patients during the surgical operation.No neurological deficit was aggravated after the patient's mobilization with brace three days after operation.The enous plexus of blood vessel at C1-C2 rupture induced by the use of electrocautery was found in three patients who showed no cerebral hemodynamic deficit after hemostasis with hemostatic sponge and cotton piece.The follow-up X-ray and CT manifested osseous fusion in all the patients,with no looseness or breakage of the screws.The late follow-up showed pain associated with movement and limited range of motion in four patients(11%)and occipital neuralgia in one.Conclusions An occiput-cervicle fixation fusion or a C1-C2 fixation fusion combined with short external fixation can reestablish the upper cervical stability and prevent further injury of the spinal cord and nerve function and hence is an ideal option for C1 burst fracture with or without rupture of the transverse ligament.     

艾滋病合并肺结核的多元化影像学表现

目的：探讨艾滋病合并肺结核的多元化影像学表现。方法：回顾性分析45例艾滋病（acquired immunodetieieney syndrome,AIDS）合并肺结核的影像学资料,CT扫描31例,DR胸片14例,经CT引导下穿刺26例,综合分析艾滋病合并肺结核的影像学表现特征。结果：45例艾滋病合并肺结核患者,病灶累及1个肺段的10例,2个肺段的6例,3—5个肺段的4例,两肺弥漫性分布的20例,肺部无阳性表现者5例,其中病理证实同时合并卡氏肺孢子虫肺炎（pneomoeystis carinii pneumonia,PCP）10例,合并细菌（化脓菌）感染8例,合并真菌感染5例。结论：艾滋病合并肺结核的影像学表现多种多样,同时合并多种病原体感染,病变表现形态多样,影像学表现缺乏特异性,肺部穿刺活检病理证实仍不失为金标准。     

耳垂缺损的不同方法修复效果观察

目的探讨用不同方法行耳垂缺损再造修复的可行性及优缺点。方法1995年1月-2006年7月共收治耳垂缺损患者45例,根据耳垂缺损的大小及对侧耳垂情况分别采用不同的手术方式进行修复再造。对于18例缺损面积较小的耳垂缺损采用耳轮滑行推进皮瓣法修复,15例中等程度缺损患者采用耳后皮瓣法修复,12例完全缺损,或虽不是完全缺损但健侧耳垂较大的患者采用皮肤扩张术 自体肋软骨移植法修复。结果45例患者分别采用上述方法进行再造修复后,耳廓、耳垂形态良好,随访4个月-8年,效果满意。结论对于不同程度的耳垂缺损畸形,应根据具体情况采用相应的修复方法,以达到最佳治疗效果。对于耳垂完全缺损或虽不是完全缺损但对侧耳垂较大的患者,应首选皮肤扩张术 自体肋软骨移植法,以获得形态良好而持久的再造耳垂。     

Splenic artery and superior mesenteric artery blood flow: nonsurgical Doppler US measurement in healthy subjects and patients with chronic liver disease

The accuracy of the duplex Doppler ultrasound system in the measurement of blood flow in the splenic artery and the superior mesenteric artery was evaluated in seven anesthetized dogs by comparing blood flow recordings obtained simultaneously with the electromagnetic flowmeter, with those obtained with the combination of B-mode and M-mode scanning. Various flow rates were produced by the infusion of dopamine. Splenic artery blood flow and superior mesenteric artery blood flow measured with the duplex system exhibited significant correlations with corresponding values obtained with electromagnetic flow measurements (r = .93 and r = .93, respectively). Changes in splanchnic circulation with the progression of chronic liver disease in humans were then investigated with the use of the duplex system. Splenic artery blood flow and superior mesenteric artery blood flow were significantly increased in patients with cirrhosis compared with patients with chronic hepatitis and healthy subjects. These results indicate that a hyperdynamic circulatory state may develop in the splanchnic circulation of the intestine and spleen in cirrhotic patients.     

Nuclear magnetic resonance (NMR) imaging in white matter disease of the brain using spin-echo sequences

Attention is drawn to the use of nuclear magnetic resonance (NMR) spin-echo sequences in the recognition of white matter disease of the brain. In 5 patients with multiple sclerosis, 8 lesions were seen with postcontrast x-ray computed tomography (CT) (37.5 g of iodine), 33 with inversion-recovery (IR) scans, and 47 with spin-echo (SE) scans. Partial volume effects were less of a diagnostic difficulty with SE scans than with IR scans. Extensive areas of abnormal white matter were seen with CT, IR, and SE scans in a patient with leucodystrophy associated with congenital muscular dystrophy. In a patient with adrenoleucodystrophy focal lesions were seen with CT, IR, and SE scans. In addition, loss of gray-white matter contrast was seen in both occipital lobes with IR scans. Extensive areas of white matter involvement were also seen in a case of Binswangers disease.     

肿瘤相关性皮肌炎的~(18)F-FDG PET-CT影像特点

目的：探讨肿瘤相关性皮肌炎的18F-FDGPET-CT影像特点。方法：回顾性分析9例皮肌炎合并恶性肿瘤患者的临床资料和18F-FDGPET—CT显像资料,采用Mann-WhitneyU秩和检验对恶性肿瘤病灶与骨骼肌的SUVmax的相关性进行统计学分析。9例中胆囊癌3例,肺癌2例,卵巢癌、食管癌、结肠癌及恶性淋巴瘤各1例。结果：所有恶性肿瘤病灶的18F-FDG摄取较高,SUVmax为7．26±5．48;7例患者18F-FDGPET—CT显像示全身骨骼肌弥漫性对称性轻度摄取增高,SUVmax为3．45±0．81,与恶性肿瘤问差异有统计学意义（Z=-2．910,P=0．004）。同机cT扫描还发现1例合并间质性肺炎,3例合并肺部感染。结论：肿瘤相关性皮肌炎的18F-FDGPET-CT表现有一定特征性,认识其影像学表现,有助于提高对此病的诊断准确性。     

Root of the superior mesenteric artery in pancreatitis and pancreatic carcinoma: evaluation with CT

To determine if changes involving the root of the superior mesenteric artery are specific for neoplasm, the authors retrospectively reviewed 173 computed tomographic (CT) examinations of patients with proved pancreatitis (103 examinations) and pancreatic ductal adenocarcinoma (70 examinations). Streaky infiltration of the fat surrounding the root was seen in 27 of 56 examinations of acute pancreatitis, in four of 24 examinations of chronic pancreatitis, in 12 of 23 examinations of pancreatitis complicated by abscess, and in 25 of 70 examinations of pancreatic carcinoma. Periarterial lymph nodes were visible in 14 with acute pancreatitis, in three with chronic pancreatitis, in six with pancreatic abscess, and in 11 with pancreatic carcinoma. A focal mass extended to within 1 cm of the root in 10 with acute pancreatitis, in two with chronic pancreatitis, in four with pancreatic abscess, and in 24 with pancreatic carcinoma; the mass obliterated the periarterial fat in seven with acute pancreatitis, in one with pancreatic abscess, and in 18 with pancreatic carcinoma. Circumferential encasement occurred in one with chronic pancreatitis, in four with pancreatic abscess, in 14 with pancreatic carcinoma, and in none with acute pancreatitis; nearly all cases of encasement revealed loss of periarterial fat. Thus, these indicators are not specific for neoplasm.     

Spin-echo anatomy of the larynx with magnetic resonance at 1.5 T

The larynges of 8 healthy and informed volunteers were studied with a superconductive MR unit at 1.5 T together with those of 10 patients with extralaryngeal pathologic conditions. The study was performed with round surface coils (5") and with dedicated sellar coils in the anterior neck. Slices were 5 mm thick, and acquired on the coronal, axial, and sagittal planes, with T1-weighting; axial scans were repeated in the same locations with double echoes, with proton-density and T2-weighting. Five patients underwent additional scans after Gd-DTPA. The larynx of a semi-frozen cadaver was examined with sellar surface coils, on similar scanning planes and with similar pulse sequences to those described above; the larynx was removed, investigated with mammographic technique, and subsequently analyzed with thin CT slices and a high-resolution reconstruction algorithm for the study of laryngeal cartilage. Axial anatomical sections were then compared with MR and CT scans, and the anatomical structures were recognized on the triplanar MR scans of a volunteer's larynx. Besides MR anatomy of supporting laryngeal structures, the authors describe in detail the muscles, plicae, spaces and cavities which can be identified on the various planes, together with the changes in signal after Gd-DTPA.     

高压氧联合放射治疗对食管癌患者survivin蛋白表达的影响

目的 探讨食管癌患者survivin蛋白的表达及高压氧联合放射治疗对survivin蛋白表达的影响。方法 应用免疫组织化学SP法检测65例食管癌患者及20名正常人食管黏膜组织survivin蛋白表达情况。结果 食管癌患者survivin蛋白表达率为70.8％ (46/65),正常人食管黏膜组织中表达率为5％ (1/20)。survivin蛋白的表达与肿瘤的淋巴转移关系密切,有淋巴转移的患者survivin蛋白阳性率与无淋巴转移的患者比较差异有统计学意义(P＜0.05)。食道癌患者高压氧联合放射治疗与单纯放射治疗比较,临床症状有所改善,survivin蛋白阳性表达率降低,差异有统计学意义(P＜0.05)。结论 survivin蛋白阳性表达与食管癌的生长及转移有关,参与食管癌的发生发展。高压氧与放射治疗联合应用可提高临床疗效。     

Shape mapping of the hippocampus in young children with autism spectrum disorder

BACKGROUND AND PURPOSE: We hypothesized the occurrence of characteristic hippocampal-shape alterations in young children with autistic spectrum disorder (ASD) who also exhibit deficits on neuropsychologic tests of medial temporal lobe (MTL) function. MATERIALS AND METHODS: Coronal 3D MR images were acquired from 3- to 4-year-old children with ASD (n = 45) and age-matched children with typical development (n = 13). Children with ASD were further subclassified into those with autism disorder (AD, n = 29) or pervasive developmental disorder-not otherwise specified (PDD-NOS) (n = 16). Variations in hippocampal shape were evaluated by using large-deformation high-dimensional brain mapping. RESULTS: Hippocampal shape measures distinguished children with ASD from those with typical development; within the ASD sample, children with AD were distinguished from those with PDD-NOS. Hippocampal-shape alterations in children with ASD were correlated with degree of mental retardation and performance deficits on tests of MTL function. CONCLUSIONS: Children with ASD exhibited an alteration of hippocampal shape consistent with inward deformation of the subiculum. This pattern of hippocampal-shape deformations in the children with ASD was accentuated in the more severely affected subgroup of children with AD and was associated with deficits on neuropsychologic tests of MTL but not prefrontal function. Hippocampal-shape deformation in the children with ASD was observed to be similar to a pattern of hippocampal shape deformation previously reported in adults with MTL epilepsy. Although the children with ASD, and those with AD in particular, PDD-NOS are at high risk for epilepsy as they enter adolescence, the specificity and causal relationship of this pattern of hippocampal-shape deformation to the development of seizures is not yet known.     

Frequency of asymptomatic microbleeds on T2*-weighted MR images of patients with recurrent stroke: association with combination of stroke subtypes and leukoaraiosis

BACKGROUND AND PURPOSE: Asymptomatic microbleeds shown by T2*-weighted MR imaging are associated with small-artery diseases, especially with intracerebral hemorrhage. Few studies have focused on the prevalence of microbleeds in patients with recurrent stroke. We investigated frequency of microbleeds in patients with recurrent stroke and association of presence of microbleeds with a combination of stroke subtypes and severity of leukoaraiosis. METHODS: The study population consisted of 102 patients with primary stroke and 54 patients with recurrent stroke. Microbleeds were counted and classified by using T2*-weighted MR imaging with a 1.0-T system. RESULTS: Patients with recurrent stroke showed a significantly higher prevalence of microbleeds (68.5%) than did patients with primary stroke (28.4%) (P <.0001). Among patients with recurrent stroke, the highest frequency of microbleeds occurred in those with intracerebral hemorrhage alone (92.3%), with the next highest frequency occurring in those with a combination of intracerebral hemorrhage and ischemic stroke (76.5%) and then those with ischemic stroke alone (50.0%) (P <.05). Leukoaraiosis was more severe in patients with recurrent stroke than in patients with primary stroke, and correlations between grade of microbleeds and severity of leukoaraiosis were found in patients with primary stroke (r = 0.367, P <.001) and in patients with recurrent stroke (r = 0.553, P <.0001). Logistic regression analysis identified recurrent stroke (odds ratio, 4.487; 95% confidence interval, 1.989-10.120) and leukoaraiosis (odds ratio, 5.079; 95% confidence interval, 2.125-12.143) as being significantly and independently associated with microbleeds. CONCLUSION: Asymptomatic microbleeds are observed to occur frequently in patients with recurrent stroke, either hemorrhagic or ischemic stroke, and are closely associated with the severity of leukoaraiosis.     

颅内动脉瘤电解脱弹簧圈栓塞治疗术中破裂的可能性及其对策

目的探讨破裂动脉瘤在电解脱弹簧圈(Guglielmi detachable coil，GDC)栓塞术中再次破裂的可能性及其相应措施。方法159例颅内动脉瘤施行GDC栓塞时，发生术中再次破裂7例。女5例，男2例，平均年龄46．9岁：7例中微导丝原性破裂1例，弹簧丝原性破裂3例，微导管原性破裂2例，弹簧圈填塞过度性破裂1例。结果3例弹簧丝原性破裂和2例微导管原性破裂均施行GDC继续填塞或调整微导管位置后继续填塞，直至瘤腔致密填塞。该5例中4例术后完全康复，1例残留一侧下肢不灵便；1例微导丝原性破裂和1例弹簧圈过度填塞性破裂，因术中出血过多致死亡。结论颅内动脉瘤GDC栓塞中发生动脉瘤破裂难以避免，操作者经验与发生率成反比，材料选择合活可降低其发生率．破裂发生后继续GDC填塞可达到完全填寨、愈复。     

Intracranial calcifications in childhood medulloblastoma: relation to nevoid basal cell carcinoma syndrome

BACKGROUND AND PURPOSE: Medulloblastoma is one of the most common posterior fossa tumors to occur in children. Our purpose was to document the frequency, location, and time of occurrence of intracranial calcifications in cranial CT studies of children with medulloblastoma. METHODS: We retrospectively reviewed cranial CT studies of 56 patients diagnosed with medulloblastoma from 1983 through 1997 for the presence of intracranial calcifications. The findings were compared with 159 cranial CT studies of patients who were evaluated in the emergency department (control group). Thirty-two patients with medulloblastoma without shunts were compared with 118 patients from the control group without shunts. Similarly, 24 patients with medulloblastoma with shunts were compared with 41 patients from the control group with shunts. RESULTS: Overall, three (9%) patients with medulloblastoma without shunts, four (16%) patients with medulloblastoma with shunts, and four (10%) patients from the control group with shunts had falx calcification. Only the two children carrying the diagnoses of medulloblastoma and nevoid basal cell carcinoma syndrome, however, had calcification of the falx cerebri shown on the cranial CT scans obtained during the peridiagnostic period. Both were diagnosed with medulloblastoma before the age of 3 years and later developed jaw cysts and multiple basal cell carcinomas in the radiation field. CONCLUSION: Previous studies have shown that falx calcification is a major component of nevoid basal cell carcinoma syndrome. Our two cases illustrate the importance of considering the diagnosis of nevoid basal cell carcinoma syndrome when falx calcification is present in young patients with medulloblastoma. If the concomitant diagnosis of nevoid basal cell carcinoma syndrome is made, alternative types of therapy should be sought to minimize radiation therapy sequelae.     

Preliminary study of patients with vertigo and dizziness using 123I-IMP

To study the application of cerebral blood flow scintigraphy with 123I-IMP for the evaluation of central dizziness, the difference in 123I-IMP accumulation between the right and left cerebellar hemispheres was determined as an asymmetry index (A.I.) in 8 normal subjects and compared with A.I. from patients with central dizziness. According to estimated lesions, 123I-IMP findings were compared with CT findings. The normal subjects had A.I. of 5.8 +/- 2.1%, whereas 36 patients with central dizziness had A.I. of 12.7 +/- 7.5%. On the basis of an A.I. of 8% or more as an abnormal finding on IMP scintigraphy, 11 of the 14 patients with estimated lesions of cerebellar hemispheres and 16 of the 20 with those of the whole cerebellum including the vermis were evaluated to have had abnormalities. Seven of 11 with estimated lesions of the brainstem and 4 of 5 with vertebrobasilar arterial insufficiency were evaluated to have had abnormalities. The findings of 123I-IMP cerebral blood flow scintigraphy were in good agreement with clinical symptoms in patients with central dizziness with estimated lesions of the cerebellar hemispheres, suggesting the possibility that this method is more useful than CT.     

严重多发伤时损伤控制骨科应用41例

目的 探讨严重多发伤时损伤控制骨科（DCO）应用的可行性和疗效。方法对1995年1月-2005年12月应用DCO方法救治严重多发伤41例的临床资料进行回顾性分析。结果29例严重多发伤伴骨盆骨折大出血，均行髂内动脉断血术，其中双侧髂内动脉结扎21例，双侧髂内动脉栓塞术8例，早期骨盆外固定支架使用10例。10例严重多发伤伴开放性股骨骨折初期仅行清创和简单外固定。2例脊柱骨折伴脊髓压迫行简单椎板减压。均在ICU复苏治疗后，再做确定性内固定手术。本组死亡率12％（5／41），死亡组损伤严重度评分（ISS）平均值41．4分，主要死于休克和合并伤。共发生并发症7例，合并急性呼吸窘迫综合征（ARDS）3例，右髂总动脉血栓形成1例，2例膈下脓肿，1例下肢深部感染，均痊愈。结论迅速准确的诊断和一体化治疗，是提高严重多发伤生存率的关键，合理应用DCO是安全有效的方法。     

Extension of radiofrequency ablation of the liver by transcatheter arterial embolization with iodized oil and gelatin sponge: results in a pig model

PURPOSE: To determine whether transcatheter arterial embolization (TAE) with iodized oil and gelatin sponge particles can be used to expand radiofrequency (RF)-induced coagulation necrosis, the morphology and histologic characteristics of ablation lesions were evaluated in the normal pig liver after three different TAE procedures. MATERIALS AND METHODS: Ten consecutive animals with 33 ablation lesions produced with an RF ablation system were randomly assigned to one of three treatment groups and a control group: a group treated with TAE with iodized oil, a group treated with TAE with gelatin sponge, a group treated with TAE with iodized oil and gelatin sponge, and a control group in which TAE was not performed. After the completion of ablation, the lesions were excised for gross and histologic examination. RESULTS: The longest and shortest diameters of ablation lesions were greatest in the group treated with TAE with iodized oil and gelatin sponge, followed by the groups treated with TAE with gelatin sponge and TAE with iodized oil (P < .05 vs controls, respectively). The hemorrhagic rim was also widest in the group treated with TAE with iodized oil and gelatin sponge (P < .05 vs controls), and it spread toward the liver periphery like a segmental hemorrhagic area adjacent to the ablation lesion. Histochemical staining for lactate dehydrogenase, maleate dehydrogenase, and nicotinamide adenine dinucleotide diaphorase showed what appeared to be 100% cellular destruction in all the ablation lesions and their hemorrhagic rims. CONCLUSION: RF ablation combined with TAE with iodized oil and gelatin sponge induces the greatest area of coagulation necrosis accompanied by peripherally spreading segmental necrosis in normal pig liver tissue.     

Parietal pleural changes in empyema: appearances at CT

The parietal pleura bordering pleural space collections was analyzed with computed tomography (CT) in 35 patients with thoracic empyema, 30 patients with malignant effusion, and 20 patients with transudatory effusion. Enhancement of the parietal pleura was present in 96% of the 25 patients with empyema who underwent contrast material-enhanced examinations. Of the 35 patients with empyema, 86% showed thickening of the parietal pleura, 60% showed thickening of the extrapleural subcostal tissues, and 35% showed increased attenuation of the extrapleural fat. None of the 20 patients with transudatory effusion showed these findings. Of the 30 patients with malignant effusion, eight patients (27%) showed chest wall changes similar to those of the patients with empyema. However, two-thirds of these patients had a recognized superimposed complication (ie, sclerotherapy). Contrast-enhanced CT appears to be sensitive to chest wall changes in patients with empyema. CT study of the parietal pleura may help suggest occult pleural space infections and may influence therapeutic decisions that vary with the stage of empyema.     

Combination of CT during arterial portography and double-phase CT hepatic arteriography with multi-detector row helical CT for evaluation of hypervascular hepatocellular carcinoma

AIM: To evaluate the diagnostic accuracy of the combination of computed tomography (CT) during arterial portography (CTAP) and double-phase CT hepatic arteriography (CTHA) with multidetector-row CT (MDCT) for the evaluation of hepatocellular carcinomas (HCCs) in patients with cirrhosis. MATERIALS AND METHODS: The combination of CTAP and double-phase CTHA was performed on 46 patients with 54 nodular HCCs. Three readers reviewed the images obtained with CTAP alone, first-phase CTHA alone, double-phase CTHA, and the combination of CTAP and double-phase CTHA. The review of the images was conducted on a segment-by-segment basis, with 368 hepatic segments, including 50 segments with 54 HCCs, reviewed for detection of HCCs with the aid of a five-point confidence scale. Diagnostic accuracy was evaluated by comparing the receiver-operating characteristic (ROC) analysis results. RESULTS: The sensitivity for detecting HCCs was significantly higher with either double-phase CTHA or the combination of CTAP and double-phase CTHA than with first-phase CTHA alone (90 and 93 versus 85%, respectively, p<0.01). The specificity for detecting HCCs was significantly higher with the combination of CTAP and double-phase CTHA than with CTAP alone (97 and 94%, respectively, p<0.01). The positive predictive values for detecting HCCs were significantly higher with double-phase CTHA than with first-phase CTHA alone (86 and 82%, respectively, p<0.05). The area under the ROC curve (Az) values were significantly higher with the combination of CTAP and double-phase CTHA (0.983) than with first-phase CTHA alone (0.959; p<0.05). CONCLUSION: The combination of CTAP and double-phase CTHA with MDCT significantly enhances the detection of HCC.     

Muscle strength and kinetic gait pattern in children with bilateral spastic CP

Cerebral palsy is often associated with an abnormal gait pattern. This study put focus on relation between muscle strength and kinetic gait pattern in children with bilateral spastic cerebral palsy and compares them with a reference group. In total 20 children with CP and 20 typically developing children participated. They were all assessed with measurement of muscle strength in eight muscle groups in the legs and a 3-dimensional gait analysis including force data. It was found that children with CP were not only significantly weaker in all muscle groups but also walked with slower velocity and shorter stride length when compared with the reference group. Gait moments differed at the ankle level with significantly lower moments in children with CP. Gait moments were closer to the maximal muscle strength in the group of children with CP. Furthermore a correlation between plantarflexing gait moment and muscle strength was observed in six of the eight muscle groups in children with CP, a relation not found in the reference group. A similar pattern was seen between muscle strength and generating ankle power with a rho=0.582-0.766. The results of this study state the importance of the relationship of the overall muscle strength pattern in the lower extremity, not only the plantarflexors.