18F-FDG PET/CT显像在治疗后宫颈癌评估中的价值

目的 探讨18F-FDG PET/CT对临床怀疑宫颈癌局部复发和(或)远处转移患者的诊断价值.方法 回顾性分析95例宫颈癌治疗后患者的18F-FDG PET/CT检查资料,采用视觉分析和半定量方法(SUVmax)分析病灶特点,最终诊断以活组织病理检查、诊断性治疗及影像学随访结果为准,采用Kappa一致性检验进行分析.结果 共有54例患者18 F-FDG PET/CT检查发现局部复发和(或)远处转移病灶,其中局部复发24例,远处转移30例;18F-FDG PET/CT诊断肿瘤复发与转移的灵敏度、特异性和准确性分别为98.1％(52/53)、95.2％ (40/42)和96.8％ (92/95),阳性预测值与阴性预测值分别为96.3％ (52/54)和97.6％(40/41).18F-FDG PET/CT检查结果与病理及临床随访结果一致性良好(Kappa=0.936,P＜0.05).结论 18F-FDG PET/CT对临床可疑宫颈癌复发的诊断具有较高的灵敏度和特异性,有助于局部复发和(或)远处转移病灶的检测,对临床进一步的诊疗具有指导作用.     

MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain

Objective:

To investigate the changes in paraspinal muscle cross-sectional area (CSA) and composition, using the digital data from lumbar spine MRIs of patients with acute and chronic low back pain (LBP).

Methods:

In total, 178 patients with unilateral LBP who had lumbar MRI examination were recruited. The data were obtained by a retrospective documentation audit. The CSAs and mean signal intensities of the bilateral paraspinal muscles [psoas major (PM), quadratus lumborum, multifidus (MF) and erector spinae (ES)] were measured, and the percentage of fat infiltration was calculated. The data between the painful side and non-painful side were compared, and between-group comparisons were tested. 42 patients with chronic unilateral LBP could indicate the problem level, and the CSA and mean signal intensity of the MF muscle were analysed at the problem level, and one vertebral above and one vertebral level below the problem level.

Results:

The CSAs of the PM and ES muscles were significantly decreased in the acute LBP group, while in the chronic LBP group, significant reduction in CSA was found in the MF and ES muscles on the painful side compared with the non-painful side. The mean signal intensity and fat content of the ES muscle on the painful side in the chronic LBP group was significantly higher than that on the painful side in the acute LBP group. The significant decrease of CSA in the MF muscle was found at multiple levels on the painful side.

Conclusion:

The present findings show that there is selective ipsilateral atrophy of paraspinal muscles, specific to the symptomatic side, in patients with acute and chronic LBP. The reduction of the muscle CSA and increased fatty infiltration occurred synchronously, and the extent of change is significantly greater in chronic LBP in the ES muscle. Atrophy of the MF muscle appears to be at multiple levels but side specific in relation to symptoms in patients with chronic LBP, and the decreased muscle CSA may occur prior to fatty infiltration.

Advances in knowledge:

There are specific paraspinal muscles undergoing atrophy and fatty infiltration in patients with acute and chronic LBP on the symptomatic side. The CSA of the MF muscle decreased at multiple levels on the symptomatic side in patients with chronic unilateral LBP, which may occur prior to fatty infiltration.     

Stent Compression in Iliac Vein Compression Syndrome Associated with Acute Ilio-Femoral Deep Vein Thrombosis

ObjectiveThis study was conducted to evaluate stent compression in iliac vein compression syndrome (IVCS) and to identify its association with stent patency.ResultsAll of the stents used were laser-cut nitinol stents. The proportion of limbs showing significant stent compression was 33%. Fifty-six percent of limbs in the significant stent compression group developed stent occlusion. On the other hand, only 9% of limbs in the insignificant stent compression group developed stent occlusion. Significant stent compression was inversely correlated with stent patency (p < 0.001). The median patency period evaluated with Kaplan-Meier analysis was 20.0 months for patients with significant stent compression. Other factors including gender, age, and type of stent were not correlated with stent patency. Significant stent compression occurred most frequently (87.5%) at the upper end of the stent (ilio-caval junction).ConclusionSignificant compression of nitinol stents placed in IVCS highly affects stent patency. Therefore, in order to prevent stent compression in IVCS, nitinol stents with higher radial resistive force may be required.     

磁共振表观弥散系数变化率对肝细胞肝癌患者单次TACE术后疗效评价的应用价值

目的 探讨磁共振表观弥散系数(ADC)变化率(即△ADC)在肝细胞肝癌(HCC)单次经导管肝动脉化疗栓塞术(TACE)术后疗效评价中的应用价值.方法 选择48例确诊为中晚期HCC并于TACE术前、术后1个月接受常规CT、MRI扫描以及MRI弥散加权成像和动态增强扫描的患者,建立所有患者的随访数据,随访中以肿瘤出现进展为随访结束点,记录患者治疗后肿瘤无进展生存期(PFS);以TACE术后1个月再次行数字减影血管造影(DSA)的肿瘤染色结果作为“金标准”,将病灶按治疗效果分为良好组、中等组及差组3组,并根据各组PFS绘制生存曲线.分别比较△ADC、CT及MRI 3种方法对TACE术后疗效的判定价值,并与“金标准”的一致性进行检验.结果 48例患者共56个病灶纳入分析,以“金标准”评价治疗效果,结果:良好组30个、中等组16个、差组10个,3组间生存曲线差异有统计学意义(x2=29.89,P＜0.01),中位PFS分别为7.5、4.0和1.1个月;TACE术后各组ADC均升高,3组间△ADC差异有统计学意义(F=22.41,P＜0.01),且3组间生存曲线差异亦有统计学意义(x2=26.57,P＜0.01),中位PFS分别为7.5、4.6和1.8个月.经Kappa检验,△ADC与“金标准”疗效评价方法具有一致性(Kappa值为0.542,P＜0.01);以MRI和CT评价治疗效果,其与“金标准”的一致性较差(Kappa值分别为0.328和0.260,P均＜0.05),3组间生存曲线仅MRI评价方法显示差异有统计学意义(x2=30.623,P＜0.01).结论 △ADC能及时、客观地评价TACE治疗效果,对指导患者术后的后续治疗有重要临床意义.     

跟距骨联合的MRI诊断价值探讨

目的分析跟距骨联合的MRI表现及分型,探讨其临床价值。方法对我院2011年4月—2013年4月间经手术、病理证实的25例跟距骨联合的MRI资料进行回顾性分析,其中男22例,女3例,平均年龄(33.76±13.12)岁;左侧跟距骨联合13例,右侧12例。分析跟距骨联合MRI直接征象和继发征象,按发生部位分型,并按冠状面像(部分结合矢状面像)进行形态分型。结果直接征象中完全骨性联合1例(4%),MRI表现为中距跟关节骨髓连接,纤维性联合14例(56%),软骨性联合10例(40%),MRI上均表现为联合处间隙变窄,边缘不规则。纤维性联合在MR T1WI、T2WI、抑脂序列上均呈低信号;软骨性联合的MRI信号近似软骨或液体,T1WI上呈中等强度信号,T2WI及抑脂序列上呈中等至高信号。继发征象中骨髓水肿20例(80%),"醉酒侍者征"9例(36%),"距骨喙征"3例(12%),"驼背跟骨征"2例(8%),骨折1例(4%)。按部位分型为:中距跟关节7例(28%),后距跟关节4例(16%),关节外型14例(56%),前距跟关节5例(20%)均合并与其他跟距骨联合。按形态分型为:Ⅰ型14例(56%),Ⅱ型3例(12%),Ⅲ型7例(28%),Ⅳ型1例(4%)。结论 MRI能够清晰显示跟距骨联合的组织类型、发生部位和形态等,可为临床提供有价值的诊断信息。     

Posterior Soft Tissue Repair After Primary THA is Durable at Mid-term Followup: A Prospective MRI Study

Background

The enhanced posterior soft tissue repair has reduced the frequency of dislocation after primary THA performed through the posterolateral approach. However, the long-term integrity of the repair is unknown and could influence surgeon choice regarding surgical technique and THA approach.

Questions/Purposes

We asked: (1) What is the durability of the enhanced posterior soft tissue repair at a minimum of 49 months using MRI to evaluate soft tissue to bone integrity? (2) How does the appearance of the posterior soft tissues change during this time? (3) Are there patient characteristics associated with the long-term imaging appearance of the posterior repair?

Methods

All patients without a contraindication for MRI who were undergoing unilateral primary uncemented THA through a posterior approach between February and May 2005 were eligible for inclusion. Ninety percent consented to participate (36 of 40 patients), and 30 patients were followed prospectively with MRI postoperatively and again at 3 months; of those, 22 (73%; 12 men, 10 women) completed the study by having another MRI study at a minimum of 49 months (mean, 51 months; range, 49–59 months). Each patient underwent metal-artifact–reduction sequence MRI to evaluate the integrity of the posterior soft tissues, which had been repaired anatomically during primary THA at a minimum of 4 years earlier. The results were compared with those of prior MR images obtained immediately after surgery and at 3 months postoperatively. All patients were given a self-reported modified Harris hip score at the time of the most recent MRI study (maximum score = 81).

Results

At latest followup, 21 of 22 (96%) patients had a posterior capsule in contact with bone, and 21 of 22 (96%) had an intact quadratus femoris. Twenty-one patients (96%) had soft tissue or a scar from the piriformis and conjoined tendons in continuity with bone. In these cases, the interface between the piriformis and conjoined tendons and the greater trochanter observed immediately postoperatively and at 3 months postoperatively became filled with hypointense tissue, with signal characteristics similar to tendon. Time from surgery was most associated with changes in native tendon-to-bone distances (p < 0.001) and MRI signal intensity of the repair (p < 0.001).

Conclusions

At followup of just more than 4 years, the posterior capsule and quadratus femoris most often were healed to bone. In the majority of patients, scar tissue between the piriformis and conjoined tendons and bone matured to achieve orientation and signal intensity resembling native tendon. We believe the enhanced posterior soft tissue repair facilitates this process. Our results provide a plausible explanation for improved postoperative stability observed in patients receiving an enhanced soft tissue repair compared with those in whom a repair is not performed.

Level of Evidence

Level IV, therapeutic study.     

Primary Ceramic-on-ceramic Total Hip Arthroplasty Using a 32-mm Ceramic Head With a Titanium-alloy Sleeve

Background

Modern ceramic-on-ceramic bearings have become attractive alternatives to conventional polyethylene in total hip arthroplasty (THA) as a result of their low wear and minimal particle production. However, 28-mm heads in ceramic-on-ceramic bearing couples have been associated with ceramic fracture. To address these issues, 32-mm and larger ceramic heads with a titanium-alloy sleeve have been introduced, although limited data are available on their durability and clinical outcomes.

Questions/purposes

We determined (1) the survivorship of the primary ceramic-on-ceramic THA using a 32-mm ceramic head with a titanium-alloy sleeve at a minimum followup of 5 years; (2) Harris hip scores; (3) the incidence of ceramic fracture and noisy hip; and (4) the proportion of hips showing radiographic evidence of osteolysis.

Methods

From November 2005 to August 2009, we performed 301 ceramic-on-ceramic THAs using a 32-mm ceramic head with a titanium-alloy sleeve in 270 patients. Of these, 12 patients (12 hips [4%]) died from problems unrelated to surgery and 13 patients (15 hips [5%]) were lost during followup before a minimum of 5 years had been reached, leaving 245 patients who had 274 THAs with a minimum followup of 5 years (mean, 6.5 years; range, 5–9 years) in this retrospective analysis. During the study period, 30% (301 of 997 hips) were performed with this articulation based on the operating surgeon’s discretion. The mean patient age at the time of surgery was 55 years (range, 16–82 years). All operations were performed at a single center. All of the ceramic implants were hot isostatic-pressed, laser-marked, proof-tested third-generation alumina. We determined the implant survival, Harris hip scores, incidence of ceramic fracture or noisy hips (based on a questionnaire), and presence of osteolysis.

Results

The survival rate of ceramic-on-ceramic bearings in primary THA using a 32-mm ceramic head with a titanium-alloy sleeve was 98% (95% confidence interval, 96%–100%) at 9 years. The Harris hip score improved from a mean of 47 points preoperatively to 93 points at last followup. One ceramic head fractured at 6 years postoperatively. No ceramic liners fractured. Audible hip clicking and squeaking were identified in four hips and one hip, respectively. Osteolysis was detected in three hips, but none had symptoms.

Conclusions

Primary ceramic-on-ceramic THA using a 32-mm ceramic head with a titanium-alloy sleeve has a survivorship of 98% at 9-year followup. Nevertheless, surgeons should be aware of the potential risks of ceramic fracture, noise, and osteolysis associated with the use of a ceramic head with a titanium-alloy sleeve.

Level of Evidence

Level IV, therapeutic study.