Background: A well-established reference is lacking for diagnosing lateral patellar compression syndrome (LPCS), and this diagnosis currently depends on clinicians? subjective judgment and several examination results. X-rays are primarily used to diagnose LPCS, but they have low detection rates of patellar tilt using the congruence angle (CA) and patellar tilting angle (PTA). Methods: We enrolled 87 patients (31 men and 56 women; mean age: 42.11?15.33 years) between 2016 and 2019 and divided them as per diagnosis into three groups of 29 each: LPCS, patellar dislocation (PD, control), and meniscus tear (MT, negative control) groups. A senior radiologist and the chief physician of sports medicine examined their patellar axial radiographs of the knee in 30? flexion using a computer imaging system, measuring LPCA, CA and PTA. Univariate analysis of variance and Kruskal-Wallis H test were used to compare measurement data with normal distribution and non-normal distribution, respectively. Bonferroni correction was used to analyze different indicators for different groups. The area under the curve (AUC) was calculated to verify the value of LPCA in the initial diagnosis of LPCS. Results: LPCA (19.88?7.49) was significantly higher in LPCS group than in MT (13.68?4.69) and PD groups (10.16?4.43) (P<0.01) and was also significantly higher on affected side than on healthy side (16.44?5.00) (P=0.04). LPCA >13.9? had sensitivity and specificity of 89.66% and 68.97%, respectively, for LPCS diagnosis (AUC: 0.82, 95% confidence interval: 0.719?0.891, P<0.001). Conclusions: We demonstrated that LPCA measured using an axial patellar radiograph of the knee in 30? flexion is high in patients with LPCS, and it may be used for diagnosing LPCS.

The purpose of this study was to compare clinical outcomes and graft healing after anterior cruciate ligament (ACL) reconstruction with anteromedial and central femoral tunnel placement. During 2016 and 2018, 110 consecutive patients underwent single bundle ACL reconstruction; 85 patients met the inclusion criteria, and each patient underwent 3D-CT within 1 week and MRI 1.5 years after the operation. The central point of the femoral tunnel and signal/noise quotient (SNQ) of three regions of interest (ROI) in the intra-articular graft were measured to analyse the tunnel position and graft healing extent. Clinical assessments, including functional scores, KT-2000 arthrometer measurements and pivot-shift tests, were evaluated at the 2-year follow-up. Patients were divided into two groups depending on the femoral tunnel position: the anteromedial position group (Group A) and the centre position group (Group B). Seventy-one patients were available for the 2-year follow-up and MRI examination: 34 patients in Group A and 35 patients in Group B, and 2 patients were excluded for an eccentric tunnel position. No graft failure occurred, and compared with the preoperative assessment outcomes, the outcomes of both groups improved at the final follow-up. Group A was significantly better than Group B regarding the KT-2000 arthrometer measurements (P = 0.031). No significant differences were observed in terms of functional scores, pivot-shift test results, or the SNQ between groups. No differences in clinical outcomes or graft healing were found between AM and central femoral tunnel placements in single bundle ACL reconstruction. Therefore, satisfactory clinical outcomes, knee stability and graft healing can be obtained for both femoral tunnel placements. II.

Objective:To explore the value of X-ray signs with applying low dose of contrast agent to confirm successful puncture in direct shoulder MR arthrography.Methods:In total 669 patients who underwent shoulder MR arthrography in Peking University Third Hospital from January 2016 to August 2018 were retrospectively analyzed. All patients received the anterior approach puncture in shoulder arthrography. X-ray films were taken after 1-2 ml contrast agent was injected. Six X-ray signs of contrast agent distribution were recorded. MR arthrography findings were used to confirm whether the puncture was success. Kappa analysis was used to verify the consistency between each 2 signs. The accuracy rate of each X-ray sign to confirm the successful puncture was calculated. X-ray signs were paired to define the best diagnostic index of successful puncture.Results:Successful puncture was performed in arthrographies for all 669 cases .The displaying rates of six signs were as follows. Contrast agent distribution at overlapping humeral head away from the needle was 66.8% (447/669), in axillary recess was 64.7% (433/669), in glenohumeral space was 93.9% (628/669), in subscapular bursa was 69.8% (467/669), in sheath of long head tendon of biceps brachii (LHBT) was 1.9% (13/669), between LHBT and supraspinatus tendon was 17.2% (115/669). Consistency of each 2 signs was poor (Kappa<0.2), in which the poorest consistency was found between contrast agent overlapping humeral head away from the needle and contrast agent in glenohumeral space (Kappa=-0.115). With combining the above 2 signs, the accuracy rate for defining successful puncture was 100% (669/669).Conclusion:In direct shoulder arthrography by anterior approach, X-ray signs with low dose of contrast agent can be regard as the method to confirm successful puncture. The accuracy rate of the signs of contrast agent distribution at overlapping humeral head away from the needle or in glenohumeral space to define a successful puncture is 100%.

目的 探讨肩袖全层撕裂患者关节镜下缝合固定术后早期发生再撕裂的因素及MRI的应用价值.方法 回顾性分析2015年1月～2017年12月65例肩袖全层撕裂患者关节镜下缝合固定术的临床和MRI资料.对可能影响术后早期再撕裂的年龄、性别、外伤史、吸烟史、糖尿病史、术前肌肉质量、肌肉挛缩程度、撕裂大小、术者、术式进行分析.结果 本组65例中,术后3个月5例(7.7％)发生再撕裂(Sugaya分型Ⅳ、Ⅴ型),经单因素分析,术前肌肉质量(OR=21.000,P=0.000)、撕裂大小(OR=10.118,P=0.028)、术式(OR=22.667,P=0.000)对术后早期再撕裂的影响有统计学意义.经趋势χ2检验,术前肌肉质量(χ2=13.675,P=0.000)、撕裂大小(χ2=6.139,P=0.013)与术后早期再撕裂的发生存在一定的线性变化趋势.结论 肩袖全层撕裂关节镜下缝合固定术后发生早期再撕裂的主要因素是术前肌肉质量差、大或巨大撕裂以及单排缝合固定,术前肌肉质量越差、撕裂程度越严重的患者发生早期再撕裂的可能性越大;术后3个月的MRI检查可以客观显示再撕裂的发生.

Objective:To study the imaging and pathology manifestations of primary nonHodgkin lymphoma (NHL) of spine.Methods:The imaging materials of twelve patients with pathology confirmed primary NHL of spine were retrospectively analyzed.All of the twelve patients had plain CT,of them,9 patients had contrast-enhanced CT.Eleven patients had plain MRI,ten cases with contrast-enhancement.Pathology diagnosis was obtained in 2 patients with surgical resection and 10 patients with needle biopsy.Results:Of the twelve patients,seven cases had solitary vertebral involvement,including cervical spine (one case),thoracic spine (four cases) and lumbar spine (two cases).Five patients had multiple vertebral involvement,with skipped lesions in two cases and contiguous lesions in four cases (one case one case had also skipped lesions).Associated pathology fracture of vertebrae were found in six cases;four cases had collapsed vertebra.CT showed osteolytic lesion with soft tissue mass in nine cases,including seven cases with moth-eaten appearance and two cases with infiltrative bone destruction;mixed osteolytic and osteosclerosis in one case.On MRI,soft tissue mass surrounding vertebrae destruction could be revealed,appearing as low signal on T1WI,high signal on T2 WI.The soft tissue mass showed mild-to-moderate enhancement after contrast administration on CT and MRI.The pathology diagnosis was NHL in these 12 patients,with ten cases as diffuse larger B-cell lymphomas (10/12).Conclusion:The imaging findings of primary NHL of the spine mainly manifested as a single or multiple contiguous vertebral body with osteolytic destruction (moth-eaten,infiltrative destruction or associated with osteosclerosis),extra-dural soft tissue mass surrounding the vertebral lesion,normal intervertebral space,yet without periosteal reaction or calcification.Needle biopsy is an important approach for the early diagnosis of primary NHL.

Objective To investigate the CT and MRI features of Langerhans cell histiocytosis (LCH) with multiple spinal involvement.Methods The CT and MRI data of 13 patients with multiple LCH lesions in spine confirmed by pathology were retrospectively analyzed.All of 13 cases underwent CT examination (1 case underwent enhanced scanning) and 12 cases underwent MR examination (6 cases underwent enhanced scanning).Results In 13 cases,there were 8 cases of single central lesions invading the adjacent vertebrae and 5 cases of multiple central lesions.There were 19 core spinal lesions and 15 adjacent invading lesions in a total of 34 vertebrae lesions.Eighteen core lesions (18/19,94.74 ％) had different degrees and shape of vertebral compression.A total of 34 abnormal vertebrae were found in 13 cases by CT,which were manifested as osteolytic bone destruction.Eighteen cortical bones of 19 core vertebrae were incomplete,and a paravertebral soft-tissue masses were observed.There were 33 vertebrae lesions in 12 patients who underwent MR examination,including 18 core spinal lesions and 15 adjacent invading lesions.The lesions displayed equal,slightly lower or low signal on T1WI,slightly higher or high signal on T2WI and high signals on fat suppression sequences.A paravertebral soft-tissue masses were observed in 17 core spinal lesions (17/18,94.44％).Conclusion CT and MRI manifestations of spinal multiple LCH have certain characteristics.The level of diagnosis and differential diagnosis should be improved by deepen understanding of the disease image performance,but the diagnosis still depends on the pathology.

目的探讨3.0T MR髋关节造影（MRA）在髋臼唇撕裂诊断中的价值。方法回顾性分析74例髋关节疾病患者的髋关节镜及术前髋关节MRA资料。以关节镜检查结果为金标准,评估3.0T MRA诊断髋臼前唇和上唇撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确率,并比较MRA诊断髋臼前唇和上唇撕裂的差异。结果 74例患者的75个髋关节中,关节镜证实61处前唇撕裂,29处上唇撕裂。2名医师（医师1和医师2）采用MRA诊断髋臼前唇撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为90.16%（55/61）和91.80%（56/61）、78.57%（11/14）和85.71%（12/14）、94.83%（55/58）和96.55%（56/58）、64.71%（11/17）和70.59%（12/17）、88.00%（66/75）和90.67%（68/75）,诊断上唇撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为89.66%（26/29）和93.10%（27/29）、91.30%（42/46）和95.65%（44/46）、86.67%（26/30）和93.10%（27/29）、93.33%（42/45）和95.65%（44/46）、90.67%（68/75）和94.67%（71/75）。2名医师诊断髋臼前唇和上唇撕裂的一致性好（Kappa值分别为0.924和0.916）。MRA诊断髋臼上唇撕裂的阴性预测值高于前唇,差异有统计学意义（P=0.01）,而敏感度、特异度、阳性预测值和准确率的差异均无统计学意义（P均＞0.05）。结论 3.0T髋关节MRA是诊断髋臼唇撕裂的可靠影像方法。

住院医师规范化培训是当前培养专科医师的主体模式,将导师制引入住院医师规范化培训,将促进对住院医师综合能力的培养.介绍导师制应用到放射科住院医师规范化培训中发挥的作用、具体实施办法及教学的具体方法,可以促进师生共同努力,以期培养更多的优秀放射科医师.

Objective To study the CT and MRI features of the chordoma in the mobile spine.Methods The CT and MRI fea-tures were retrospectively analyzed in twenty-four cases of chordoma in the mobile spine.Results In all the twenty-four cases,bone lesions were solitary in eight cases and multiple in sixteen cases,mostly occurred in cervical,occasionally occurred in thoracic or lum-bar vertebra.Both vertebral body and part appendix were involved in all cases.CT imaging showed that all the lesions mainly mani-fested as osteolytic bone destruction,peripheral osteosclerosis and the cortical bone were incomplete.Soft-tissue mass involved para-vertebral and intraspinal.Five lesions appeared vertebrae compression.Eight lesions appeared intervertebral foramen expansion.Le-sions appeared honeycomb or annular enhancement after contrast media injection.Lesions were presented as heterogeneous slightly hypo-isointensity on T1 WI,hyperintensity on T2 WI.Low signal fibrous septa within the tumors were seen.Lesions appeared hon-eycomb enhancement after Gd-DTPA injection.Conclusion CT and MRI findings of chordoma in the mobile spine can be regarded as characteristic,which are helpful for clinical diagnosis.

目的 探讨脊柱症状性血管瘤的CT表现.方法 回顾分析29例经病理证实的脊柱症状性血管瘤的CT表现.结果 29例病例中单发病变22例,多发病变7例,可发生在颈椎、胸椎或腰椎,其中26例病例同时累及大部分甚至全部椎体及部分附件结构.全部病例均表现为不同程度的溶骨性骨质破坏,23例椎体或附件可见轻微膨胀性改变,25例可见骨小梁增粗、稀疏,19例呈蜂窝状改变,11例见栅栏样改变,27例可见骨质硬化,27例病变骨皮质不完整,全部病例均可见软组织肿块形成,20例可见不同程度的椎体压缩.结论 脊柱症状性血管瘤的CT表现具有一定特征性,是术前准确诊断的重要依据.

Objective To compare the morphology of shoulder girdle and trunk bones of swine,canine,simian and human being by multi-slice computed tomography(MSCT).Methods MSCT scan was performed on swine,canine,simian and humans.The original images were reconstructed orthogonally,and to compare the curvature of the spine,structure and components of the vertebra,sternum,ribs and shoulder girdle.Results The basic components of the vertebra and ribs of swine, canine and simian were the same as in human being.The spine curvature,the number of vertebrae and ribs,structure of sternum and connection of chest and ribs,and the composition of shoulder girdle in the animals were different with those in humans.The simian spine curvature and shoulder girdle were the same as that of human being.It had cervical,thoracic,lumbar and sacral curvature,and the shoulder girdle was composed of scapula and clavicle.However,swine and canine had cervical, thoracic lumbar and sacral curvature,and the shoulder girdle was composed of scapula only.Conclusion The morphology of trunk bones and shoulder girdle in rhesus monkey is similar with that of humans,but there is a great difference between Guizhou xiang pig,Beagle dogs and human being.MSCT provides a relatively non-invasive,rapid,dynamic and continuous observation method in vivo.

Objective:To discuss the value of CT-guided intervertebral discography in diagnosing discogenic low back pain,and evaluate the radiographic features of positive disc.Method:48 patients suspected of discogenic low back pain underwent intervertebral discography by CT-guidance.Diagnosis was confirmed according to the response of the patients.The intervertebral discs after discography were classified according to the Dal-las discogram description (DDD).The relationship between the Dallas discogram description cliassification and discogenic low back pain was analyzed.Result:30 of 48 patients showed a positive intervertebral discography (62.5%) involving 38 intervertebral discs.According to the DDD for the degeneration of annular fibrosus,the grade 2 and 3 were accounted for 63.2% of positive discs,for disruption of annular fibrosus,the grade 2 and 3 accounted for 94.7% of positive discs.Conclusion:The CT-guided intervetebral discography is a reliable method to diagnose the discogenic low back pain,it can clearly show the rupture site and degree of the annular disruption.

Objective To analyze the characteristics and its possible mechanism on MRI-PWI proved cerebral blood flow uneven distribution without corresponding clinical signs. Methods There were seven cases of one hundred which performed the examination between January 2008 and January 2009 with cerebral blood flow uneven distribution without corresponding clinical signs. All patients underwent lifelong follow-up(varied from 7 days to 14 months). Retrospectively analyzed the clinical manifestation, MRA and PWI features of the 7 cases. Results There were 13 cerebral blood flow uneven distribution regions in 7 cases. One region was consistent with both clinical symptom and MRA features. Two regions were consistent with clinical symptom but weren't consistent with MRA feature. Four regions were consistent with MRA feature but weren't consistent with clinical symptom. Six regions were consistent with neither clinical symptom nor MRA feature. Six regions accorded with PWI grade II, Six regions accorded with PWI grade III, one region accorded with PWI grade IV. Conclusion PWI proved cerebral blood flow uneven distribution not only existed in the ischemic cerebrovascular attack patients. Brain blood flow uneven distribution of this type had no definite correlation with MRA abnormal and clinical symptoms. PWI/DWI mismatch should combine with the distribution of cerebral blood flow before to assess the patient's condition.

Objective To investigate and compare the range of application of MSCT and MRI to whole body integrated imaging of rhesus monkey,and the application of Total Imaging Matrix(TIM) to the systems imaging of rhesus monkey with contrast-enhanced imaging technology.And to compare the imaging findings between human and rhesus monkey.Methods 64-dectector row CT was performed in a adult male rhesus,and then 3D surfaceshadeddisplay(SSD) construction was applied to show the locomotor system.Magnetic resonance imaging(MRI) at 3.0 Tesla was performed with contrast-enhanced imaging technology,maximum intensity projection(MIP) and TIM technology to show the nervous system and recirculating system of rhesus monkey.Results the CT images showed the numbers of lumbar vertebra,lumbar vertebra,caudal vertebrae and caudal vertebrae were all larger than those in human; cervical spines had no bifurcation which differ from human.The contrast-enhanced MRI images showed that the recirculating system of rhesus monkey was similar with human;the ratio of longitudinal diameter and latitudinal diameter in telencephalon was lower than human,and the location of spinal cord enlargement was lower than human.(Conclusions MSCT) and MRI can be adopted to observe dynamic morphological changes of big animals continuously,noninvasively and rapidly.

Objective To observe the CT findings and evolution process of the cervical Langerhans cell histiocytosis (LCH). Methods The CT findings were retrospectively analyzed in 33 cases of LCH. All the cases were confirmed pathologically, and 14 cases were followed up. Results In all the 34 lesions of 33 cases, the lesions located mostly in both vertebral body and appendix. Osteolysis and cortical destruction, different degrees of vertebral compression and soft-tissue mass were found in all 34 lesions. Other changes such as expansion (21/34), cortical thickness (9/34) and peripheral osteosclerosis (4/34) could also be demonstrated in some lesions. Adjacent vertebrae were involved in 8 of 34 lesions. The CT findings of the follow-up cases included reduction of lesion range, increase of bone density, decrease or disappearance of soft-tissue mass, peripheral osteosclerosis, cortical bone thickness and vertebral height recovery in some degree. Conclusion The diversity of CT findings can be regarded as the characteristic features of the cervical LCH. The imaging manifestations are related to the different periods of the disease progress, and are helpful for the diagnosis of this disease.

1病历简介 患者,男,34岁.颈肩部麻木、疼痛2年,加重伴走路不稳3个月就诊.体检:颈部僵硬,后颈部及双肩、三角肌区域皮肤感觉迟钝.右侧Hoffmanns征(+),Babinskis征(+).实验室检查:血沉(ESR):44mm/h,碱性磷酸酶(ALP):2170u/1.

Objective:To investigate the usefulness of CT-guided percutaneous biopsy in the differential diagnosis of spinal lesions.Method:Four hundred and sixty-seven patients with undiagnosed spinal lesions underwent CT-guided percutaneous biopsy.There were 281 male and 186 female,from 2 to 81 years old,with an average age of 43 years.The accuracy and safety of biopsy were analyzed retrospectively.Result:Four hundred and seventy-six spinal lesions in 467 patients underwent biopsy.3 lesions did not acquire enough specimens,the satisfaction rate of biopsy was 99.4%.4 cases(8.4‰) occurred mild complications,but no severe complications at all.416 lesions in 407 patients obtained a definite diagnosis proved by operation or clinical follow-up,the accuracy of biopsy was 87.9%.198 cases received operations,the coincidence between biopsy and operation was 81.8% (162/198).The rates of missed diagnosis and misdiagnosis were 12.6% and 12.8% respectively.Conclusion:CT-guided percutaneous biopsy of the spinal lesions is an accurate and minimally invasive diagnosis method.It plays an important role in the differential diagnosis of spinal lesions.